CVS: Anatomy of the mediastinum Flashcards
What is the plane between the sternal angle and the T4/T5 vertebral interspace called?
the transverse thoracic plane
What is the space bounded by ribs 1, T1 vertebra and the jugular notch called?
The thoracic inlet
Which gland/lymphoid organ sits posterior to the sternal angle in children?
What does it do?
What happens to it after puberty?
The thymus
It produces T lymphocytes in childhood
After puberty it is replaced by adipose tissue
What is cancer of the thymus called?
Thymoma
Name a lymphatic vessel that runs in the posterior mediastinum
Thoracic duct
Which vein drains the posterior part of the intercostal spaces?
The azygous vein
Which level does the trachea bifurcate at?
The level of the sternal angle
Which part of the mediastinum does the thymus lie in?
The anterior mediastinum
Name the organs and structures in the middle mediastinum
Pericardium Heart Superior part of IVC Inferior part of SVC Pulmonary trunk Proximal part of pulmonary arteries Distal part of pulmonary veins Ascending aorta
Which part of the aorta lies in the posterior mediastinum?
The thoracic aorta
Is the trachea mainly in the superior or inferior mediastinum?
The superior mediastinum
What is the name of the space in the diaphragm through which the aorta passes?
The aortic hiatus
What are the bilateral branches from the thoracic aorta?
The posterior intercostal arteries
1 for each intercostal space
What are the branches from the thoracic aorta’s anterior surface?
Bronchial arteries Mediastinal arteries Oesophageal arteries Pericardial arteries Phrenic arteries
What is another name for the hilar lymph nodes?
The bronchopulmonary lymph nodes
What is the name for the space in the diaphragm through which the oesophagus passes?
The oesophageal hiatus
What is the name of the swollen start of the thoracic duct in the abdomen?
cisterna chyli
What are the lymph nodes at the bifurcation of the trachea called?
Tracheobronchial lymph nodes
How does the right phrenic nerve pass through the diaphragm?
It passes through the diaphragm with the IVC to supply the diaphragm from the inferior aspect
How does the left phrenic nerve pass through the diaphragm?
It pierces through the left dome of the diaphragm to supply it from its inferior aspect
Name the remnant of the ductus arteriosus
Ligametum arteriosum
Are the phrenic nerves lateral or medial to the vagus nerves?
Lateral
Are the vagus nerves lateral or medial to the recurrent laryngeal nerves?
Lateral
Are the brachiocephalic veins anterior or posterior to the SVC?
Anterior
Is the SVC anterior or posterior to the arch of the aorta?
Anterior
Is the trachea anterior or posterior the arch of the aorta?
Posterior
Is the oesophagus anterior or posterior to the trachea?
Posterior
Is the oesophagus anterior or posterior to the thoracic duct?
Anterior
What is the distance from the right atrium to the sternal angle?
5cm
Where do the left and right recurrent laryngeal nerves come from?
They are branches of the left and right vagus nerves
Where does the right recurrent laryngeal nerve go?
Does it enter the chest?
It hooks under the right subclavian artety
It does not enter the chest
Where does the left recurrent laryngeal nerve go?
Does it enter the chest?
It hooks under the arch of the aorta
It does enter the chest
What form the phrenic nerves?
The anterior rami of cervical spinal nerves 3, 4 and 5
What do the phrenic nerves supply?
Somatic motor to the diaphragm
Somatic sensory to: The mediastinal parietal pleura Fibrous pericardium The diaphragmatic parietal pleura Diaphragmatic parietal peritoneum
Where are the vagus nerves from?
Cranial Nerve X
What do the vagus nerves contain?
Somatic sensory nerves for the laryngopharynx and larynx
Somatic motor nerves for the pharynx and larynx
Autonomic parasympathetic nerves for the thoracic and abdominal organs
Name the branches of the vagus nerve that supply the pharynx and larynx
The recurrent laryngeal nerves
What do the vagus nerves contain once they have given off their recurrent laryngeal branches?
Only parasympathetic fibres
Why can inflammation of the liver or gallbladder cause referred pain to the shoulder tip?
The inflammation irritates the parietal peritoneum lining the inferior surface of the diaphragm which is supplied by the phrenic nerve (C3,4,5)
The supraclavicular nerves (C3,4) supply the dermatomes over the tip of the shoulder and enter the spinal cord at the same level as the phrenic nerves
The brain refers the pain to the more superficial structure, i.e. the skin over the shoulder tip
What is the superficial vein of the upper limb?
The cephalic vein
What are the anterior intercostal arteries branches of?
The internal thoracic arteries
What are the posterior intercostal arteries branches of?
The thoracic aorta
Where do the anterior intercostal veins drain to?
The internal thoracic veins
Where do the posterior intercostal veins drain to?
The azygous vein
What arteries supply the palm?
The palmar arches
Which arteries supply the digits?
The digital arteries
What is the name of the main vein in the lower limb?
What is the name of the pump supplied by the skeletal muscle?
The great saphenous vein
The musculo-venous pump
What is the site for auscultating bruits?
The birfurcation of the common carotid artery
What muscle is the bifurcation of the common carotid artery anterior to?
the sternocleidomastoid muscle
Where is the brachial pulse felt?
Medial to the biceps tendon in the popliteal fossa
Which tendon is the pulse of the radial artery lateral to?
Tendon of the flexor carpi radialis
Where is the pulse in the femoral artery felt?
Inferior to the midpoint of the inguinal ligament
Which tendon is the pulse of the dorsalis pedis artery felt medial to?
The tendon of the extensor hallucis longis
Which artery is a cardiac pacing wire inserted into under US guidance?
The subclavian artery
Where is a central line inserted under US guidance?
The internal jugular vein or femoral vein
