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HAE - Quiz 3 > Mediastinum > Flashcards

Mediastinum Flashcards

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1
Q

Mediastinum

A
  • central region of the thoracic cavity
  • contains the heart and great vessels
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2
Q

Transverse Thoracic Plane

A
  • division of the mediastinum into superior/inferior portions by horizontal plane that passes through:

Anterior - Sternal Angle

Posterior - disc between T4-T5

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3
Q

Inferior Divisions of the Mediastinum

A
  • anterior, middle, posterior divisions of the pericardium
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4
Q

Borders of the Mediastinum

A

Superior - superior thoracic aperture

Inferior - diaphragm

Lateral - Pleural cavities and lungs

Anterior - sternum

Posterior - thoracic vertebrae

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5
Q

Pericardium

A
  • pericardial sac - the membrane that surrounds the heart

Layers - outer fibrous layer and inner serous layer

  • superior limit - transverse thoracic plane
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6
Q

Fibrous Pericardium

A
  • tough outer layer of the pericardium that does not stretch
  • fused to the diaphragm and continuous with the tunica adventitia of the great vessels
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7
Q

Serous Pericardium

A

Visceral Serous Layer - applied to the surface of the heart (forms outer layer of heart wall and can be called epicardium in that context)

Parietal Serous Layer - lines the internal surface of the fibrous pericardium

  • both are continuous near the origins of the great vessels (i.e. fist in a balloon)
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8
Q

Pericardial Cavity

A
  • potential space between the visceral and parietal serous pericardium
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9
Q

Great Vessels

A
  • large arteries and veins connected to the heart

Includes - SVC, IVC, Ascending Aorta, Pulmonary Trunk, Pulmonary Veins

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10
Q

Superior Vena Cava

A
  • large vein that receives venous drainage from the head, upper extremeties, and thorax
  • drains into the RA
  • convergence of the Left and Right Brachiocephalic Veins (Right Brachiocephalic Vein formed by convergence of Right Subclavian Vein and Right Internal Jugular Vein)
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11
Q

Inferior Vena Cava

A
  • large vein that receives venous drainage from the lower half of the body (abdomen, pelvis, lower extremities)
  • drains into the RA
  • enters thoracic cavity by traveling through an opening in the diaphragm at T8
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12
Q

Aorta

A
  • largest artery in the body
  • arises from LV and immediately gives off Right and Left Coronary Arteries

In thorax, has 3 parts:

Ascending Aorta (ends at transverse thoracic plane)

Aortic Arch (begins and ends the transverse thoracic plane

Descending Aorta (aka thoracic aorta - begins at the transverse thoracic plane)

In abdomen: Abdominal Aorta - descends and bifurcates at L4 into common iliac arteries

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13
Q

Pulmonary Trunk

A
  • aka Main Pulmonary Artery
  • outflow tract from RV
  • bifurcates into right and left pulmonary arteries

Right Pulmonary Artery - travels posterior to ascending aorta and SVC towards Right Lung

Left Pulmonary Artery - travels anterior to the thoracic aorta

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14
Q

Pulmonary Veins

A
  • four veins carrying oxygenated blood from the lungs to the LA
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15
Q

Thymus

A
  • lymphoid organ involved in dev’t of immune system (T-cells)
  • primarily active during childhood, undergoes involution during puberty and mostly replaced by fat

Location - posterior to the sternum, anterior to the great vessels and pericardium

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16
Q

Brachiocephalic Trunk

A
  • the first branch of the aortic arch
  • gives rise to the Right Sublcavian Artery and the Right Common Carotid Artery
  • supplies upper right quadrant of the body
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17
Q

Left Common Carotid Artery

A
  • second branch of the aortic arch
  • supplies head and neck region
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18
Q

Left Subclavian Artery

A

- third branch of the aortic arch

  • supplies the left upper quadrant of the body
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19
Q

Aortic Arch

A
  • peak of the aorta bw ascending and descending aorta (above the transverse thoracic plane)

Three branches:

  1. Brachiocephalic Trunk
  2. Left Common Carotid Artery
  3. Left Subclavian Artery
    * Remember you “ABCs” (Aorta, Brachicephalic, Carotid, Subclavian)*
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20
Q

Epicardium

A
  • visceral serous layer of the pericardium that forms the outer layer of the heart
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21
Q

Ascending Aorta

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A
  • gives rise to the coronary arteries
  • lies below the transverse thoracic plane
22
Q

Descending Aorta

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A
  • aka Thoracic Aorta
  • begins at the transverse thoracic plane
  • descends anterolateral to the left of the vertebral column
  • passes posterior to the diaphragm and becomes abdominal aorta from T12-L4 until it bifurcates
23
Q

Ligamentum Arteriosum

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A
  • remnant of the ductus arteriosis (channel bw the pulmonary trunk and aortic arch that allowed blood to bipass lungs in fetus)
  • fibrous after closure of ductus arteriosis at birth
  • location between aortic arch and pulmonary vessels called “Autopulmonary window” by radiologists
24
Q

Trachea

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A
  • posterior to the great vessels in the midline
  • bifurcates into right and left main bronchi at T4 vertebral level
25
**Tracheobronchial Lymph Nodes**
- lymph nodes surrounding the trachea at the _tracheal bifurcation_ - receive lymphatic drainage from lungs and other thoracic viscera
26
**Paratracheal Lymph Nodes**
- lymph nodes surrounding the _lateral aspect of the trachea above the bifurcation_ - receive lymphatic drainage from lungs and other thoracic viscera
27
**Esophagus**
- located posterior to the trachea - continuous with the pharynx superiorly and the stomach inferiorly - exits thorax/enters the abdoment through the diaphragm at **T10** vertebral level through the **Esophageal Hiatus**
28
**Azygous Venous System**
- receives drainage from the thoracic wall (i.e. posterior intercostal veins) and viscera (i.e. esophageal and mediastinal veins) _Travels_ - anterolateral to the _right_ of the vertebral column - **hemiazygos** and **accessory hemiazygos** travel anterolateral to the _left_ of the vertebral column - drain into azygous via branches across the midline)
29
**Azygous Drainage**
Superiorly - SVC Inferiorly - IVC in the abdomen \*\*Azygous serves as a _collateral channel_ if the IVC becomes blocked
30
**Thoracic Duct**
- largest lymphatic vessel in the body - begins in upper abdomen as a dilation called **Cisterna Chyli** - in mediastinum travels on the _anterior_ aspect of the vertebral column (to the right of descending aorta and left of azygous vein) - passes through the posterior diaphram into the mediastinum alongside the aorta _Termination_: merges with venous system at junction of _Left Internal Jugular Vein_ and _Left Subclavian Vein_
31
**Cisterna Chyli**
- dilation/beginning of the thoracic duct in the abdomen
32
**Thoracic Duct Sources**
- entire lower half of the body and upper left quadrant of the body - returns fluid to the venous system (RUQ drains into Right Lymphatic Duct)
33
Relationship between azygous, thoracic duct, and descending aorta
From right to left Azygous Vein → Thoracic Duct → Descending/Thoracic Aorta
34
**Sympathetic Trunks** **(Sympathetic Chain)**
- extend from the base of the skull to the coccyx - travel lateral to the vertebral column - various branches leave the sympathetic chain ganglia throughout the thorax
35
**White and Gray Rami Communicantes**
- connect the sympathetic trunks to the spinal nerves - emerge from the posterolateral parts of the ganglia
36
**Cardiac Nerves**
- emerge from the anteromedial parts of the _cervical and upper thoracic sympathetic ganglia_ - contain _post-ganglionic sympathetic_ neurons that innervate the _viscera of the thorax_ by traveling through **visceral plexuses**
37
**Visceral Plexuses**
- contains visceral nerves in the thorax (i.e. cardiac nerves) that travel through the plexus to get to their targets _Three major subdivisions_: **Cardiac Plexus** - superficial and deep aspects of the aortic arch **Pulmonary Plexus** - surrounds the trachial bifurcation and primary bronchi **Esophageal Plexus** - surrounds the esophagus
38
**Thoracic Splenchnic Nerves**
- emerge from the anteromedial parts of the _T5-T12_ sympathetic ganglia - contain _pre-ganglionic sympathetic_ neurons that innervate _viscera_ in the _abdominal and pelvic cavities_ \*\*just pass through thorax\*\* _Three Nerves_: **Greater Splanchnic** (T5-T9) **Lesser Splanchnic** (T10-T11) **Least Splanchnic** (T12)
39
**Structures Passing Through Diaphragm**
Inferior Vena Cava (T8) Esophagus (T10) Aorta (T12) *- sympathetic chains pass through with aorta* "*I 8 10 E A 12" - I ate 10 eggs at 12*
40
**Phrenic Nerves** **(Origination)**
- arise from _C3-C5_ ventral rami
41
**Phrenic Nerves** **(Travel)**
- enter mediastinum through superior thoracic aperture - _anterior to the roots of the lungs_ and descend to the diaphragm along the _lateral aspect of the pericardium_
42
**Phrenic Nerves** **(Actions)**
- provide _somatic motor fibers_ to the diaphragm - convey _somatic sensations_ from the central part of the diaphragm, fibrous and parietal serous pericardium, mediastinal pleura, and the central part of the diaphragmatic pleura
43
**Pericardiacophrenic Vessels**
_Travel_ - with phrenic nerve _Provide_ - blood to the pericardium and diaphragm
44
**Vagus Nerves** **(Origination)**
- arise from the _brainstem_ _Travel_ - in neck near the coratid arteries and posterior to the root of the lung _Enter_ - thorax via the superior thoracic aperture - branch into cardiac plexus, pulmonary plexus, and esophageal plexus
45
**Vagus Nerves** **(Right, Left Travel)**
**Left Vagus Nerve** - in contact with _aortic arch_ - enters esophageal plexus on the _anterior aspect of esophagus_ **Right Vagus Nerve** - travels along the _trachea_ - enters esophageal plexus on the _posterior aspect of the esophagus_ **Both** - travel posterior to the root of the lung - regroup as **Anterior and Posterior Vagal Trunks** after plexuses before traveling through diaphragm with _esophagus_
46
**Vagus Nerves** **(Actions)**
_Parasympathetic_ - decrease HR, constrict bronchial tree, stimulate peristalsis and secretion of mucous from esophagus _Visceral Afferent_ - convey sensations of stretch from the lungs, pain from the heart, and participate in visceral reflexes
47
**Phrenic vs. Vagus Nerve Travel**
**Phrenic Nerve** - travels _anterior_ to the root of the lung **Vagus Nerve** - travels _posterior_ to the root of the lung
48
**Left Recurrent Laryngeal Nerve** **(Origination)**
- branch of the _Vagus Nerve_ - arises near the _aortic arch_
49
**Left Reccurent Laryngeal Nerve** **(Travel)**
- through the _aortopulmonary window_ posterior to the _ligamentum arteriosum_ - ascends back into the neck along the _lateral aspect of the trachea_
50
**Right Recurrent Laryngeal Nerve**
- travels around the right subclavian artery in the neck (i.e. not in the mediastinum)
51
**Left Recurrent Laryngeal Nerve (Action)**
- innervates portions of the larynx - somatic efferent fibers to muscles - compression (i.e. by aortic aneurysm or mass) can produce hoarseness in the voice
52
Major Branches of Descending Aorta
_Major Branches:_ **Bronchial Arteries** - supply lungs **Esophageal Arteries** - supply esophagus **Posterior Intercostal Arteries** - supply chest wall

HAE - Quiz 3 (2 decks)

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