The Rest of the Mediastinum Picture Cards Flashcards
vagus nerve: recurrent laryngeal branches
This is a view of the posterior thorax with the spine and ribs removed. What veins are these? What do they drain?
Superior intercostal veins. They receive blood from the 2nd, 3rd, and 4th intercostal veins as well as the left bronchial veins.
Which two large veins combine in the abdomen to form the IVC? Which veins join the IVC just before it ascends through the diaphragm?
The common iliac veins combine to form the IVC. The hepatic veins join the IVC just before it ascends through the diaphragm.
What does the yellow arrow point to?
Greater splanchnic nerve
What structures do the arrows point to?
- Superior vena cava
- Azygos arch
- Azygos vein
- Accessory hemiazygos vein
- Hemiazygos vein
Remember that the hemiazygos veins are highly variable!
Name the lymph nodes.
- Paratracheal nodes
- Superior/inferior tracheobronchial nodes
- Virchow’s node (sentinel node for gastric cancer!)
- Posterior mediastinal nodes
- Superior phrenic nodes
Name the veins associated with the numbers. Number 7 isn’t a vein, but this area does have a name and an important structure drains into it.
Also:
Which brachiocephalic vein is larger in diameter? Which one is more vertical? Which internal jugular is larger?
- Right brachiocephalic vein - larger, more vertical
- Left brachiocephalic vein
- SVC
- Left internal jugular vein
- Right internal jugular vein - larger
- Inferior thyroid vein (usually there are more than 1)
- Left venous angle - thoracic duct drains into this area
What are the arrows pointing to? Why is there a big yellow square thing drawn in?
- Thoracic duct
- Cisterna chyli
- Left venous angle
The yellow square denotes the upper right quadrant of the body, which is not drained by the thoracic duct.
How can a clinician measure jugular venous pressure? What does it tell you?
Have the patient lie at a 45 degree angle and turn his/her head to the left. The path of the internal jugular vein can be seen between the sternocleidomastoid muscles. Then, put a ruler pointing upwards from the sternal angle and intersect that ruler with a straight line drawn from the highest point at the IJ vein where a pulse can be seen. It tells you the right atrial pressure.
Name the three esophageal constrictions.
Why are they clinically relevant?
- Pharyngoesophageal constriction
- Aortobronchial constriction
- Diaphragmatic constriction
These constriction points tend to slow down swallowed substances, due to smaller diameter and weaker peristalsis. This means bad things you swallow can damage these places more than other places.
Name this and what it empties into.
Azygos vein, empties into the SVC
Azygos vein
Name the arteries. There is sometimes a third branch off the brachiocephalic artery. What is it?
- Ascending aorta
- Aortic arch
- Descending aorta
- Left coronary artery
- Right coronary artery
- Brachiocephalic artery
- Right subclavian artery
- Right common carotid artery
- Left common carotid artery
- Left subclavian artery
Sometimes there is a thyroid ima artery that branches off the bottom of the brachiocephalic trunk and goes up to the thyroid.
What are these?
- Right vagus nerve
- Recurrent laryngeal nerves
- Left vagus nerve
What is the probe stuck under?
Ligamentum arteriosum
- Ascending aorta
- Aortic arch
- Descending aorta
- Brachiocephalic artery
- Right common carotid artery
- Right subclavian artery
- Left common carotid artery
- Left subclavian artery
Are there variations to the branches off the aortic arch?
Yeah
Also state what #5 does.
- Left pulmonary artery
- Left main stem bronchus
- Inferior pulmonary vein
- Descending aorta
- Left superior intercostal vein - drains 2nd, 3rd, 4th intercostal veins and the left bronchial vein
- Phrenic nerve
- Thoracic duct
- Left vagus nerve (right before the recurrent branch underneath the aorta).
- Trachea
- Right vagus nerve
- Right phrenic nerve
Esophageal plexus
