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CV exam 1 AP > Organization of the thorax: Thoracic cavities and mediastinum > Flashcards

Organization of the thorax: Thoracic cavities and mediastinum Flashcards

1
Q

what are the three compartments of the thoracic cavity

A

2 lateral pulmonary cavities

central mediastinum

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2
Q 
what are the borders of the mediastinum
5 boundaries (S, L, I, A, P)
A
  1. Superior: superior thoracic aperture
  2. Lateral: mediastinal parietal pleura
  3. Inferior: diaphragm
  4. Anterior: sternum and costal cartilages
  5. Posterior: bodies of thoracic vertebrae
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3
Q

what are the divisions of the mediastinum

A

superior

inferior

  • anterior
  • middle–> heart and pericardial cavity
  • posterior
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4
Q

what are the boundaries of the superior mediastinum

A
  1. Superior: superior thoracic aperture
  2. Inferior: transverse plane passing from sternal angle to the disk between TV4-TV5, (transverse thoracic plane).
  3. Anterior: manubrium
  4. Posterior: anterior surface of vertebral bodies of TV1-TV4
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5
Q

what is the transverse thoracic plane and what structures are right on it (3)

A

transverse plane passing from sternal angle to the disk between TV4 and TV5

structures:
concavity of arch of aorta
ligamentum arteriosum
left pulmonary artery

vagus splits up and becomes a plexus around esophagus
trachea bifurcates (carina) 
azygous vein dumping into superior vena cava
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6
Q

what is the clavicle a landmark for?

A

internal jugular joins the subclavian to form the brachiocephalic L and R

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7
Q

1st rib is a landmark for what?

A

two brachiocephalics come together

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8
Q

3rd rib is a landmark for what

A

where the superior vena cava drains into the right atrium

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9
Q

What are the major structures in the superior mediastinum (8)

A 
thymus
brachiocephalic veins
superior vena cava
aortic arch and main branches
trachea
esophagus
thoracic duct
sympathetic trunk
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10
Q 
where is the thymus located?
in infants what is the significance?  adults?
what is its vascular supply?
lympathic drainage?
innervation?
A

a. Located directly posterior to manubrium.
b. Primary lymphatic organ in infants, in adults mostly replaced with fatty tissue.
c. Vascular supply – internal thoracic and inferior thyroid vessels.
d. Lymphatic drainage – parasternal and tracheobronchial nodes.
e. Innervation is mainly from the vagus nerve and sympathetic trunk (vasomotor).

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11
Q

where are the brachiocephalic veins formed and from what veins?
which side is longer and where does this particular vein travel

A

a. Formed posterior to sternoclavicular joint from union of subclavian and internal jugular veins (called venous angle or jugulovenous angle).
b. Left brachiocephalic v. is longer than right and travels transversely across superior mediastinum; right brachiocephalic v. descends just right of manubrium.

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12
Q

what is the superior vena cava formed from?

where does it descend

A

a. Formed from the union of the left and right brachiocephalic veins.
b. Descends to the right of the sternum from the level of the first costal cartilage to the third costal cartilage (third rib) (where it then enters the right atrium).

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13
Q

where does the aorta begin?
where does it course?
when does it become the descending thoracic aortic?

A

a. Begins at TV4/TV5 intervertebral space as a continuation of ascending aorta.
b. Arches posteriorly and to the left over the root of the left lung.
c. Ends posteriorly and to the left of midline at the TV4/TV5 intervertebral disc, becoming the descending (thoracic) aorta.

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14
Q

what are the 3 main branches of the aorta?

A

brachiocephalic trunk (right)–> becomes right common carotid and right subclavian

left common carotid artery
left subclavian artery

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15
Q

where is the ligamentum arteriosum

what is the significance of the ligamentum arteriosum

A

passes from the origin of the left pulmonary artery to the arch of the aorta

represents remnant of the fetal ductus arteriosus which shunted blood from the pulmonary trunk to aorta in order to bypass the fetal lungs.

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16
Q

what is the origin of the phrenic nerve?
what does the phrenic nerve supply motor innervation to?
what does the phrenic nerve supply sensory innervation to?

A

a. Derived from spinal segments C3, C4, C5 (keeps the diaphragmn alive)
b. Motor innervation to the thoracic diaphragm.
c. Sensory innervation to the diaphragm, mediastinal pleura, and pericardium.

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17
Q

where does the phrenic nerve enter the thorax?

where does it sit in relation to the root of the lung

A

d. Enters thorax from neck by passing anterior to the subclavian artery.
e. Pass anterior to the root of the lungs

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18
Q

what is origin of the vagus nerve

where does it enter the superior mediastinum? and where does it sit in relation to the root of the lung?

A

cranial nerve 10

a. Enter the superior mediastinum along lateral border of common carotid arteries.
b. Pass posterior to the root of the lung.

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19
Q

what type of nerve cell processes does the vagus nerve carry?

what branch does the left vagus nerve give off and where does this branch course?

A

c. Carry preganglionic parasympathetic nerve cell processes to thoracic autonomic plexuses.

gives off a left recurrent laryngeal nerve which loops underneath the arch of the aorta just lateral to the ligamentum arteriosum, then courses superiorly in the tracheo-esophageal groove to supply laryngeal muscles.

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20
Q

as the left and right vagus nerves approach the esophagus in the posterior mediastinum what do they become

A

left–> anterior vagal trunk

right–> posterior vagal trunk

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21
Q

what is the cause of hoarseness?

A

due to loss of innervation to laryngeal muscles).

Due to its position in the superior mediastinum, aortic aneurysm, bronchogenic or esophageal cancer, and/or enlargement of mediastinal lymph nodes can impinge on the recurrent laryngeal nerve

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22
Q

what are the structures of the anterior mediastinum

A

thymus, sternopericardial ligaments, fat, lymphatics, connective tissue

bunch of shit

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23
Q

what are the borders of the anterior mediastinum

A

a. Superior: transverse thoracic plane
b. Inferior: diaphragm
c. Lateral: mediastinal parietal pleura
d. Anterior: sternum
e. Posterior: anterior surface of pericardium

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24
Q

what are the 5 boundaries of the posterior mediastinum

A

a. Superior: transverse thoracic plane
b. Inferior: diaphragm
c. Lateral: mediastinal parietal pleura
d. Anterior: sternum
e. Posterior: anterior surface of pericardium

25
Q

what are the major contents of the posterior mediastinum (6)

A

1) Thoracic (descending) aorta
2) Esophagus
3) Azygous venous system
4) Vagus nerves
5) Thoracic duct and lymph nodes
6) Sympathetic trunk (sympathetic chain ganglia)
and splanchnic nerves

26
Q

where does the esophagus originate

where does it travel in the superior mediastinum and in the posterior mediastinum?

A

at the CV6 level as a continuation of the pharynx

b. Travels through superior mediastinum posterior and slightly left of trachea.
c. Travels right along midline through the posterior mediastinum.

27
Q

where does the esophagus exit the thorax? what is the landmark

A

exits through the esophageal hiatus of the diaphragm at TV10

28
Q

what are the landmarks of the Cervical, Thoracic and Diaphragmatic Constrictions

A

cervical- CV6 pharyngoesophageal

thoracic- TV4-5 broncho-aortic

diaphgragmatic - TV10

29
Q

what is the vascular supply of the esophagus

A

esophageal and bronchial arteries and veins.

30
Q

what is the lymphatic drainage of the esophagus

A

posterior mediastinal lymph nodes

31
Q

what is the sympathetic innervation of the esophagus

A

i. Preganglionic nerve cell bodies at T2-T6 and processes enter sympathetic chain.
ii. Postganglionic nerve cell bodies in sympathetic chain ganglia.

32
Q

why does esophageal pain sometimes present similarly to MI pain

A

Many of the postganglionic nerve cell processes travel with the cardiopulmonary splanchnic nerves ; thus esophageal pain and pain from myocardial infact can present very similarly.

33
Q

what is the parasympathetic innervation of the esophagus

A

a. Preganglionic nerve cell bodies in brainstem, processes travel with vagus nerve.
b. Vagus nerve provides numerous esophageal branches.
c. Postganglionic cell bodies in the wall*** of esophagus.

34
Q

what are the functions of the parasympathetic innervation to the esophagus

A

vasodilation
increased gland secretion
increased peristalsis

35
Q

what are the functions of the sympathetic innervation to the esophagus

A

vasoconstriction

decreased gland secretion

36
Q

where does the descending aorta travel in the posterior mediastinum?

where does it exit?

A

left of the midline

exits thorax at TV12 through aortic hiatus of thoracic diaphragm

37
Q

what are the branches of the descending aorta ?

A

Posterior intercostal (9 pair) and subcostal arteries

Bronchial artery (usually 2 on left and 1 on right)

  1. Esophageal artery (3-5 unpaired branches)
  2. Pericardial and mediastinal arteries (unpaired)
  3. Superior phrenic arteries (1 pair)
38
Q

what is the landmark for when the azygos arches anteriorly over the root of the right lung to enter the SVC?

A

TV4

39
Q

what is the landmark for when the hemiazygos (more left in the posterior mediastinum) crosses the midline and joins the azygos vein

A

TV9

40
Q

where is the landmark for when the accessory hemiazygos crosses the midline and joins the azygos vein

A

TV8

41
Q

where does the thoracic duct begin?

where does it travel and enter the thorax

A

at LV2 from the dilated sac called the cisterna chyli

enters the thorax with the aorta and ascends along the midline posterior to the esophagus

42
Q

at what point does the thoracic duct cross to the left of midline and travel in the superior mediastinum to the left of the esophagus

A

TV5

43
Q

what is the path of the thoracic duct in the neck

A

passes posterior to the left common carotid and internal jugular vein to enter the VENOUS ANGLE

the venous angle is the junction of the left subclavian and the left jugular veins

44
Q

from what structures does the thoracic duct receive drainage before emptying into the venous angle ?

A

left bronchomediastinal
left jugular
left subclavian trunk

45
Q

what does the right lympathic duct drain?

A

right side of head, right neck

right arm

46
Q

ultimately, what does the thoracic duct receive ?

A

both lower extremities
the entire pelvis
abdomen
left upper extremity

3/4 of body!!

47
Q

what does an autonomic pelxus contain

A

both sympathetic and parasympathetic components

48
Q

where are thoracic splanchnic nerves headed

A

going to prevertebral ganglia in the abdomen

49
Q

what are thoracic splanchnic nerves composed of?

A

PREGANGLIONIC sympathetic nerve cell process

50
Q

greater splanchnic

A

T5-T9

51
Q

lesser splanchnic

A

T10-T11

52
Q

least splanchnic

A

T12

53
Q

where does the inferior vena cava enter the heart? what landmark?

A

6th costal cartilage

54
Q

where does the right brachiocephalic vein end up in the neck?

A

ends at level of 1st costal cartilage

55
Q

in the thorax what does the vagus nerve give branches of? x4

A

recurrent laryngeal
cardiac
pulmonary
esophageal

56
Q

what does the azygos drain and communicate with

A

drains both thoracic and abdominal walls and communicates with the vertebral plexus of veins

57
Q

what might an aortic aneurysm cause?

A

dysphagia (difficulty swallowing)

hoarseness

58
Q

what is a hiatal hernia and what is it usually accompanied by?

A

protrusion of the abdominal viscera or the omentum through the esophageal hiatus into the thoracic cavity

usually has gastritis and epigastric pain too

59
Q

The thoracic vertebral level of structures traversing the diaphragm is …. (esophagus, aorta, inferior vena cava)

A

T8 for the inferior vena cava, T10 for the esophagus, and T12 for the aorta. The anteroposterior position is inferior vena cava, esophagus, and aorta.

CV exam 1 AP (12 decks)

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