Aldridge - Superior And Posterior Mediastinum

Question 1

Borders of the superior mediastinum

Answer 1

Manubrium anteriorly to T1/T4 vertebrae posteriorly

Thoracic inlet superior
Sternal angle inferior

Question 2

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

Answer 2

Thymus gland

Question 3

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

Answer 3

Large vessels to and from the heart

Question 4

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

Answer 4

Tubular structures (esophagus, aorta, etc. )

Question 5

Borders of the posterior mediastinum

Answer 5

Anterior to vertebrae T5 - T12

Superior to sloping diaphragm

Posterior to pericardium

Inferior to sternal angle

Question 6

Arch of aorta begins at

Answer 6

The sternal angle

Question 7

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

Answer 7

Right sternoclavicular joint

Question 8

The descending thoracic aorta technically starts ___

Answer 8

Inferior to the level of the sternal angle

Question 9

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

Answer 9

Vertebra T12

Question 10

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

Answer 10

Posterior intercostal arteries 3-11

1 and 2 come from superior intercostal branch of costocervical trunk

Question 11

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?

Answer 11

Thymus anteriorly

Brachiocephalic trunk (A) and left common carotid artery posteriorly

Question 12

Contains deoxygenated blood from all structures above the diaphragm

Answer 12

Superior vena cava

Question 13

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

Answer 13

The sternal angle

Question 14

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

Answer 14

Right

Question 15

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

Answer 15

Right ascending lumbar vein

Question 16

Superior continuation of the right ascending lumbar vein.

Lies anterior to the right side of thoracic vertebral bodies.

Answer 16

Azyygous vein

Question 17

Azygous vein drains blood from:

Answer 17

Bronchial veins (lung tissue)

Esophageal veins (esophagus)

Posterior intercostal veins (right thoracic wall)

Hemiazygous and accessory azygous veins (left thoracic wall)

Vertebral venous plexus

Question 18

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

Answer 18

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

Question 19

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

Answer 19

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

Question 20

Structures passing through the aortic hiatus;

Answer 20

Aorta
Azygous vein
Hemiazygous vein
Thoracic duct

Question 21

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.

Answer 21

Thoracic duct

Question 22

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

Answer 22

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

Question 23

The thoracic duct begins by draining the _________ from the abdomen

Answer 23

Cisterna chyli

Question 24

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

Answer 24

The start of the left brachiocephalic vein

Question 25

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

Answer 25

Left bronchomediastinal (from left lung) Left subclavian Left jugular

Question 26

The right lymphatic duct drains into

Answer 26

The start of the right brachiocephalic vein

Question 27

How does the phrenic nerve course in the right superior mediastinum

Answer 27

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

Question 28

How does the left phrenic nerve run through the superior mediastinum

Answer 28

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

Question 29

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

Answer 29

Posterior

Question 30

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

Answer 30

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

Question 31

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

Answer 31

They pass anteriorly to the root of the lung

Question 32

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?

Answer 32

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

Question 33

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?

Answer 33

It directly pierces the left dome of the diaphragm

Question 34

What organs are innervated by the vagus nerve (parasympathetic_

Answer 34

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

Question 35

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.

Answer 35

Ligamentum arteriosum

Question 36

Location of the left vagus nerve in the superior mediastinum

Answer 36

Crosses left side of aortic arch

Question 37

Location of right vagus nerve in superior mediastinum

Answer 37

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

Question 38

What is the course of the Right recurrent laryngeal nerve

Answer 38

It hooks around the right subclavian artery and ascends into neck between esophagus and trachea Does NOT enter sup mediastinum

Question 39

Branches of vagus nerve in the superior mediastinum

Answer 39

Left - recurrent laryngeal nerve Branches of cardiac and pulmonary innervation (small)

Question 40

The vagus nerve passes _____ to the root of lung

Answer 40

Posterior

Question 41

The right vagal trunk is on the ______ side of esophagus

Answer 41

Posterior

Question 42

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

Answer 42

Anterior

Question 43

How does the vagus nerve go through the diaphragm?

Answer 43

Passes with the esophagus

Question 44

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

Answer 44

Thymus

Question 45

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)

Answer 45

Trachea

Question 46

Where does the trachea divide into the principle bronchi?

Answer 46

At the level of the sternal angle | Principal bronchi are in middle mediastinum

Question 47

Where are aspiration pneumonias most likely and why?

Answer 47

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

Question 48

The left main bronchus crosses anterior too the

Answer 48

Aorta and esophagus | May constrict esophagus

Question 49

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

Answer 49

Carina

Question 50

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

Answer 50

Tracheobronchial

Question 51

Three sites for possible constriction of the esophagus

Answer 51

Junction of pharynx and esophagus Aortic arch and left main bronchus Esophageal hiatus in diaphragm

Question 52

In thorax, blood supply to the esophagus comes from ?

Answer 52

Esophageal branches of the aorta

Question 53

What part of the heart is located anterior to the esophagus

Answer 53

Left atrium | W/ pericardium in between

Question 54

What levels do the greater splanchic nerves arise from ?

Answer 54

Spinal nerve levels T5 - T9

Question 55

Course of Greater Splanchnic Nerves

Answer 55

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

Question 56

Vertebral level that inferior vena cava passes through diaphragm

Answer 56

T8

Question 57

Vertebral level that esophagus passes thru diaphragm

Answer 57

T 10

Question 58

Vertebral level that aorta passes through diaphragm

Answer 58

T12

Question 59

Anatomical structures at level of sternal angle:

Answer 59

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

Question 60

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

Answer 60

They pierce the crura of the muscular diaphragm

Question 61

How does the sympathetic trunk pass the diaphragm

Answer 61

Not by piercing it, but by passing behind it