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anatomy of the thorax > superior mediastinum > Flashcards

superior mediastinum Flashcards

1
Q

what is the mediastinum

A

midline partition that separates thee pleural cavities

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2
Q

where is the mediastinum

A

from the superior thoracic aperture to inferior thoracic aperture
between sternum anteriorly and thoracic vertebrae posteriorly

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3
Q

what happens at the superior thoracic cavity

A

airways enter and vein drains back to the heart

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4
Q

what is the role of the mediastinum

A

acts as a conduit for structures that pass through thorax and structures that connect thoracic organs to other body structures
2 way conduit - head and neck to chest cavity and in reverse
airway from superior to carina to lungs pharynx opening in nasal cavities through thorax and to abdomen, nerve control heart and lung from brain into pericardium and airways

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5
Q

what does a PA x ray mean

A

x ray go through back of body and detector is at the front

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6
Q

why is a PA x ray done

A

PA/AP give different size of organs
heart is anterior - if PA short distance to detector - little dispersion
if AP - big distance to detector= large dispersion

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7
Q

components of the mediastinum

A

trachea - C6-T4/5 from larynx to bifurcation into principle bronchi
oesophagus - from pharynx, muscular tube, pierce diaphragm T10
heart and pericardium
thoracic duct - lymphatic drainage (remove interstitial fluid and involved in metastatic disease)
nerves and great vessels

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8
Q

what is the larynx

A

air way in throat

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9
Q

what structures pass through the diaphragm and where

A

T8 - inf V C
10 - oesophagus
12 - aorta

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10
Q

what do 8 10 12 relate to in the chest

A

pleural cavity

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11
Q

what does 6 8 10 levels relate to in the chest

A

level lungs

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12
Q

where is the superior mediastinum

A

above sternal angle

from superior thoracic aperture

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13
Q

where is the inferior mediastinum

A

below sternal angle

above inferior thoracic aperture

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14
Q

what 3 parts make up the inferior mediastinum

A

middle
anterior
posterior

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15
Q

middle mediastinum

A

has pericardial sac and heart

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16
Q

anterior mediastinum

A

anterior to heart

small

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17
Q

posterior mediastinum

A

behind pericardial sac and diaphragm
has nerves of SNS and veins that drain chest from abdomen to heart
has everything that moves from superior to inferior

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18
Q

what are the contents of the superior mediastinum

A 
thymus - immunologically active, replaced by fat 
phrenic nerves - contract diaphragm and provide sensation for pericardium and peritoneal lining (under diaphragm)
great veins 
main lymphatic trunk 
vagus nerves
great arteries
trachea and main  bronchi 
upper oesophagus
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19
Q

what are the great veins

A

superior vena cava (enter RA from above)

inferior vena cava (enter RA from below - through the central tendon of diaphragm T8!)

20
Q

describe the superior vena cava in situ

A

offset to the R
formed by the union of R and L brachiocephalic veins
brachiocephalic vein forms internal jugular veins (drain head) and subclavian veins (drain arms)

21
Q

what is the path of the L brachiocephalic vein

A

crosses at sternoclavicular joint, and manubrium and 1st rib posterior to manubrium to reach R brachiocephalic vein to form the SVC
the veins move anterior to the arteries

22
Q

describe the azygous vein

A

asymmetric
largest on R
anterior intercostal vessels drained into internal thoracic vessels
drains posterior wall of thorax and abdomen
hemiazygos and accessory hemiazygos on L - drain chest wall
arches over the R lung root
runs behind SVC carrying deoxygenated blood
drains into the superior VC

23
Q

inferior vena cava in situ

A

little in thorax
goes straight into the RA
most is in the abdomen

24
Q

where does the L superior intercostal vein drain into

A

brachiocephalic vein

25
Q

arteries in superior mediastinum

A

ascending aorta - come superior from the heart
arch of aorta - move superiorly, laterally and down
descending aorta - down back, diaphragm and to abdomen at T12

26
Q

ascending aorta

A

R and L coronary arteries
supply heart muscle with the most oxygenated blood
terminal arteries
may need bypass (from leg vein)

27
Q

aortic arch

A

brachiocephalic trunk - R common carotid and R subclavian arteries
L common carotid
L subclavian artery - under clavical - to axilla and upper limbs

28
Q

relation of aortic arch to pulmonary branch

A

anterior

29
Q

relation of aorta nad arteries to airways

A

aortic arch anterior to trachea
arches over L main bronchus at lung root
trachea is behind and between the brachiocephalic and L common carotid arteries
azygous vein runs along the back of the chest - arch over airways over lung root into back of superior vena cava

30
Q

explanation of the points components pass through diaphragm

A

aorta almost vertical at the back - pass more posteriorly and so at a lower vertebral level than oesophagus and IVC
then oesophagus
than IVC

31
Q

distribution of the common carotid arteries

A

divide into internal and external carotids high in the neck at laryngeal prominence
they are the main arteries of the head and neck - with vertebral arteries from subclavian arteries)
internal supply brain

32
Q

pulmonary trunk

A

outflow of the R ventricle
deox blood via L and R pul arteries to the lungs
1st travels backwards behind the arch - emerge to L of aorta from RV

33
Q

when listen to aorta you listen

A

to R of sternum

34
Q

when listen to pulmonary artery you listen

A

L of sternum

35
Q

pulmonary trunk

A

from RV
deox blood to lung
divide into L and R pul arteries

36
Q

describe the remnant of fetal circulation in the pulmonary trunk

A

remnant of the ductus arteriosus - vessel from pul trunk to aorta to bypass lungs - blood into the systemic system
this closes off - forms ligamentum arteriosum

37
Q

where are the phrenic nerves formed

A

in cervical p5 plexus - C3, 4 5

38
Q

what do the phrenic nerves do

A

they are motor to the diaphragm
sensory to- central tendon of diaphragm, mediastinal pleura, pericardium, peritoneum of central diaphragm - innervate underside of the diaphragm

39
Q

C3 4 5 …. (rhyme)

A

keeps diaphragm alive

40
Q

what does the R phrenic nergve lie on top of to reach the diaphragm

A

R brachiocephalic vein
SVC
R side of heart and pericardium - in front of the lung root

41
Q

what is the effect of damage to the laryngeal nerves

A

change voice

need to know about the difference in length

42
Q

why is the point of the ligamentum arteriosum anatomically important

A

nerves emerging from neck winds round here and goes back towards the neck
from vagus nerve
2 small branches - recurrent laryngeal nerves, 1 winds round here other around R subclavian artery on the R side
discrepancy in length

43
Q

describe the relations of the great arteries to main nerves

A

vagus nerves are lateral to the common carotid
left vagus - anterior to the aortic arch
left phrenic crosses vagus to cross the aortic arch anteriorly
vagus is behind the lung root
R phrenic is in front of the lung, runs right next to the SVC - down pericardium through diaphragm - innervates other side

44
Q

describe the path of the left phrenic and vagus nerves

A

cross arch of aorta
left phrenic decends in front of lung root
L vagus - behind the lung root - gives off L recurrent laryngeal nerve - recurs around ligamentum arteriosum and aortic arch
break into many branches round oesophagus forms oesophageal nerve and through diaphragm at T10 with oesophagus

45
Q

path of the R vagus nerve

A

lies on the trachea
crosses behind the root lung
recurrent laryngeal branch recurs around R subclavian artery
breaks up into branches on the oesophagus

anatomy of the thorax (14 decks)

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