mediastinum Flashcards
(175 cards)
1
Q
Occupied by the mass of tissue between the two pulmonary cavities
A
mediastinum
2
Q
Central compartment of the thoracic cavity
A
mediastinum
3
Q
Covered on each side by mediastinal pleura and contains all the thoracic viscera and structures EXCEPT the lungs
A
mediastinum
4
Q
which boundary of the mediastinum is the superior thoracic aperture
A
superiorly
5
Q
which boundary of the mediastinum is the diaphragm
A
inferiorly
6
Q
which boundary of the mediastinum is the pleural cavities
A
laterally
7
Q
which boundary of the mediastinum is the sternum and costal cartilages
A
anteriorly
8
Q
which boundary of the mediastinum is the thoracic vertebrae
A
posteriorly
9
Q
Extends inferiorly from the superior thoracic aperture to the horizontal plane that includes the sternal angle anteriorly and passes approximately through the junction (IV disc) of T4-T5 vertebrae posteriorly, often referred to as the transverse thoracic plane (imaginary line)
A
superior mediastinum
10
Q
Between the transverse thoracic plane and the diaphragm
A
inferior mediastinum
11
Q
the inferior mediastinum is further subdivided into
A
anterior, middle, posterior
12
Q
includes pericardium, heart, and roots of its great vessels (ascending aorta, pulmonary trunk, SVC)
A
middle mediastinum (inferior)
13
Q
A fibroserous membrane that covers the heart and the beginning of its great vessels
A
pericardium
14
Q
pericardium has two layers
A
fibrous and serous
15
Q
Tough fibrous membrane that covers the heart and the origin of the great vessels (arteries: pulmonary artery and the aorta)
A
fibrous pericardium
16
Q
Avoids overdistension of the heart
A
fibrous pericardium (function)
17
Q
Prevents sudden overfilling of the heart
A
fibrous pericardium (function)
18
Q
Continuous superiorly with the tunica adventitia of the great vessels entering and leaving the heart and with the pretracheal layer of deep cervical fascia
A
superior continuation of the fibrous pericardium
19
Q
Attached anteriorly to the posterior surface of the sternum by the sternopericardial ligaments
A
anterior continuation of the fibrous pericardium
20
Q
Bound posteriorly by loose connective tissue to structures in the posterior mediastinum
A
posterior continuation of the fibrous pericardium
21
Q
Continuous inferiorly with the central tendon of the diaphragm by the pericardiacophrenic ligament
A
inferior continuation of the fibrous pericardium
22
Q
Composed mainly of mesothelium, a single layer of flattened cells forming an epithelium that lines both the internal surface of the fibrous pericardium and the external surface of the heart
A
serous pericardium
23
Q
Lines the inner surface of the fibrous pericardium
A
parietal layer of the serous pericardium
24
Q
Forms the outer layer (epicardium) of the heart wall and the roots of the great vessels
A
visceral layer of the serous pericardium
25
Is a potential space between opposing layers of the parietal and visceral layers of serous pericardium
pericardial cavity
26
Because of the lining, we will be able to appreciate that there are two potentialspaces at the back of the heart
pericardial sinuses
27
Posterior to the intrapericardial parts of the pulmonary trunk and ascending aorta, anterior to the SVC and superior to the atria of the heart
transverse pericardial sinus
28
a single layer of flattened cells forming an epithelium that lines both the internal surface of the fibrous pericardium and the external surface of the heart
mesothelium
29
While performing surgery on the aorta or pulmonary artery, a surgeon can pass a finger and make a ligature through the sinus between the arteries and veins, thus stopping the blood circulation with the ligature
transverse pericardial sinus
30
Between the great arteries
transverse pericardial sinus
31
Pericardial reflections of the PVs and IVC laterally
Oblique pericardial sinus
32
Wide pocket-like recess in the pericardial cavity posterior to the base (posterior aspect) of the heart, formed by the left atrium
Oblique pericardial sinus
33
BLOOD SUPPLY OF PERICARDIUM
pericardiophrenic artery
musculophrenic artery
bronchial, esophageal, and superior phrenic arteries
coronary arteries
34
main arterial supply of the pericardium
pericardiophrenic artery
35
Arterial supply to the pericardium, branches of the internal thoracic artery (ITA)/ internal mammary artery (IMA)
pericardiophrenic artery
36
a branch coming from the subclavian artery
internal thoracic artery (ITA)/ internal mammary artery (IMA)
37
Often accompanies or at least parallels the phrenic nerve to the diaphragm
pericardiophrenic artery
38
Terminal branch of the ITA
musculophrenic artery
39
Branches coming from the anterior wall of the descending thoracic aorta; At the back of the pericardium
Bronchial, Esophageal, and Superior phrenic arteries
40
supplies the visceral layer of the pericardium only; The first branches of the aorta
coronary arteries
41
venous drainage of the pericardium
pericardiophrenic veins
Variable tributaries of the azygos venous system
42
Tributaries of the brachiocephalic (or internal thoracic) veins
Pericardiacophrenic veins
43
Drain directly to the brachiocephalic (innominate vein) or sometimes it can drain directly into the branches that comes along with the internal thoracic artery
Pericardiacophrenic veins
44
nerve supply of the pericardium
phrenic nerve (C3-C5)
vagus nerve
sympathetic trunks
45
Primary source of sensory fibers of the pericardium
phrenic nerve (C3-C5)
46
Pain sensations conveyed by these nerves are commonly referred to the skin (C3–C5 dermatomes) of the ipsilateral supraclavicular region (top of the shoulder of the same side)
phrenic nerve (C3-C5)
47
vasomotor of the pericardium
sympathetic trunks
48
A phenomenon whereby noxious stimuli originating from a structure are perceived as pain arising from a superficial part of the body
referred pain
49
Supraclavicular area (C3-C5)
Pain sometimes at the level of the shoulder
pericardial involvement
50
Chest and arm (T1-T4)
T1 - T3 (Moore’s)
Chest pains, back, arm
heart/cardiac pain
51
pain in the back
MI
52
Superior to the transverse thoracic plane, passing through the sternal angle and the junction (IV disc) of vertebrae T4 and T5
superior mediastinum
53
includes (from anterior to posterior):
Thymus
Great vessels, with the veins anterior to the arteries and related nerves
Inferior continuation of cervical viscera and related
nerves
Thoracic duct and lymphatic trunks
superior mediastinum
54
veins of superior mediastinum
Brachiocephalic
SVC
55
arteries of superior mediastinum
Arch of aorta and roots of its major branches
Brachiocephalic trunk
Left common carotid artery
Left subclavian artery
56
nerves of superior mediastinum
Vagus nerve
Phrenic nerve
Cardiac plexus of nerves
57
cervical viscera
Anterior: trachea
Posterior: esophagus
58
related nerves in the inferior continuation of cervical viscera
Left recurrent laryngeal nerves
59
Traverses the superior mediastinum
Thoracic duct and lymphatic trunks
60
the order of the majorstructuresin the superior mediastinum, from anterior to posterior,
(1) thymus, (2) veins, (3) arteries, (4) airway, (5) alimentary tract, and (6) lymphatic trunks
61
Primary lymphoid organ at the inferior part of the neck and anterior to the superior mediastinum
thymus
62
Flat gland with flask-shaped lobes that lies posterior to the manubrium and extends into the anterior mediastinum, anterior to the fibrous pericardium
thymus
63
After puberty → involution and replaced by fat
thymus
64
For pediatric patients, are relatively bigger compared to adults, in adults replaced by fatty tissue
thymus
65
arterial supply of thymus
Derived mainly from:
Anterior intercostal arteries
Anterior mediastinal branches of the ITA/IMA
66
venous drainage of thymus
End in the left brachiocephalic, ITA/IMA, and inferior thyroid veins
67
lymphatic vessels of thymus
End in the parasternal, brachiocephalic, and tracheobronchial lymph nodes
68
great vessels
brachiocephalic
SVC
ascending aorta
aortic arch
69
The right and left _____ are formed posterior to the sternoclavicular (SC) joints by the union of the internal jugular and subclavian veins
brachiocephalic veins
70
At the level of the inferior border of the 1st right costal cartilage, the _____ unite to form the SVC
brachiocephalic veins
71
: twice as long as the right brachiocephalic vein
left brachiocephalic vein
72
shunt blood from the head, neck, and upper limbs to the right atrium (RA
brachiocephalic veins
73
Returns blood from all structures superior to the diaphragm EXCEPT for the heart and the lungs
SVC
74
Passes inferiorly and ends at the level of the 3rd costal cartilage, where it enters the RA of the heart
SVC
75
Begins at the aortic orifice
ascending aorta
76
Its only branches are the coronary arteries, arising from the aortic sinuses
ascending aorta
77
The ascending aorta is intrapericardial, and for this reason, and because it lies inferior to the transverse thoracic plane, it is considered a content of the middle mediastinum
ascending aorta
78
Begins at the sternal angle
aortic arch
79
Arches superiorly, posteriorly and to the left, and then inferiorly (descends posterior to the L root of the lung)
aortic arch
80
The superior mediastinum is a very critical area. Injuries can potentially hit neurovascular structures, including the aerodigestive system
TRUE
81
also known as cranial nerve X
Vagus nerve
82
Exit at the cranium and descend through the neck posterolateral to the common carotid arteries
Vagus nerve
83
Usually contain at the level of the neck within the carotid sheath along with the internal jugular vein and carotid artery
Vagus nerve
84
Enters the thorax anterior to the RSCA, where it gives rise to the right recurrent laryngeal nerve
right vagus nerve
85
Hooks around the RSCA and ascends between the trachea and esophagus to supply the larynx
Right recurrentlaryngeal nerve
86
gives rise to the right recurrent laryngeal nerve
right vagus nerve
87
Continues postero- inferiorly through the superior mediastinum on the R side of the trachea
right vagus nerve
88
passes posterior to the R brachiocephalic vein, SVC, and root of the R lung where it divides into many branches contributing to the right pulmonary plexus and esophageal (nerve) plexus
right vagus nerve
89
Descends in the neck posterior to the LCCA
left vagus nerve
90
Enters the mediastinum between the LCCA and LSCA
left vagus nerve
91
At the arch, it diverges posteriorly from the phrenic nerve
left vagus nerve
92
The LVN is separated laterally from the phrenic nerve by the left superior intercostal vein
left vagus nerve
93
Curves medially at the arch to give rise to the left recurrent laryngeal nerve
left vagus nerve
94
give rise to the left recurrent laryngeal nerve
left vagus nerve
95
Passes inferior to the arch of the aorta, immediately lateral to the ligamentum arteriosum, and ascends to the larynx in the groove between the trachea and the esophagus
Left recurrentlaryngeal nerve
96
Continues inferiorly and posterior to the root of the left lung, where it breaks up into many branches that contribute to the left pulmonary and esophageal (nerve) plexus
left vagus nerve
97
main difference of the right and left vagus nerve
Main difference with the right is the course of the vagus nerve around the arch of the aorta
98
Right side vagus nerve would usually loop around the subclavian artery
TRUE
99
Left side vagus nerve would loop around the arch of the aorta to become recurrent laryngeal nerve
TRUE
100
difference of the r and l vagus nerve
Right side would usually loop around the subclavian artery
Left side would loop around the arch of the aorta to become recurrent laryngeal nerve
101
Both vagus nerve continues within the chest cavity, extending toward the abdominal area
TRUE
102
Main supply to the diaphragm
Phrenic Nerve
103
Supply the diaphragm with motor and sensory fibers (1/3)
Phrenic Nerve
104
Also supplies sensory fibers to the pericardium and mediastinal pleura
Phrenic Nerve
105
Enters the superior mediastinum between the SCA and origin of brachiocephalic vein, anterior to the roots of the lungs
Phrenic Nerve
106
To differentiate phrenic nerve from vagus nerve
Phrenic nerve would lie anterior to the pulmonary hilum
Vagus nerve would course at the posterior of the hilum
107
Passes along the R side of the R brachiocephalic vein, SVC, and pericardium over the RA
right phrenic nerve
108
It also passes anterior to the root of the right lung and descends on the right side of the IVC to the diaphragm, which it pierces near the caval opening
right phrenic nerve
109
Descends between the LCCA and LSCA, left surface of the aortic arch, anterior to the root of the lung and over the fibrous pericardium of the LA and LV
left phrenic nerve
110
Most branching of the phrenic nerves or distribution to the diaphragm occurs on the diaphragm’s inferior (abdominal) surface.
left phrenic nerve
111
Fibromuscular tube that extends from the pharynx to the stomach
esophagus
112
Enters the superior mediastinum between the trachea and vertebral column, where it lies anterior to the bodies of the T1–T4 vertebrae
esophagus
113
Flattened A-P, inclines to the left but pushed back to the median plane by the arch of the aorta
esophagus
114
Compressed anteriorly by the root of the left lung
esophagus
115
Thoracic duct lies left to the esophagus, deep (medial) to the arch of the aorta
esophagus
116
Below the arch, inclines to the left as it approaches the esophageal hiatus (T10)
esophagus
117
posterior mediastinum is inferior to
transverse thoracic plane
118
posterior mediastinum is anterior to
T5-T12 vertebrae
119
posterior mediastinum is posterior to
pericardium and diaphragm
120
posterior mediastinum is between the
parietal pleura of the 2 lungs
121
includes:
Thoracic aorta
Thoracic duct
Lymphatic trunks
Posterior mediastinal lymph nodes
Azygos and hemi-azygos veins
Esophagus
Esophageal nerve plexus
posterior mediastinum
122
Continuation of the arch of aorta
thoracic aorta
123
Begins on the left side of the inferior border body of the T4 vertebra
thoracic aorta
124
Descends in the left sides of T5-T12 (pos mediastinum)
thoracic aorta
125
Approaches the median plane as it descends and displaces the esophagus to the right
thoracic aorta
126
Surrounded by thoracic aortic plexus
thoracic aorta
127
Lies posterior to the root of the left lung, pericardium, and esophagus
thoracic aorta
128
Terminates at the anterior to the inferior border of T12
thoracic aorta
129
Enters the abdomen through the aortic hiatus
thoracic aorta
130
Thoracic duct and azygos vein ascend on its right side and accompany it through the hiatus
thoracic aorta
131
when the thoracic aorta terminates at the anterior to the inferior border of T12 it becomes
abdominal aorta
132
Branches of the descending aorta arise and course within three vascular planes except
superior phrenic arteries and pericardial branches
133
Anterior, midline plane of unpaired visceral branches to the gut (embryonic digestive tube) and its derivatives
esophageal arteries (A in inset)
134
Lateral planes of paired visceral branches serving viscera other than the gut and its derivatives
bronchial arteries (B in inset)
135
Although the right and left bronchial arteries may arise directly from the aorta, most commonly, only the paired left bronchial arteries do so; the right bronchial arteries arise indirectly as branches of a right posterior intercostal artery (usually the 3rd)
TRUE
136
Posterolateral planes of paired (segmental) parietal branches to the body wall
9 posterior intercostal arteries
137
Descends into the posterior mediastinum, passing posterior to and to the right of the arch, posterior to the pericardium and LA
esophagus
138
Constitutes the primary posterior relationship of the base of the heart
esophagus
139
It then deviates to the left and passes through the esophageal hiatus in the diaphragm at the level of the T10 vertebra, anterior to the aorta
esophagus
140
3 constrictions (impressions) of the esophagus
Arch
Left main bronchus
Diaphragm
141
Constrictors are created because of its close relationship within the mediastinum
- Arch of the aorta can create an impression in the leftside of the esophagus
- Anteroposteriorly it is compressed by the left main bronchus
- Diaphragm almost likely a sphincter so circumferential compression
TRUE
142
Largest lymphatic channel
Thoracic duct
143
Conveys most lymph in the body except from the right superior quadrant (right half of the face, right upper limb, right thorax)
Thoracic duct
144
Originates from the cisterna chyli (chyle cistern) in the abdomen and ascends through the aortic hiatus in the diaphragm
Thoracic duct
145
It ascends in the posterior mediastinum among the thoracic aorta on its left, the azygos vein on its right, the esophagus anteriorly, and the vertebral bodies posteriorly
Thoracic duct
146
At the level of the T4, T5, or T6 vertebra, the thoracic duct crosses to the left, posterior to the esophagus, and ascends into the superior mediastinum
Thoracic duct
147
Near its termination, the thoracic duct often receives the jugular, subclavian, and bronchomediastinal lymphatic trunks (although any or all these vessels may terminate independently)
Thoracic duct
148
In continuity with the cervical and lumbar sympathetic trunks
thoracic sympathetic trunks
149
Lie against the heads of the ribs in the superior part of the thorax, the costovertebral joints in the midthoracic level, and the sides of the vertebral bodies in the inferior part of the thorax
thoracic sympathetic trunks
150
Part of the abdominopelvic splanchnic nerves supplying the viscera below the diaphragm
Lower Thoracic Splanchnic Nerves(5th- 12th sympathetic ganglia)
151
They supply sympathetic innervation or most of the abdominal viscera
Lower Thoracic Splanchnic Nerves(5th- 12th sympathetic ganglia)
152
Smallest subdivision of the mediastinum
anterior mediastinum
153
Lies between the body of the sternum and the transversus thoracis muscles anteriorly, and the pericardium posteriorly
anterior mediastinum
154
Continuous with superior mediastinum superiorly, limited inferiorly by the diaphragm
anterior mediastinum
155
Consists of loose connective tissue (sternopericardial ligaments), fat, lymphatic vessels, a few lymph nodes, and branches of the internal thoracic vessels
anterior mediastinum
156
Contains the inferior part of the thymus (in infants and children)
anterior mediastinum
157
No vitalstructures, mainly fatty tissues
anterior mediastinum
158
In tumors involving anterior mediastinum, usual differential diagnosis include the 4Ts (tinoma, terrible lymphoma, thyroid anterathoma)
TRUE
159
The outline of the heart can be traced on the anterior surface of the thorax by using the following guidelines:
Superior - Inferior border of the 2nd left costal cartilage to the 3rd right costal cartilage
Right - 3rd right costal cartilage to the 6th right costal cartilage (this border is slightly convex to the right)
Inferior - Inferior end of the right border (6th right costal cartilage) to a point in the 5th ICS close to the left MCL (the left end of this line corresponds to the location of the apex of the heart and the apex beat
Left - Line connecting the left ends of the lines representing the superior and inferior borders
TRUE
160
auscultatory areas of the heart for pulmonary area
2nd ICS (intercostal space) LUSB (left upper sternal border)
161
auscultatory areas of the heart for 2nd pulmonic area
3rd LICS
162
auscultatory areas of the heart for aortic area
2nd ICS RUSB
163
auscultatory areas of the heart for mitral area
5th LICS (apex of the heart)
164
auscultatory areas of the heart for tricuspid area
4th LICS
165
auscultatory areas of the heart for the aortic valve
2nd ICS, right of the sternum
166
auscultatory areas of the heart for the pulmonary valve
2nd ICS, left of the sternum
167
auscultatory areas of the heart for the tricuspid valve
5th ICS, left of the sternum
168
auscultatory areas of the heart for the mitral valve
5th ICS, between sternum and nipple
169
auscultatory areas for the apex of the left lung
just above the 1st rib; left side, back
170
auscultatory areas for the superior lobe of the left lung
2nd ICS, left side, back
171
auscultatory areas for the inferior lobe of the left lung
7th ICS, left side, back
172
auscultatory areas for the inferior lobe of the right lung
6th ICS, right, front, midaxilliary
173
auscultatory areas for the superior lobe of the right lung
2nd ICS, below sa line sa neck
174
auscultatory areas for the middle lobe of the right lung
4th ICS, left sa nipple adjacent
175
auscultatory areas for the apex of the right lung
above the 1st rib, front, right, may clavicle
