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Cardiology > Anatomy of the mediastinum > Flashcards

Anatomy of the mediastinum Flashcards

1
Q

What is dysphagia?

A
  • difficulty swallowing
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2
Q

Where is the mediastinum situated?

A
  • the mediastinum is the area that lies in between the lungs
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3
Q

The mediastinum is split into what 2 parts?

A
  • superior

- inferior

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4
Q

Where does the superior mediastinum begin?

A
  • at the THORACIC INLET level of the 1st rib/ T1 vertebra/ jugular notch
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5
Q

What is thoracic outlet syndrome?

A
  • when the vessels/nerves are compressed around the thoracic inlet
  • causes pain in the arm
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6
Q

Where is the inferior mediastinum?

A
  • situated below the transverse thoracic plane

- at the level between the sternal angle and T4/T5 interspace

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7
Q

How many sections is the inferior mediastinum split into?

A
  • 3

- anterior/ middle/ posterior

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8
Q

Name a structure in the anterior mediastinum (that is usually only present during childhood)

A
  • thymus
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9
Q

What does the thymus gland do?

A
  • secretes hormones (e.g. thymosin)

- produces T lymphocytes

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10
Q

What does the thymus convert to after puberty?

A
  • adipose tissue
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11
Q

Name 3 different types of tumour that can affect the thymus

A
  • thymoma (benign)
  • thymic carcinoma (malignant)
  • lymphoma (blood tumour)
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12
Q

Name the structures found in the middle mediastinum

A
  • pericardium
  • heart
  • inferior part of SVC
  • superior part of IVC
  • pulmonary trunk
  • proximal part of pulmonary arteries
  • distal part of pulmonary veins
  • ascending aorta
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13
Q

Name the structures found in the posterior mediastinum

A
  • vagus nerves/ vagal trunk
  • azygous veins
  • sympathetic chains
  • thoracic aorta
  • thoracic duct
  • superior part of IVC
  • oesophagus
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14
Q

Where does the vagal trunk pass through?

A
  • through the diaphragm with the oesophagus (oesophageal hiatus) into the abdomen
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15
Q

Blood from where drains into the azygous vein?

A
  • blood from intercostal veins drains inferiorly to azygous vein
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16
Q

Where is the azygous vein located?

A
  • right side of posterior mediastinum
  • arches anterior + superior to lung hilum
  • sits anteriorly + medially to oesophagus
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17
Q

Where does blood from the intercostal veins drain to anteriorly?

A
  • the internal thoracic (internal mammary) veins
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18
Q

How many (bilateral) posterior intercostal arteries are there?

A
  • 11 (one per intercostal space)
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19
Q

What arteries branch from the thoracic aorta’s anterior surface?

A
  • bronchial
  • oesophageal
  • mediastinal
  • pericardial
  • phrenic

BOMPP!

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20
Q

What do the bronchial arteries do?

A
  • supply arterial blood for the lung tissue
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21
Q

What do the phrenic arteries do?

A
  • supply blood to diaphragm (visceral afferent nerve innervation from phrenic nerve!)
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22
Q

What branches off from the arch of the aorta?

A
  • brachiocephalic trunk (containing right common carotid + subclavian arteries)
  • left subclavian artery
  • left common carotid
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23
Q

What is located at the ascending aorta (at the position of the aortic sinuses on the semilunar valve)?

A
  • coronary arteries
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24
Q

Where does the thoracic duct drain to?

A
  • venous angle (situated at site of sternoclavicular joint)
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25
Q

What lymphatic vessels drain to the thoracic duct?

A
  • all deep + superficial lymphatic vessels of the body (minus a few on the right hand side)
26
Q

Where does the thoracic duct lie in relation to the a) oesophagus b) azygous vein

A

a) posteriorly

b) left

27
Q

Where does the thoracic duct begin + what is the mass of lymph nodes found there called?

A
  • superior retroperitoneum

- cisterna chyli

28
Q

What hiatus in the diaphragm does the thoracic duct pass through?

A
  • aortic hiatus
29
Q

Name 2 types of lymph nodes found in the lungs (that drain into the thoracic duct)

A
  • hilar (bronchopulmonary)

- tracheobronchial

30
Q

What happens to the thoracic duct at the sternal angle?

A
  • shifts to left hand side of body
31
Q

What other major lymphatic vessel in the body (which drains structures on the right hand side) drains to the venous angle?

A
  • right lymphatic duct
32
Q

Describe the vagus nerve

A
  • longest cranial nerve
  • contains motor/sensory fibres
  • passes through neck/thorax/abdomen
  • widest nerve distribution in body
  • somatic/visceral afferent + efferent fibres
33
Q

Describe the course + position of the vagus nerve within the body

A
  • descends vertically within the carotid sheath
  • posterolateral to the internal/common carotids
  • medial to the internal jugular vein
34
Q

Describe the course of the right vagus nerve (in detail)

A
  • crosses in front of the 1st part of the subclavian artery
  • reaches the thorax on the right side of the trachea (this separates it from the right pleura)
  • inclines BEHIND the hilum of the right lung
  • courses medially towards the oesophagus to form the oesophageal plexus with the left vagus nerve
35
Q

Describe the course of the left vagus nerve (in detail)

A
  • crosses intron of the left subclavian artery
  • enter thorax between left common carotid + subclavian arteries
  • descends on the left side of the aortic arch (this separates it from the pleura)
  • inclines BEHIND the root of the left lung
  • deviates medially to reach the oesophageal plexus with the right vagus nerve
36
Q

In the superior mediastinum, name the structures from anterior to posterior

A
  • branchiocephalic veins
  • SVC
  • arch of the aorta
  • trachea
  • oesphagus
  • thoracic duct
37
Q

In the superior mediastinum name the structures from lateral to medial

A
  • phrenic nerve
  • vagus nerve
  • recurrent laryngeal nerve
38
Q

Describe the course of the right recurrent laryngeal (inferior) nerve

A
  • branches from the vagus nerve at the root of the neck (around the right subclavian artery)
  • courses superiorly in the tracheoesophageal groove
  • enters the larynx between the cricopharynxgeus and oesophagus
  • HOOKS UNDER RIGHT SUBCLAVIAN ARTERY (doesn’t enter the chest!)
39
Q

Describe the course of the left recurrent (inferior) laryngeal nerve

A
  • branches from vagus nerve at root of neck
  • loops around aortic arch distal to the ligamentum arteriosum
  • HOOKS UNDER ARCH OF AORTA (does enter chest!)
40
Q

What is the ligamentum arteriosum?

A

Remnant of the ductus arterioles (primitive aorta/pulmonary trunk) from embryo

41
Q

The main trunk of the recurrent laryngeal nerve lies in a triangle. Name what is is bound by a) laterally b) medially

A

a) common carotid artery; IJV; vagus nerve

b) trachea; oesophagus

42
Q

Name the nerves of the superior mediastinum (from lateral to medial)

A
  • phrenic nerve
  • vagus nerve
  • recurrent laryngeal nerve
43
Q

What is the phrenic nerve formed by?

A

-anterior rami of spinal nerves C3/4/5

44
Q

Were does the phrenic nerve course?

A
  • through the neck on the anterior surface of the scalenus anterior
  • course through the chest between the mediastinal parietal pleura + the fibrous pericardium
  • enters the diaphragm
45
Q

What is the function of the phrenic nerve?

A

SOMATIC SENSORY INNERVATION: mediastinal parietal pleura; diaphragmatic parietal pleura; fibrous pericardium; muscle + central tendon of the diaphragm; diaphragmatic parietal peritoneum

SOMATIC MOTOR INNERVATION: skeletal muscle of diaphragm

VISCERAL AFFERENT INNERVATION: all the arterioles of the above structures

46
Q

What is the vagus nerve?

A
  • cranial nerve X
47
Q

What is the function of the vagus nerve?

A

SOMATIC SENSORY: laryngopharynx + larynx

SOMATIC MOTOR: pharynx + larynx

AUTONOMIC PARASYMPATHETIC: thoracic + abdominal organs

48
Q

What is the recurrent laryngeal nerve?

A
  • branch of vagus nerve
49
Q

What is the function of the recurrent laryngeal nerve?

A
  • supplies pharynx + larynx
50
Q

Once the vagus nerve has given off its recurrent laryngeal branches what does it contain?

A

-only parasympathetic nerves (innervation of thorax + abdomen)

51
Q

Why does inflammation of the gallbladder cause pain in the shoulder?

A
  • referred pain
  • the diaphragmatic parietal peritoneum is irritated
  • diaphragm is innervated by the phrenic nerve
  • phrenic nerve = C3/4/5
  • the SUPRACLAVICULAR NERVE also arises fromC3/4
  • supraclavicular nerve supplies the dermatomes over the tip of the shoulder
  • therefore the brain refers the pain to a more superficial structure: shoulder (via supraclaviuclar nerves) and not the gallbladder (via phrenic nerves)
52
Q

If a patient’s tracheobronchial lymph nodes are infiltrated by cancer - why can this cause hoarseness and dysphagia?

A
  • tracheobronchial lymph nodes compress various nervous structures in the mediastinum (e.g. the vagus/recurrent laryngeal nerve etc)
  • these nerves innervate the pharynx + larynx (motor + sensory)
  • therefore compression of these nerves can prevent the patient from swallowing/sensing - causing dysphagia and hoarseness
53
Q

Where can we feel the peripheral pulses?

A
  • bifurcation of the common carotid artery
  • upper limb = brachial + radial
  • lower limb = femoral; popliteal; posterior tibial; dorsalis pedis
54
Q

Where is bifurcation of the common carotid artery situated?

A
  • anterior to the sternocleidomastoid at the level of the upper border of thyroid cartilage
55
Q

Why do we specifically auscultate the common carotid?

A
  • carotid bruits
56
Q

Where are the following situated? a) brachial artery b) radial artery

A

a) medial to the biceps tendon in the popliteal fossa

b) lateral to the tendon of the FLEXOR CARPI RADIALIS

57
Q

Where are the following situated?

a) femoral artery
b) popliteal artery
c) posterior tibial artery
d) dorsalis pedis artery

A

a) inferior to the midpoint of the inguinal ligament (halfway between ASIS + pubic tubercle)
b) in popliteal fossa (immediately posterior to knee joint)
c) between posterior border of the medial malleolus + achilles tendon
d) medial to tendon of EXTENSOR HALLUCES LONGUS (distal to ankle joint)

58
Q

Name 3 points of arterial access to left side of heart + the purposes of each

A

1) subclavian: insertion of cardiac pacing wire (under US guidance)
2) radial: cannulation for arterial BP/ ABG sampling
3) femoral: intravascular interventions

59
Q

Name 2 points of venous access to the right side of the heart + the purposes of each

A

1) IJV: insertion of a central line (under US guidance)

2) femoral: insertion of central line + intravascular interventions

60
Q

Why are venous access points situated very close to the heart?

A
  • to allow the conditions to be as close as possible to that of the right atrium
61
Q

Name the 2 major lymphatic vessels

A
  • thoracic duct

- right lymphatic duct

Cardiology (6 decks)

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