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Clinical Anatomy > Superior Mediastinum > Flashcards

Superior Mediastinum Flashcards

1
Q

What is the parallel of the RML in the left lung?

A

Lingula

  • Not true lobe but region of L lung
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2
Q

How to ID abnormalities of the RML on XR?

A
  • Right heart border will be obscured on frontal view

- Heart will be obscured on lateral view but posterior is clear

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3
Q

How to ID abnormalities of the RUL on XR?

A
  • Opacity will be above the major (horizontal) fissure on frontal view
  • Same on lateral view
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4
Q

How to ID abnormalities of the RLL on XR?

A
  • Opacity in lower region w/ blunting of costophrenic angle on frontal view
  • Opacity will be in retrocardiac region on lateral view

*Check heart border to see if also possible RML

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5
Q

How to ID abnormalities of LUL on XR?

A
  • Left upper lung opacity on frontal view
  • Clear heart borders & retrocardiac region on lateral

*Lingular would cause loss of left ventricle border on both views

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6
Q

How to ID lingular abnormalities?

A
  • Lose left heart border on frontal view

- Heart is hyperdense on lateral view while retrocardiac area is clear

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7
Q

Transverse thoracic plane

A
  • Divides superior & inferior mediastinum

- Aka sternal angle

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8
Q

What divides the mediastinum into superior & inferior parts?

A

Transverse thoracic plane or sternal angle

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9
Q

What level is the transverse thoracic plane/sternal angle at?

A

T4-T5

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10
Q

What is most superficial in the superior mediastinum?

A

Remnant of thymus

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11
Q

What does the superior mediastinum containt?

A
  • Great vessels (arch of aorta, brachiocephalic trunk, left common carotid artery, left subclavian artery, SVC, R&L brachiocephalic veins, bifurcation of pulmonary trunk & roots of pulmonary arteries)
  • Trachea
  • Esophagus
  • Remnant of thymus
  • Phrenic, vagus, & LEFT recurrent laryngeal nerves
  • Cardiac plexus
  • Thoracic duct
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12
Q

Which thoracic level does the SVC form?

A

1st costal cartilage

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13
Q

Which level does the arch of the aorta form?

A

Sternal angle (T4-T5)

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14
Q

Ligamentum arteriosum

A
  • Attaches inferior part of aortic arch to superior part of left pulmonary artery
  • Remnant of ductus arteriosus
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15
Q

What ligament attaches the aortic arch to the left pulmonary artery?

A

Ligamentum arteriosum

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16
Q

Name the arteries in the superior mediastinum.

A

(Right to left)

  • Brachiocephalic trunk –> right subclavian artery + right common carotid artery
  • Left common carotid artery
  • Left subclavian artery
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17
Q

Where do the internal thoracic arteries branch from?

A

R&L subclavian arteries

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18
Q

What first branches off of the subclavian arteries?

A

Internal thoracic arteries

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19
Q

What are the internal thoracic arteries also known as?

A

Mammarian arteries

20
Q

Name the nerves in the superior mediastinum.

A
  • R&L phrenic nerves (superficial)
  • R&L vagus nerves (deep)
  • Left recurrent laryngeal nerve
21
Q

What nerve wraps around the aortic arch (behind the ligamentum arteriosum)?

A

Left recurrent laryngeal nerve

22
Q

What nerve wraps around the right subclavian artery?

A

Right recurrent laryngeal nerve

23
Q

What does the left recurrent laryngeal nerve wrap around?

A

Aortic arch

24
Q

What does the right recurrent laryngeal nerve wrap around?

A

Right subclavian artery

25
Q

What symptoms would present if the left recurrent laryngeal nerve is injured?

A

Voice hoarseness

26
Q

Damage to what nerve would present as voice hoarseness?

A

L recurrent laryngeal nerve

27
Q

What does the left vagus nerve become in relation to the esophagus?

A

Anterior vagal trunk

28
Q

What does the right vagus nerve become in relation to the esophagus?

A

Posterior vagal trunk

29
Q

Besides from direct nerve damage, what also could cause voice hoarseness?

A
  • Mass in the AP window such as tumor/lymph node enlargement due to compression of L recurrent laryngeal nerve
  • Mass in the apex of the R lung due to compression of R recurrent laryngeal nerve
30
Q

What is the location of the phrenic & vagus nerves in relation to the hilum?

A
  • Phrenic anterior

- Vagus posterior

31
Q

Where does the thoracic duct empty into?

A
  • Venous system near the union of the L internal jugular & left subclavian veins
  • Aka L venous angle
  • Where L brachiocephalic vein forms
32
Q

Describe relative location of the thoracic duct.

A

Mostly travels up the R side of the body, but crosses midline to left side of the body around T4 level

33
Q

What pushes the mediastinum away from midline?

A
  • Pleural effusion

- Tension pneumothorax

34
Q

What pulls the mediastinum away from midline?

A
  • Pulmonary collapse (atelectasis)

- Pneumonectomy

35
Q

How does a tension pneumothorax differ from a plain pneumothorax?

A

It has mass effect.

36
Q

What is the cardiac plexus?

A
  • Autonomic nerve fibers supplying the heart
  • Lies anterior to bifurcation of the trachea & posterior to ascending aorta
  • Post-ganglionic sympathetic, preganglionic parasympathetic, visceral afferent fibers that extend from plexus along the coronary vessels to components of the conducting system, especially the SA node
  • Sympathetic stimulation –> inc rate/force of contractions & dilate coronary arteries
  • Parasympathetic stimulation –> slow heart rate, reduce force of contraction, constrict coronary arteries
37
Q

Origin of phrenic nerves

A

C3-C5 (anterior rami)

“C3, 4, 5, keep the diagphragm alive!”

38
Q

What do the phrenic nerves innervate?

A

Diaphragm

39
Q

Where does the vagus nerve originate?

A

Medulla of brainstem

40
Q

Where do the intercostal nerves originate?

A

T1-T11 (anterior rami)

41
Q

Where do the subcostal nerves originate?

A

T12 (anterior rami)

42
Q

Location of right vagus nerve in relation to blood vessels.

A
  • Anterior to right subclavian artery

- Posterior to R brachiocephalic vein

43
Q

Location of left vagus nerve in relation to blood vessels.

A
  • In between left common carotid & left subclavian arteries
  • Posterior to L brachiocephalic vein
44
Q

Location of phrenic nerves in relation to blood vessels.

A
  • Between subclavian arteries & brachiocephalic veins
45
Q

What is the trachea made up of?

A
  • C-shaped cartilaginous rings

- Posterior aspect is muscular

46
Q

What are the three most common areas of coronary artery occlusion?

A

1) LAD of LCA (40-50%)
2) RCA (30-40%)
3) Circumflex branch of LCA (15-20%)

Clinical Anatomy (25 decks)

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