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Cardiopulmonary Renal > Mediastinum > Flashcards

Mediastinum Flashcards

1
Q

What is the mediastinum?

A

The thoracic compartment between the two pleural sacs

Contains the major organs of the thoracic cavity

  • except the lungs
  • highly mobile
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2
Q

What is the plane of Ludwig (trans thoracic plane)?

A

An imaginary horizontal plane across the thorax

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3
Q

What are the anterior and posterior boundaries of the plane of ludwig?

A

Anterior boundary:
-manubriosternal joint
AKA, angle of Louis
-2nd costal cartilage

Posterior boundary
-T4/5 intervertebral disc

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4
Q

What are the structures of the plane of Ludwig?

A
  • Superior vena cava enters the pericardium
  • Arch of the aorta
  • Trachea bifurcation
  • pulmonary trunk bifurcation
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5
Q

Define the superior, inferior, posterior and anterior borders of the superior mediastinum

A

Superior: 1st rib, T1, jugular notch

Inferior: transthoracic plane

Posterior: T1-T4 vertebrae

Anterior: manubrium

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6
Q

What are the contents of the superior mediastinum?

A

Contents:

  • esophagus
  • thoracic duct
  • thymus
  • trachea
  • aortic arch and major vessels
  • left and right brachiocephalic veins
  • superior vena cava
  • pulmonary arteries
  • nerves
    • phrenic
    • recurrent laryngeal
    • phrenic
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7
Q

Where is the thymus located?

A

Located in the anterior part of superior mediastinum, posterior to the manubrium

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8
Q

What occurs to the thymus in puberty?

A

Involuted after puberty (replaced by fat)

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9
Q

What is the arterial blood supply of the thymus?

A

Internal thoracic and anterior intercostal

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10
Q

What is the veinous drainage of the thymus?

A

Into brachiocephalic, internal thoracic, and inferior thyroid veins

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11
Q

What 8s the lymphatic drainage of the thymus?

A

Into parasternal, brachiocephalic and tracheobronchialnlymph nodes

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12
Q

What is the trachea?

A
  • Continuation from the larynx at C6
  • Lies anterior to the esophagus
  • terminates at transthoracic plane
    • bifurcates into right and left main bronchi

-Is crossed over by the arches of the aorta and the azygos vein

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12
Q

What is the trachea?

A
  • Continuation from the larynx at C6
  • Lies anterior to the esophagus
  • terminates at transthoracic plane
    • bifurcates into right and left main bronchi

-Is crossed over by the arches of the aorta and the azygos vein

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13
Q

What are the 3 branches of the aortic arch?

A

Brachiocephalic trunk

  • right Subclavian
  • right common carotid

Left common carotid

Left Subclavian

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14
Q

What are brachiocephalic veins?

A

Formed by the union of the Subclavian and internal jugular veins

Located posterior to the sternoclavicular joints

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15
Q

What is the Subclavian artery divided by?

A

Divided into 3 parts by the anterior scalene muscle

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16
Q

What is the first part of the Subclavian artery?

A

Vertebral artery

Internal thoracic artery

Thyrocervical trunk

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17
Q

What is the second part of the Subclavian artery?

A

Costocervical trunk

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18
Q

What is the third part of the Subclavian artery?

A

Dorsal scapular (May arise from 1st or 2nd part of Subclavian artery

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19
Q

When does the Subclavian artery become the axilla artery?

A

Becomes the axillary artery at the lateral border of rib 1

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20
Q

What is the impact of the vagus nerve in the mediastinum?

A
  • Travels along the common carotid artery
  • Divides inti several branches as it reaches the esophagus, forming the esophageal plexus
  • Continues down in abdomen
    • Anterior vagal trunk mainly from the left vagus nerve.
    • Posterior vagal trunk mainly from the right vagus nerve

Parasympathetic and visceral afferent to the thoracic vertebra

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21
Q

What is the impact of the recurrent laryngeal nerve in the mediastinum ?

A
  • Arise from vagus nerves on either side
  • Left associated with arch of the aorta
  • Right associated with Right Subclavian artery
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22
Q

What is the impact of the phrenic nerves in the mediastinum?

A
  • enters superior mediastinum between the Subclavian artery and the root of the brachiocephalic vein
  • Courses along the pericardium, pierces through the diaphragm
  • sensory and motor innervation to the diaphragm
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23
Q

What can thoracic outlet syndrome be caused by?

A
  • extra rib attaching to the 7th cervical vertebra and rib 1
  • muscular abnormalities
  • trauma, tumor
24
Q

What does the thoracic outlet syndrome cause?

A

Leads to compression of axillary inlet components:
-Subclavian artery/vein: thrombosis/ embolization

-Nerves (C8-T1): sensory deficit, muscle wasting

25
Q

What are the symptoms of thoracic outlet syndrome?

A

May be present with intermittent or consistent symptoms

  • neurological: pain, parasthesia, paresis/paralysis
  • Vascularm pallor, pulselessness, poikilothermia (cold), edema (venous compression)
26
Q

What are the superior, inferior, anterior and posterior borders of the inferior mediastinum ?

A

Superior: transthoracic plane

Inferior: diaphragm

Anterior: body of the sternum

Posterior: T5-T12

27
Q

What are the divisions of the inferior mediastinum ?

A
  • Anterior
  • Middle
  • Posterior
28
Q

What are the anterior and posterior borders of the anterior mediastinum?

A

Anterior: sternum

Posterior: pericardium

29
Q

What are the contents of the anterior mediastinum?

A
  • thymus(or what remains)
  • lymph nodes
  • connective tissue
30
Q

What is the middle mediastinum bounded by?

A

Bounded by the fibrous layer and parietal layer of serous pericardium on all sides.
-pericardium is tightly adhered to the diaphragm inferiorly

31
Q

What are the contents of the middle mediastinum?

A

Heart

  • ascending aorta
  • intrapericardial superior vena cava
  • pulmonary trunk

Main bronchi

32
Q

What are the anterior and posterior boundaries of the posterior mediastinum?

A

Anterior: pericardium

Posterior: vertebrae T5-T12

33
Q

What are the contents of the posterior mediastinum ?

A

Sympathetic chain

Esophagus

Esophageal plexus

Azygos venous system

Descending thoracic aorta

Thoracic duct

34
Q

Where are sympathetic chains located?

A

Sympathetic chains are located laterally to the vertebral column
-contain interconnected sympathetic ganglia

Forms 3 distinct splachnic nerves
-greater, lesser and least

35
Q

What are the distinct splachnic nerves?

A

Greater

  • T5-9 with some variation
  • Joins the celiac ganglion

Lesser

  • T10-11
  • Joins aortico-renal ganglion

Least

  • T12 but not always present
  • Joins the renal plexus
36
Q

Describe the course of the esophagus

A

The continuation of the pharynx from C6 vertebral level

  • Enters the thorax through the superior thoracic aperture
  • Changes position as it travels downward
  • Passes through the diaphragm at T10 level
  • Ends where it enters the stomach at the cardiac sphincter
37
Q

What are the constrictions of the esophagus ?

A
  • Junction with the pharynx. (C6)
  • Where crossed by arch of aorta
  • Where crossed by left main bronchus (T4/5)
  • Passage through the diaphragm at the esophageal hiatus (T10)
38
Q

What is the arterial blood supply of the thoracic portion of the esophagus?

A

Thoracic aorta & bronchial arteries

39
Q

What is the innervation of the thoracic portion of the esophagus ?

A

Esophageal plexus, sympathetic trunks

40
Q

What is the arterial supply of the abdominal portion of the esophagus?

A

Left gastric artery, left inferior phrenic

41
Q

What is the innervation of the abdominal portion of the esophagus ?

A

Vagal trunks, greater splachnic nerves

42
Q

What is the veinous drainage of the thoracic portion of the esophagus?

A

Azygos, hemiazygos veins

43
Q

What is the lymphatic drainage of the thoracic portion of the esophagus ?

A

Thoracic duct, posterior mediastinal nodes

44
Q

What is the veinous drainage of the abdominal portion of the esophagus?

A

Left gastric vein

45
Q

What is the lymphatic drainage of the abdominal portion of the esophagus?

A

Left gastric nodes

46
Q

What is the azygos system?

A
  • Form a collateral drainage pathway between the IVC and SVC
  • Drain the back, thoracoabdominal wall, and mediastinal viscera
47
Q

What does the azygos system of veins consist of?

A
  • The azygos and hemiazygos are formed from roots of the IVC and/or renal veins merging with ascending lumbar and subcostal veins
  • Hemiazygos from the inferior left half of the body and accessory hemiazygos from upper left side (T5-T8) cross over to drain into azygos
  • Azygos runs along the right side of the body in the posterior mediastinum, ascends along the inferior 8 thoracic vertebrae, arches over the root of right lung at T4, to drain into to the SVC
48
Q

What are the branches of the descending aorta?

A
  • posterior intercostal arteries
  • 1 or 2 bronchial arteries
  • Pericardial and mediastinal branches
  • Esophageal branches
  • Superior phrenic artery
  • Subcostal artery
49
Q

What is the trajectory of the descending thoracic aorta?

A
  • Continuation from aortic arch (T4/5)
  • Travels along the left side of the esophagus in its entire length down the thorax
  • Pierces aortic hiatus at T12 level to becomes the abdominal aorta
50
Q

What is the diaphragm?

A

Separation between thorax and abdomen

51
Q

What are the 3 openings of the diaphragm?

A

T8= inferior vena cava (right)

T10= esophagus (left)

T12= aorta (midline)

52
Q

The what is the largest and most prominent lymphatic vessel in the body?

A

Thoracic duct

53
Q

Where does the thoracic duct start and end?

A

Starts in the abdomen as confluence (cisterna chyli)

  • Travels on the right for the most part
  • Passes through the diaphragms aortic hiatus
  • Travels between the azygos vein on the right and aorta on the left; esophagus anterior and vertebral bodies and posteriorly
  • Crosses midline at T5 to the left side of the thorax
  • Enters the root of the neck to drain into the junction of left Subclavian and left internal jugular veins
54
Q

What is the function of the thoracic duct?

A

Carries lymph from the entire body except: the right head and neck, right upper limb and right thorax (drain to right lymphatic duct)

55
Q

Where does the thoracic duct receive lymph from?

A

Receive lymph from:
-Confluence from lymph trunks from abdomen, pelvis, perineum, and lower limbs

  • Lymphatic ducts from posterior diaphragmatic and posterior mediastinal nodes
  • Descending trunks draining lower 6-7 intercostal spaces on both sides
  • Lymphatic trunks from upper left 5-6 intercostal spaces
  • Also often drains the left jugular trunk- drains left side of head & neck, left Subclavian trunk (drains left upper limb)
56
Q

What are the causes of an injury to the thoracic duct?

A
  • pathology affecting, lungs, great vessels, esophagus, spine, lymph nodes
  • penetrating trauma
  • Susceptible to inadvertent injury during medical interventions because the thoracic duct is thin walled and dull white
    • Catheterizations (e.g. internal jugular vein)
    • Surgeries (e.g. esophagostomy)
57
Q

What does injury to thoracic duct present with?

A

Presence of chyle (fluid mixture of lipids, proteins, lymphocytes) in

  • Chylothorax
  • Chylomediastinum
  • Chylopericardium

Cardiopulmonary Renal (35 decks)

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