Thoracic-Abdominal Wall Circulation

Question 1

Where does the Internal Thoracic/Mammary Artery run?

Answer 1

Between the Internal Intercostal muscles and the Transversus Thoracis

Question 2

Where do the Anterior Intercostal Arteries and Posterior Intercostal Arteries Anatamose?

Answer 2

1. PIAs from Highest (Superior) Intercostal Artery: Lateral Wall
2. PIAs from Descending Aorta: Anterior Wall (b/c PIAs from Aorta much larger than AIAs)

Question 3

Where does the Superior Epigastric Artery run?

Answer 3

Between the Rectus Abdominus and the Posterior layer of the Rectus Sheath

Question 4

Where does the Superior Epigastric Artery Anastamose with the Inferior Epigastric Artery?

Answer 4

At the level of the Umbilicus

Question 5

Where does the Musculophrenic Artery Anastamose with the Deep Circumflex Iliac Artery?

Answer 5

At the level of the Umbilicus

Question 6

Where does the External Iliac Artery Split into the Inferior Epigastric Artery and the Deep Circumflex Iliac Artery?

Answer 6

Just superior to the Inguinal Ligament

Question 7

Where does the Internal Thoracic/Mammary Artery split into the Musculophrenic Artery and the Superior Epigastric Artery?

Answer 7

At the level of the Xiphisternal Junction

Question 8

Where does the Musculophrenic Artery Run?

Answer 8

Between the Transverse Abdominus and the Internal Oblique

Question 9

What are the Alternative Routes of circulation in someone with Aortic Coarctation?

Answer 9

1. ITA to AIAs to PIAs
2. ITA to MPA to AIAs to PIAs
3. Axillary Artery branches to PIAs

Question 10

How would Aortic Coarctation be manifested in a patient?

Answer 10

High BP in the Common Carotid Artery, Axillary Artery, etc.

Question 11

What are the exceptions to the general circulation pattern of the veins vs. arteries in the Thoracic Abdominal Wall?

Answer 11

1. The Highest (Superior) Intercostal Vein drains directly into the Subclavian Vein (No Costocervical Trunk)
2. The Internal Thoracic Vein drains directly into the Brachiocephalic Vein

Question 12

What is the Parent of the Azygous Vein?

Answer 12

The most superior lumbar veins

Question 13

What does the Azygous Vein Drain?

Answer 13

The Posterior Thoracic Wall and superior posterior abdominal wall

Question 14

What does the Posterior Superior Intercostal Vein drain?

Answer 14

The Upper 3 Posterior Intercostal Spaces

Question 15

What are the options for the drainage of the Right Upper 3 Posterior Intercostal Veins?

Answer 15

1. Right Highest (Superior) Intercostal Vein to the Right Subclavian Vein
2. Right Posterior Superior Intercostal Vein to the Azygous Vein and then, posteriorly and superiorly to the root of the lung, to the SVC

Question 16

What are the Options for the Drainage of the Hemiazygous Vein?

Answer 16

1. Cross over Vertebrae Anteriorly to the Azygous Vein

2. Connect to the Left Posterior Superior Intercostal Vein to the Left Brachiocephalic Vein

Question 17

What are the Options for the drainage of the Left Upper 3 Posterior Intercostal Veins?

Answer 17

1. Left Highest (Superior) Intercostal Vein to the Left Subclavian Vein
2. Left Posterior Superior Intercostal Vein between the Phrenic and Vagus Nerves and arching over the Arch of the Aorta to the Left Brachiocephalic Vein

Question 18

Where does the Left Posterior Superior Intercostal Vein run?

Answer 18

Between the Phrenic and Vagus Nerves and then arches over the arch of the Aorta to the Brachiocephalic Vein

Question 19

Where does the Sternopericardial (Pericardiophrenic) Vein drain?

Answer 19

Received by the Left Posterior Superior Intercostal Vein as it connects with the Left Brachiocephalic Vein

Question 20

Where does the Inferior Thyroid Vein Drain?

Answer 20

Into the Left Brachiocephalic Vein

Question 21

Where does the Azygous vein drain?

Answer 21

Posterior and superior to the root of the lung to the SVC

Question 22

What is a plexus of vertebral veins?

Answer 22

Batson’s plexus

Question 23

What is the Parent of the Sternopericardial/Pericardiophrenic Artery?

Answer 23

Internal Thoracic Artery

Question 24

What is the Parent of the Pericardial Arteries?

Answer 24

The Descending Aorta