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Year 1 HLB > Mediastinum: Superior, Anterior and Posterior > Flashcards

Mediastinum: Superior, Anterior and Posterior Flashcards

1
Q

What is the mediastinum?

A
  • central compartment of the thoracic cavity
  • surrounded by loose connective tissue
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2
Q

What is the superior limit of the superior thoracic aperture, also called the thoracic inlet?

A
  • manubrium
  • 1st rib
  • clavicle
  • T1-T4 vertebrae
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3
Q

What is the name given to the plane that lines the inferior border of the superior mediastinum, separating it from the inferior mediastinum?

A
  • transverse thoracic plane
  • also known as plane of ludwig
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4
Q

What is the anatomic position of the transverse thoracic plane?

A
  • sternal angle / angle of Louis
  • T4-T5 vertebrae
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5
Q

What is the importance of the transverse thoracic plane/plane of ludwig?

A
  • important structures are formed or divide here
  • arch of aorta
  • bifurcation of trachea at carina
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6
Q

What are the 2 principle nerves that pass through the superior mediastinum?

A
  • vagus nerve
  • phrenic nerve
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7
Q

Which vertebrae does the phrenic nerves originate from?

A
  • C3, 4 and 5
  • keeps us alive
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8
Q

What are the great vessels that pass through the superior mediastinum?

A
  • arteries = arch of aorta and branches
  • veins = brachiocephalic veins and superior vena cava
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9
Q

What are the visceral structures that pass through the superior mediastinum?

A
  • thymus gland (part)
  • trachea
  • oesophagus
  • thoracic duct
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10
Q

The brachiocephalic veins pass anteriorly to the aortic arch, which in turn is in front of what visceral structure?

A
  • trachea
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11
Q

What is the first vein that the superior vena cave bifurcates into in the superior mediastinum?

A
  • the left and right brachiocephalic veins
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12
Q

Is the left or right brachiocephalic vein longer?

A
  • left
  • crosses over superior aspect of aortic arch
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13
Q

What do the left and right brachiocephalic veins bifurcate into?

A
  • internal jugular veins (left and right)
  • subclavian veins (left and right)
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14
Q

Why would a catheter that needs to enter the heart be better places in the right jugular vein and the left jugular vein?

A
  • more direct route
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15
Q

What does ABCs stand for when looking at the arteries of the superior mediastinum?

A
  • A = aorta
  • B = brachiocephalic
  • C = common carotid arteries
  • S = subclavian arteries
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16
Q

Is there a left and right brachiocephalic artery?

A
  • no just the right
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17
Q

What does the brachiocephalic artery bifurcate into?

A
  • right common carotid artery
  • right subclavian artery
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18
Q

Where do the left subclavian and common carotid arteries bifurcate directly from?

A
  • aortic arch
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19
Q

A fracture to the 1st rib is uncommon, but if it occurs it has a mortality of 30%, why is this so high?

A
  • subclavian artery and vein runs between 1st rib and clavicle
  • damage to rib likely damages blood vessels
  • ⬆️ risk of haemorrhage
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20
Q

In addition to damaging the subclavian artery ands vein, a fracture of the 1st rib can cause damage to a nerve, which nerve is this?

A
  • brachial plexus
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21
Q

What is the ligamentous arteriosum?

A
  • fibrous connective tissue
  • connects aortic arch and pulmonary artery
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22
Q

What did the ligamentous arteriosum originate from?

A
  • ductus arteriosus
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23
Q

What is the ductus arteriosus?

A
  • known as a shunt
  • blood vessel connecting aortic arch and pulmonary artery
  • important prenatally as lungs dont function
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24
Q

What is the foramen ( in the heart called fossa ovalis), and where is it in the heart?

A
  • opening
  • in heart known as a shunt
  • hole connecting left and right atria in babies
  • blood misses the lungs which are not formed yet
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25
Q

When do the foreman and ductus arteriosus close?

A
  • at birth
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26
Q

Do the the phrenic nerves supplying the diaphragm and pericardium provide sensory infromation (pain, stretch etc..)?

A
  • yes
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27
Q

Where do the phrenic nerves enter the superior mediastinum?

A
  • between brachiocephalic veins and subclavian arteries
  • anterior to the trachea
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28
Q

Where do the vagus nerves originate from?

A
  • 10th cranial nerve in brainstem
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29
Q

Where do the vagus nerves enter the superior mediastinum?

A
  • medially compared to phrenic nerves
  • runs close to trachea on the right - on left aorta keeps away from trachea
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30
Q

Where is the thymus gland located?

A
  • posterior to sternum
  • crosses superior and anterior mediastinum
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31
Q

What does parasternal mean?

A
  • vertical line on front of thorax
  • either side of the sternum
32
Q

Which lymph nodes drain into the thymus gland before it becomes fibrotic?

A
  • parasternal, brachiocephalic and tracheobronchial
33
Q

What supplies the blood to the thymus gland?

A
  • internal thoracic arteries
34
Q

When does the thymus gland atrophy and become fibrotic?

A
  • after puberty
35
Q

What is the neuromuscular disease that has been linked with a benign growth of the thymus gland?

A
  • myasthenia gravis
36
Q

From the vertebrae, is the oesophagus or trachea closer to the anterior aspect of the body?

A
  • trachea - oesophagus lies on the vertebrae
37
Q

What is the oesophagus generally composed of?

A
  • muscular tube
38
Q

The oesophagus generally runs medially, however it is pushed to the left because of what?

A
  • aorta
39
Q

What is the thoracic duct?

A
  • largest lymphatic channel - transports lymph to venous system
40
Q

Where does the thoracic duct drain into the venous system?

A
  • aprox T4 vertebrae
  • into internal jugular and subclavian veins
41
Q

What are the borders of the posterior mediastinum?

A
  • anterior = pericardium
  • posterior = T2-T12
  • lateral = mediastinal pleura (lungs)
  • superior = transverse thoracic plane
  • inferior = diaphragm
42
Q

What are the 2 main vessels of the posterior mediastinum?

A

1 - thoracic aorta 2 - azygos system of veins

43
Q

What are the 3 main nerves running through the posterior mediastinum?

A

1 - vagus nerve 2 - sympathetic trunk 3 - splanchnic nerves

44
Q

What are the 2 main visceral structures running through the posterior mediastinum?

A

1 - oesophagus 2 - thoracic duct

45
Q

Where does the thoracic aorta lie in the posterior mediastinum?

A
  • left side of T5-T12 vertebrae - oesophagus, thoracic duct and azygos veins lies to the right
46
Q

What are the 2 anatomical landmarks to identify where the thoracic aorta ends in posterior mediastinum?

A
  • vertebrae T12
  • hiatus (hole) of diaphragm
47
Q

There are 9 pairs of posterior intercostals vessels, where do they run in the intercostals?

A
  • along groove on inferior aspect of ribs
48
Q

The most superior pair of intercostal vessels are not supplied by the thoracic aorta, where do they come from?

A
  • subclavian arteries
49
Q

In addition to the 9 pairs of posterior intercostals vessels supply, what other arteries run off the thoracic aorta?

A
  • subcostal arteries
  • pericardium
  • pairs of bronchial arteries
  • oesophageal
  • superior phrenic
50
Q

If a patient need a pleural drain or sample, is it better to go above or below the ribs?

A
  • above to avoid blood vessels
51
Q

What are the 2 main components of the venous blood flow in the posterior mediastinum?

A

1 - azygos veins

2 - hemiazygos veins

52
Q

Where does the azygos vein drain into?

A
  • superior vena cava
53
Q

Where does the azygos vein lie?

A
  • right side of thoracic vertebrae
54
Q

What drains into the azygos vein?

A
  • posterior intercostals
  • bronchial veins
  • vertebral venous plexus
55
Q

What 2 components make up the hemiazygos located on the left side of the thoracic vertebrae?

A

1 - main hemiazygos (T9-T11)

2 - accessory hemiazygos (T5-T8)

56
Q

The main hemiazygos is from T9-T11, where does it then drain into?

A
  • azygos vein
57
Q

The accessory hemiazygos drains from superior intercostals. What 2 places is it able to drain into?

A

1 - directly into azygos vein

2 - main hemiazygos and then into azygos vein

58
Q

What is the structural importance of having the azygos on the right hand size of the vertebrae?

A
  • if inferior vena cava is damaged azygos can compensate
  • colateral blood vessels form
  • ⬆️ diameter of azygos
59
Q

Does the vagus nerve supply parasympathetic or sympathetic stimulus?

A
  • parasympathetic
60
Q

Where do the right and left vagus nerves originate from in the brain?

A
  • medulla
61
Q

Where do the right and left vagus nerves enter the mediastinum?

A
  • posterior to sternoclavicular joint
  • through superior mediastinum
62
Q

Where do the vagus nerves try to stay close to?

A
  • midline of the body
63
Q

Although the right vagus nerves stays relatively central, the left vagus nerve is pushed to the left by what?

A
  • aorta
64
Q

Where does the right recurrent laryngeal nerve run?

A
  • under right subclavian artery
  • between trachea and oesophagus
65
Q

Where does the right recurrent laryngeal nerve supply?

A
  • larynx
66
Q

Where does the left recurrent laryngeal nerve run?

A
  • hooks inferiorly to aortic arch
  • immediately lateral to ligamentum arteriosum
67
Q

Where does the left recurrent laryngeal nerve descend after the aortic arch?

A
  • in groove between oesophagus and trachea
68
Q

When having surgery to the posterior mediastinum what could cause damage to the vocal cords?

A
  • damage to the left recurrent laryngeal nerve
  • can cause paralysis of larynx, impairing ability to cough
69
Q

In addition to surgery what else may impinge on the left recurrent laryngeal nerve causing a horse voice?

A
  • inflamed lymph nodes of the large bronchi
  • they would press on the nerve
70
Q

What is the sympathetic trunk?

A
  • paired bundles of fibres either side of the vertebrae
  • form ganglia
71
Q

The upper 5 functional elements of the sympathetic trunk in the posterior mediastinum pass to which 3 plexus?

A

1 - pulmonary

2 - cardiac

3 - oesophageal

72
Q

The upper 5 functional elements of the sympathetic trunk in the posterior mediastinum form what?

A
  • pre ganglionic fibres that then synapse
73
Q

The lower 5 functional elements of the sympathetic trunk in the posterior mediastinum do not synapse, but instead form pre ganglionic fibres where?

A
  • abdomen
74
Q

Where does the thoracic duct originate from?

A
  • cisterna chyli (L2)
75
Q

What is the cisterna chyli?

A
  • a dilated sac
  • drains all lymphatics of small intestines
76
Q

Where does the thoracic ducts ascend?

A
  • through aortic hiatus (hole in diaphragm)
  • anterior to thoracic vertebrae

Year 1 HLB (25 decks)

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