Mediastinum Flashcards
Boundaries
Pulmonary cavity, sternum and vertebral column
Mediastinal changes
Widen with tumors, effusions
Narrow with lung masses, pleural effusionsI
Inferior mediastinum
Anterior - contains fat, vessels, remnants of thymus
Middle - contains heart, great vessels, arch of azygos, phrenic n, main bronchi
Posterior
Heart coverings
Fibrous pericardium, serous pericardium
Serous pericardium
Parietal, visceral
Separated by sinuses
Visceral pericardium
Endo - mto - endo
Transverse sinus
Between aorta/pulm trunk and SVC/IVC
Oblique sinus
Behind left atrium, allows It expand
Beck’s triad
Cardiac tamponade - due to blood accumulation in pericardium
Hypotension, jugular v. distension, muffled heart sounds
Pericarditis
Inflammation of pericardium
Friction rub
Nerve that radiates pain is phrenic
Pericardial effusion
Fluid in pericardium
Hemopericardium
Blood in pericardium
Pericardiocentesis
Remove fluid in pericardial effusion and hemopericardium, in left 5th or 6th ICS, infrasternally or laterally
Arterial supply of pericardium
Pericardiacophrenic artery
Cononary arteries (on visceral pericardium)
Venous supply of pericardium
Pericardiacophrenic veins
Azygous veins
Innervation of pericardium
Sensory - phrenic n.
Sympathetic - cardiopulmonary splanchnic n. (T1-T4)
Parasympathetic - vagus nerve
Superior mediastinum
Above sternal angle
Contains brachiocephalic veins, SVC, azygos, arch of aorta, brachiocephalic trunk, cc and subclavian, thymus, thoracic duct, trachea, esophagus, vagus and phrenic n
Thymus
Lymphoid organ
2 lobes
Involutes after puberty
Thymoma = tumor
Left brachiocephalic vein
Longer and runs diagonally over aortic arch
Unites with right at 1st costal cartilage - svc
Azygos arch
Loops superiorly around root of right lung, empties into SVC
SVCS
Obstruction of SVC, swelling in face, neck, upper body, arms, SOB
Arch of aorta
Begins and ends over sternal angle
ABCS
Arch, brachiocephalic trunk, cc, subclavian
Coarctation of aorta
Narrowing stenosis, often near ligaments arteriosum
Brachial artery pressure increased, femoral pressure decreased, femoral pulses delayed
Aortic arch aneurysm
Left recurrent laryngeal nerve stretches, hoarseness
Phrenic nerve
Anterior to root of lung
Vagus nerve
Posterior to root of lung, gives off recurrent laryngeal
Left recurrent laryngeal
Loops under arch of aorta/ligamentum arteriosum
Between esophagus and trachea
Right recurrent laryngeal
Hook under subclavian artery
Ligamentum arteriosum
Connects aorta to left pulmonary artery
Trachea
Begins at C6, cricoid cartilage
Bifurcates at sternal angle
Lies more right
Esophagus
Fibromascular tube
Posterior to trachea
Lies more to the left
Narrows at aortic arch and esophageal hiatus
Descending thoracic aorta
T4 down
Gives off esophageal, pericardial, bronchial, posterior intercostal and subcostal a
Chylothorax
Accumulation of lymph from lymph escaping vulnerable thoracic duct
Differentiate from effusion by testing triglycerides
Virchow’s node
Enlarged lymph node in supraclavicular fossa
Associated with testicular, GI, gastric cancer metastasis
Accessory hemiazygous
T5-T8
Left, crosses to right side
Hemiazygous
T9-T11
Left, crosses to right side
Azygous drainage
T1 drains into brachiocephalic vein
T2-T4 drain into left superior intercostalS vein
SVC obstruction
Collateral circulation helps
Thoracic duct
Between azygos and esophagus
Sternal angle
T4/T5
Arch of aorta
Arch of azygos vein
Superior lobe of the right lung
Superior vena cava