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Anatomy > Lungs And Mediastinum > Flashcards

Lungs And Mediastinum Flashcards

1
Q

Thoracic cavity contents

A

. 2 pleural sacs and mediastinum
. Pleural sacs: closed serous sacs that contain lungs and pleural cavities
. Mediastinum: central compartment containing most remaining thoracic structures

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2
Q

Post. Thoracic wall

A

. Includes thoracic vertebral bodies, sympathetic trunks and intercostal spaces
. Related to mediastinal structures but not part of mediastinum

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3
Q

Mediastinum boundaries

A 
. Sup: sup. Thoracic aperture 
. Inf: diaphragm 
. Sternum ant. 
. Thoracic vertebral bodies post. 
. Lat: R/L pleural sacs
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4
Q

Superior mediastinum

A

. Btw sup. Thoracic aperture and transverse thoracic plane
. Oblique plane through sternal angle and T4-5 disc
. Contains thymus, great veins, aortic arch w/ branches, vagus, and phrenic nn., trachea, esophagus, thoracic duct

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5
Q

Inferior mediastinum

A

. Extends inf. From transverse thoracic plane to diaphragm

. Subdivided into ant., middle, and post. Mediastinum

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6
Q

Anterior mediastinum

A

. Btw. Sternal body and pericardial sac

. Contains CT, fat, and lymph nodes

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7
Q

Middle mediastinum

A

. Pericardial sac and contents

. Contains pericardium, heart, root of great vessels, phrenic nerves

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8
Q

Posterior mediastinum

A

. Btw pericardial sac and vertebral column

. Contains esophagus, thoracic duct, descending aorta and branches, and a yoga venous system

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9
Q

T/F mediastinum anatomical conduit for structures traveling btw head, neck, thorax, and abdomen

A

T

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10
Q

Longitudinal structures generally moves from ___ mediastinum to ___ mediastinum

A

. Superior

. Posterior or middle

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11
Q

Mobility of viscera in mediastinum

A

, lie one vertebra higher in supine position

. Lie lower during inspiration than expiration

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12
Q

Thymus

A

. Lymphoid organ
. Post. To sternum
. Products T-lymphocytes
. Large in youth, replaced by fatty CT in adults

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13
Q

Great veins

A

. Drain head, neck, and upper extremities
. Brachiocephalic vv. formed by union of internal jugular and subclavian vv.
. Sup. Vena cava: formed by union of R/L brachiocephalic vv., terminates in middle mediastinum

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14
Q

R versus L brachiocephalic vv. Pathway

A

R: descends vertical and is shorter
L: courses obliquely ant. To aortic arch and it’s branches

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15
Q

Aortic arch

A

. Direct continuation of ascending aorta
. Sup. To transverse thoracic plane
. Courses posteriorly and to the left
. Gives 3 branches (brachiocephalic trunk, left common carotid, and left subclavian a.)
. Connected to L Pulmonary a. By ligamentum arteriosum (remnant of fetal ductus arteriosus)

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16
Q

Brachiocephalic trunk divides to form ____

A

. R common carotid

. R subclavian aa.

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17
Q

Aortic dissection

A

. Tear in aortic intima permits formation of subintimal hematoma
. Usually on ascending aorta or aortic arch
. Rupture assoc. w/ abrupt onset of severe chest and back pain and is frequently fatal

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18
Q

Trachea

A

. Membranous tube extending from larynx to level of T4-5 intervertebral disc
. Terminates by bifurcation into R/L primary bronchi marked by carina (keel-shaped)
. C-shaped cartilages that are deficient post. To permit food

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19
Q

Esophagus

A

. Continuous btw sup. And post. Mediastinum
. Musculomembranous tube connecting pharynx w/ stomach
. Immediately post. To trachea and ant. To vertebral bodies in sup. Mediastinum
. Immediately post. To pericardium and L atrium in post. mediastinum

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20
Q

Dysphagia

A

. Difficulty swallowing

. Can be caused by enlargement of mediastinal lymph nodes or hypertrophy of L atrium

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21
Q

Thoracic duct

A

. Enters thorax via aortic hiatus and drains into venous system at junction of L subclavian and internal jugular vv.
. Lies lat. to esophagus and post. To aortic arch in sup. Mediastinum
. Lies an. Vertebral column, btw azygos v. And descending aorta, and post. To esophagus in the post. Mediastinum

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22
Q

Structures restricted to post. Mediastinum

A

. Descending aorta

. Azygos system

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23
Q

Descending aorta and branches

A

. Continuation of aortic arch
. Descends on left side of vertebral column
. Branches: bronchial aa (bronchial tree and lungs), esophageal aa., sup. Phrenic aa. (Diaphragm), and post. Intercostal aa. ( to intercostal spaces and thoracoabdominal wall, right post. Intercostal cross ant. To vertebral bodies)

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24
Q

Coarctation of aorta

A

. Distal to attachment of ligamentum arteriosum postductal)
. Collateral circulation can develop via subclavian, internal thoracic, ant. And post. Intercostal aa. To maintain blood flow through descending aorta

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25
Q

Azygos system

A

. Venous networks draining thoracoabdominal wall and mediastinal viscera

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26
Q

Azygos v.

A

. Vertical venous channel that ascends on right of vertebral column
. Arch of azygos passes anteriorly sup. To root of R lung to drain into sup. Vena vena at T4 vertebral level
. Communicates w/ inf. Vena cava inf.
. Receives R sup. Intercostal v and all other post. Intercostal vv. Except 1st post. Intercostal v.

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27
Q

Right sup. Intercostal vein

A

. Unions of post. Intercostal vv. 2-4

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28
Q

Where does 1st post. Intercostal v. Drains to ___

A

right brachiocephalic v.

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29
Q

Hemiazygos and accessory hemiazygos vv.

A

. Vertical venous channels lying left of vertebral column
. Hemiazygos v.: receives post. Intercostal vv. 9-12 on the left then crosses ant. To vertebral bodies to drain into azygos v.
. Accessory: receives post. Intercostal 5-8 before draining into hemiazygos v. W/ azygos v.

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30
Q

1st post. Intercostal and sup. Intercostal v. On left drain directly to ____

A

Brachiocephalic v.

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31
Q

Superior to diaphragm from thoracic duct receives ____

A

. All structure inf. To diaphragm
. Post. Intercostal lymph vessels form post. Thoracic wall
. Lymph trunks from left: jugular lymph trunks (drains head and neck), subclavian trunk (drains upper limb), and bronchomediastinal trunk (drains lung and bronchial tree, mediastinum, and ant. Thoracic wall)

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32
Q

Right lymphatic duct

A

. Receives the right bronchomediastinal trunk draining lung and bronchial tree, mediastinum, and ant, thoracic wall on right

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33
Q

Chylothorax

A

Lymph accumulation in mediastinum/pleural cavity from thoracic duct damage
. Treatment: Ligate thoracic duct

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34
Q

Phrenic n.

A

. From C3-5 vnteral rami
. Provides motor and sensory innervation to diaphragm
. sensory innervation to pericardium and parietal pleura

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35
Q

Phrenic n. Pathway in sup. Mediastinum

A

. L phrenic n. Courses inferiorly post. To L brachiocephalic v. And ant. To aortic arch
. Right phrenic n. Lies lat. to R brachiocephalic v. And sup. Vena cava

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36
Q

Phrenic n. Pathway In inf. Medianstinum

A

. Lie btw pericardium and mediastinal pleura and ant. To lung roots

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37
Q

Vagus n.

A

. Provides presynaptic parasympathetic fibers to thoracic and abdominal viscera and motor and sensory innervation to larynx

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38
Q

Left vagus n.

A

. Courses ant. And lat. to arch of aorta in sup. Mediastinum
. Left recurrent laryngeal n. Lips around aortic arch near ligamentum arteriosum and ascends lat. to trachea
. Descends post. To root of lung and lat. to descending aorta and esophagus in post. Mediastinum before esophageal plexus

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39
Q

Persistent hoarseness from compression of L recurrent laryngeal n. Is warning sign for ____

A

Aortic aneurysms/ dissection
. Metastatic carcinoma of lung
. Mediastinal lymphoma

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40
Q

Right vagus n.

A

. R recurrent laryngeal n. Arises in root of neck and loops around R subclavian a.
. Descends post. To great veins and medial to arch of azygos v. In sup. Mediastinum
. Lies post. To root of lung and lat. to esophagus in post. Mediastinum before joining esophageal plexus

41
Q

Cardiac and pulmonary branches of R/L vagus nn. Contribute to ____

A

Cardiac and pulmonary autonomic plexuses

42
Q

Esophageal plexus and vagal trunks

A

. Fibers of r/L vagus nn. Join esophageal plexus

. Fibers reassemble to form ant. And post. Vagal trunks that accompany esophagus through esophageal hiatus

43
Q

Anterior vagal trunk

A

Contains fibers from L vagus n.

44
Q

Posterior vagal trunk

A

. Contains fibers rom right vagus n.

45
Q

Sympathetic trunk (chain)

A

. 1st thoracic sympathetic ganglion fuses w/ inf. Cervical ganglion to form stellate ganglion
. Trunks lie lat. to vertebral bodies and ant. To necks of ribs
. Contains cell bodies of postsynaptic sympathetic neurons

46
Q

Thoracic branches of sympathetic chain and pathways

A

. Cardiac branches: postsynaptic sympathetic fibers pass medially to joint cardiac and pulmonary plexuses
. Esophageal branches: join esophageal plexus
. Thoracic splanchnic nn.: carry presynaptic fibers that synapse on prevertebral ganglia in abdomen

47
Q

Greater splanchnic nn.

A

Roots from T5-9 ganglia

48
Q

Lesser splanchnic nn.

A

Roots from T10-11 ganglia

49
Q

Least splanchnic n.

A

From T12 ganglion

50
Q

Visceral afferent fibers supplying thoracic structure follow ______ pathways

A

Sympathetic and parasympathetic

51
Q

Sympathetic associated visceral afferents

A

Convey pain sensations from the heart and other thoracic and abdominal viscera

52
Q

Parasympathetic associated visceral afferent

A

. Convey sensation from bronchial tree (cough reflex), unconscious sensations related to homeostasis, and sensations of nausea

53
Q

Pleural sac

A

. Visceral pleura and parietal pleura

54
Q

Visceral pleura

A

. Inseparable from surface of lung and extending into fissures
. Innervated by visceral afferent and insensitive to pain

55
Q

Parietal pleura

A

. Lines thoracic wall
. Contains costal pleura (contacts ribs and intercostal muscles), diaphragmatic pleura (contacts sup. Surface of diaphragm), mediastinal pleura (contacts structures of mediastinum), and cervical pleura (dome extending through thoracic inlet sup. To 1st rib)
. Supplied by somatic afferent fibers carried by intercostal and phrenic nn. And highly sensitive to pain

56
Q

Pain in costal pleura and peripheral portions of diaphragmatic pleura referred to _____

A

Thoracoabdominal wal

57
Q

Pain in mediastinal pleura and central portion of diaphragmatic pleura os referred to ____

A

Lower neck and shoulder

58
Q

Pleural cavity

A

. Closed potential space btw visceral and parietal layers
. Contains thin layer serous fluid that acts as lubricant and facilitates free movement of lungs
. Lungs NOT in pleural cavities

59
Q

Pleuritis/pleurisy

A

. Inflammation of pleura
. Roughens pleural surfaces creating friction on respiration that is a subtle as pleural fremitis (rub)
. Can lead to pleural effusion or formation of pleural adhesions

60
Q

Pleural reflections

A

. Regions of transition btw different portions of parietal pleura
. Lines of pleural reflection mark boundaries of pleural sac

61
Q

Sternal line

A

. Marks ant. Reflection of costal pleura to mediastinal pleura
. Left sternal line deviates to left at level of 5th intercostal space leaving pericardial sac ind I react contact w/ ant. Thoracic wall

62
Q

Pericardiocentesis

A

. Needle inserted into 5th intercostal space

. Passes to bare area of pericardium w/o encountering parietal pleura

63
Q

Costal line

A

. Marks reflection of costal pleura to diaphragmatic pleura and inf. Extend of pleural sac
. Slopes inf. And post.
. Base of lung 2 ribs sup. To costal line

64
Q

Midclavicular line

A

Located at level of 8th rib

65
Q

Midaxillary line

A

10 rib level

66
Q

Midscapular line

A

12th rib level

67
Q

Pleural recesses

A

. Region of contact btw layers of parietal pleura at sites of pleural reflection
. Potential spaces that accommodate lung expansion
. Costodiaphragmatic and costomediastinal recesses

68
Q

Costodiaphragmatic recess

A

. Lies btw costal and diaphragmatic pleura
. Most inf. Point in pleural cavity
. Frequent site of fluid accumulation

69
Q

Costomediastinal recess

A

Btw costal and mediastinal pleura, adjacent and post. To sternum

70
Q

Pleurocentesis

A

. Draw off fluid in costodiaphragmatic space

71
Q

Lung surfaces

A

. Base: rests of sup. Surface of diaphragm
. Apex: extends into root of neck sup. To 1st rib
. Costal surface: post. And lat.
. Mediastinal: bears impressions of mediastinal structures

72
Q

Right lung structure

A

. Shorter, broader, and heavier than left lung
. 3 lobes
. Horizontal and oblique fissure

73
Q

Left lung structure

A 
. Taller and narrower than right lung 
. 2 lobes 
. Oblique fissure 
. Cardiac notch: accommodates heart
. Lingula: tongue-like projection of sup. Lobe just inf. To cardiac notch, corresponds t middle lobe of right lung
74
Q

Hilus

A

Indentation on mediastinal surface that transmits structures connecting lung to mediastinum

75
Q

Root of lung

A

. Structures that connect lung to mediastinum
. Primary bronchus, pulmonary a. And vv, bronchial aa., vv., nn., and lymph
. Pleural sleeve (encloses root structures)
. Pulmonary ligament: bilaminar fold extending inf. From root of lung

76
Q

Anthracosis

A

. Inhaled carbon particles that can’t be cleared from lungs and accumulate in CT and lymph nodes

77
Q

Coal worker’s pneumoconiosis/black lung

A

. Causes by extended environmental or occupational exposure leads to inflammation, fibrosis, and severely diminished lung function

78
Q

Primary bronchi

A

. Terminal branches of trachea

. R side is shorter, broader and more vertically oriented than the left

79
Q

Aspirated objects more likely to pass into which lung?

A

Right lung

80
Q

Secondary (lobar) bronchi

A

. Begins at hilus

. Supplies single lobe

81
Q

Tertiary (segmental) bronchi

A

. W/in lung tissue

82
Q

Bronchopulmonary segment

A

. Pyramidal segment of lung tissue supplied by single tertiary (segmental) bronchus
. Small anatomically and functionally self-contained unit of lung tissue
. Separated from adjacent segments CT septa
. Supplied by tertiary branches of pulmonary aa.

83
Q

Lung volume reduction surgery

A

Diseased lung segments respected to improve function of healthy segments

84
Q

Pulmonary vessels

A

. Carry deoxygenated blood to lungs and return oxygenated blood to heart.

85
Q

Pulmonary aa.

A

. Terminal branches of pulmonary trunk
. Ant. And sup. To bronchi at hilus
. Following branching of bronchial tree
. Tertiary artery branches are intrasegmental and supplies single segment w/ no arterial anastomosis btw adjacent segments

86
Q

Pulmonary embolism

A

. Obstruction of pulmonary arteries
. Causes interruption of pulmonary perfusion and acute respiratory distress
. Caused by blood clots, bacteria, fat globules, or gas bubbles in bloodstream

87
Q

Pulmonary veins

A

. 2 per side (sup. And inf)
. Located ant. And inf. To bronchi at the hilus
. W/in lung tributaries of pulmonary veins course independently of arteries
. Individual bronchopulmonary segments drained by multiple pulmonary vein tributaries whose courses are intersegmental

88
Q

Bronchial vessels

A

. Supply CT of lungs and conducting portions of bronchial tree
. Bronchial aa: direct branches fo descending aorta that follow bronchial tree branching
. Bronchial vv: drain to azygos vein system where blood is distributed by bronchial aa. Returns via pulmonary vein system
. Veins are smaller than bronchial aa.

89
Q

Lymphatic drainage of lungs

A

. Follows bronchial tree
. Intrapulmonary lymph nodes drain to bronchopulmonary nodes at hilus of lung
. Bronchopulmonary nodes drain to tracheobronchial nodes located sup. And inf. To bifurcation of trachea

90
Q

Inf. Tracheobronchial lymph nodes

A

. Sentinel nodes
. Enlargement dur to infection, lymphoma, or tumor metastasis can produce a deviation of carina that is visible in bronchoscopy

91
Q

Innervation of lungs and bronchial tree

A

. Ant, and post. Pulmonary plexuses

. Surround bifurcation of trachea and extend laterally btw layers of pulmonary ligaments

92
Q

Sympathetic innervation of lungs and bronchial tree

A

. Inhibit smooth muscle and glands of bronchial tree
. Leads to bronchodilation, reduced secretion
. Stimulate smooth muscle in pulmonary vessels causing vasoconstriction

93
Q

Parasympathetic stimulation in lungs and bronchial tree

A

. Stimulate smooth muscles and glands of bronchial tree causes bronchoconstriction and inc. secretion
. Inhibits smooth muscle in pulmonary vessels causing vasodilation

94
Q

Visceral afferent fibers in lungs and bronchial tree

A

. Vagus n. To bronchial mucosa (cough reflex), bronchial tree (monitor bronchoconstriction), and pulmonary vessels (chemo/baroreceptors)
. Convey sensations from bronchial tree and visceral pleura (sympathetic)

95
Q

Pulmonary ventilation

A

. Lung inflation maintained by physical forces that resist the natural tendency of elastic lung tissue to recoil (collapse)
. Surface tension of serous fluid and neg. pressure w/in pleural cavity maintain contact btw visceral pleura and parietal pleura

96
Q

Pneumothorax

A

. Air in pleural cavity causing lung collapse

97
Q

Ope pneumothorax

A

. Sucking chest wound

. Occurs when respiratory movements cause air to rush in and out of thorax via open wound

98
Q

Tension pneumothorax

A

. Tissue flap admits air but prevents escape
. Air in thorax displaces and compresses mediastinum and interferes w/ venous return to the heart causing jugular vein distension and tracheal shift toward the uninsured side

Anatomy (49 decks)

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