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HAE - Quiz 3 > Mediastinum > Flashcards

Mediastinum Flashcards

1
Q

Mediastinum

A
  • central region of the thoracic cavity
  • contains the heart and great vessels
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2
Q

Transverse Thoracic Plane

A
  • division of the mediastinum into superior/inferior portions by horizontal plane that passes through:

Anterior - Sternal Angle

Posterior - disc between T4-T5

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3
Q

Inferior Divisions of the Mediastinum

A
  • anterior, middle, posterior divisions of the pericardium
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4
Q

Borders of the Mediastinum

A

Superior - superior thoracic aperture

Inferior - diaphragm

Lateral - Pleural cavities and lungs

Anterior - sternum

Posterior - thoracic vertebrae

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5
Q

Pericardium

A
  • pericardial sac - the membrane that surrounds the heart

Layers - outer fibrous layer and inner serous layer

  • superior limit - transverse thoracic plane
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6
Q

Fibrous Pericardium

A
  • tough outer layer of the pericardium that does not stretch
  • fused to the diaphragm and continuous with the tunica adventitia of the great vessels
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7
Q

Serous Pericardium

A

Visceral Serous Layer - applied to the surface of the heart (forms outer layer of heart wall and can be called epicardium in that context)

Parietal Serous Layer - lines the internal surface of the fibrous pericardium

  • both are continuous near the origins of the great vessels (i.e. fist in a balloon)
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8
Q

Pericardial Cavity

A
  • potential space between the visceral and parietal serous pericardium
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9
Q

Great Vessels

A
  • large arteries and veins connected to the heart

Includes - SVC, IVC, Ascending Aorta, Pulmonary Trunk, Pulmonary Veins

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10
Q

Superior Vena Cava

A
  • large vein that receives venous drainage from the head, upper extremeties, and thorax
  • drains into the RA
  • convergence of the Left and Right Brachiocephalic Veins (Right Brachiocephalic Vein formed by convergence of Right Subclavian Vein and Right Internal Jugular Vein)
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11
Q

Inferior Vena Cava

A
  • large vein that receives venous drainage from the lower half of the body (abdomen, pelvis, lower extremities)
  • drains into the RA
  • enters thoracic cavity by traveling through an opening in the diaphragm at T8
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12
Q

Aorta

A
  • largest artery in the body
  • arises from LV and immediately gives off Right and Left Coronary Arteries

In thorax, has 3 parts:

Ascending Aorta (ends at transverse thoracic plane)

Aortic Arch (begins and ends the transverse thoracic plane

Descending Aorta (aka thoracic aorta - begins at the transverse thoracic plane)

In abdomen: Abdominal Aorta - descends and bifurcates at L4 into common iliac arteries

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13
Q

Pulmonary Trunk

A
  • aka Main Pulmonary Artery
  • outflow tract from RV
  • bifurcates into right and left pulmonary arteries

Right Pulmonary Artery - travels posterior to ascending aorta and SVC towards Right Lung

Left Pulmonary Artery - travels anterior to the thoracic aorta

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14
Q

Pulmonary Veins

A
  • four veins carrying oxygenated blood from the lungs to the LA
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15
Q

Thymus

A
  • lymphoid organ involved in dev’t of immune system (T-cells)
  • primarily active during childhood, undergoes involution during puberty and mostly replaced by fat

Location - posterior to the sternum, anterior to the great vessels and pericardium

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16
Q

Brachiocephalic Trunk

A
  • the first branch of the aortic arch
  • gives rise to the Right Sublcavian Artery and the Right Common Carotid Artery
  • supplies upper right quadrant of the body
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17
Q

Left Common Carotid Artery

A
  • second branch of the aortic arch
  • supplies head and neck region
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18
Q

Left Subclavian Artery

A

- third branch of the aortic arch

  • supplies the left upper quadrant of the body
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19
Q

Aortic Arch

A
  • peak of the aorta bw ascending and descending aorta (above the transverse thoracic plane)

Three branches:

  1. Brachiocephalic Trunk
  2. Left Common Carotid Artery
  3. Left Subclavian Artery
    * Remember you “ABCs” (Aorta, Brachicephalic, Carotid, Subclavian)*
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20
Q

Epicardium

A
  • visceral serous layer of the pericardium that forms the outer layer of the heart
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21
Q

Ascending Aorta

A
  • gives rise to the coronary arteries
  • lies below the transverse thoracic plane
22
Q

Descending Aorta

A
  • aka Thoracic Aorta
  • begins at the transverse thoracic plane
  • descends anterolateral to the left of the vertebral column
  • passes posterior to the diaphragm and becomes abdominal aorta from T12-L4 until it bifurcates
23
Q

Ligamentum Arteriosum

A
  • remnant of the ductus arteriosis (channel bw the pulmonary trunk and aortic arch that allowed blood to bipass lungs in fetus)
  • fibrous after closure of ductus arteriosis at birth
  • location between aortic arch and pulmonary vessels called “Autopulmonary window” by radiologists
24
Q

Trachea

A
  • posterior to the great vessels in the midline
  • bifurcates into right and left main bronchi at T4 vertebral level
25
Q

Tracheobronchial Lymph Nodes

A
  • lymph nodes surrounding the trachea at the tracheal bifurcation
  • receive lymphatic drainage from lungs and other thoracic viscera
26
Q

Paratracheal Lymph Nodes

A
  • lymph nodes surrounding the lateral aspect of the trachea above the bifurcation
  • receive lymphatic drainage from lungs and other thoracic viscera
27
Q

Esophagus

A
  • located posterior to the trachea
  • continuous with the pharynx superiorly and the stomach inferiorly
  • exits thorax/enters the abdoment through the diaphragm at T10 vertebral level through the Esophageal Hiatus
28
Q

Azygous Venous System

A
  • receives drainage from the thoracic wall (i.e. posterior intercostal veins) and viscera (i.e. esophageal and mediastinal veins)

Travels - anterolateral to the right of the vertebral column

  • hemiazygos and accessory hemiazygos travel anterolateral to the left of the vertebral column - drain into azygous via branches across the midline)
29
Q

Azygous Drainage

A

Superiorly - SVC

Inferiorly - IVC in the abdomen

**Azygous serves as a collateral channel if the IVC becomes blocked

30
Q

Thoracic Duct

A
  • largest lymphatic vessel in the body
  • begins in upper abdomen as a dilation called Cisterna Chyli
  • in mediastinum travels on the anterior aspect of the vertebral column (to the right of descending aorta and left of azygous vein)
  • passes through the posterior diaphram into the mediastinum alongside the aorta

Termination: merges with venous system at junction of Left Internal Jugular Vein and Left Subclavian Vein

31
Q

Cisterna Chyli

A
  • dilation/beginning of the thoracic duct in the abdomen
32
Q

Thoracic Duct Sources

A
  • entire lower half of the body and upper left quadrant of the body
  • returns fluid to the venous system

(RUQ drains into Right Lymphatic Duct)

33
Q

Relationship between azygous, thoracic duct, and descending aorta

A

From right to left

Azygous Vein → Thoracic Duct → Descending/Thoracic Aorta

34
Q

Sympathetic Trunks

(Sympathetic Chain)

A
  • extend from the base of the skull to the coccyx
  • travel lateral to the vertebral column
  • various branches leave the sympathetic chain ganglia throughout the thorax
35
Q

White and Gray Rami Communicantes

A
  • connect the sympathetic trunks to the spinal nerves
  • emerge from the posterolateral parts of the ganglia
36
Q

Cardiac Nerves

A
  • emerge from the anteromedial parts of the cervical and upper thoracic sympathetic ganglia
  • contain post-ganglionic sympathetic neurons that innervate the viscera of the thorax by traveling through visceral plexuses
37
Q

Visceral Plexuses

A
  • contains visceral nerves in the thorax (i.e. cardiac nerves) that travel through the plexus to get to their targets

Three major subdivisions:

Cardiac Plexus - superficial and deep aspects of the aortic arch

Pulmonary Plexus - surrounds the trachial bifurcation and primary bronchi

Esophageal Plexus - surrounds the esophagus

38
Q

Thoracic Splenchnic Nerves

A
  • emerge from the anteromedial parts of the T5-T12 sympathetic ganglia
  • contain pre-ganglionic sympathetic neurons that innervate viscera in the abdominal and pelvic cavities

**just pass through thorax**

Three Nerves:

Greater Splanchnic (T5-T9)

Lesser Splanchnic (T10-T11)

Least Splanchnic (T12)

39
Q

Structures Passing Through Diaphragm

A

Inferior Vena Cava (T8)

Esophagus (T10)

Aorta (T12)

- sympathetic chains pass through with aorta

“I 8 10 E A 12” - I ate 10 eggs at 12

40
Q

Phrenic Nerves

(Origination)

A
  • arise from C3-C5 ventral rami
41
Q

Phrenic Nerves

(Travel)

A
  • enter mediastinum through superior thoracic aperture
  • anterior to the roots of the lungs and descend to the diaphragm along the lateral aspect of the pericardium
42
Q

Phrenic Nerves

(Actions)

A
  • provide somatic motor fibers to the diaphragm
  • convey somatic sensations from the central part of the diaphragm, fibrous and parietal serous pericardium, mediastinal pleura, and the central part of the diaphragmatic pleura
43
Q

Pericardiacophrenic Vessels

A

Travel - with phrenic nerve

Provide - blood to the pericardium and diaphragm

44
Q

Vagus Nerves

(Origination)

A
  • arise from the brainstem

Travel - in neck near the coratid arteries and posterior to the root of the lung

Enter - thorax via the superior thoracic aperture

  • branch into cardiac plexus, pulmonary plexus, and esophageal plexus
45
Q

Vagus Nerves

(Right, Left Travel)

A

Left Vagus Nerve

  • in contact with aortic arch
  • enters esophageal plexus on the anterior aspect of esophagus

Right Vagus Nerve

  • travels along the trachea
  • enters esophageal plexus on the posterior aspect of the esophagus

Both - travel posterior to the root of the lung

  • regroup as Anterior and Posterior Vagal Trunks after plexuses before traveling through diaphragm with esophagus
46
Q

Vagus Nerves

(Actions)

A

Parasympathetic - decrease HR, constrict bronchial tree, stimulate peristalsis and secretion of mucous from esophagus

Visceral Afferent - convey sensations of stretch from the lungs, pain from the heart, and participate in visceral reflexes

47
Q

Phrenic vs. Vagus Nerve Travel

A

Phrenic Nerve - travels anterior to the root of the lung

Vagus Nerve - travels posterior to the root of the lung

48
Q

Left Recurrent Laryngeal Nerve

(Origination)

A
  • branch of the Vagus Nerve
  • arises near the aortic arch
49
Q

Left Reccurent Laryngeal Nerve

(Travel)

A
  • through the aortopulmonary window posterior to the ligamentum arteriosum
  • ascends back into the neck along the lateral aspect of the trachea
50
Q

Right Recurrent Laryngeal Nerve

A
  • travels around the right subclavian artery in the neck (i.e. not in the mediastinum)
51
Q

Left Recurrent Laryngeal Nerve (Action)

A
  • innervates portions of the larynx - somatic efferent fibers to muscles
  • compression (i.e. by aortic aneurysm or mass) can produce hoarseness in the voice
52
Q

Major Branches of Descending Aorta

A

Major Branches:

Bronchial Arteries - supply lungs

Esophageal Arteries - supply esophagus

Posterior Intercostal Arteries - supply chest wall

HAE - Quiz 3 (2 decks)

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