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HLB > Superior, Anterior and Posterior Mediastina > Flashcards

Superior, Anterior and Posterior Mediastina Flashcards

1
Q

insert superior mediastinum diagram

A

insert

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2
Q

Boundaries of the superior mediastinum (5):

A
  • Superiorly: is the superior thoracic
    aperture (manubrium, Rib 1, T1)
  • Inferiorly: marked by the transverse
    thoracic plane (sternal angle T4/T5)
  • Anteriorly: manubrium
  • Posteriorly: T1-T4/T5 vertebral bodies
  • Laterally: mediastinal pleura
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3
Q

Contents of the Superior Mediastinum (7):

A

Great Vessels:
- arteries: arch of aorta and branches
- veins: brachiocephalic, superior vena cava

Nerves:
- phrenic nerve
- vagus nerve

Visceral Structures:
- thymus gland (part)
- trachea
- oesophagus
- thoracic duct

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4
Q

Contents of Superior Mediastinum diagram?

A

???

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5
Q

Surface projection of the trachea, oesaphagus and the thoracic aorta

A

insert

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6
Q

Each brachiocephalic vein is formed by the union of

A

an internal jugular vein and a subclavian vein

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7
Q

Veins in the superior mediastinum

A

insert

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8
Q

The superior vena cava is formed by

A

the union of the left and right brachiocephalic veins

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9
Q

Right and Left internal jugular veins on Xray

A

insert

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10
Q

Arteries in the superior mediastinum diagram

A

insert

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11
Q

What does the brachiocephalic trunk branch into

A

the right common carotid and the right subclavian arteries

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12
Q

Chest X-Ray

A

insert

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13
Q

First Rib Fracture

A
  • combination of injuries, first rib runs under clavicle, hard to access subclavian and stop the bleeding
  • high velocity injury: 30% mortality
  • Vascular injury: subclavian artery
  • Nerve injury: brachial plexus injury
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14
Q

Ligamentum Arteriosumn (4):

A
  • embryological remnant of the ductus arteriosus: which connects the pulmonary trunk and the arch of the aorta
  • important in fetal circulation allowing blood to bypass the immature lungs
  • closes at birth and remains in the adult as a ligamentous structure ;
  • patent ductus arteriosus
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15
Q

Phrenic Nerves:

  • originates
  • enters mediastinum (which part of mediastinum)
  • right hand side runs over
  • left hand side over
  • motor supply to
  • sensory supply to
  • pain referral
A
  • originate from the anterior rami of C3,C4,C5
  • enters the superior mediastinum between brachiocephalic veins and subclavian arteries passing anterior to main bronchi (hence slightly different on both sides)
  • right hand side over pericardium
  • left hand side over the ventricles
  • motor supply of diaphragm
  • sensory supply:
    • diaphragm (central region)
    • pleura (diaphragmatic and mediastinal)
  • can refer pain:
    • irritation below diaphragm can be referred to shoulder tip
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16
Q

Vagus Nerves:

  • originates
  • enters mediastinum (which part)
  • fives rise to
  • passes into
  • right hand side close to
  • left hand side close to
A
  • cranial nerve X originate from the medulla
  • enter the superior mediastinum medial to the
    phrenic nerve and posterior to the sterno-
    clavicular joint
  • gives rise to a recurrent laryngeal branch to
    supply the larynx
  • passes into the posterior mediastinum posterior
    to the main bronchi
  • right hand side vagus nerve close to trachea
  • left hand side vagus nerve away from trachea due
    to great vessels
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17
Q

Visceral Structures: Trachea:

  • which part of the mediastinum
  • -
A
  • superior mediastinum
  • Tube C-shaped cartilage rings
  • trachealis muscle runs posteriorly
  • runs from larynx to the bronchi
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18
Q

Which part of the mediastinum is the superior vena cava located?

A

Superior mediastina

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19
Q

Which part of the mediastinum are the brachiocephalic veins found?

A

Superior mediastina

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20
Q

Which part of the mediastinum is the left common carotid artery located in? Branch of?

A
  • superior mediastina
  • arch of aorta
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21
Q

Which part of the mediastinum is the left subclavian artery located in? Branch of?

A
  • superior mediastinum
  • arch of aorta
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22
Q

3 branches of the arch of aorta:

A
  • brachiocephalic trunk
  • left common carotid artery
  • left subclavian artery
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23
Q

Visceral Structures: Oesophagus(5):

A
  • superior mediastinum
  • muscular tube
  • runs from the pharynx to the stomach
  • midline
  • beginning of arch, moves to the left,
    behind left main bronchus
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24
Q

Root of the lung is

A

a collection of structures that suspend the lungs from the mediastinum

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25
Q

Each root of the lung comprises of (6):

A
  • bronchus
  • pulmonary artery
  • pulmonary veins
  • bronchial arteries
  • pulmonary plexus of nerves
  • lymphatics
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26
Q

Relations of the root of the right lung to the mediastinum

A

insert diagram

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27
Q

What is the relation of the right subclavian artery to the right lung?

A

The right subclavian artery arches over and is related to the superior lobe of the right lung as it passes over the dome of the cervical pleura and into the axilla (superior mediastinum)

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28
Q

What is the relation of the right subclavian vein to the right lung?

A

The right subclavian vein arches over and is related to the superior lobe of the right lung as it passes over the dome of the cervical pleura and into the axilla (superior mediastinum)

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29
Q

The —— surface of the right lung lies adjacent to a number of important structures in the mediastinum and the root of the neck (1)(5):

A
  • medial surface of the right lung
  • heart
  • inferior vena cava
  • superior vena cava
  • azygous vein
  • oesophagus
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30
Q

Relations of the Left Lung Root to the mediastinum:

A

insert diagram

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31
Q

What is the relation of the left subclavian artery to the left lung?

A

arches over and is related to the superior lobe of the left dome as it passes over the dome of cervical pleura and into the axilla (superior mediastinum)

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32
Q

What is the relation of the left subclavian vein to the left lung?

A

arches over and is related to the superior lobe of the left lung as it passes over the dome of cervical pleura and into the axilla (superior mediastinum)

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33
Q

Major structure of the superior mediastinum related to the ——- surface of the left lung (1)(7):

A
  • the heart (left ventricle)
  • aortic arch
  • descending thoracic aorta
  • oesophagus
  • left subclavian artery
  • left subclavian vein
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34
Q

The —– position of the right main bronchus result in it being

A
  • vertical
  • most common site for inhaled foreign bodies
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35
Q

CT scan of main bronchi position

A

insert

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36
Q

Thoracic duct:

  • mediastinum
  • is
  • transports
  • from to
  • drains where into where
  • receives
A
  • passes through the superior and posterior mediastinum
  • transports lymph to the venous system
  • from abdomen into chest
  • drains posterior and superior mediastinum
  • drains into the confluence of the left subclavian vein and the left internal jugular vein = left venous angle
  • receives multiple branches throughout the thorax
37
Q

Oesophagus passes through which part of the mediastinum?

A
  • superior and posterior mediastinum
38
Q

Thoracic duct label on diagram

A

insert

39
Q

What occurs at the transthoracic plane?

A
  • origin and end of aortic arch
  • bifurcation of the trachea
  • at sternal angle T4/T5b
40
Q

phrenic nerve pneumonic

A

C3,4,5 keeps the diaphragm alive

41
Q

phrenic nerve diagram

A

insert

42
Q

vagus nerve diagram

A

insert

43
Q

The trachea is a very static structure.

True or False?

A

False
Mobile structure
Moves when swallowing

44
Q

Trachea and Oesophagus diagram

A

insert

45
Q

Root of the lung diagram

A

insert

46
Q

Relation of right lung root abbreviation to remember anterior structures and where does the oesophagus lie?

A

Anteriorly: veins artery bronchus
VAB
oesophagus lies directly behind the root of the lung

47
Q

Thoracic duct:

  • mediastinum
  • is
  • transports
  • receives
A
  • passes through the superior and posterior mediastinum
  • transports lymph to the venous system
  • from abdomen into chest
  • in superior mediastinum drains both posterior and superior aspect into the confluence of the left subclavian and left internal jugular vein = venous angle?
  • receives multiple branches throughout the thorax
48
Q

Anterior mediastinum diagram

A

insert

just the blue

49
Q

Boundaries of the anterior mediastinum (5):

A
  • Laterally: mediastinal pleura (part of
    parietal pleural membrane) (2
    pleura with space so lung can
    move within)
  • Anteriorly: body of sternum and the
    transversus thoracis muscles
  • Posteriorly: pericardium
  • Superiorly: continuous with the superior
    mediastinum at the level of the
    sternal angle
  • Inferiorly: diaphragm
50
Q

Thymus gland and the mediastinum location

A
  • immediately deep to the sternum in the superior and anterior mediastinum
51
Q

Thymus gland is responsible for

A
  • lymphoid organ responsible for T lymphocyte maturation
52
Q

Thymus gland: Lymph drains from

A

parasternal, brachiocephalic and tracheobronchial nodes

53
Q

Thymus gland is supplied with oxygenated blood by

A

the internal thoracic arteries

54
Q

Thymus gland after puberty

A

atrophies and is replaced with fat

55
Q

The thymus produces and secretes ——, a hormone that

A
  • thymosin
  • stimulates T cell production
56
Q

Boundaries of the posterior mediastinum

A

insert

57
Q

Boundaries of the posterior mediastinum (5):

A
  • anteriorly: posterior pericardium
  • posteriorly: vertebrae T5-T12
  • Laterally: mediastinal pleura (part of the
    parietal pleural membrane)
  • Superiorly: transverse thoracic plane T4/T5
  • Inferiorly: diaphragm
58
Q

Boundaries of the posterior mediastinum (5):

A
  • anteriorly: posterior pericardium
  • posteriorly: vertebrae T5-T12
  • Laterally: mediastinal pleura (part of the
    parietal pleural membrane)
  • Superiorly: transverse thoracic plane T4/T5
  • Inferiorly: diaphragm
59
Q

Contents of the posterior mediastinum (7):

A

Vessels:
- thoracic aorta
- azygous system of veins

Nerves:
- vagus nerve
- sympathetic trunk
- splanchinic nerves

Visceral Structures:
- oesophagus
- thoracic duct

60
Q

Thoracic Aorta:

  • which part of the mediastinum
  • location
  • oesophagus lies to the
  • terminates at
  • on right hand side
A
  • posterior mediastinum
  • descends on the left side of vertebrae T5-
    T12
  • oesophagus lies to its right
  • terminates at T12 to enter the abdomen
    through the aortic hiatus in the diaphragm
  • thoracic duct and azygous veins ascend on
    the right hand side
61
Q

Name the branches of the thoracic aorta (6):

A
  • 9 pairs of posterior intercostal (inferior)
  • subcostal artery
  • bronchial (usually paired)
  • pericardial
  • oesophageal
  • superior phrenic artery
62
Q

Branches of the thoracic aorta diagram

A

insert

63
Q

The supreme intercostal artery originates from

A

the costocervical trunk, which originates from the subclavian artery

64
Q

Azygous vein:

  • which part of mediastinum?
  • location?
  • the azygous vein arches over …
  • what drains into the azygous vein on the right
    side?
  • what drains into the azygous vein from the left
    side?
A
  • posterior mediastinum
  • located ascending to the right side of the thoracic
    vertebra
  • arches over the root of the right lung to join the
    superior vena cava
  • posterior intercostal veins, bronchial veins and
    the vertebral venous plexus drain into it
  • the hemiazygous and accessory hemiazygous
    veins drains the left side of thorax and drains
    into azygous
65
Q

Hemi-azygous veins:

  • which part of the mediastinum?
  • ascends on the
  • location of accessory hemi-azygous vein and what
    does it drain?
  • location of hemi-azygous vein and what does it
    drains?
  • both drain into
A
  • posterior mediastinum
  • ascends on the left side, posterior to the aorta
  • accessory hemi-azygous vein drains the posterior
    intercostal veins T5-T8
  • hemi-azygous vein drains the posterior intercostal
    veins T9-T11
  • both drain into the azygous vein separately
66
Q

Insert FHD diagram of azygous system

A

insert

67
Q

CT scan

A

insert

68
Q

Vagus Nerve: posterior mediasteinum:

  • originates
  • enters
  • continues
  • contributes
  • what supply?
A
  • both right and left originate from the medulla
  • enters the superior mediastinum medial to the
    phrenic nerve and posterior to the sterno-
    clavicular joint
  • continues into the posterior mediastinum
  • contributes to pulmonary, cardiac and
    oesophageal plexus
  • parasympathetic supply
69
Q

Vagus Nerve posterior mediastinum diagram:

Which part of the mediasteinum?

A

insert

70
Q

Name the structures highlighted

A

insert vagus nerve posterior mediastinum diagram

71
Q

Right mediastinum diagram

A

insert

72
Q

Left mediastinum diagram

A

insert

73
Q

Right Recurrent Laryngeal Nerve (3):

A
  • hooks under the right subclavian artery and ascends between the trachea and oesophagus
  • supplies the larynx
  • right vagus continues posterior to the right of the
    trachea, posterior to the right brachiocephalic
    vein and right lung root
74
Q

Left Recurrent Laryngeal Nerve (3):

A
  • hooks inferiorly to the aortic arch, immediately
    lateral to ligamentum arteriosum
  • ascends in groove between oesophagus and
    trachea
  • rest of the left vagus nerve runs posteriorly to the
    lung root to the oesophageal plexus
75
Q

Sympathetic Trunk:

  • which part of the mediastinum?
  • is and located
  • passes
  • carries
A
  • posterior mediastinum
  • vertical chain of sympathetic nerves running on
    either side of the vertebral column
  • sympathetic fibers pass to the pulmonary, cardiac
    and oesophageal plexus
  • afferent fibers carrying sensory information from
    the thoracic viscera
76
Q

Superficial Cardiac Plexus diagram

A

insert

77
Q

deep cardiac plexus diagram

A

insert

78
Q

Oesophagus: Posterior mediastinum:

  • descends from
  • passes
  • veers sligtly
  • pierces
  • three constrictions
  • innervation
A
  • descends from superior mediastinum posterior to
    the trachea
  • passes posterior to the right of the aorta and
    posterior to the left atrium
  • veers slightly left before
  • piercing the oesophageal hiatus of the diaphragm
    at T10, lying anterior to the abdominal aorta
  • constricted by: arch of aorta, left main bronchus,
    diaphragm
  • innervated by vagus and sympathetic trunk via
    the oesophageal plexus
79
Q

Oesophagus diagram

A

insert

80
Q

Thoracic Duct: Posterior Mediastinum:

A
  • originates in the cisterna chyli in the abdomen L2
  • ascends through the aortic hiatus passing
    anterior to the thoracic vertebrae
  • ascends into the superior mediastinum and
    drains into the left venous angle
  • junction of the left internal jugular and subclavian
    veins
81
Q

Thoracic duct diagram

A

insert

82
Q

Lymph drainage of the body diagram

A

insert

83
Q

Why can lung cancer cause a horse voice?

A
  • lymph node enlargement due to lung
    cancer
  • puts pressure on the LEFT recurrent laryngeal nerve
84
Q

When you cough what happens?

A
  • vocal cords come together
  • pressure in trachea
  • vocal cord movement controlled by recurrent laryngeal nerves
85
Q

Left Recurrent Laryngeal Nerve diagram

A

insert

86
Q

Right Recurrent Laryngeal Nerve diagram

A

insert

87
Q

Superficial cardiac plexus lies on

A

the arch of the aorta

88
Q

Deep cardiac pleura lies on

A

bifurcation of the trachea

89
Q

Splanchnic Nerves:

A
  • greater splanchnic nerves arise from the
    sympathetic trunk and paravertebral
    ganglia at levels T5-T9
  • lesser splanchnic nerves arise from T10-
    T11
  • least splanchnic nerves arise from T12

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