8. Thoracic Angiology Flashcards
what is the location & path of the aorta
located L side of heart
after L ventricle - tracel superiorly as ascending aorta - then turn L and become arch of aorta - then travel inferiorly as descending thoracic aorta thru the thorax - then go thru aortic hiatus on thoracic diaphragm and travel as abdominal aorta
what are the branches of the ascending aorta
R & L coronary As
where does the Right coronary A travel
travel anteriorly around heart to post aspect in right AV groove
What are the branches of the right coronary a & what do they supply
- sinuatrial nodal - to SA node
- conus branches - to conus arteriosus
- atrial branches - to R atrium
- post interventricular A -
- (interventricular septal branches supply interventricular septum)
- right marginal A -(travel along inf border)
- atrioventricular nodal - to AV node
- R. posterolateral A - to L ventricle
what A supplies most of the conducting system (AV bundle, R/L bundle branches)?
anterior interventricular A (from L coronary)
some by post interventricular A (from R coronary)
What are the branches of the L coronary A
- Anterior interventricular A - to AV bundle/conducting sys
- Circumflex A- travel posteriorly around heart
- Left Marginal A- travel along left margin
how does the L coronary A travel
off of ascending aorta (behind aortic trunk) traveling superiorly around heart to post aspect
what are the branches of the anterior interventricular A
- conus branch: conus arteriosus
- lateral (diagonal) A - descend alond ant heart
- interventricular branches: interventricular septum, AV bundle, R/L bundle branches
what are the branches of the circumflex A
post L ventricular A
L marginal A
what surgical technique is used for obstruction of the coronary A
coronary A bypass graft
great saphenous V used (bc similar sizes) and placed to bypass the blockage
what is the basics of coronary angioplasty
insert small balloon catheter into lumen of coronary A
-inflate ballon to flatten obsturcted plaque against wall & increase size of lumen to improve blood flow
what branches off the arch of the aorta
subclavian A
L common carotid A
brachiocephalic trunk
where does the internal thoracic A branch from and how does it travel
from subclavian A
travel inferiorly to post aspect of anterior chest wall - btn ribs & transverse thoracic M
what are the 4 branches of the internal thoracic A
anterior intercostal A
pericardiacophrenic A
Musculophrenic A (terminal)
superior epigastric A (terminal)
what are the sources of mammary As
- internal thoracic A perforating branches –> medial mammary
- lateral thoracic A–> lateral mammary
- Post intercostal A lateral cutaneous branch –> lateral mammary
what are the branches of the axillary A (pertaining to thorax)
superior thoracic A - supply 1-2 intercostal spaces & superior most serratus ant M
lateral thoracic A- supply pect major/minor Ms, serratus ant M & intercostal Ms (give off lateral mammary A)
what are the 3 vascular planes that the descending aorta is divided into
- unpaired vascular branches
- paired lateral visceral branches
- paired segmental parietal branches
what are the unparied visceral branches
mediastinal A - LM of post mediastinum
esophageal A - middle 1/3 esophagus
pericardial A - pericardium
what are the bronchial As
= paired lateral visceral branches
R = supply strucutres of hilum of R lung
L =supply strucutres of hilum of L lung
supply bronchi!!!!!
what are the paired segmental As
posterior intercostal A (1 of 3 branches = lateral cutaneous A)
subcostal A
what are the branches of the posterior intercostal A
doral branch: travel w post ramus of spinal Ns
collateral branch: travel along sup edge of rib inferior to intercostal space (thats why inject in middle of spaces!)
lateral cutaneous A: thru intercostal M to supply skin & subcutaneous tissue of lateral trunk (give off lateral mammary branches)
what is the superior phrenic A
comes off before aortic hiatus
doesnt fit into 3 vascular categories
supply thoracic diaphragm
what are all the As that supply the thoracic diaphragm
musculophrenic A (from internal thoracic)
pericardiacophrenic A (from internal thoracic)
superior phrenic A (from descending thoracic aorta)
what is the pul trunk
exit heart from R ventricle at superior border -travel towards lungs
-produce R & L pul As
What are the branches of the R pul A
& what are the segments of the those branches
superior lobular A (segmentals = apical, ant & post)
middle lobular A (segmentals = lateral & medial)
inferior lobular A (segmentals = sup, ant basal, lateral basal, medial basal & post basal)
what are the branches of the L pul A
& what are the respective segments
superior lobular A (segmentals = apical, ant & lingular)
inferior lobular A (segmentals = sup, anteromed basal, lat basal & post basal)
what is it called when a pul A is obstructed
pulmonary embolism
could be blood clot, fat globule, air bubble
=cant do gas exchange
where do pul Vs start and end
begin as intersegmental Vs btn bronchiopul segments
end into L atrium
what are the branches of the pul Vs
R & L superior/inferior Vs
what are the cardiac veins associated with the coronary sinus
great cardiac V
middle cardiac V
small cardiac V
what is the path for the great cardiac V
start on ant aspect of heart btn R & L ventricles - then travel anteriorly btn interventricular A then around heart -travel with circumflex A and empty into coronary sinus
* travels with the ant interventricular A & then circumflex A
what is the path for the anterior cardiac Vs
anterior surface of heart - cross over R AV groove - empty into R atrium directly
what does the small cardiac V travel with
around inf border of heart & empty into coronary sinus
travels w/ R marginal A
how does the middle cardiac V travel
travel w post interventricular A along post aspect of heart btn R & L ventricles & dump into coronary sinuses
how are smallest cardiac Vs different from others
extremely small with NO VALVES
exist in myocardium -communicate w/ internal chambers of the heart directly
what makes up the superior vena cava
union of R & L brachiocephalic Vs & azygos Vs
what forms the inferior vena cava
union of R & L common iliac V
-travel thru abd thru vena caval foramen of thoracic diaphragm then into R atrium
what is the azygous venous complex
3 Vs that fill in the gap that sup & inf vena cava dont cover
- azygous V
- hemiazygous V
- accessory hemiazygous V
what does the azygous V drain
R post intercostal V (travel with post intercostal A in costal groove & meet w/ sup vena cava)
what do the hemiazygous & accessory hemiazygous Vs do?
hemiazygous V: drain left lower posterior intercostal V
accessory hemiazygous V: drain left upper post intercostal V
both: communicate w/ azygous V via communicating branches
what is the function of the thoracic duct
originate as chyle cistern in abd
drain:
- LE, Pelvis, Abd
- left 1/2 thorax
- L UE
- L head/neck
- in thorax - drains subclavian lymphatic trunk & bronchomedistinal trunk
where does the thoracic duct empty
venous system at
jxn of L. internal juglaur V
& L . subclavian V
what drains the cranial and cervical LNs
jugular trunk
how does the subclavian trunk drain the UR & axilla
via axillary lymphatic plexus
what does the lymphatic duct drain
subclavian lympathic trunk
bronchomediastinal trunk
-empty into brachocephalic V
what does the bronchomediastinal trunk drain
LNs:
parasternal
paratracheal
paraesophageal
sup phrenic
brachiocephalic
what is the primary lymphoid organ
thymus
located in anterior superior mediastinum
gradually replaced by fat after puberty
what are the axillary LNs
(associated w/ breast cancer)
- pectoral
- interpectoral
- deltopectoral
- supraclavicular
- inf deep cervical
where do axillary LNs empty
subclavian lymphatic trunk –> then R lymphatic duct or thoracic duct
what does the parasternal LNs drain
subareolar lymphatic plexus
parietal pleura
thymus
(empty into bronchomediastinal trunk then R lymphatic trunk/thoracic duct)
what do tracheobronchial LNs drain & where do they empty
bronchopul LNs
subepicardial lymphatic plexus
empty into bronchomediastinal trunk
what doe the bronchopul LNs drain
lympathic plexuses of lung
- superficial - superficial lung & visceral pleura
- deep - deep lung & bronchi
what do anterior mediatinal LNs drain
parietal pleura
what do post mediastinal LNs drain
parietal pleura
esophagus
post. pericardium
thoracic diaphragm
middle post intercostal space
