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103-theme 1 > posterior mediastinum > Flashcards

posterior mediastinum Flashcards

1
Q

what are the boundaries of the posterior mediastinum? 5

A
  • antieror= posterior pericardium
  • posterior= vertebra T5-12
  • lateral=mediastinal pleura
  • superior=transverse thoracic plane
  • inferior=diaphragm
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2
Q

what are contents of the posterior mediastinum? 7

A
  • oesophagus
  • thoracic duct
  • azygous system of veins
  • thoracic duct
  • vagus nerve
  • sympathetic trunk
  • splanchnic nerves
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3
Q

describe the sympathetic outflow to the posterior mediastinum?
parasympathetic?

A

thoracolumbar outflow: T1 to L2

craniosacral outflow: some cranial nerves (including Vagus nerve) and S2,3,4

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4
Q

what is the sympathetic trunk? 4

A
  • vertical chain of sympathetic nerves running the length of the vertebral column
  • located on both sides of vertebral bodies
  • paravertebral (chain) ganglia located along its length
  • in the thoracic spine, usually one ganglion per spinal level
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5
Q

describe spinal nerve levels T1-4/5? 4

A
  • supply thoracic area with sympathetic nerves
  • preganglionic sympathetic fibres leave the spinal nerves (white rami communicates) and synapse at the paravertebral ganglion
  • postganglionic sympathetic fibres leave the ganglion (grey rami communicates) and pass to the pulmonary, cardiac and oesophageal plexi
  • these nerves also carry afferent fibres (carrying sensory information) from the thoracic viscera they supply back to the brain
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6
Q

what is a dermatome map related to the posterior mediastinum? 4

A
  • dermatome= an area of skin supplied by a single cord level or spinal nerve
  • pain from the heart can be felt down the arm and across the chest (T1-4/5)
  • the sensory supply to the diaphragm is carried by the phrenic nerve, which can come from c,3,4,5
  • referred pain from the diaphragm can be felt at the shoulder
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7
Q

describe spinal nerve levels T5/6-12? 3

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 prevertebral (pre-aortic) ganglia before passing onto the abdominal viscera
  • these form the 3 splanchnic nerves
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8
Q

describe the splanchnic nerves? 5

A
  • greater splanchnic nerves arise from levels T5-9
  • lesser splanchnic nerves arise from levels T10-11
  • least splanchnic nerves arise from level T12
  • they descend medially from ganglia across the vertebral bodies and enter abdomen by piercing the diaphragm
  • carry preganglionic sympathetic fibres and visceral afferent fibres from the abdominal viscera
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9
Q

describe the vagus nerve in the posterior mediastinum? 3

A
  • continues into the posterior mediastinum to contribute to pulmonary, cardiac, oesophageal plexuses
  • parasympathetic supply
  • preganglionic fibres until they reach the plexus
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10
Q

what happens to the right recurrent laryngeal branch of the vagus nerve? 2

A
  • hooks under the right subclavian artery and ascends between the trachea and the oesophagus
  • continues posterior to the right of the trachea, posterior to right brachiocephalic vein and lung root/hilum
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11
Q

what happens to the left recurrent laryngeal branch of the vagus nerve? 3

A
  • hooks inferiorly to the aortic arch, immediately lateral to ligamentum arteriosum
  • ascends similarly to the right nerve to supply the larynx
  • rest of left vagus runs posteriorly to lung root
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12
Q

what happens to the thoracic aorta? 5

A
  • continuous with arch of aorta
  • descends on the left side of the vertebrae T-T12
  • 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 vein ascend on its right hand side and also pass through the aortic hiatus
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13
Q

what are the branches of the thoracic aorta? 7

A
  • paired:
  • posterior intercostal
  • subcostal
  • bronchial
  • superior phrenic
  • unpaired:
  • pericardial
  • oesophageal
  • mediastinal
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14
Q

name the different veins in the azygous system? 8

A
  • left and right superior intercostal vein
  • azygous vein
  • accessory hemi-azygous vein
  • hemi-azygous vein
  • ascending lumbar veins
  • lumbar veins
  • vena cava
  • subcostal vein
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15
Q

what do the ascending lumbar veins do?

A

allow for collateral circulation of venous blood

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16
Q

describe the azygous vein? 6

A
  • arises on right side by junction of subcostal (T12 level) and ascending lumbar veins
  • drains deoxygenated blood from the posterior thoracic-abdominal walls and viscera
  • tributaries= posterior intercostal veins (T5-12), bronchial veins, vertebral venous plexus
  • arches over root of right lung to join SVC
  • usually receives blood from the hemi-azygous veins which drain the left side
  • forms a collateral pathway between the SVC and IVC
17
Q

describe the hemi-azygous veins? 5

A
  • arises on left side by junction of subcostal (T12) and ascending lumbar veins
  • ascends on the left side posterior to the aorta draining left posterior intercostal levels T9-11
  • crosses to right and joins azygous
  • accessory hemi-azygous drain levels T5-8
  • crosses t7/8 to join azygous and sometimes hemi-azygous
18
Q

where does the thoracic duct originate from, and where does it go? 3

A
  • cisterna chyli (L2)
  • ascends through aortic hiatus passing anterior to thoracic vertebrae
  • ascends into superior mediastinum and drains into venous systems at the left venous angle
19
Q

describe the oesophagus? 6

A
  • descends from superior mediastinum posterior to the trachea
  • muscular tube
  • passes posterior to and to the right of the aorta
  • veers slightly left before piercing the diaphragm
  • becomes anterior to abdominal aorta before entering the stomach
  • innervation= CNX and sympathetic trunk via oesophageal plexus
20
Q

what are the 3 constrictions of the oesophagus? 3

A
  • arch of the aorta
  • left main bronchus
  • diaphragm

103-theme 1 (5 decks)

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