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Structure And Function III > Aldridge - Superior And Posterior Mediastinum > Flashcards

Aldridge - Superior And Posterior Mediastinum Flashcards

1
Q

Borders of the superior mediastinum

A

Manubrium anteriorly to T1/T4 vertebrae posteriorly

Thoracic inlet superior
Sternal angle inferior

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2
Q

Anterior part of the superior mediuastinum is continuous with the anterior mediastinum and contains the

A

Thymus gland

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3
Q

Middle part of sup mediastinum is continuous with the middle mediastinum and contains the

A

Large vessels to and from the heart

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4
Q

Posterior part of the superior mediastinum is continuous with the posterior mediastinum and contains

A

Tubular structures (esophagus, aorta, etc. )

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5
Q

Borders of the posterior mediastinum

A

Anterior to vertebrae T5 - T12

Superior to sloping diaphragm

Posterior to pericardium

Inferior to sternal angle

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6
Q

Arch of aorta begins at

A

The sternal angle

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7
Q

The brachiocephalic artery branches at the level of the ________ to form the right subclavian and right common carotid arteries

A

Right sternoclavicular joint

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8
Q

The descending thoracic aorta technically starts ___

A

Inferior to the level of the sternal angle

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9
Q

The thoracic aorta passes thru the aortic hiatus in the diaphragm at the level of ______

A

Vertebra T12

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10
Q

9 pairs of posterior intercostal arteries come off of the thoracic aorta to supply which intercostal spaces

A

Posterior intercostal arteries 3-11

1 and 2 come from superior intercostal branch of costocervical trunk

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11
Q

What is the left brachiocephalic vein surrounded by as it obliquely crosses the sup mediastinum to join the right brachiocephalic vein to make the superior vena cava?

A

Thymus anteriorly

Brachiocephalic trunk (A) and left common carotid artery posteriorly

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12
Q

Contains deoxygenated blood from all structures above the diaphragm

A

Superior vena cava

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13
Q

The superior vena cava receives the azygos vein at the level of _

A

The sternal angle

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14
Q

The superior vena cava is at the _____ border of the superior mediastinum

A

Right

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15
Q

Directly drains the right posterolateral abdominal wall into the inferior vena cava

A

Right ascending lumbar vein

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16
Q

Superior continuation of the right ascending lumbar vein.

Lies anterior to the right side of thoracic vertebral bodies.

A

Azyygous vein

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17
Q

Azygous vein drains blood from:

A

Bronchial veins (lung tissue)

Esophageal veins (esophagus)

Posterior intercostal veins (right thoracic wall)

Hemiazygous and accessory azygous veins (left thoracic wall)

Vertebral venous plexus

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18
Q

How can tumors metastasize from the lungs to the spinal cord?

A

Lungs —> bronchial veins —> azygous veins —> posterior intercostal veins —> intervertebral veins —> vertebral venous plexus

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19
Q

Describe the route that blood from the upper extremities and head and neck is able to return to the right atrium when a bronchiogenic tumor is blocking the superior vena cava

A

Sup vena cava -> azygous vein ascending lumbar vein -> inferior vena cava -> right atriuum

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20
Q

Structures passing through the aortic hiatus;

A

Aorta
Azygous vein
Hemiazygous vein
Thoracic duct

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21
Q

The main lymph channel of the body, receiving all lymph from below the diaphragm, left side of the thoracic cavity, left upper extremity, and left side of head and neck.

A

Thoracic duct

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22
Q

Location of cistern chyli (dilated lymph sac in the abdomen)

A

Immediately inferior to the diaphragm, anterior to vertebra L1 and right of the aorta

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23
Q

The thoracic duct begins by draining the _________ from the abdomen

A

Cisterna chyli

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24
Q

In the root of the neck, where does the thoracic duct drain in to ?

A

The start of the left brachiocephalic vein

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25
Q

What three lymph trunks does the thoracic duct receive in the root of the neck ?

A

Left bronchomediastinal (from left lung)

Left subclavian

Left jugular

26
Q

The right lymphatic duct drains into

A

The start of the right brachiocephalic vein

27
Q

How does the phrenic nerve course in the right superior mediastinum

A

The right phrenic nerve runs between the subclavian artery and vein and against the lateral border of the superior vena cava and right brachiocephalic vein

28
Q

How does the left phrenic nerve run through the superior mediastinum

A

Enters from neck between left suubclavian artery and vein.

Courses lateral to the left common carotid.

Crosses the arch of aorta anterior to left vagus nerve

29
Q

The left vagus nerve crosses the arch of the aorta ____ to the left phenic

A

Posterior

30
Q

How do the phrenic nerves pass through the middle mediastinum (bilaterally)

A

Passes between the mediastinal parietal pleura and the fibrous pericardium, then passes ANTERIOR to the root of the lung

31
Q

How do the phrenic nerves, in the middle mediastinum pass in relationship to the root of the lung

A

They pass anteriorly to the root of the lung

32
Q

How does the right phrenic nerve exit the middle mediastinum to innervate the right dome of the diaphragm and the middle diaphragmatic pleura and peritoneum?

A

It exits through the caval opening, with the inferior vena cava

33
Q

How does the left phrenic nerve exit the middle mediastinum to innervate the left dome of the diaphragm and the middle diaphragmatic pleura and peritoneum?

A

It directly pierces the left dome of the diaphragm

34
Q

What organs are innervated by the vagus nerve (parasympathetic_

A

All thoracic viscera

Most of gut (as far as the left colic flexure of large intenstine)

Note; many of these structures innervated are formed embryologically from derivates of the foregut and midgut

35
Q

A fibrotic remnant of the fetal ductus arteriosus which is a shunt between the left pulmonary artery and the arch of aorta. These sometimes need ligated if patent in infants. The left recurrent laryngeal nerve (motor to larynx) crosses under this.

A

Ligamentum arteriosum

36
Q

Location of the left vagus nerve in the superior mediastinum

A

Crosses left side of aortic arch

37
Q

Location of right vagus nerve in superior mediastinum

A

Enters the superior mediastinum anterior to the right subclavian artery. Descends lateral to the trachea

38
Q

What is the course of the Right recurrent laryngeal nerve

A

It hooks around the right subclavian artery and ascends into neck between esophagus and trachea

Does NOT enter sup mediastinum

39
Q

Branches of vagus nerve in the superior mediastinum

A

Left - recurrent laryngeal nerve

Branches of cardiac and pulmonary innervation (small)

40
Q

The vagus nerve passes _____ to the root of lung

A

Posterior

41
Q

The right vagal trunk is on the ______ side of esophagus

A

Posterior

42
Q

The left vagal trunk is on the ______ side of the esophagus

A

Anterior

43
Q

How does the vagus nerve go through the diaphragm?

A

Passes with the esophagus

44
Q

Bilobed lymphoid organ of the immune system; attains maximal size by puberty. Post-puberty, gland regresses and becomes infiltrated w/ fat

Located immediately posterior to the manubrium of sternum

Blood supply is thru branches of internal thoracic artery and inferior thyroid artery

A

Thymus

45
Q

Begins in neck, below larynx, at level of vertebra C6

Location in neck and sup mediastinum; anterior and slightly to the right of the esophagus

Divides into pricipal bronchi at level of sternal angle (principle bronchi are located w/in middle mediastinum)

A

Trachea

46
Q

Where does the trachea divide into the principle bronchi?

A

At the level of the sternal angle

Principal bronchi are in middle mediastinum

47
Q

Where are aspiration pneumonias most likely and why?

A

Most likely in the middle or lower lobe of the right lung.

Right lung because the right main bronchus is shorter, more vertically oriented, and wider diameter.

Mid/lower lobe because their lobular bronchi are continuation of main bronchus

48
Q

The left main bronchus crosses anterior too the

A

Aorta and esophagus

May constrict esophagus

49
Q

The “keel” at the division of the trachea into to main bronchi

Important landmark

A

Carina

50
Q

Enlargement of _____ lymph nodes due to bronchogenic carcinoma can cause distortion of the carina

A

Tracheobronchial

51
Q

Three sites for possible constriction of the esophagus

A

Junction of pharynx and esophagus

Aortic arch and left main bronchus

Esophageal hiatus in diaphragm

52
Q

In thorax, blood supply to the esophagus comes from ?

A

Esophageal branches of the aorta

53
Q

What part of the heart is located anterior to the esophagus

A

Left atrium

W/ pericardium in between

54
Q

What levels do the greater splanchic nerves arise from ?

A

Spinal nerve levels T5 - T9

55
Q

Course of Greater Splanchnic Nerves

A

Emerge from symp trunk at levels T5 - T9
Course inferiorly alongside mediastinum, pierce the diaphragm, innervate preaortic ganglion, the celiac and superior mesenteric ganglia

56
Q

Vertebral level that inferior vena cava passes through diaphragm

A

T8

57
Q

Vertebral level that esophagus passes thru diaphragm

A

T 10

58
Q

Vertebral level that aorta passes through diaphragm

A

T12

59
Q

Anatomical structures at level of sternal angle:

A

Costal cartilage of rib 2 articulates with sternum

Arch of aorta

Level of disc between t4 and t5

Line of demarcation between sup and inf mediastinum

Sup extent of fibrous pericardium

Trachea divides into main bronchi

Azygos vein enters superior vena cava

60
Q

How do the greater, lesser and least splanchnic nerve pass the diaphragm

A

They pierce the crura of the muscular diaphragm

61
Q

How does the sympathetic trunk pass the diaphragm

A

Not by piercing it, but by passing behind it

Structure And Function III (24 decks)

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