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Medicine MD3001 cardiovascular system > Posterior mediastinum > Flashcards

Posterior mediastinum Flashcards

1
Q

what are the boundaries of the inferior mediastinum?

A
  • inferior to the plane of T4/5 and the sternal angle

- superior to the thoracic outlet

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2
Q

What are the3 parts of the inferior mediastinum?

A
  • part of the anterior
  • middle
  • posterior
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3
Q

What are the boundaries of the posterior mediastinum?

A
  • posterior to the pericardial sac and the diaphragm

- from the IV disc between T4 and T5 to the posterior attachment of the diaphragm at T12

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4
Q

List the contents of the posterior mediastinum

A
  • descending (thoracic) aorta
  • thoracic duct and mediastinal lymph nodes
  • azygous vein= hemi azygous vein
  • oesophagus
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5
Q

Which level does the descending aorta extend from and what is its anatomical landmark? where does it extend to?

A
  • T4/5
  • 2nd left costal cartilage
  • to aortic hiatus in the diaphragm at T12 behind the median arcurate ligament
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6
Q

What are the branches of the descending aorta?

A
  • oesophageal arteries
  • posterior intercostal arteries
  • subcostal arteries
  • bronchial arteries
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7
Q

Where do the oesophageal arteries supply?

A

middle third of the oesophagus

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8
Q

how many posterior intercostal arteries are there? Where do they supply?

A
  • 9

- supply 9 intercostal spaces from 3-11

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9
Q

Where are the subcostal arteries located? What do they supply?

A
  • inferior to the 12th rib

- supply the posterior abdominal wall

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10
Q

how many bronchial arteries are on the left and how many on the right?

A
  • 2 on the left

- 1 on the right

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11
Q

What vein drains the middle of the oesophagus?

A

azygous vein

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12
Q

Which arteries branch from the subclavian arteries?

A

internal thoracic arteries (mammary arteries)

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13
Q

What do the internal thoracic arteries branch to give? What do these vessels anastomose with?

A
  • anterior intercostal arteries

- posterior intercostal arteries branching from the aorta

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14
Q

What is the benefit of the anastomoses between the anterior and posterior intercostal arteries?

A

in coarctation of the aorta a collateral circulation maybe established

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15
Q

What level does the oesophagus pierce the diaphragm? What is its orientation when it pierces the diaphragm?

A
  • T10

- it swings anteriorly and to the left

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16
Q

What are the 3 levels of the oesophagus?What is the composition of the muscle at the 3 levels of the oesophagus?

A
  • upper 1/3, middle and lower 1/3
  • upper=striated voluntary muscle
  • middle=mix
  • lower=smooth involuntary muscle
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17
Q

What structure is located between the pharynx and the oesophagus?

A

cricopharyngeal sphincter

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18
Q

What is the function of the cricopharyngeal sphincter?

A

prevents air being sucked into the stomach during inhalation

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19
Q

how is physiological cardiac sphincter of the stomach formed?

A

lower oesophagus passes through the Right crus of diaphragm just left of midline and entry is oblique to the stomach

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20
Q

What is the function of the cardiac sphincter?

A

prevents gastric reflux

21
Q

What is the nerve supply to the upper oesophagus?

A

branches of the vagus nerves= recurrent laryngeal nerves

22
Q

what is the arterial supply and venous drainage of the upper oesophagus?

A
  • internal thyroid arteries

- brachiocephalic veins

23
Q

which lymph nodes does the upper oesophagus drain to?

A

deep cervical nodes

24
Q

What 2 arteries supply the middle oesophagus?

A
  • directly from the the thoracic aorta

- bronchial arteries

25
Q

What is the nerve supply to the middle of the oesophagus?

A

oesophageal plexus

26
Q

which lymph nodes does the middle oesophagus drain to?

A

tracheobronchial nodes

27
Q

What is the arterial supply and venous drainage to the lower oesophagus?

A
  • left gastric artery

- venous drainage to the left gastric then hepatic portal vein

28
Q

What is the nerve supply to the lower oesophagus?

A

branches from the oesophageal plexus:

  • vagus
  • sympathetic
29
Q

wat is the lymph drainage of the lower oesophagus?

A
  • left gastric nodes

- coeliac nodes

30
Q

Which veins form the porto-systemic anastomoses of the oesophagus?

A

submucosal veins between the middle and abdominal portions

31
Q

What effect does cirrhotic liver disease have on the submucosal veins?

A

raises the portal venous pressure, blood escapes via submucosal veins and in to the azygous vein
once they become dilated and torturous

32
Q

What are dilated and torturous submucosal veins called? what do the have the potential to do?

A
  • oesophageal varices

- may cause fatal haemorrhage

33
Q

What are the 4 oesophageal constrictors?

A
  • upper oesophageal sphincter
  • aortic arch
  • left main bronchus
  • diaphragm
34
Q

how is the pulmonary trunk related to the oesophagus?

A

crosses anteriorly to it

35
Q

which heart chamber is related to the oesophagus?

A

left atrium

36
Q

Which parts of the body does the thoracic duct not drain lymph from?

A
  • right thorax
  • right upper limb
  • head and neck
37
Q

Why do you have to be carful when carrying out thoracic surgery with regards to the lymphatic system?

A
  • care has to be taken to avoid damage to the thoracic duct

- leakage of lymph will cause a chylothorax

38
Q

what level does the thoracic duct pierce the diaphragm? accompanying which structures?

A
  • T12

- thoracic aorta and azygous vein

39
Q

Which lymph nodes lie alongside the trachea?

A

paratracheal nodes

40
Q

Where are posterior mediastinal lymph nodes located?

A

behind the heart, adjacent to the oesophagus

41
Q

Describe lymph drainage in the thorax starting from the lungs.

A
  • pulmonary nodes drain into bronchopulmonary (around main bronchi)
  • bronchopulmonary drain into inf. and sup. Tracheobronchial nodes
  • Tracheobronchial and Posterior mediastinal nodes drain into paratracheal lymph nodes
  • paratracheal, parasternal and anterior mediastinal all drain into Bronchomediastinal lymph trunks
42
Q

Which veins branch from the Azygous vein?

A

intercostal veins

43
Q

Where does the azygous vein begin from?

A

lumbar and subcostal veins

44
Q

Which structure does the azygous vein lie on?

A

the vertebral column

45
Q

what is the route taken by the azygous vein as it enters the SVC? what landmark indicates the entry of the azygous vein into the SVC

A
  • passes posterior to R lung hilum then superior to it as it arches into SVC at
  • 2nd R Costal Cartilage
46
Q

What are the 2 parts of the Hemi-azygous vein?

A
  • lower

- accessory (upper)

47
Q

Which veins does the lower Hemi azygous vein have connections with?

A

left renal veins

48
Q

what level does the lower H. Azy vein cross to the right?

A

T9

49
Q

Where does the accessory hemi azygous vein decrease from? What level does it cross to the right?

A
  • decreases from the 4th intercostal space on the left

- crosses to right at T8

Medicine MD3001 cardiovascular system (44 decks)

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