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Block 3: Anatomy & Embryo > Sup & Post Mediastinum > Flashcards

Sup & Post Mediastinum Flashcards

1
Q

What are the boundaries of the superior mediastinum?

A

Superior thoracic aperture, to transverse thoracic line (angle of Louis and then posterior to T4/T5)

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2
Q
  1. Where is the thymus located? Is it a primary or secondary organ, and what type?
  2. Blood supply?
  3. Vein drainage? Pathway?
  4. Where do thymic lymphatics end?
A
  1. Primary lymphoid organ, located partially in inferior neck, and partially in superior mediastinum, and anterior to fibrous pericardium.
  2. Anterior intercostal a and mediastinal a (brr of internal thoracic a)
  3. Thymic vv, which drain into left brachiocephalic v, internal thoracic v, and inferior thyroid v
  4. End in parasternal, brachiocephalic, and tracheobronchal lymph nodes.
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3
Q

Brachiocephalic veins unite to form what? Where does this happen/

A

They form the superior vena cava, at the inferior border of R1 costal cartilage

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4
Q

Which brachiocephalic vein is longer? By how much?

A

The left is 2X longer than the right.

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5
Q

The superior vena cava drains blood to the heart from which parts of the body?

A

Head, neck, and upper limbs (everywhere above the diaphragm except heart and lungs)

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6
Q
  1. What area is the superior vena cava in?
  2. What is its location in comparison to the trachea and ascending aorta?
  3. At what level does the SVC enter the right atrium?
A
  1. It’s in the superior mediastinum, and half in the middle mediastinum.
  2. It is anterolateral to the trachea, and posterolateral to ascending aorta.
  3. Enters the atrium at the level of the third costal cartilage
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7
Q

What does the phrenic nerve pass between in the superior mediastinum? What other mediastinum does it pass through?

A

B/w mediastinal pleura and the SVC.

Later passes through posterior mediastinum

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8
Q

Where does the aortic arch start?

Where is its apex in comparison to the trachea/esophagus?

A

Posterior to 2nd sternocostal joint on the RIGHT.

Apex is to the left of them.

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9
Q

What branches come off the aortic arch, in order of proximal to distal? What does the first further branch in to, and where?

A
  1. Brachiocephalic trunk- divides into right common carotid a. and right subclavian a. at sternoclavicular jt.
  2. Left common carotid a.
  3. Left subclavian a.- has NO branches in superior mediastinum
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10
Q

What does the ligamentum arteriosum attach to? What is it a remnant of?

A

Goes from root of left pulmonary artery to the inferior aspect of the aortic arch.
Remnant of the ductus arteriosus.

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11
Q

Where does the left recurrent laryngeal start “recurring?” What does it travel between on its way back up?

A

Recurs beneath aortic arch, next to ligamentum arteriosum.

Ascends b/w trachea and esophagus.

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12
Q

Where does the right recurrent laryngeal n start recurring? Travels between what on its way up?

A

recurs around right subclavian, and ascends b/w trachea and esophagus.

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13
Q

the L/R pulmonary plexuses, L/R esophageal plexuses, and the cardiac plexus are all made up of what nerves?

A

branches/termination of the L/R vagus nerves.

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14
Q

How can you tell the phrenic nerve from the vagus nerve in the superior mediastinum?

A

The phrenic nerve courses ANTERIOR to the root of the lung.

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15
Q

Sensory and motor innervations of the phrenic nerve?

A

Motor to diaphragm

Sensory to diaphragm, pericardium and mediastinal pleura

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16
Q

How does the right phrenic nerve leave the thorax?

The left?

A

Passes through vena cava hiatus.

The left pierces the diaphragm separately.

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17
Q

The trachea is slightly to which side?

Is it part of the posterior mediastinum?

A

The right side.

NO

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18
Q

Where does the trachea bifurcate?

A

At level of sternal angle.

19
Q

Where can the thoracic duct be seen next to the esophagus, and on which side?

A

In the superior mediastinum, on the left side

20
Q

Which vertebrae is the posterior mediastinum anterior to?

A

T5-T12

21
Q

Descending (thoracic) aorta goes from what vertebrae to what vertebrae?

A

T5-T12

22
Q

Is the descending (thoracic) aorta posterior or anterior to the esophagus? Which way does the esophagus get displaced?

A

It is posterior to it. It displaces the esophagus to the right.

23
Q

Where does the descending aorta end? What does it become?

A

When it passes the diaphragm through the aortic hiatus at T12, where it becomes the abdominal aorta.

24
Q

What innervates the thoracic aorta?

A

The thoracic aorta plexus.

25
Q

Besides the aorta, what elses goes through the aortic hiatus?

A

azygous vein and the thoracic duct

26
Q

Branches of descending aorta, in descending order. What do they supply?

A
  1. Bronchial aa- 1 right, and 2 small left– supply the lungs, bronchi, lung trachea, and regional lymph nodes
  2. Posterior intercostal aa- 9 brr, from 3rd to 11th intercostal spaces
  3. Mediastinal aa- very small; regional lymph nodes and other regional structures
  4. Esophageal aa- middle 1/3 of esophagus
  5. Pericardial aa- go to the pericardium
  6. Superior phrenic a.- posterior diaphragm
  7. Subcostal a- related to/in series with posterior intercostal aa.
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27
Q

Which mediastinii does the esophagus pass through?

A

The superior and posterior.

28
Q

Esophagus penetrates the diaphragm through what? At what level?

A

Through the esophageal hiatus, at T10

29
Q

Which mediastinum is the thoracic duct in?

Where does it start in the abdomen?

A

The superior and posterior mediastinum. Starts at the cisterna chyli

30
Q

The pericardiacophrenic a and v are in which mediastinum?

A

Superior mediastinum

31
Q

What is the largest lymphatic vessel in the body?

A

The thoracic duct.

32
Q

In the posterior mediastinum, where is the thoracic duct in relation to the descending aorta and the azygos vein?

A

It is in the middle, with the desc. aorta on the left and azygos vein on the right.

33
Q

Where does the thoracic duct end, superiorly? Drains into?

A

Near junction of left internal jugular v. and left subclavian v. (drains into left subclavian)

34
Q

Right lymphatic duct drains into?

A

The right internal jugular v.

35
Q

The azygos vein usually arises from what structure? Courses superiorly in which mediastinum, next to which vertebrae? Goes it go over or under lung root? terminates where?

A

From the root of the inferior vena cava (low in abdomen). Courses in posterior mediastinum to the right of the lower 8 thoracic vertebrae. Goes over lung root, and terminates in the SVC

36
Q

The hemiazygos usually arises from what structure? Which vertebrae is it next to? What does it drain into?

A

renal vein. Next to T9-T12. Drains into azygos vein.

37
Q

Tributaries of the azygos vein? 5

A
  1. Posterior intercostal vv on right side
  2. vertebral venous plexuses
  3. mediastinal vv
  4. esophageal vv
  5. bronchial vv.
38
Q

Hemiazygos vein: When it crosses to the right side, what is it anterior/posterior to?

A

Anterior to vertebrae, posterior to esophagus, aorta, thoracic duct.

39
Q

Hemiazygos vein receives tributaries from what?

A

subcostal vv and left posterior intercostal vv.

40
Q

Accessory hemiazygos veins receive which specific tributaries? At what level does it cross over, and what does it drain into?

A

Tributaries form FOURTH TO EIGHTH intercostal spaces.

Crosses spine at T8, draining into the azygos vein.

41
Q

Posterior mediastinal lymph nodes: Receive lymph from where?

A
  1. Esophagus
  2. Post. pericardium
  3. Diaphragm
  4. Middle posterior intercostal spaces
42
Q

What nerves exist in the posterior mediastinum? 4

A
  1. Phrenic n
  2. Posterior intercostal nn
  3. Splanchnic nn
  4. Pre synaptic fibers from 5th to 12th sympathetic ganglii
43
Q

What connects somatic intercostal nn to sympathetic chain galnglia?

A

rami communicans

Block 3: Anatomy & Embryo (8 decks)

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