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module 103 - theme 1 > posterior mediastinum > Flashcards

posterior mediastinum Flashcards

1
Q

what is the anterior boundary of the posterior mediastinum?

A

posterior pericardium

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2
Q

what is the posterior boundary of the posterior mediastinum?

A

vertebrae T5-12

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3
Q

what is the lateral boundary of the posterior mediastinum?

A

mediastinal pleura

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4
Q

what is the superior boundary of the posterior mediastinum?

A

transverse throacic plane

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5
Q

what is the inferior boundary of the posterior mediastinum?

A

diaphragm

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6
Q

what is contained in the posterior mediastinum?

A
  • oesophagus
  • thoracic aorta
  • azygous system of veins
  • thoracic duct
  • vagus nerve
  • sympathetic trunk
  • splanchnic nerves
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7
Q

what is the flow of the sympathetic nervous system?

A

thoracolumbar outflow T1 to L2

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8
Q

what is the flow of the parasympathetic nervous system?

A

craniosacral outflow - some cranial nerves (including vagus nerve), S2, S3 and S4

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9
Q

what is the sympathetic trunk?

A

vertical chain of sympathetic nerves running the entire length of the vertebral column

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10
Q

where is the sympathetic trunk located?

A

both sides of vertebral bodies and the paravertebral ganglia is located along its length

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11
Q

in the thoracic spine how many ganglia are there per spinal level?

A

one ganglion per spinal level

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12
Q

what happens at spinal nerve levels T1-T4/5?

A
  • preganglionic sympathetic fibres leave the spinal nerve (white rami communicates) and synapse at paravertebral ganglion
  • postganglionic sympathetic fibres leave the ganglion (grey rami communicates) and pass to the pulmonary, cardiac and oesophageal plexi
  • these nerves can also carry afferent fibres (carrying sensroy information) from the thoracic viscera they supply back to the brain
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13
Q

what is a dermatome?

A

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

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14
Q

where is pain from the heart felt?

A

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

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15
Q

what nerve supplies to the diaphragm?

A

phrenic nerve C3, C4 and C5

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16
Q

where can referred pain from the diaphragm be felt?

A

shoulder

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17
Q

what happens at spinal nerve levels T5/6-T12?

A
  • preganglionic sympathetic fibres leave the spinal cord (white rami communicates) and enter the ganglion but don’t synapse
  • hence, preganglionic sympathetic fibres leave these ganglia and synapse in the paravertebral (pre-aortic) ganglia before passing to the abdominal viscera
  • there form the 3 splanchnic nerves
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18
Q

where do the greater splanchnic nerves arise from?

A

levels T5-9

19
Q

where do the lesser splanchnic nerves arise from?

A

levels T10-11

20
Q

where do the least splanchnic nerves arise from?

A

levels T12

21
Q

generally where do splanchnic nerves travel?

A

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

22
Q

what do splanchnic do?

A

carry preganglionic sympathetic fibres to and visceral afferent fibres from the abdominal viscera

23
Q

where does the vagus nerve enter?

A
  • enters superior mediastinum posterior to the sternoclavicular joint
  • the left and right recurrent laryngeal nerves branch from it but have differing courses
  • continues into posterior mediastinum to contribute to pulmonary, cardiac and oesophageal plexues
24
Q

what type of supply is the vagus nerve?

A

parasympathetic supply

25
Q

where does the right vagus nerve travel?

A
  • right recurrent laryngeal branch hooks under right subclavian artery and ascends between trachea and oesophagus
  • right vagus continues posterior to the right of the trachea, posterior to right brachiocephalic vein and lung root/hilum
26
Q

what does the right vagus supply?

A

the larynx

27
Q

where does the left vagus nerve travel?

A
  • left recurrent laryngeal nerve hooks inferiorly to the aortic arch, immediately lateral to ligamentum arteriosum
  • rest of the left vagus runs posteriorly to lung root
28
Q

what does the left vagus supply?

A

the larynx

29
Q

where does the thoracic aorta travel?

A
  • continues with arch or aorta
  • descend on the left side of the vertrbae T5-12
  • oesophagus positioned to its right
  • terminates at vertebral level T12 where it enters the abdomen through the aortic hiatus in the diaphragm
  • thoracic duct and azygous veins ascend on its right hand side and also pass through diaphragm at the aortic hiatus
30
Q

what are the paired branches of the thoracic aorta?

A

1) posterior intercostal
2) subcostal
3) bronchial
4) superior phrenic

31
Q

what are the unpaired branches of the thoracic aorta?

A

1) pericardial
2) oesophageal
3) mediastinal

32
Q

where does the azygos vein travel?

A
  • arises on the right side by junction of subcostal (T12) level and ascending lumbar veins
  • arches over root of right lung to join SVC
33
Q

what does the azygos vein do?

A
  • it drains deoxygenated blood from the posterior thoraco-abdominal walls and viscera
  • usually receives blood form the Hemiazygous veins which drains the left side
  • forms a collateral pathway between the SVC and IVC
34
Q

what are the tributaries of the azygos vein?

A

posterior intercostal veins (level T5-T11), bronchial veins, vertebral venous plexus

35
Q

where does the hemi-azygous vein travel?

A
  • arises on the left side by the junction of subcostal (T12 level) and ascending lumbar veins
  • ascends on the left side posterior to aorta draining left posterior intercostal veins level T9-11
  • crosses T7/8 to joint azygos and sometimes joins hemi-azygos
36
Q

what does the hemi-azygos vein do?

A
  • corsses to right and joins azygos vein

- accessory hemi-azygos drains levels T5-T8 on left side

37
Q

what is the thoracic duct?

A

the largest lymph channel

38
Q

what does the thoracic duct do?

A

conveys all lymph from body except head, neck, upper limb and throat on right side

39
Q

where does the thoracic duct originate?

A

Cisterna Chyli in abdomen (L2)

40
Q

where does the thoracic duct travel?

A
  • ascends through aortic hiatus passing anterior to thoracic vertebrae
  • ascends into superior mediastinum and drains into venous system at the left venous angle (junction of internal jugular and subclavian veins)
41
Q

where does the oesophagus travel?

A
  • descends from superior mediastinum posterior to the trachea
  • passes posterior and to the right of aorta
  • veers slightly left before piercing through the diaphragm
  • becomes anterior to abdominal aorta before entering the stomach
42
Q

what is the innervation of the oesophagus?

A

CNX and sympathetic trunk via oesophageal plexus

43
Q

what is the oesophagus?

A

a muscular tube

44
Q

where are the 3 constrictions of the aorta?

A

1) arch of aorta
2) left main bronchus
3) diaphragm

module 103 - theme 1 (6 decks)

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