Mediastinum in relation to endovascular interventions

Question 1

What is meant by dysphagia?

Answer 1

Difficulty swallowing

Question 2

What is found in the anterior mediastinum?

Answer 2

In an adult, this section is mostly filled with adipose tissue
In a child, this contains the thymus, which is responsible for maturation of T-lymphocytes
This slowly becomes replaced by adipose tissue after puberty

Question 3

What structures are found in the middle mediastinum?

Answer 3

Pericardium
Heart
Parts of the great vessels

Question 4

What are some characteristics of azygous veins?

Answer 4

They are highly fragile and prone to rupture in chest trauma
It arches anteriorly and superiorly to the lung hilum to drain into the SVC
It drains blood from each of the intercostal veins which are found in each intercostal space

Question 5

Where does the aorta pass through the diaphragm?

Answer 5

Through the aortic hiatus

Question 6

What are the branches of the ascending aorta?

Answer 6

The left and right coronary arteries

Question 7

What are the 3 branches of the arch of the aorta?

Answer 7

Brachiocephalic trunk
Left common carotid artery
Left subclavian artery

Question 8

What are the 2 branches of the brachiocephalic trunk?

Answer 8

Right common carotid artery
Right subclavian artery

Question 9

What are the branches of the thoracic aorta?

Answer 9

• 11 pairs of bilateral posterior intercostal arteries
• Anterior:
• Bronchial arteries
• Oesophageal arteries
• Mediastinal arteries
• Pericardial arteries
• Phrenic arteries

Question 10

Where does lymph from the grey areas travel?

Answer 10

Into the thoracic duct and then into the left venous angle

Question 11

Where does lymph from the pink areas travel?

Answer 11

Into the right lymphatic duct and then into the right venous angle

Question 12

What forms the left venous angle?

Answer 12

The left internal jugular vein and the left subclavian vein

Question 13

What forms the right venous angle?

Answer 13

The right internal jugular vein and the right subclavian vein

Question 14

Which lymph nodes are found around the main bronchus of the lung?

Answer 14

Bronchopulmonary (Hillar) lymph nodes

Question 15

Where does lymph from the bronchopulmonary lymph nodes drain into before the thoracic duct or right lymphatic duct?

Answer 15

Tracheobronchial lymph nodes

Question 16

What name is given to the swollen start of the thoracic duct?

Answer 16

Cisterna chyli

Question 17

Where does the thoracic duct start?

Answer 17

At the cisterna chyli in the abdomen

Question 18

Describe the path of the thoracic duct

Answer 18

It starts in the abdomen and passes through the aortic hiatus
It then travels between the oesophagus and azygous vein and then into the left venous angle

Question 19

Describe the path of the right vagus nerve

Answer 19

The right vagus nerve travels along the medial surface of the trachea, then posterior to the Hilum, before forming a plexus with the left surface of the oesophagus

Question 20

Describe the path pf the left vagus nerve

Answer 20

The left vagus nerve travels over the surface of the arch of the aorta, then posterior to the hilum, before forming a plexus with the right on the surface of the oesophagus

Question 21

What are the structures of the superior mediastinum from anterior to posterior?

Answer 21

Brachiocephalic veins
Superior vena cava
Arch of aorta
Trachea
Oesophagus
Thoracic duct

Question 22

What are the nerves of the superior mediastinum from lateral to medial?

Answer 22

Phrenic
Vagus
Recurrent laryngeal nerves (of vagus)

Question 23

What forms the right brachiocephalic vein?

Answer 23

Right subclavian vein and right internal jugular vein

Question 24

What forms the left brachiocephalic vein?

Answer 24

Left subclavian vein and left internal jugular vein

Question 25

What forms the superior vena cava?

Answer 25

Left and right brachiocephalic veins

Question 26

Which veins are the central veins?

Answer 26

Internal jugular veins
Subclavian veins
Brachiocephalic veins
Superior vena cava
Right atrium
Inferior vena cava
Iliac veins
Femoral veins

Question 27

What is clinically important about the central veins?

Answer 27

They are the sites for central venous cannulation

Question 28

What forms the phrenic nerves?

Answer 28

The C3, 4 and 5 spinal nerves

Question 29

Where does the right recurrent laryngeal nerve hook?

Answer 29

It hooks under the right subclavian artery, much higher than the left recurrent laryngeal nerve

Question 30

Where does the left recurrent laryngeal nerve hook?

Answer 30

It hooks under the ligament arteriosum

Question 31

Where do the phrenic nerves provide somatic motor innervation to?

Answer 31

The diaphragm

Question 32

Where do the phrenic nerves provide somatic sensory innervation to?

Answer 32

Mediastinal parietal pleura
Fibrous pericardium
Diaphragmatic parietal pleura
Diaphragmatic parietal pericardium

Question 33

What types of innervation are carried by the vagus nerve (Before splitting)?

Answer 33

Somatic sensory nerves
Somatic motor nerves
Autonomic parasympathetic nerves

Question 34

Where do the phrenic nerves provide somatic sensory innervation to?

Answer 34

The palate
The laryngopharynx
The larynx

Question 35

Where do the phrenic nerves provide somatic motor innervation to?

Answer 35

The pharynx
The larynx

Question 36

Where do the phrenic nerves provide autonomic parasympathetic nerves to?

Answer 36

The thoracic and abdominal organs

Question 37

Which innervations are contained in the vagus nerve after splitting into the recurrent laryngeal nerves?

Answer 37

Autonomic parasympathetic only