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Block 2 Gross > Lecture 18: Anterior, Superior, and Posterior Mediastinum > Flashcards

Lecture 18: Anterior, Superior, and Posterior Mediastinum Flashcards

1
Q

Define Mediastinum

A

Region of thorax located between the two pleural sacs and extends from the thoracic inlet to the diaphragm

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2
Q

What are the anterior and posterior bounds of the mediastinum

A

Anterior- sternum and costal cartilages.

Posterior- Bodies of thoracic vertebrae

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3
Q

What are the primary two divisions of the mediastinum

A

superior and inferior portions

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4
Q

What are the 3 subdivisions of the inferior mediastinum

A

anterior, middle, and posterior

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5
Q

What are the anterior and posterior boundaries of the anterior mediastinum

A

Anterior: Anterior surface of the pericardium

Posterior. Posterior surface of the costal cartilages and posterior surface of sternum

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6
Q

What does the middle portion of the mediastinum contain

A

Heart and pericardium

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7
Q

What does the posterior portion of the mediastinum contain

A

Posterior surface of pericardium, and anterior surface of vertebral bodies T5-T12

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8
Q

Vertebral levels of the superior mediastinum

A

T1-T4

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9
Q

Anterior and Posterior bounds of superior mediastinum

A

Posterior surface of manubrium and anterior surface of thoracic vertebrae T1-T4

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10
Q

List of structures in the anterior mediastinum

A

thymus gland, internal thoracic a.

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11
Q

What is the role of the thymus gland in the child, what happens as the individual ages

A

Makes antibodies, the gland in the aging individual no longer functions and turns to fat.

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12
Q

Where is the thymus gland located within the anterior mediastinum

A

between the two braciocephalic veins

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13
Q

At the 6th rib what does the internal thoracic a. break into

A

Musculophrenic a. and superior epigastric a,

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14
Q

What does the musculophrenic a. supply

A

diaphragm

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15
Q

what does the superior epigastric a. supply

A

rectus sheath

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16
Q

What is the internal thoracic a. a branch of?

A

Subclavian a.

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17
Q

What are two other arterial branches given off by the internal thoracic a.

A

anterior intercostal a- supply intercostal spaces

Periocariacophrenic a- supplies phrenic n.

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18
Q

Constriction of the aorta will result in rib notching due to what anastomose?

A

Internal thoracic and intercostal a.

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19
Q

What is the most anterior structure of superior mediastinum

A

thymus

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20
Q

For the ducts, arteries, and veins in the superior mediastinum, which are most anterior and posterior?

A

Veins- anterior
Arteries- intermediate
Ducts (trachea esophagus, thoracic duct)- Posterior

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21
Q

What structure in the superior mediastinum is as far lateral as possible

A

phrenic n.

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22
Q

Is the left recurrent laryngeal n. a part of the superior mediastinum? What about the right

A

Yes, the right however is not because it is in the root of the neck

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23
Q

Branches coming off the superior vena cava in the superior mediastinum

A

left and right brachiocephalic vein

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24
Q

Branches coming of the arch of the aorta in the superior mediastinum

A

Descending aorta, brachiocephalic a., left common coratid a. and Left subclavian a.

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25
Q

In the superior mediastinum, what direction are the veins and arteries directed?

A

Veins- right and arteries-left because the venous portion of the heart is to the left and the opposite is true for the arterial portion

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26
Q

What are the two branches off the brachiocephalic veins

A

Subclavian v. and internal jugular v.

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27
Q

How does Superior vena cava syndrome arise

A

Results from obstruction of the superior vena cava

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28
Q

What is a common cause of superior vena cava syndrome

A

Enlargement of lymph nodes from cancer

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29
Q

What are symptoms of superior vena cava syndrome

A

Redness to face and upper extremities due to the back up of blood from superior vena cava which dilates capillaries

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30
Q

What organ is present in both the superior and anterior mediastinum

A

thymus

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31
Q

What are the two portions of the aorta

A

Ascending and desending

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32
Q

At what point does the ascending aorta start to descend posteriorly

A

At the sternal angle

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33
Q

What does the descending aorta come into contact with

A

Trachea and esophagus

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34
Q

What would a lesion of the aorta also likely involve?

A

Trachea and esophagus because they are in contact with one another

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35
Q

What is the most common anomaly when it comes to branching off of the aorta

A

The vertebral artery may instead of coming off the subclavian will come off between the left common coratid a. and left subclavian a.

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36
Q

What is the only branch of the brachiocephalic a. that is in the superior mediastinum

A

thyroidea ima

37
Q

what does the thyroidea ima supply?

A

Thyroid gland

38
Q

What are the two branches of the brachiocephalic a.

A

right subclavian a and right common coratid a.

39
Q

At way point does the right brachiocephalic a divide into the right subclavian a. and right common coratid a.

A

Posterior to the sternoclavicular joint

40
Q

What part of the mediastinum contains the descending aorta?

A

Posterior

41
Q

What is the point of bifurcation of the trachea called?

A

Carina

42
Q

Where is the carina located

A

Sternal angle

43
Q

In what lung are aspirated objects more likely to enter and why

A

Right lung because the right mainstream bronchus is wider and more vertical than the left.

44
Q

Are primary bronchi in the superior mediastinum

A

no

45
Q

Is the esophagus posterior or anterior to the trachea

A

posterior

46
Q

Where does the thoracic duct begin

A

in the abdomen opposite SMA at the upper end of the cistern chyli

47
Q

What are the regions of the body not drained by the thoracic duct?

A

The right upper extremity, right chest, right neck, and right side of face

48
Q

What does the lymph from the thoracic duct drain into

A

the juncture between the left internal jugular v. and left subclavian v.

49
Q

What drains the lymph from the right upper extremity, right thorax, right head and neck?

A

Right lymphatic duct

50
Q

Where does the right lymphatic duct drain into the venous system

A

At the junction of the right subclavian and right internal jugular v.

51
Q

Do the phrenic nerves descend into the superior mediastinum

A

Yes (From C3,4,5)

52
Q

How can someones vocal cords be paralyzed?

A

By damaging the left recurrent laryngeal n (comes off vagus)

53
Q

What nerve forms a plexus around the trachea

A

Vagus

54
Q

Where does the left recurrent laryngeal n. course

A

around the left side of the ligament arteriosum under the arch of the aorta

55
Q

Are the left and right recurrent laryngeal nerves present in the superior mediastinum?

A

Left yes right no. The right is at the root of the neck and loops between the esophagus and trachea

56
Q

Since the left recurrent laryngeal n. is located in the anterior mediastinum (lots of lymph nodes) what are they prone to?

A

Paralysis of vocal cords caused by pinching the l. recurrent laryngeal n. from enlarged lymph nodes

57
Q

What is another way the left recurrent laryngeal branch may be compromised?

A

aortic aneurism (the thoracic aorta is prone to these)

58
Q

What are the two plexi that the left vagus nerve contributes to

A

The esophageal and cardiac autonomic plexus

59
Q

Are the paired sympathetic chains also located in the superior mediastinum?

A

Yes

60
Q

What are the contents of the posterior mediastinum

A

esophagus (with its vagal plexi), descending aorta, thoracic duct, azygos/hemiazygos/accessory azygos veins, and splanchnic nerves

61
Q

Where are the 3 regions where the esophagus narrows

A
  1. Its origin
  2. at its midpoint where it is constricted by the aortic arch and left mainstream bronchus
  3. Inferiorly where it passes through the diaphragm
62
Q

Where does the azygous vein lie?

A

To the right side of the vertebral column

63
Q

Where does the azygous empty into

A

Superior vena cava

64
Q

Which intercostal spaces are directly drained by the azygous vein

A

5-12

65
Q

How is blood from intercostal spaces (2-4) indirectly drained into the azygous v.

A

Blood drains into the right superior intercostal vein, which empires into the azygous v.

66
Q

Where does the hemiazygous v. begin?

A

At level of diaphragm

67
Q

What intercostal spaces does the hemiazygous drain

A

8-12

68
Q

Where does the accessory hemiazygous begin and end

A

Intercostal space T4-T7

69
Q

Where is the thoracic duct positioned?

A

Between the azygous v. and the aorta

70
Q

What are the 3 branches the descending aorta gives off

A
  1. Paired posterior intercostal a.
  2. bronchiol arteries
  3. Esophageal arteries
71
Q

Why is the sympathetic chain present in the superior mediastinum but not the posterior mediastinum and the splanchnic n. are located in the posterior, which come off of the sympathetic chain?

A

Because as you travel down, the chain mosts posterior to the vertebral bodies (thus moving out of the mediastinum since the posterior border of the mediastinum is the anterior surface of the vertebral bodies)

72
Q

To review: What are all of the components of the anterior mediastinum

A

Thymus and internal thoracic a.

73
Q

To review: What are all of the components of the superior mediastinum

A
  • Left and right brachiocephalic veins
  • Ascending and arch of aorta
    - Branches: Left brachiocephalic a., Left common coratid a., and left subclavian a.
  • Thoracic duct, esophagus, trachea
74
Q

What vessels are located in the root of the neck

A
  • Branches off of the left and right brachiocephalic veins: Subclavian v. and internal jugular v.
  • Branches off left brachiocephalic a.: Right Subclavian a. and right common coratid a.
75
Q

What are the structures in the posterior mediastinum

A

esophagus (with its vagal plexi), descending aorta, thoracic duct, azygos/hemiazygos/accessory azygos veins, and splanchnic nerves

76
Q

Describe the location of the thymus

A

Sits between the two brachiocephalic v.

77
Q

Describe the location of the internal thoracic a.

A

Run with the phrenic n and pericardiophrenic a. and v.

78
Q

In the superior mediastinum, what is the arrangement for the three different ducts (thoracic, trachea, and esophagus)

A

Trachea (inferior to descending aorta), esophagus, thoracic duct

79
Q

What vessels coming off of the aorta are most anterior? Most posterior?

A

Goes in alpha-order from anterior to posterior: Left brachiocephalic, left common coratid, and left subclavian

80
Q

In the posterior mediastinum, where is the azygous v. located

A

Right side of vertebral column deep to the esophagus

81
Q

Where is the thoracic duct

A

Sandwiched between the descending aorta and azygous v.

82
Q

From what intercostal spaces do the two hemiazygous veins run?

A

Accessory hemiazygous- T4-T7

Hemiazygous- T5-12

83
Q

What do the accessory and hemiazygous veins drain into?

A

Azygous

84
Q

What are the 3 vessels the descending aorta gives off in the abdomen posterior to the diaphragm

A
  1. paired posterior intercostal a
  2. bronchial a.
  3. esophageal a.
85
Q

Splanchnic nerves

A

Run from sympathetic chain towards the anterior vertebral column

86
Q

List all the structures found in more than one segment of the mediastinum

A
  • Aorta
  • Thoracic duct
  • Esophagus
  • Vagus n
  • Phrenic n.
87
Q

What is related to the esophagus as it passes through the thorax

A

aorta, main stem (or primary bronchus), and the pericardium

88
Q

Why can the phrenic n. be damaged during coronary bypass surgery

A

Because the phrenic nerve in the anterior mediastinum is glued to the heart

Block 2 Gross (11 decks)

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