Anatomy of Mediastinum in Relation to Endovascular Interventions Flashcards
where is mediastinum located
area that lies between the lungs superior; thoracic inlet - T4 (stops at transverse thoracic plane) anterior middle posterior *Diaphragm at inferior*
where is thoracic inlet located
bounded by ribs 1, T1 vertebra and jugular notch
where is transverse thoracic plane
between sternal angle and T4/5 IV disc
describe the anterior mediastinum
between the sternum and fibrous pericardium
includes;
thymus - gland producing T lymphocytes in childhood, adipose tissue after puberty. Can become - thymoma, thymic carcinoma, lymphoma
describe the middle mediastinum
includes;
pericardium
heart
parts of great vessels that connect with heart - inferior SVC, superior SVC, pulmonary trunk and pulmonary arteries, pulmonary veins, ascending aorta
describe the posterior mediastinum
includes; vagus nerves 2 main bronchi thoracic aorta oesophagus (both vagal trunks pass thorugh diaphragm with oesophagus onto stomach) thoracic duct (lymph to left venous angle) sympathetic chains/trunks azygous veins
describe azygous veins
carries blood from intercostal veins to SVC
may be ruptured in chest drama
demonstrate aorta and its mediastinal branches
PP in order of branches; coronary arteries brachiocephalic trunk left common carotid artery left subclavian artery
branches from the thoracic aorta's anterior surface; bronchial arteries (lungs) oesophageal arteries mediastinal arteries pericardial arteries phrenic arteries
bottom of aorta - hiatus (opening) into the diaphragm
bilateral posterior intercostal arteries for each intercostal space
describe drainage of right lympathatic duct
drains into right venous angle (right upper body)
describe drainage of thoracic duct
drains lymph into left venous angle (left upper body and both legs), located at left sternoclavicular joint
thoracic duct can be ruptured in chest trauma
describe lymph drainage from the lungs
bronchopulmonary lymph nodes surround the main bronchus at the lung root
tracheo-bronchial lymph nodes around the bifurcation of the trachea
in some patients the lymph form the left inferior lobe drains into the right lymphatic duct
in pulmonary malignancy, metastases can spread via lymphatics
describe the superior mediastinum
from anterior to posterior, it includes; brachiocephalic veins and SVC arch of aorta (and 3 branches) trachea oesophagus thoracic duct
from lateral to medial, it includes;
phrenic nerves
vagus nerves
recurrent laryngeal nerves
describe central veins
those large veins close enough to the heart such that the pressure within them is said to approximately reflect the pressure within the right atrium
includes; internal jugular veins subclavian veins brachiocephalic eins SVC right atrium IVC iliac veins femoral veins
describe nerves surrounding the heart
PP left/right; recurrent laryngeal nerves - left hooks under arch of aorta and enters chest, right hooks under right subclavian artery and does not enter chest vagus nerves phrenic nerves
describe referred pain from diaphragm
e.g. liver abscess or inflammation of gallbladder
irritates parietal peritoneum lining inferior surface of diaphragm, supplied by phrenic nerves (C3, 4, 5) supraclavicular nerves (C3, 4) supply dermatomes over shoulder tip and enter spinal cord at same level as phrenic nerve => brain refers the pain to most superficial structure which is the shoulder tip rather than the parietal peritoneum
