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Thoracic Cavity Flashcards

1
Q

thoracic cavity

A

A. Three compartments; two lateral pulmonary cavities and a central mediastinum.
B. The mediastinum is not a structure it is a geographic region.
C. Contains organs involved in respiration and cardiovascular systems.

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2
Q

Mediastinum boundaries

A
  1. Superior: superior thoracic aperture
  2. Lateral: mediastinal parietal pleura
  3. Inferior: diaphragm
  4. Anterior: sternum and costal cartilages
  5. Posterior: bodies of thoracic vertebrae
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3
Q

Mediastinum divisions

A
  1. Superior Mediastinum
  2. Inferior Mediastinum
    a. Anterior mediastinum
    b. Middle mediastinum
    c. Posterior mediastinum
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4
Q

Transverse thoracic plane

A

sternal angle to the disc between TV4 and TV5. Concavity of the arch of aorta, ligamentum arteriosum, and left pulmonary artery exist here. Trachea bifurcates into right and left bronchus.

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5
Q

Superior mediastinum boundaries

A
  1. Superior: superior thoracic aperture
  2. Inferior: transverse plane passing from sternal angle to the disc between TV4-TV5, (transverse thoracic plane).
  3. Anterior: manubrium
  4. Posterior: anterior surface of vertebral bodies of TV1-TV4
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6
Q

superior mediastinum major structures

A

Thumus, Brachiocephalic veins, Superior vena cava, Aortic arch and main branches, trachea, esophagus, thoracic duct, sypmathetic trunk/ sympathetic chain ganglia, phrenic nerve, vagus nerve,

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7
Q

Thymus

A

a. Located directly posterior to manubrium.
b. Primary lymphatic organ in infants, in adults mostly replaced with fatty tissue.
c. Vascular supply – internal thoracic and inferior thyroid vessels.
d. Lymphatic drainage – parasternal and tracheobronchial nodes.
e. Innervation is mainly from the vagus nerve and sympathetic trunk (vasomotor).

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8
Q

Brachiocephalic veins

A

a. Formed posterior to sternoclavicular joint from union of subclavian and internal jugular veins (called venous angle or jugulovenous angle).
b. Left brachiocephalic vein is longer than right and travels transversely across superior mediastinum; right brachiocephalic vein descends just right of manubrium.

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9
Q

Superior vena cava

A

a. Formed from the union of the left and right brachiocephalic veins.
b. Descends to the right of the sternum from the level of the 1st costal cartilage to the 3rd costal cartilage where it enters the right atrium.

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10
Q

aortic arch and main branches

A

a. Begins at TV4/TV5 intervertebral space as a continuation of ascending aorta.
b. Arches posteriorly and to the left over the root of the left lung.
c. Ends posteriorly and to the left of midline at the TV4/TV5 intervertebral disc where it becomes the descending (thoracic) aorta.
d. 3 main branches (65% of population)
1. Brachiocephalic trunk (artery)
2. Left common carotid artery
3. Left subclavian artery
e. Ligamentum arteriosum passes from the origin of the left pulmonary artery to the arch of the aorta; represents remnant of the fetal ductus arteriosus which shunted blood from the pulmonary trunk to aorta in order to bypass the nonfunctional fetal lungs.

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11
Q

Phrenic nerve

A

a. Derived from spinal segments C3, C4, C5 (…keep the diaphragm alive)
b. Motor innervation to the thoracic diaphragm.
c. Sensory innervation to the diaphragm, mediastinal pleura, and pericardium.
d. Enters thorax from neck by passing anterior to the subclavian artery, lies on the anterior scalene muscle
e. Passes anterior to the root of the lungs

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12
Q

Vagus Nerve (Cranial Nerve X)

A

a. Enters the superior mediastinum along lateral border of common carotid arteries.
b. Passes posterior to the root of the lung.
c. Carry preganglionic parasympathetic nerve cell processes to thoracic autonomic plexuses.
d. Within superior mediastinum, the left vagus nerve gives off a left recurrent laryngeal nerve which loops underneath the arch of the aorta just lateral to the ligamentum arteriosum, then courses superiorly in the tracheo-esophageal groove to supply most of the laryngeal muscles. (Right recurrent laryngeal nerve recurs around the right subclavian artery in the root of the neck)
e. As the right and left vagus nerves approach the esophagus in the posterior mediastinum, the left vagus becomes the anterior vagal trunk and the right vagus becomes the posterior vagal trunk due to embryonic rotaion of the gut tube.
f. CLINICAL CORRELATION: Due to its position in the superior mediastinum, aortic aneurysm, bronchogenic or esophageal cancer, and/or enlargement of mediastinal lymph nodes can impinge on the recurrent laryngeal nerve and cause hoarseness due to loss of innervation to the laryngeal muscles.

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13
Q

Anterior mediastinum boundaries

A

. Boundaries

		1. Superior: transverse thoracic plane
		2. Inferior: diaphragm
		3. Lateral: mediastinal parietal pleura
		4. Anterior: posterior surface of sternum
		5. Posterior: anterior surface of pericardium
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14
Q

anterior mediastinum contents

A

Not much there. Thymus remnants, sternopericardial ligaments, fat, lymph nodes, connective tissue

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15
Q

Middle mediastinum

A

(heart and pericardial cavity)

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16
Q

posterior mediastinum boundaries

A
  1. Superior: transverse thoracic plane
  2. Inferior: diaphragm
  3. Lateral: mediastinal parietal pleura
  4. Anterior: posterior surface of pericardium
  5. Posterior: bodies of thoracic vertebrae TV5-TV12
17
Q

Esophagus

A

a. Originates at the CV6 level as a continuation of the pharynx.
b. Travels through superior mediastinum posterior and slightly left of trachea.
c. Travels right along midline through the posterior mediastinum.
d. Exits thorax through the esophageal hiatus of the diaphragm at TV10.
e. Cervical, thoracic and diaphragmatic constrictions –
CV6 pharyngoesophageal, TV4-5 aortobronchial, TV10 diaphragmatic.
f. Vascular supply – esophageal and bronchial arteries and veins.
g. Lymphatic drainage – posterior mediastinal lymph nodes

18
Q

Esophagus innervation

A
  1. Esophageal autonomic plexus – carries sympathetic and parasympathetics
  2. Sympathetic
    i. Preganglionic nerve cell bodies at T2-T6 and processes enter sympathetic chain.
    ii. Postganglionic nerve cell bodies in sympathetic chain ganglia.
    Many of these nerve cell processes travel with the cardiopulmonary splanchnic nerves; thus esophageal pain and pain from myocardial infact can present very similarly.
  3. Functions: constriction of vessel walls; decreased gland secretion.
  4. Parasympathetic – vagal fibers become plexiform around the esophagus
    a. Preganglionic nerve cell bodies in brainstem, processes travel with vagus nerve.
    b. Vagus nerve provides numerous esophageal branches.
    c. Postganglionic cell bodies in the wall of esophagus.
    d. Functions:vasodilation; increased gland secretion; and peristalsis
19
Q

Descending (thoracic) aorta

A

a. Continuation of the aortic arch at TV4/TV5 level.
b. Travels through the posterior mediastinum to the left of midline.
c. Exits thorax at TV12 through aortic hiatus of thoracic diaphragm.
d. Branches
2. Posterior intercostal (9 pair) and subcostal arteries
3. Bronchial arteries (usually 2 on left and 1 on right)
4. Esophageal arteries (3-5 unpaired branches)
5. Pericardial and mediastinal arteries (unpaired)
6. Superior phrenic arteries (1 pair)

20
Q

Major structores of the posterior mediastinum

A

Esophagus, descending (thoracic) aorta, azygos system of veins, lymphatics, thoracic splanchnic nerves

21
Q

Azygos system of veins

A

Provides collateral circulation for venous blood between the IVC and SVC. No valves– bidirectional flow.

22
Q

azygos vein

A
  1. Formed by union of right ascending lumbar and right subcostal veins.
  2. Tributaries: right posterior intercostal veins, right esophageal, bronchial, mediastinal, pericardial, hemiazygos, and accessory hemiazygos veins.
  3. Travels superiorly on the right side of the vertebral bodies, at TV4 it arches anteriorly over the root of right lung to enter the SVC.
  4. Receives tributaries from the IVC.
23
Q

hemiazygos

A
  1. Forms from union of left ascending lumbar and left subcostal veins.
  2. Receives blood from the inferior 3 left posterior intercostal veins.
  3. Travels superiorly through the posterior mediastinum to the left of midline; at about TV9 crosses the midline and joins the azygos vein.
24
Q

accessory hemiazygos

A
  1. Begins at medial end of the 4th or 5th intercostal space and descends to about TV8 where it cross the midline and joins the azygos vein.
  2. Drains left posterior intercostal veins (4 - 8).
  3. Left posterior intercostals 1- 4 drain directly into left brachiocephalic vein
25
Q

lymphatics of posterior mediastinum

A

a. Begins at LV2 level from a dilated sac called the cisterna chyli.
b. Enters thorax with aorta and ascends along midline; posterior to esophagus.
c. At TV5, crosses to the left of midline and travels in the superior mediastinum to the left of the esophagus. In the neck, the duct passes posterior to left common carotid artery and internal jugular vein to enter the venous angle thus turning lymphatic fluid to the venous circulation
d. In the thorax, the thoracic duct receives the left bronchomediastinal, left jugular, and left subclavian trunks before emptying into the venous angle.

26
Q

thoracic splanchnic nerves– headed for preaortic abdominal autonomic plexuses.

A

a. Composed of preganglionic sympathetic nerve cell processes. (Note: most other splanchnic nerves are postganglionic nerve cell processes!)
b. Greater splanchnic nerve (T5-T9)
c. Lesser splanchnic nerve (T10-T11)
d. Least splanchnic (T12)
g. Sympathetic trunk gives origin to the greater, lesser and least splanchnic nerves- preganglionic sympathetic nerves cell processes going to pre-aortic sympathetic ganglia

27
Q

thoracic duct

A

main lymphatic drainage for 3/4 of the body, goes to left jugulovenous angle.

28
Q

cisterna chyle

A

at LV2, drains pelvis, lower extremity, abdomen lymphatics to thoracic duct.

29
Q

Greater splanchnic nerve cord levels

A

T5-T9

30
Q

Lesser splanchnic nerve cord levels

A

T10-11

31
Q

Least splanchnic nerve cord level

A

T12

CV (15 decks)

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