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LQB389 > Regional Anatomy of the Mediastinum > Flashcards

Regional Anatomy of the Mediastinum Flashcards

1
Q

Superior Boundary of the Superior Mediastinum

A

Thoracic Inlet (1st ribs and costal cartilages, jugular notch of manubrium and T1) `

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2
Q

Inferior Boundary of the Superior Mediastinum

A

Imaginary Plane which passes through the sternal angle, intervertebral disc of T4/5 and aorticopulmonary window

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3
Q

Anterior Boundary of the Superior Mediastinum

A

Manubrium of the Sternum

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4
Q

Posterior Boundary of the Superior Mediastinum

A

T1-T4/5

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5
Q

Lateral Boundary of the Superior Mediastinum

A

Parietal Pleura

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6
Q

Superior Border of the Anterior Mediastinum

A

Imaginary Plane which passes through the sternal angle, intervertebral disc of T4/5 and aorticopulmonary window

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7
Q

Inferior Border of the Anterior Mediastinum

A

Thoracic Diaphragm

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8
Q

Anterior Border of the Anterior Mediastinum

A

Body of the Sternum

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9
Q

Posterior Border of the Anterior Mediastinum

A

Fibrous Pericardium

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10
Q

Lateral Border of the Anterior Mediastinum

A

Parietal Pleura

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11
Q

Superior Border of the Middle Mediastinum

A

Imaginary Plane which passes through the sternal angle, intervertebral disc of T4/5 and aorticopulmonary window

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12
Q

Inferior Border of the Middle Mediastinum

A

Thoracic Diaphragm

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13
Q

Anterior Border of the Middle Mediastinum

A

Fibrous Pericardium

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14
Q

Posterior Border of the Middle Mediastinum

A

Fibrous Pericardium, tracheal bifurcation, primary bronchi

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15
Q

Lateral Border of the Middle Mediastinum

A

Parietal Pleura

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16
Q

Superior Border of the Posterior Mediastinum

A

Imaginary Plane which passes through the sternal angle, intervertebral disc of T4/5 and aorticopulmonary window

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17
Q

Inferior Border of the Posterior Mediastinum

A

Thoracic Diaphragm

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18
Q

Anterior Border of the Posterior Mediastinum

A

Fibrous pericardium, tracheal bifurcation, primary bronchi

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19
Q

Posterior Border of the Posterior Mediastinum

A

T4/5 - T12

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20
Q

Lateral Border of the Posterior Mediastinum

A

Parietal Pleura

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21
Q

Blood Vessel Contents of the Superior Mediastinum

A

Brachiocephalic Veins, Superior Vena Cava (proximal half), Aortic arch and its branches

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22
Q

Nervous Tissue Contents of the Superior Mediastinum

A

Phrenic nerves, vagus nerves, left recurrent laryngeal nerve

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23
Q

Large Organ Contents of the Superior Mediastinum

A

Trachea and associated lymph nodes, oesophagus, thoracic duct, thymus or its remnant, brachiocephalic lymph nodes

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24
Q

Blood Vessel Contents of the Anterior Mediastinum

A

Internal Thoracic Blood Vessels

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25
Q

Nervous Tissue Contents of the Anterior Mediastinum

A

Nil

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26
Q

Large Organ Contents of the Anterior Mediastinum

A

Thymus or its remnant, loose connective tissue (sternopericardial ligaments), parasternal lymph nodes

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27
Q

Blood Vessel Contents of the Middle Mediastinum

A

Great Vessels of the Heart, Pulmonary Arteries and Veins, Arch of the Azygos Vein

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28
Q

Nervous Tissue Contents of the Middle Mediastinum

A

Phrenic Nerves

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29
Q

Large Organ Contents of the Middle Mediastinum

A

Heart, terminal end of the trachea and primary bronchi, Bronchotracheal lymph nodes

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30
Q

Blood Vessel Contents of the Posterior Mediastinum

A

Descending thoracic aorta, azygos, hemiazygos and accessory hemiazygos veins

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31
Q

Nervous Tissue Contents of the Posterior Mediastinum

A

Vagus nerves (contributes to oesophageal nerve plexus)

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32
Q

Large Organ Contents of the Posterior Mediastinum

A

Oesophagus, Thoracic Duct, Posterior mediastinal lymph nodes

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33
Q

Artery Definition: Terminal Branch

A

o An artery end by dividing into different arteries with different names

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34
Q

Artery Definition: Continuation

A

o An artery crosses a certain landmark and so the name changes (the same artery continues named as a different vessel)

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35
Q

Artery Definition: Collateral Branch

A

o ‘Side-branch’

o Original artery continues past that side-branch

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36
Q

Vein Definition: Confluence

A

o Veins uniting or coming together to form another single (larger) vein, a union

o e.g., Right and Left Brachiocephalic Veins -> Superior Vena Cava

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37
Q

Vein Definition: Tributary

A

o A side vein joins onto a larger vein (a side-branch, however the blood is flowing in a different direction to arteries)

o e.g., Right and left renal veins are tributaries of the inferior vena cava

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38
Q

Vein Definition: Continuation

A

o A vein crosses a certain landmark and so the name changes (the same vein continues named as a different vessel)

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39
Q

Major Mediastinal Compartments

A

The mediastinum is divided into superior and inferior mediastina by an imaginary plane that passes through the sternal angle, aorticopulmonary window and the intervertebral disc between T4/T5 vertebrae

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40
Q

What compartments is the Inferior Mediastinum divided into?

A

o The anterior mediastinum, the middle mediastinum and the posterior mediastinum

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41
Q

What are the 4 differing Coronary Anastomoses of the heart?

A
  • Right Dominant
  • Left Dominant
  • Codominant
  • Single Coronary Artery
42
Q

Explain the Right Dominant Coronary Arterial Pattern

A

o Right Coronary Artery provides the collateral branch of the posterior interventricular artery
o 80-85%

43
Q

Explain the Left Dominant Coronary Arterial Pattern

A

o Circumflex artery provides the collateral blood flow

o 10%

44
Q

Explain the Codominant Coronary Arterial Pattern

A

o Shared blood flow from the right and the left

o 20%

45
Q

Explain the Single Artery Coronary Arterial Pattern

A

o Coronary Artery arises from the left and provides all of the blood to the left and right side of the heart

o Only one potential anastomoses

o 0.03-0.07%

46
Q

What are the tributaries of the coronary sinus?

A
  • The great cardiac vein and posterior vein of the left ventricle are tributaries of the left side of the coronary sinus
  • The small and middle cardiac veins are tributaries of the right side of the coronary sinus
47
Q

Where is the aorticopulmonary window located?

A
  • Bounded by the inferior surface of aortic arch and the superior surface of the right pulmonary artery
  • Located at T4/T5 and forms part of the boundary between superior and inferior mediastina
48
Q

What nerve passes through the aorticopulmonary window?

A

• Left recurrent laryngeal nerve passes through the aorticopulmonary window

49
Q

Where is the Great Cardiac Vein located and where does it drain into?

A
  • Follows the anterior interventricular artery and circumflex artery
  • Drains into the left side of the Coronary Sinus
50
Q

Where is the Small Cardiac Vein located and where does it drain into?

A
  • Accompanies the Right Coronary Artery in the Atrioventricular Groove
  • Drains into the to the right of the middle cardiac vein Coronary Sinus
51
Q

Where is the Middle Cardiac Vein located and where does it drain into?

A
  • Begins at the apex and ascends into the posterior interventricular sulcus
  • Drains into the right side Coronary Sinus
52
Q

What does the Posterior Vein of the Left Ventricle do and where does it drain into?

A
  • Drains regions of the Left Ventricle that the Great and Middle Veins have not been able to
  • Empties into the Coronary Sinus
53
Q

Where is the Apex of the Heart located?

A

o Apex lies deep to the 5th intercostal space and 7-9 cm to the left of the midline

54
Q

Where is the Base of the Heart Located?

A
  • Base of the heart forms the posterior aspect

* Faces T6-T9 and is mostly formed by the left atrium and some portion of the right atrium

55
Q

What is the Fossa Ovalis and where is it located?

A
  • Located on the interatrial septum

- It is the remnant of the foetal foramen ovale

56
Q

What type of blood is found in the Right Superior Pulmonary Vein?

A

Oxygenated

57
Q

What type of blood is found in the SVC?

A

Deoxygenated

58
Q

What type of blood is found in the Pulmonary Trunk?

A

Deoxygenated

59
Q

What type of blood is found in the Ascending Aorta?

A

Oxygenated

60
Q

What arteries lie in the Interventricular Grooves?

A

Posterior and Anterior Interventricular Arteries

61
Q

What arteries lie in the Atrioventricular groove?

A

Right Coronary Artery and Circumflex Artery

62
Q

Origin of the Right Coronary Artery

A

Collateral Branch of the Ascending Aorta

63
Q

Accompanying Vein to the Right Coronary Artery

A

Small Cardiac Vein

64
Q

Course of the Right Coronary Artery

A

Courses to the right in the atrioventricular groove between the right auricle and right ventricle

It then terminates in the posterior wall of the left ventricle

65
Q

Branches of the Right Coronary Artery

A

It has two collateral branches - Right Marginal Artery and the Posterior Interventricular Artery

66
Q

Origin of the Right Marginal Artery

A

Collateral Branch of the Right Coronary Artery

67
Q

Course of the Right Marginal Artery

A

Runs towards the apex of the heart along the right border

68
Q

Origin of the Posterior Interventricular (Descending Artery)

A

Collateral Branch of the Right Coronary Artery

69
Q

Location of the Posterior Interventricular Artery

A

Lies in the posterior interventricular sulcus

70
Q

Origin of the Left Coronary Artery

A

Arises as a collateral branch of the ascending aorta

71
Q

Course of the Left Coronary Artery

A

Courses between the pulmonary trunk and left auricle to reach the atrioventricular groove

It then terminally divides into the anterior interventricular artery and the circumflex artery

72
Q

Origin of the Anterior Interventricular Artery

A

Terminal Branch of the Left Coronary Artery

73
Q

Course of the Anterior Interventricular Artery

A

Courses in the anterior interventricular sulcus towards the apex

74
Q

Origin of the Circumflex Artery

A

Terminal Branch of the Left Coronary Artery

75
Q

Course of the Circumflex Artery

A

Continues in the atrioventricular sulcus and courses around the left border of the heart to the posterior surface

It then terminates in the posterior wall of the LV

76
Q

Origin of the Left Marginal Artery

A

Collateral Branch of the Circumflex Artery

77
Q

Course of the Left Marginal Artery

A

Descends down the left border of the heart

78
Q

What is the Coronary Sinus and where does it drain into?

A
  • Dilated vein that is located in the posterior atrioventricular sulcus
  • All the major cardiac veins drain into it
  • Drains into the right atrium
79
Q

Origin of the Phrenic Nerve

A

Cervical Plexus (derived from the anterior rami of the cervical nerves)

80
Q

Course of the Phrenic Nerve (Together)

A

Descends lateral to the heart between the fibrous pericardium and the parietal pleura

81
Q

Course of the Right Phrenic Nerve (Individual)

A

Courses along the right side of the SVC, right atrium and right side of the IVC

82
Q

Course of the Left Phrenic Nerve (Individual)

A

Courses along the left auricle and left ventricle

83
Q

Termination of the Phrenic Nerve

A

Each nerve enters the thoracic diaphragm lateral to the pericardium and divides into a number of branches

Branches provide motor supply to the thoracic diaphragm and partial sensory innervation

84
Q

Origin of the Vagus Nerve

A

Arises from the medulla oblongata within the head as the tenth cranial nerve (CN X)

85
Q

Course of the Right Vagus Nerve

A

Courses anterior to the brachiocephalic trunk and posterior to the right brachiocephalic vein to the right side of the trachea

Continues posterior to the SVC into the posterior mediastinum

86
Q

Branches of the Right Vagus Nerve

A
  • The right recurrent laryngeal nerve branches off in the root of the neck.
  • Therefore, it does not enter the superior mediastinum
87
Q

Course of the Left Vagus Nerve

A

Courses to the left of the left common carotid artery and posterior to the left brachiocephalic vein

Then continues inferiorly into the posterior mediastinum

88
Q

Branches of the Left Vagus Nerve

A

Left Recurrent Laryngeal Nerve

Arising anterior to the arch of the aorta, it passes through the aortic pulmonary window and ascends lateral to the trachea towards the neck

89
Q

Thymus variation with age

A

In a child, the thymus was large and was in both the superior and anterior mediastinum.

In a young adult, there is some regression of the inferior thymic tissue, and it is in the superior mediastinum.

In an elderly individual, a thymic remnant remains within the superior mediastinum (if tissue remains).

90
Q

Azygos Vein

A
  • Receives most of the right posterior intercostal veins

- Passes into superior mediastinum and drains into ther SVC via the arch of the azygos vein

91
Q

Hemiazygos Vein Course

A
  • Ascends posterioly on the left side of the vertebral column
  • Then courses to the right to join the azygos vein at the vertebral level of T9
  • Recevies most of the left posterior intercostal veins
92
Q

Hemiazygos Vein Location

A

Lies mainly posterior to the descending thoracic aorta

93
Q

Accessory Hemiazygos Vein Course

A

Descends from the left of the superior part of the vertebral column and drains into the azygos vein and sometimes the hemiazygos vein

94
Q

What is an Anastomoses?

A
  • Connection between blood vessels
95
Q

What can cause an anastomoses to form?

A

Pathology
- High BP, naroowing or inclusion of vessels

  • Angiogensis can cause these vessels to form and redirect the blood flow
96
Q

Examples of Anastomoses

A
  • Between the Posterior Interventricular Artery and the Terminal end of the Anterior Interventricular Artery
  • Between the Circumflex Artery and the Terminal end of the Right Coronary Artery
97
Q

sternocoastal surface

A

formed mainly by the right ventricle

98
Q

diaphragmatic surface

A

formed mainly by the right and left ventricles

99
Q

pulmonary surface

A

formed mainly by the left ventricle and occupies the cardiac notch of the left lung

100
Q

Fossa ovalis

A

a depression most evident in the right atrial side of the interatrial septum

101
Q

Termination of trachea

A

Highly variable

range between T4/5 to T7

102
Q

Thoracic duct course

A

courses to the left side opposite T5 and enters the superior mediastinum;
then ascends to the thoracic inlet along the left side of the oesophagus between the left vagus nerve and its left recurrent laryngeal branch, and enters the root of the neck; thoracic duct is crossed anteriorly by the
aortic arch.

LQB389 (13 decks)

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