Anatomy Lung, Pleura, Superior and Posterior Mediastinum Flashcards
(blank) is open to the neck. The inferior is closed by the diaphragm.
superior thoracic aperature
(blank) structures are well protected by the cage.
thoracic structures
What are the three spaces in the chest?
left and right pulmonary cavities and the mediastinum
The superior portion of the lung extends above the (blank) so what can occcur here?
1st rib so a pneumothorax can occur here
What is the area between the pulmonary cavities that is subdivided into four spaces?
mediastinum
(blank) cavities contain the lungs and the pleural sacs.
pulmonary cavities
What do pleural sacs have inside them?
NOTHING! they are empty
Is the pleural sacs closed or open?
closed
Are the lungs pushed into the pleural sac?
yes it is pushed into it but not within it
What is below the lung and the lung typically does not fill this whole area?
costodiaphragmatic recess
the (blank) pleura lines the chest wall and adheres to the contours of the chest wall and goes next to pericardial sac.
parietal
What nerves control the diaphragm?
The phrenic nerves which come from C3,4,5 keep the person alive
Is the diaphragm a skeletal muscle?
yes
Are phrenic nerves autonomic nerves or somatic spinal nerves?
somatic spinal nerves
What travel on the somatic spinal nerves of the phrenic nerve?
sympathetic, sensory and motor neurons
The (blank) on the phrenic nerve go to the blood vessels of the diaphragm.
sympathetics
The (blank) of the phrenic nerve also supply the pleura that sits neck to the pericardial sac.
sensory fibers
The (blank) pleura does not feel pain.
visceral (has no afferents)
Where does the phrenic nerve sit?
In between the pericardial sac and parietal pleura
Where does the phrenic nerve pass through?
the middle mediastinum
What are the four parts of the parietal pleura?
cervical
mediastinal
costal
diaphragmatic
Lungs have a lot of (blank) tissue
elastic
What is the space between the lung and wall of parietal pleura next to the mediastinum?
the costomediastinal recess
Lungs during quiet respiration do not fill the entire pulmonary cavity downwards, that space that isnt filled is called the (blank)
costadiaphragmatic recess.
The lung doesn’t always fill all the way medially, this is called the (blank)
costomediastinal recess
If you puncture one lung, will the other collapse?
no the are in separate sacs
If you are looking at the midclavicular line, how far does the lung extend?
to the 6th rib
If you are looking at the midclavicular line, how far does the parietal pleura extend?
to the 8th rib
If you are looking at the the mid axillary line, how far does the lung extend? the parietal pleura?
to the 8th rib
to the 10th rib
If you are looking posteriorly how far does the lung extend? How far does the parietal pleura extend?
to the 10th rib
to the 12th rib
the pleura lines to the (blank)
diaphragmatic recess
What does it tell us when we find where the pleura ends at the diaphragmatic recess?
where the diaphragm attaches to the ribs
In the back, what ribs does the diaphragm attach?
12th
In front, what ribs does the diaphragm attach to?
10th, 8th and 6th rib
What are the landmarks of the parietal pleura at the parasternal line?
rib 6
What are the landmarks of the parietal pleura at the mid-clavicular line?
rib 8
What are the landmarks of the parietal pleura at the mid-axillary line?
rib 10
What are the landmarks of the parietal pleura at the paravertebral line?
rib 12
What are the landmarks of the visceral pleura (essentially lung) of the parasternal line?
rib 4 (only correct for left lung due to cardiac notch)
What are the landmarks of the visceral pleura (essentially lung) of the mid-clavicular line?
Rib 6
What are the landmarks of the visceral pleura (essentially lung) of the mid-axillary line?
Rib 8
What are the landmarks of the visceral pleura (essentially lung) of the paravertebral line?
Rib 10
Where is the transverse plane?
What does it denote?
angle of louis and T4/5 interface
beginning of inferior mediastinum when you are lying down
(blank) are potential spaces which can fill with blood, air and water in pathological states. The spaces can be blunted or increased depending on the pathology.
Pleural recesses
The root of the lung consists mainly of what?
pulmonary arteries, pulmonary veins, bronchus (anything entering or leaving the lungs)
The point where these structures actually enter the parenchyma of the lung is considered the (blank)
hilum
On the left side the primary (blank) enters the hilum but on the right the (blank) for upper and lower lobes enter.
primary bronchus
secondary bronchi
The (Blank) runs anterior to hilum and (blank) runs posterior.
phrenic
vagus
On the right side the pulmonary artery is (blank) to the bronchus
directly anterior
On the left side the pulmonary artery is (blank) than the bronchus.
higher
The phrenic nerve and vagus nerves have different association with the hilum. Vagus travel (blank) to the root of the lung. The Phrenic travels (blank) to the root of the lung.
posterior
anterior
The trachea stops at the end of the (blank) and does not enter the (blank)
superior mediastinum
inferior mediastinum
On the right side the pulmonary arteries lie (blank) to the bronchi and pulmonary veins lie (blank) and (blank) to all other structures in the root.
anterior
inferior and anterior
The veins in both lungs are found at the (blank) margin.
anterior inferior
The right lung has (blank) lobes
three
The superior lobe and the inferior lobe is separated by the (blank) fissure.
oblique
The superior lobe and the middle lobe is separated by the (blank) fissure.
horizontal
The superior lobe and the inferior lobe is separated by the (blank) fissure.
oblique
What creates the pulmonary ligament?
there is a small continuation of parietal pleura that continues down into the inferior lobe and surrounds the vessels, and bronchi.
On the left (left lung) side the pulmonary arteries lie (blank) to the bronchi and the pulmonary veins lie (blank) to all other structures in the root.
superior
inferior and anterior
What is the bronchopulmonary (hilar) lymph node?
it is a lymph node below the pulmonary veins of the lung
Does the left lung have an oblique fissure or a horizontal fissure?
oblique
The branches of the pulmonary vein are the most (blank) and (blank) major structures hilum of both lungs.
anterior and most inferior
The relationship of the PULMONARY ARTERY to the AIRWAY uses the mnemonic (blank) which means what?
RALS. In the right (R) lung, the artery is anterior (A) to the airway. In the left (L) lung, the artery is superior (S) to the airway.
(blank) are the unit of lung supplied by one tertiary (segmental) bronchus and its accompanying artery.
Bronchopulmonary segments
What two structures are considered intrasegmental to the bronchopulmonary segment?
tertiary bronchus and accompanying artery
What structure is considered intersegmental to the bronchopulmonary segment?
pulmonary veins (drain the segment)
What drains the bronchopulmonary segment?
pulmonary veins intersegmentally
What are the bronchopulmonary segments surrounded by?
connective tissue and can be separated from the neighboring segments
How manys bronchopulmonary segments are there on the right? On the left?
10 R
8-10 L (depending on branching of secondary bronchi)
Is the left lung or the right lung smaller?
left (cardiac notch)
What bronchus supplies the bronchopulmonary segments?
tertiary segments
Which two things love each other and travel together everywhere?
tertiary bronchus and arteries
If you want to keep one segment from getting blood what do you do?
tie off one artery
If you want to drain one segment of blood what do you do?
you would have to tie off many veins because the segments are drained from multiple veins
The fact that bronchopulmonary segments each have their own blood supply and airway makes it possible to (blank)
remove a diseased segment.
The fact that veins drain adjacent segments makes it necessary to tie off the (blank) to the vein if a segment is being removed.
tributaries
Is it more common to remove an entire love or just a segment?
typically a lobe but possible to do a segment due to the conservative structure of vascularization and airway patterns
Which primary bronchi is more vertical and wider?
the right side
Which primary bronchi is longer?
the left bronchi is longer
Where do aspirated objects tend to get stuck?
right main bronchi or inferior lobar
The middle lobar is a branch of the (blank).
inferior
The right main bronchus breaks into three bronchus what are they?
right superior lobe (eparterial) bronchus
right middle lobe bronchus
right inferior lobe bronchus
What is the center of the extrapulmonary section?
carina
The left main bronchus breaks into two branches what are they?
superior lobe bronchus and inferior love bronchus
On the (blank) side, the main stem bronchus divides before entering the lung whereas, on the left side it does not.
right
The trachea divides into primary bronchi at the junction of the (blank)
ascending aorta and the arch
(blank) is limited to the superior mediastnum, but many structures traverse the superior and some component of the inferior.
trachea
Where does the trachea divide?
at the superior mediastinum
Where does the ascending aorta transition into the arch of the aorta?
at the superior mediastinum
What are some things that pass into the inferior mediastinum?
phrenic, vagus, esophagus, descending thoracic aorta
Where are the pulmonary arteries located?
nestled in aorta so considered part of the superior and inferior mediastinum
Where is the arch of the aorta and great vessels located?
in the superior mediastinum
What is the carina?
point of bifurcation of the trachea
Which is in front, the phrenic or vagus?
phrenic
Which side has the secondary bronchi enter the intrapulmonary and which side has the main bronchus enter the intrapulmonary?
the right side
the left side
The nerve supply to the lung is a repeat of the (blank) because the source is the same, they just continue further onto the pulmonary plexus.
heart
Which of these doesnt feel pain:
visceral pleura, mediastinal, costal pleura, diaphragmatic pleura?
visceral
Are the mediastinal, costal pleura, diaphragmatic pleura all innervated by the same pain nerves?
no
What are the nerve innervations to the heart?
cervical sympathetic cardiac branches,
thoracic sympathetic cardiac branches,
left vagus nerve and left recurrent laryngeal nerves
If you have pain transmitted on your lateral side what will the afferents travel on? diaphragmatic?
the intercostals
phrenic
Most lung tissues get their nutrients from the (blank) circulation.
pulmonary arteries
Most lung tissues get their nutrients from the pulmonary circulation but structures comprising the root and supporting tissues get nutrients from the (blank)
bronchiole arteries
How many bronchiole arteries are on each side?
2 on the left and one on the right
What is a parietal branch of the aorta?
an intercostal artery
whee do the superior and inferior left bronchial arteries come from?
the aorta
Which carries more deoxygenated blood the bronchial arteries or the pulmonary arteries?
the pulmonary arteries
What line the trachea and participate in fluid movement?
right and left paratracheal nodes
The (blank) drains the parenchym and drains to the bronchopulmonary nodes.
subpleural plexus
The (blank) nodes are mostly associated with the root structures, but all of the channels are freely connected.
pulmonary nodes
Does the lung have lymphatics?
yes
Explain the drainage of lymph in the lungs?
drain towards bronchopulmonary nodes on bronchi of lungs-> tracheobronchial nodes->paratracheal->thoracic duct or right lymphatic duct
Where is the thoracic duct located?
behind the subclavian and branchiocephalic vein
(blank) contains the aortic arch, roots of great vessels, esophagus, trachea, vagal, phrenic and cardiac nerves
Superior mediastinum
(blank) contains basically fat, branches of the internal thoracic artery and some thymus in children
inferior anterior mediastinum
(blank) containing the heart and the ascending aorta, pulmonary trunk and some SVC; basically everything in the pericardial sac.
inferior middle mediastinum
(blank) all other vessels, nerves and visceral structures anterior to the vertebrae, posterior to the heart and between the parietal pleura of both lungs.
inferior posterior mediastinum
What separates the superior from the inferior mediastinum?
the sternal angle
How far does the inferior mediastinum extend?
to T12
Does the anterior inferior mediastinum have mediastinum pleura in it?
upon deep inspiration only
Where in the mediastinum will you find the phrenic nerve
inferior middle mediastinum
Where would you find the descending aorta, venous return azygos system, greater, lesser and least splachnics and sympathetic chain?
inferior posterior mediastinum
Are the intercostal nerves in the inferior posterior mediastinum?
no
What does the arch of the azygos drain into?
the SVC
What are the three superior branches off the aortic arch?
(all arteries)->the brachiocephalic, the left carotid, the left subclavian
The SVC has two branches, what are they?
Which one is longer?
Which is more vertical?
the right and left brachiocephalic veins
the left :)
the right
What are the 5 layers of the superior mediastinum from outside in?
glandular layer (thymus layer)-> venous layer-> arterial layer (arch of aorta and BCS)-> respiratory layer (trachea)->digestive layer
These are all part of what?
Aortic arch and roots of its three superior branches (B,C,S), some pulmonary trunk with left and rt. arteries, some SVC with the arch of azygos draining in, rt. and lt. brachiocephalic veins, phrenic and vagus nerves, lt. recurrent laryngeal, trachea, esophagus and some thymus.
superior mediastinum
Where does the vagus go and where is it located?
it goes onto esophagus and passes posterior to root of lung
what contributes to plexus on esophagus?
L and R vagus
(blank) courses in front of hilum of lung and in front of the pericardial sac.
phrenic (in front)
Posterior mediastinum- The area posterior to the heart and diaphragm, anterior to the vertebral column between (blank) and flanked on either side by the pulmonary cavities. Essentially sandwiched between the mediastinal layers of parietal pleura.
T5 and T12,
Posterior- The area posterior to the heart and diaphragm, anterior to the vertebral column between T5 and T12, and flanked on either side by the pulmonary cavities. Essentially sandwiched between the (blank).
mediastinal layers of parietal pleura.
What are these a part of?
Thoracic descending aorta and its branches, esophagus and esophageal plexus, azygos and hemi azygos system of veins, thoracic duct and associated lymph nodes, and the greater, lesser and least thoracic splanchnic nerves.
the posterior mediastinum
Where is the azygos?
What side is the hemiazygous or accessory azygous on?
right side
left side
What is the importance of the azygous system?
to drain venous return from thoracic body wall and has potential for collateral flow.
When is it truly important that the azygous has potential for collateral flow?
during portal hypertension
Technically, the (blank) and (blank) are not in the posterior because they lie along side the vertebrae, but for simplicity we will include them.
sympathetic trunk and the roots of the splanchnic nerves
The (blank) contributes mostly to the anterior esophageal plexus but there is mixing of fibers from the rt. and lt. vagal nerves. After the plexus the fibers reconvene on their way to the stomach as the (blank). The esophageal plexus also receives sympathetics from (blank)
left vagus
anterior and posterior vagal trunks.
thoracic splanchnics.
WHere does the vagus come from?
brain stem
The right vagus contributes mostly to the posterior (blank) but there is mixing of fibers from the rt. and lt. vagal nerves. After the plexus the fibers reconvene on their way to the stomach as the anterior and posterior vagal trunks.
esophageal plexus
Important branches of the thoracic aorta include what?
esophageal arteries, bronchial arteries, posterior intercostal arteries, superior phrenic arteries and two subcostal arteries.
Bronchial, esophageal arteries are (blank) branches.
visceral
The right bronchial artery comes off the (blank) branch but it is still considered a visceral branch.
parietal
Once you are below the diaphragm the aorta gives off arteries called (blank)
subcostal
The azygos system is unpaired and drains the (blank)
body wall, esophagus and bronchial veins
The azygos system is unpaired and drains the body wall, esophagus and bronchial veins. It ultimately drains into the SVC by arching over the root of the lung on the (blank).
right
Both the azygos and hemiazygos veins communicate with the abdominal cavity via direct connection to the (blank) . More importantly, the azygos system connects to the portal system indirectly through the (blank)
ascending lumbar veins
esophageal venous plexus.
arch of azygos is on which side?
the right
Where will you find the accessory hemiazygous?
The hemiazygous?
8th rib and up
9th rib and down
there is a lot of variability within the azygous/hemiazygous/accessory system. SO sometimes you do not have an accessory or hemiazgous so what do you do?
intercostals on the left will jump over the midline and go into the azygous system on the right side
If you have portal hypertension what does you azygous system allow for?
it allows for collateral flow so you can dialate these vessels and allow for blood to flow out of the liver into the azygos system to reduce your portal hypertension
The lower esophagus has a significant number of veins called the (blank)
submucousal venous plexus
Plexus of veins close to the internal surface of the esophagus are Clinically significant because dilated vessels from portal hypertension can be (blanK)
ruptured easily and bleed extensively.
Does the arch of azygos run superior to the root of the lung?
yes
What is the thoracic duct sandwiched between?
the descending aorta and the esophagus
The thoracic duct ultimately receives the lymph from the entire body except the (blank) of the chest and the (blank) .
upper right quadrant
right side of the head
The thoracic duct lies between the esophagus and the thoracic aorta as it passes from its origin, just inferior to the diaphragm, to its point of emptying into the venous system at the junction of the (blank).
left internal jugular and the left subclavian vein
Flow in the thoracic duct is facilitated by (blank) created through respiration.
pressure changes
Where is the origin of the thoracic duct?
just inferior to the diaphragm
