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Gross III > Superior and Posterior Mediastinum > Flashcards

Superior and Posterior Mediastinum Flashcards

1
Q

Where is the superior mediastinum found?

A

Superior to transverse plane between the sternal angle and T4-T5 IVD

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2
Q

WHat are the contents of the superior mediastinum? (From anterior to posterior)

A
  • Thymus
  • Brachiocephalic vv and superior vena cava
  • Arch of aorta and roots of brachiocephalic trunk, left common carotid a. and left subclavian a.
  • Vagus n., phrenic n. and recurrent laryngeal nn.
  • Trachea, esophagus and thoracic duct
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3
Q

What is the thymus?

A

Bi-lobed, primary lymphoid organ located most superficially in superior mediastinum

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4
Q

Where is the thymus located?

A

Immediately posterior to manubrium, antersuperior to pericardium

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5
Q

What is the function of the thymus?

A

Site of development of T lymphocytes

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6
Q

What is the arterial supply of the thymus?

A

The internal thoracic and anterior intercostal arteries

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7
Q

What happens to the thymus after puberty?

A

It atrophies and undergoes fatty replacement

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8
Q

How many brachiocephalic veins are there?

A

Two, a right and left

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9
Q

What makes up the brachiocephalic vein?

A

Formed by the union of the internal jugular v and subclavian v.

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10
Q

What does the brachiocephalic veins drain?

A

Drain blood indirectly from head, neck and upper extremity

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11
Q

Which brachiocephalic vein is longer and by how much?

A

Left brachiocephalic v. is longer and twice as long as the right

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12
Q

Where does the left brachiocephalic vein pass in regards to the aortic arch?

A

Left brachiocephalic v. passes anterior to major branches of aortic arch

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13
Q

Where does the left brachiocephalic vein receive lymph from?

A

Thoracic duct

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14
Q

Where does the right brachiocephalic vein receive lymph from?

A

Right Lymphatic duct

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15
Q

What makes up the superior vena cava?

A

Union of right and left brachiocephalic vv.

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16
Q

At which level is the cuperior vena cava?

A

At level of 1st costal cartilage

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17
Q

Where is the superior vena cava located?

A

Located on right side of superior mediastinum

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18
Q

Where does the superior vena cava drain blood from?

A

All structures superior to the diaphragm except the heart and lungs

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19
Q

What drains into the superior vena cava?

A

Right and left brachiocephalic veins

Azygos vein via the arch of azygos vein

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20
Q

How does the arch of the azygos travel in regards to the root of the right lung?

A

Arch of azygos v. passes superior to root of right lung

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21
Q

In regards to the pericardial sac, where does the azygos vein communicate with the superior vena cava?

A

Receives azygos v. just superior to entry into pericardial sac

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22
Q

At what level does the superior vena cava drain into the right atrium?

A

Level of 3rd costal cartilage

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23
Q

Where is the aortic arch located in regards to the pulmonary arteries?

A

Located anterior/superior to right pulmonary a. and posterior to left pulmonary a.

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24
Q

What are the major branches of the aortic arch?

A

Brachiocephalic trunk (right side only)
- Divides into right common carotid a. and right subclavian a.
Left common carotid a.
Left subclavian a.

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25
Q

What does the aortic arch continue as?

A

Continues as descending thoracic aorta (in posterior mediastinum)

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26
Q

At what vertebral level does the ascending aorta become the aortic arch?

A

T4

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27
Q

At what vertebral level does the aortic arch become the descending thoracic aorta?

A

T4

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28
Q

Where is the right vagus nerve located in the superior mediastinum?

A

Located posterior to right brachiocephalic v. and anterior to right subclavian a.

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29
Q

Where does the right recurrent laryngeal nerve loop?

A

Loops posteriorly around right subclavian a.

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30
Q

What does the right recurrent laryngeal nerve ascend between?

A

Ascends between trachea and esophagus to larynx

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31
Q

What does the right recurrent laryngeal nerve innervate?

A

Innervates intrinsic muscles of larynx (except cricothyroid m.)

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32
Q

Where is the left vagus nerve located in the superior mediastinum?

A

Loops posteriorly around aortic arch, just lateral to ligamentum arteriosum

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33
Q

What does the left recurrent laryngeal nerve ascend between?

A

Ascends between trachea and esophagus to larynx

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34
Q

What does the left recurrent laryngeal nerve innervate?

A

Innervates intrinsic muscles of larynx (except cricothyroid m.)

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35
Q

What happens if both recurrent laryngeal nerves are compressed by tumors in the upper thoracic region?

A

May present as hoarseness of voice

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36
Q

Where do both vagus nerves travel in regards to the lung root?

A

Both vagus nn. pass posterior to lung root

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37
Q

What type of neurons are carried by the vagus nerve?

A

Contain presynaptic parasympathetic neurons

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38
Q

What plexi does the vagus nerve contribute to?

A

Contribute to cardiac plexus, pulmonary plexus and esophageal plexus

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39
Q

What does parasympathetic input do in the cardiac plexus?

A

Parasympathetic input slow heart rate and constricts coronary aa

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40
Q

What does parasympathetic input do in the pulmonary plexus?

A

Parasympathetic input constricts bronchioles and dilates pulmonary vessels

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41
Q

What does parasympathetic input do in the esophageal plexus?

A

Parasympathetic input increases smooth muscles activity and gland secretion

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42
Q

What do neurons in the left vagus nerve emerge from the esophageal plexus as?

A

Anterior vagal trunk

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43
Q

Where is the anterior vagal trunk found?

A

Found on anterior surface of esophagus

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44
Q

What do neurons in the right vagus nerve emerge from the esophageal plexus as?

A

posterior vagal trunk

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45
Q

Where is the posterior vagal trunk found?

A

Found on posterior surface of esophagus

46
Q

The Phrenic nerve is located between which structures?

A

Located between subclavian a. and brachiocephalic v.

47
Q

What ventral rami form the phrenic nerve?

A

C3-C5

48
Q

What type of innervation (motor or sensory) does the phrenic nerve supply?

A

Both motor and sensory

49
Q

What does the phrenic nerve innervate?

A

Thoracic diaphragm
Parietal pericardium
Mediastinal and diaphragmatic pleura

50
Q

What innervation does the phrenic nerve provide on the thoracic diaphragm?

A

Motor and sensory innervation of thoracic diaphragm

51
Q

What innervation does the phrenic nerve provide on the parietal pericardium and mediastinal and diaphragmatic pleura?

A

Sensory

52
Q

How does the phrenic nerve in regards to the lung, mediastinal pleura and parietal pericardium?

A

Passes anterior to lung root between mediastinal pleura and parietal pericardium

53
Q

What does the phrenic nerve run with?

A

pericardiacophrenic a. and v.

54
Q

What do the pericardiacophrenic a. and v. branch from/to?

A

Branches of internal thoracic a. and v.

55
Q

What do the pericardiacophrenic a. and v. supply?

A

Supplies pericardium and diaphragm

56
Q

What are the 3 regions of the inferior mediastinum?

A

Anterior
Middle
Posterior

57
Q

What does the anterior mediastinum consist of?

A

Lower part of thymic remnant

Adipose tissue

58
Q

What is contained within the anterior mediastinum?

A

Internal thoracic vessels and associated lymphatics

59
Q

What is contained in the middle mediastinum?

A

Heart
Pericardium
Roots of the great vessels

60
Q

Where is the posterior mediastinum found?

A

Located T5-T12, posterior to pericardium and between pulmonary cavities

61
Q

What are the contents of the posterior mediastinum?

A
  • Descending thoracic aorta
  • Esophagus and esophageal plexus (with anterior/posterior vagal trunks)
  • Thoracic duct and lymph nodes
  • Azygos system of veins
  • Thoracic sympathetic trunk and thoracic splanchnic nn. (not technically part of the posterior mediastinum, but in close relationship)
62
Q

Where does the descending thoracic aorta begin?

A

Continuation of aortic arch beginning at T4

63
Q

Where does the descending thoracic aorta travel?

A

Descends through thorax on left sides of T5-T12 vertebral bodies

64
Q

What does the descending thoracic aorta do in regards to the esophagus?

A

Displaces esophagus to the right

65
Q

How does the descending thoracic aorta travel in regards to the thoracic diaphragm?

A

Passes behind thoracic diaphragm via aortic hiatus

66
Q

At what vertical level is the aortic hiatus found?

A

T12

67
Q

What does the descending thoracic aorta become after the aortic hiatus?

A

Continues inferior to aortic hiatus as abdominal aorta

68
Q

What structures pass through the aortic hiatus?

A

Thoracic duct and azygos v. and the descending thoracic aorta

69
Q

What are the unpaired anterior visceral branches of the descending thoracic aorta?

A

Esophageal aa. (2-5 of these)

70
Q

What are the Paired lateral visceral branches of the descending thoracic aorta?

A

Bronchial aa. (to trachea, bronchi, lung tissue, lymph nodes)

71
Q

What are the Paired parietal branches of the descending thoracic aorta?

A

 Posterior intercostal aa.
 9 pair in 3rd-11th intercostal spaces
 Subcostal aa.

72
Q

What are the additional branches of the descending thoracic aorta?

A

Pericardial aa.
Mediastinal aa.
Superior phrenic a. (to superior surface of thoracic diaphragm)
- Anastomoses with musculophrenic and pericardiacophrenic aa.

73
Q

What is the esophagus?

A

fibromuscular tube extending from pharynx to stomach

74
Q

Where is the esophagus located in the superior aperature between T1-T4?

A

Located between trachea and T1-T4 vertebral bodies in superior mediastinum

75
Q

Where is the esophagus located in the superior aperature between T5-10?

A

Located posterior to pericardium adjacent to T5-T10 in posterior mediastinum

76
Q

What are the esophageal constrictions?

A 
Upper esophageal sphincter
Aortic arch
Left main bronchus
Thoracic diaphragm
 Constrictions are only evident during swallowing
77
Q

How does the esophagus pass through the thoracic diaphragm?

A

Via the esophagel hiatus

78
Q

What vertebral level is the esophagel hiatus found?

A

T10

79
Q

What is the thoracic duct?

A

Largest lymphatic vessel in the body

80
Q

Where is the thoracic duct located?

A

Located posterior to esophagus between descending thoracic aorta and azygos v.

81
Q

What does the thoracic duct do?

A

Drains lymph from entire body except upper right quadrant and head

82
Q

How does the thoracic duct start?

A

As the cisterna chyle at the ov

83
Q

How does the thoracic duct pass from the abdomen to the thorax?

A

Aortic hiatus (T12)

84
Q

Where does the thoracic duct ascend along and what vertebral levels does this occur?

A

T5-T12

85
Q

At what level does the thoracic duct drain?

A

T4-T5

86
Q

What does the thoracic duct drain into?

A
  • Left subclavian v. or
  • Junction between left subclavian v. and internal jugular v. (left venous angle)
  • Internal jugular v. (least common)
87
Q

What does the Azygos system of veins drain?

A

Drains the back, thoracoabdominal walls and mediastinal viscera

88
Q

What happens If the venous return from the lower body is occupled?

A

The Axygos System of veins Provides an alternate route for venous return from lower body

89
Q

What is the thoracic sympathetic trunk

A

Series of paravertebral ganglia linked by interganglionic rami
Continuous with cervical and lumbar sympathetic trunks

90
Q

Where is the thoracic sympathetic trunk located?

A

Parallels vertebral bodies bilaterally

Located peripheral to costal pleura adjacent to necks of ribs

91
Q

How is the thoracic sympathetic trunk connected to each intercostal nerve?

A

rami communicantes

92
Q

What are white ramus communicans?

A

Contains myelinated presynaptic sympathetic neurons passing from spinal cord to intercostal nn. into ganglion in sympathetic trunk

93
Q

Where are white ramus communicans found?

A

Found from T1-L2 only

94
Q

What are grey ramus communicans?

A

Contains unmyelinated postsynaptic sympathetic neurons passing from sympathetic trunk ganglion into intercostal nn.

95
Q

where are grey ramus communicans found?

A

Found at all vertebral levels

96
Q

What neurons are contained in thoracic splanchnic nerves?

A

Contain presynaptic sympathetic neurons

97
Q

True or false: The thoracic splanchnic nerves contain postganglionic symathetic neurons?

A

False, Contain presynaptic sympathetic neurons

98
Q

Does the presynaptic sympathetic neuron synapse prior to entering the thoracic splanchnic nerves?

A

Synapse occurs in prevertebral (preaortic) ganglia in abdomen

99
Q

What are the different thoracic splanchnic nerves?

A

Greater thoracic splanchnic n.
Lesser thoracic splanchnic n.
Least thoracic splanchnic n.

100
Q

Where is the greater thoracic splanchnic nerve found?

A

Presynaptic sympathetic neurons originating at T5-T9

101
Q

Where is the lesser thoracic splanchnic nerve found?

A

Presynaptic sympathetic neurons originating at T10-T11

102
Q

Where is the least thoracic splanchnic nerve found?

A

Presynaptic sympathetic neurons originating at T12

103
Q

What do the thoracic splanchnic nerves supply?

A

Supply sympathetic innervation to most abdominal viscera

104
Q

What type of afferent fibers are contained in the thoracic splanchnic nerves ?

A

Contain visceral afferents (pain) from abdominal/pelvic viscera

105
Q

What are the apertures in the diaphragm that exit the mediastinum?

A

Caval hiatus
Esophageal hiatus
Aortic hiatus

106
Q

What is the caval hiatus?

A

Most anterior aperature

107
Q

Where does the caval hiatus exit?

A

Exits from middle mediastinum at T8 vertebral level

108
Q

Where does the esophageal hiatus exit?

A

Exits from posterior mediastinum at T10 vertebral level

109
Q

What is the Aortic hiatus?

A

Most posterior aperature

110
Q

Where does the Aortic hiatus exit?

A

Descending thoracic aorta exits posterior mediastinum at T12 vertebral level

111
Q

What hiatus does the anterior and posterior vagal trunks use to exit the mediastinum?

A

Esophageal hiatus

112
Q

What hiatus does the thoracic duct and azygos vein use to enter the mediastinum?

A

Aortic hiatus

Gross III (11 decks)

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