Lecture 19: Mediastinum and Respiratory Diaphragm

Question 1

Superior mediastinum structures

Answer 1

Trachea

Question 2

Inferior mediastinum structures

Answer 2

Lymph nodes
Phrenic nerves
Pericardiacophrenic artery
Heart
Aorta
Azygos veins

Question 3

Structures found in both superior and inferior mediastinum

Answer 3

Esophagus
Thoracic duct
Sympathetic trunks
Vagus nerves
Thymus

Question 4

Blood supply to thymus

Answer 4

Anterior mediastinal arteries

Inferior thyroid arteries

Question 5

Esophagus passes through the diaphragm at what level

Answer 5

T10

Question 6

Upper third of esophagus innervated by

Answer 6

Recurrent laryngeal nerve

Question 7

Lower two thirds of esophagus innervated by

Answer 7

Vagus nerve and sympathetic chain

Question 8

Thoracic aorta begins and ends at what levels and pierces what

Answer 8

Begins at T4 (sternal angle) ends at T12 (diaphragm)

Pierces diaphragm

Question 9

Azygos vein is union of what veins

Answer 9

Right ascending lumbar and right subcostal veins

Question 10

Hemiazygos vein is union of what two veins and pierces what

Answer 10

Left ascending lumbar and left subcostal

Pierces diaphragm

Question 11

Left thoracic duct receives lymph from

Answer 11

Body below diaphragm

Question 12

Right thoracic duct receives lymph from

Answer 12

Right thoracic cavity, right upper extremity, right head/neck

Question 13

Vagus nerve root

Answer 13

Parallel to esophagus
Passes posterior to root of lung
Pierces diaphragm at T10
Becomes gastric nerve
Right vagus--> posterior vagus trunk
Left vagus--> anterior vagus trunk

Question 14

Left recurrent laryngeal nerve hooks around

Answer 14

Arc of aorta

Question 15

Right recurrent laryngeal nerve hooks around

Answer 15

Subclavian artery (therefore it arises in the neck, not the thorax)

Question 16

Phrenic nerve route

Answer 16

Passes anterior to pulmonary root (only nerve to do so)
Sole motor innervation to diaphragm
Pain via phrenic nerves usually referred to base of neck and tip of shoulder
Accompanied by pericardiacophrenic arteries

Question 17

Superior fascia of diaphragm

Answer 17

Parietal thoracic fascia

Question 18

Inferior fascia of diaphragm

Answer 18

Transversalis fascia

Question 19

The aortic opening to the diaphragm is at what level

Answer 19

T12

Question 20

Attachments to respiratory diaphragm

Answer 20

Ribs
TV 12
Distal end of sternum
Central tendon

Question 21

Caval foramen

Answer 21

Inferior vena cava pierces esophagus w/right phrenic nerve at T8

Question 22

Esophageal hiatus

Answer 22

Esophagus pierces diaphragm with vagus nerve at T10

Question 23

Aortic hiatus

Answer 23

Aorta pierces diaphragm w/splanchnic nerve at T12

Question 24

Nerve supply to diaphragm via

Answer 24

Phrenic nerve

Question 25

Blood supply to superior diaphragm

Answer 25

Pericardiacophrenic artery from internal thoracic
Musculophrenic artery from internal thoracic
Superior phrenic artery from aorta

Question 26

Blood supply to inferior diaphragm

Answer 26

Inferior phrenic artery from aorta

Question 27

Crura ligaments of diaphragm

Answer 27

Originate from lumbar vertebrae

Right crura swings left and forms a weak sphinctor around the esophagus

Question 28

Median arcuate ligament

Answer 28

Around aortic opening

Bridges proximal ends of crura

Question 29

Medial arcuate ligaments

Answer 29

Frrom deep fascia of psoas major muscle

Question 30

Lateral arcuate ligaments

Answer 30

From deep fascia of quadratus lomborum muscle