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103 Theme 1 - Anatomy > Posterior Mediastinum > Flashcards

Posterior Mediastinum Flashcards

1
Q

What are the boundaries of the posterior mediastinum?

Anterior

Posterior

Lateral

Superior

Inferior

A

Anterior – posterior pericardium

Posterior – vertebrae T5-12

Lateral – mediastinal pleura

Superior – transverse thoracic plane

Inferior – diaphragm

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2
Q

What 7 structures make up the posterior mediastinum?

A
  • Oesophagus
  • Thoracic aorta
  • Azygos system of veins
  • Thoracic duct
  • Vagus nerve
  • Sympathetic trunk
  • Splanchnic nerves
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3
Q

What is the sympathetic and parasympathetic supply to the posterior mediastinum?

A

Sympathetic - thoracolumbar outflow: T1 to L2

Parasympathetic - craniosacral outflow: some cranial nerves (including Vagus nerve) and S2, S3, S4

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4
Q
A
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5
Q

What is the sympathetic chain and where is it located?

A
  • Vertical chain of sympathetic nerves running the entire length of the vertebral column
  • Located on both sides of vertebral bodies
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6
Q

Where are paravertebral ganglia located?

A

Along the sympathetic chain

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7
Q

How many ganglia are there in the sympathetic chain?

A

In the thoracic spine usually one ganglion per spinal level

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8
Q

Complete the diagram of nerves

A
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9
Q

Complete the diagram of the sympathetic chain

A
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10
Q

Which spinal levels of the sympathetic chain does thoracic sympathetic supply come from?

A

T1-T4/5

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11
Q

Describe what is happening in the diagram at -

The pink line

The blue line

The yellow line

A

Pink line - preganglionic sympathetic fibres leave the spinal nerve (white rami communicantes) and synapse at a paravertebral ganglion

Blue line - postganglionic sympathetic fibers leave the ganglion (grey rami communicantes) and pass to the pulmonary, cardiac & oesophageal plexi

Yellow line - these nerves also carry afferent fibers (carrying sensory information) from the thoracic viscera they supply back to the brain

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12
Q

What is a dermatome?

A

An area of skin supplied by a single spinal cord level or spinal nerve

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13
Q

Where can pain from the heart be felt and which spinal level is this?

A

Can be felt down arm and across chest (T1-T4/5)

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14
Q

Where does the sensory supply for the diaphragm originate from and where is referred pain from the diaphragm felt?

A

The sensory supply to the diaphragm is partially carried by the phrenic nerve - C3, C4, C5

Referred pain from the diaphragm can be felt at the shoulder

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15
Q

What are the 3 splanchnic nerves and which spinal level do they originate from?

A
  1. Greater splanchnic nerves arise from levels T5-9
  2. Lesser splanchnic nerves arise from levels T10-11
  3. Least splanchnic nerves arise from level T12
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16
Q

Where do the splanchnic nerves travel?

A

Descend medially from ganglia across the vertebral bodies and enter abdomen by piercing the diaphragm

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17
Q

What nerve fibres make up the splanchnic nerves?

A

Carry preganglionic sympathetic fibres and visceral afferent fibres from the abdominal viscera

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18
Q

What nerves have been highlighted in this diagram?

A

Splanchnic nerves

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19
Q

Complete the diagram

A
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20
Q

Complete the diagram

A
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21
Q

Which cranial nerve is the vagus nerve?

A

CNX

Cranial nerve 10

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22
Q

Complete the diagram of the nervous structures

A
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23
Q

Where does the vagus nerve enter the superior mediastinum?

A

Enters superior mediastinum posterior to sternoclavicular joint

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24
Q

Which nerves branch from the vagus nerve in the superior mediastinum?

A

The left and right recurrent laryngeal nerves

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25
Q

Where does the vagus nerve supply in the posterior mediastinum?

A

Contributes to pulmonary, cardiac and oesophageal plexuses supply

26
Q

Is the vagus nerve supply in the posterior mediastinum sympathetic or parasympathetic?

A

Parasympathetic

27
Q

At which point is the vagus nerve no longer made of preganglionic fibres?

A

The plexus

28
Q

Which nerve is this?

A

Right vagus nerve

29
Q

Where does the left and right recurrent laryngeal branch loop?

A

Left recurrent laryngeal nerve hooks inferiorly to the aortic arch, immediately lateral to ligamentum arteriosum.

Right recurrent laryngeal branch hooks under right subclavian artery and ascends between trachea and oesophagus.

30
Q

Where does the right and left vagus nerve travel to after giving off the recurring laryngeal branches?

A

Right vagus continues posterior to the right of the trachea, posterior to Right Brachiocephalic vein and lung root/ hilum.

Left vagus runs posteriorly to lung root.

31
Q

Which nerve is this?

A

Left vagus nerve

32
Q

Which part of the aorta is the thoracic aorta continious with?

A

Arch of aorta

33
Q

Where does the thoracic aorta travel in the posterior mediastinum?

A

Descends on the left side of vertebrae T5-T12

Oesophagus positioned to its right

34
Q

Where does the thoracic aorta terminate and which other structures also pass through the diaphragm?

A
  • Terminates at vertebral level T12 where it enters the abdomen through the aortic hiatus in the diaphragm
  • Thoracic duct and azygos veins ascend on its right hand side and also pass through diaphragm at the aortic hiatus
35
Q

Complete the diagram of the branches of the thoracic aorta

A

Paired

1) Posterior intercostal
2) Subcostal
3) Bronchial
4) Superior Phrenic

Unpaired

a) Pericardial
b) Oesophageal
c) Mediastinal

36
Q

Complete the diagram of the azygous system?

A
37
Q

Complete the diagram of the azygous system

A
38
Q

Complete the diagram of the azygous system

A
39
Q

Where does the azygous vein arise from?

A

Arises on right side by junction of subcostal (T12 level) and ascending lumbar veins

40
Q

Where does the hemi-azygous vein arise from?

A

Arises on left side by junction of subcostal (T12 level) and ascending lumbar veins

41
Q

Where does the azygous vein drain deoxygenated blood from?

A

The posterior thoraco-abdominal walls and viscera.

Usually receives blood from the hemiazygos veins which drain the left side.

42
Q

What are the tributaries of the azygous vein?

A

Posterior intercostal veins (levels T5-T11), bronchial veins, vertebral venous plexus

43
Q

Where does the azygous vein arch over?

A

Root of right lung to join superior vena cava

44
Q

The azygous vein forms a collateral pathway between which 2 vessels?

A

Superior vena cava and inferior vena cava

45
Q

Where do the hemi-azygous veins ascend to?

A

Ascends on the left side posterior to aorta draining left posterior intercostal veins levels T9-11

46
Q

Where does the accessory hemi-azygous vein drain from?

A

Levels T5-T8 on left side

47
Q

Where does the accessory hemi-azygous vein cross over to join the azygous vein?

A

Crosses T7/8 to join azygos and sometimes joins hemi-azygos

48
Q

What is the largest lymph channel?

A

Thoracic duct

49
Q

Which areas of the body does the thoracic duct drain lymph from?

A

Conveys all lymph from body except the head, neck, upper limb and thorax on the right side

50
Q

Where does the thoracic duct originate from and where does it travel to?

A
  1. Originates in the Cisterna Chyli in abdomen (L2)
  2. Ascends through the Aortic hiatus passing anterior to thoracic vertebrae
  3. Ascends into superior mediastinum and drains into venous system at the left venous angle
51
Q

Where is the venous angle?

A

Junction of internal jugular and subclavian veins

52
Q

Complete the diagram

A
53
Q

Complete the diagram of lymph drainage of the body

A
54
Q

Does the oesophagus travel superiorly or anteriorly to the trachea?

A

Posteriorly

55
Q

How does the oesophagus pass in relation to the aorta?

Anterior/Posterior

Left/Right

A

Passes posterior and to the right of aorta

56
Q

Does the oesophagus veer slightly left or right when piercing the diaphragm?

A

Slightly left

57
Q

Does the oesophagus become anterior or posterior to the abdominal aorta before passing into the stomach?

A

Anterior

58
Q

What is the innervation of the oesophagus?

A

CNX and Sympathetic trunk via Oesophageal plexus

59
Q

Where are the 3 constrictions of the oesophagus?

A
  1. Arch of aorta
  2. Left main bronchus
  3. Diaphragm
60
Q

Complete the diagram of the 3 constrictions of the oesophagus

A

103 Theme 1 - Anatomy (7 decks)

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