Thorax Flashcards
Contents of the superior mediastinum?
Superior vena cava
Brachiocephalic veins
Arch of aorta
Thoracic duct
Trachea
Oesophagus
Thymus
Vagus nerve
Left recurrent laryngeal nerve
Phrenic nerve
Contents of the anterior mediastinum?
Thymic remnants
Lymph nodes
Fat
Contents of the posterior mediastinum?
Oesophagus
Thoracic aorta
Azygos vein
Thoracic duct
Vagus nerve
Sympathetic nerve trunks
Splanchnic nerves
Contents of the middle mediastinum?
Pericardium
Heart
Aortic root
Arch of azygos vein
Main bronchi
What is the border of the superior mediastinum?
above line between manubriosternal angle and T4/5
Where is the apex of both lungs?surface anatomy
4cm superior to the sterno-costal joint of the first rib
Where is the apex of the middle right lobe?
posterior and it lies deep to the 6th rib in the mid axillary line
Anteriorly what is the middle right lobe in contact with?
5th, 6th and 7th costal cartiladges.
Where is aortic valve replacement commonly seen on Xray?
Usually located medial to the 3rd interspace on the right.
where is mitral valve replacement commonly seen on Xray?
Usually located medial to the 4th interspace on the left.
where is tricuspid valve replacement commonly seen on Xray?
Usually located medial to the 5th interspace on the right.
Left recurrent laryngeal nerve path?
Arises from the vagus on the aortic arch. It hooks around the inferior surface of the arch, posterior to the ligamentum arteriosum and passes upwards through the superior mediastinum and lower part of the neck.
It passes with the inferior thyroid artery and inserts into the larynx.
What does the left recurrent laryngeal supply?
oesophagus and trachea (supplies both).
Path of the right recurrent laryngeal?
Arises from vagus anterior to the first part of the subclavian artery, hooks under it, and ascends superomedially. It passes close to the common carotid and finally the inferior thyroid artery to insert into the larynx
Which vessel provides greatest contribution to arterial supply of the breast?
60% of the arterial supply to the breast is derived from the internal mammary artery
Nerve supply of the breast?
Branches of intercostal nerves from T4-T6.
Arterial supply of the breast?
Internal mammary (thoracic) artery
External mammary artery (laterally)
Anterior intercostal arteries
Thoraco-acromial artery
Venous drainage of the breast?
Superficial venous plexus to subclavian, axillary and intercostal veins.
Lymphatic drainage of the breast?
70% Axillary nodes
Internal mammary chain
Other lymphatic sites such as deep cervical and supraclavicular fossa (later in disease)
Constrictions of the oesophagus?
- cricoid cartilage
- arch of the aorta
- left principle bronchus
- diaphragmatic hiatus
Venous drainage of the oesophagus?
upper third - inferior thyroid
middle third - azygous branches
lower third - left gastric
Lymphatics of oesophagus?
upper third - deep cervical
middle third - mediastinal
lower third - gastric
Nerve supply of the oesophagus?
Upper half is supplied by recurrent laryngeal nerve
Lower half by oesophageal plexus (vagus)
Muscularis external of the oesophagus by each third?
upper third -striated muscle
mid third - Smooth & striated muscle
lower third - smooth muscle
What are the surface anatomy boundaries of the breast?
2nd - 6th Rib
Mid-Axillary Line
Sternum
What does the breast lie on?
deep fascia and pec major
What type of tissue is the breast?
modified sweat glands (mammary)
What is the arterial supply of the breast?
Vessels of Axillary Artery
Lateral Thoracic, Thoraco-acromial etc.
Internal Thoracic
2nd-4th IC Arteries via perforators
what is the venous drainage of the breast?
Parallels arteries into:
Axillary Vein
Internal Thoracic Vein
IC Veins
nerve innervation of breast?
Anterior/Lateral Cutaneous Branches of 2nd - 6th IC Nerves
What are the 5 groups of axillary lymph nodes?
Anterior, Posterior, Medial, Lateral, Apical
What does the RCA supply?
Right atrium
Diaphragmatic part of the right ventricle
Usually the posterior third of the interventricular septum
The sino atrial node (60% cases)
The atrio ventricular node (80% cases)
What does the LCA supply?
The LCA supplies:
Left atrium
Most of left ventricle
Part of the right ventricle
Anterior two thirds of the inter ventricular septum
The sino atrial node (remaining 40% cases)
What is the innervation of the heart?
Autonomic nerve fibres from the superficial and deep cardiac plexus
Where are the superficial and deep cardiac plexus’?
Anterior to the bifurcation of the trachea
posterior to the ascending aorta
superior to the bifurcation of the pulmonary trunk
What is the parasympathetic supply to the heart?
The parasympathetic supply to the heart is from presynaptic fibres of the vagus nerves
From which structure is the central tendon of the diaphragm derived?
septum transversum
How is the diaphragm formed in embryology?
formed between the 5th and 7th weeks of gestation through the progressive fusion of the septum transversum, pleuroperitoneal folds and via lateral muscular ingrowth
Which are the components contributing to diaphragmatic segments
Septum transversum - Central tendon
Pleuroperitoneal membranes - Parietal membranes surrounding viscera
Cervical somites C3 to C5 - Muscular component of the diaphragm
Which fascia overlies the apex of the lungs?
Sibson’s fascia
where is sibsons fascia found?
The suprapleural fascia (Sibson’s fascia) runs from C7 to the first rib and overlies the apex of both lungs.It lies between the parietal pleura and the thoracic cage.
what seperates the sternum and clavicle?
Articular disc
what are the sternoclavicular joints stabilised by?
sterno-clavicular and costoclavicular ligaments
There is fresh blood at chest drain insertion- most likely vessel?
Intercostal artery
Structures found within the right atrium?
Musculi pectinati
Crista terminalis
Opening of the coronary sinus
Fossa ovalis
