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CV System > Thorax 9: Posterior Mediastinum > Flashcards

Thorax 9: Posterior Mediastinum Flashcards

1
Q

What vertebral levels define the posterior mediastinum?

A

T4/5 and posterior attachment of the diaphragm at T12

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2
Q

what are the levels that define the thoracic aorta?

A

from T4/5/angle of louis at 2nd costal cartilage to the aortic hiatus at T12

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3
Q

how does the thoracic aorta pass through the diaphragm

A

runs between the crura and behind the median arcuate ligament

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4
Q

define the relationship of the thoracic aorta to the vertebral bodies

A

initially lies on the left of vertebral bodies

moves to midline in lower thorax

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5
Q

Name the branches of the aorta

A 
posterior intercostal arteries
bronchial arteries
oesophageal arteries
subcostal arteries
small branches to diaphragm and pericardium
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6
Q

how many posterior intercostal arteries are there and what do they supply?

A

9 arteries that supply lower 9 intercostal spaces from ribs 3-11

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7
Q

what artery supplies the first 2 intercostal spaces and what does it arise from

A

superior intercostal artery arising from the costocervical trunk of the subclavian arteries

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8
Q

where do the anterior intercostals arise from?

A

internal thoracic arteries arising from the subclavian arteries

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9
Q

how many bronchial arteries are there?

A

2 left and 1 right

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10
Q

what part of the oesophagus is supplied by the thoracic aorta?

A

middle 1/3 of the oesophagus

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11
Q

what drains the part of the oesophagus supplied by the thoracic aorta?

A

azygous vein

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12
Q

what artery supplies the posterior abdominal wall

A

subcostal arteries that lie inferior to the 12th rib

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13
Q

what is the vascular supply of the superior 1/3 of the oesophagus

A

arterial from inferior thyroid arteries

venous to brachiocephalic veins

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14
Q

what is the nervous supply of the superior 1/3 of the oesophagus?

A

recurrent laryngeal nerves of the vagus nerve

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15
Q

the deep cervical nodes drain which part of the oesophagus?

A

superior 1/3

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16
Q

what part of the oesophagus is made up of striated muscle only

A

superior 1/3

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17
Q

which part of the oesophagus is made up of mixed muscle

A

middle 1/3

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18
Q

what part of the oesophagus is supplied by the oesophageal plexus?

A

middle and inferior 1/3s

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19
Q

the tracheobronchial nerves drain which part of the oesophagus?

A

middle 1/3

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20
Q

what is the vascular supply of the inferior 1/3 of the oesophagus

A

arterial - left gastric artery

venous - left gastric vein and portal vein

21
Q

what is the lymphatic drainage of the inferior 1/3 of the oesophagus?

A

coeliac nodes

22
Q

what are the relationships of the oesophagus in the superior mediastinum?

A

posterior to trachea

right of the aorta

23
Q

what are the relationships in the inferior mediastinum of the oesophagus?

A

swings forward and to the left
anterior to the aorta
leaves at T10

24
Q

what forms the cardiac sphincter?

A

the oblique entry of the oesophagus into the stomach
resting tone of smooth muscle
prevents gastric reflux

25
Q

what is significant about the submucosal veins

A

form an anastomoses between the venous drainage of the lower and middle 1/3s
connects the portal and systemic circulations

26
Q

what is the distance to the upper oesophageal sphincter and what is the anatomical landmark

A

17cm

junction of oesophagus with pharynx

27
Q

name the 4 oesophageal sphincters

A

upper oesophageal sphincter
arch of the aorta
left main bronchus
lower oesophageal sphincters

28
Q

what is the distance to the 3rd oesophageal sphincter

A

28 cm

29
Q

what is the distance to the last oesophageal sphincter

A

43 cm

30
Q

what problems are caused by the oesophageal sphincters

A

blockage more likely
passage of instruments more difficult
slow down passage of caustic substances

31
Q

what is found posterior to the oesophagus

A

thoracic duct and thoracic aorta inferiorly

32
Q

at what point does the thoracic duct cross the oesophagus

A

T4/5

33
Q

where does the thoracic duct receive lymph from?

A

left
jugular lymph trunk of head and neck
subclavian lymph trunk of upper limb
bronchomediastinal trunk of left thorax

34
Q

where are posterior mediastinal nodes found

A

behind the heart near the oesophagus

35
Q

describe the route of lymph from pulmonary nodes

A

bronchopulmonary - inferior and superior tracheobronchial - paratrancheal - bronchomediastinal lymph trunks

36
Q

describe the route of lymph from the posterior mediastinal nodes

A

paratracheal - bronchomediastinal

37
Q

which node groups drain straight into the bronchomediastinal trunks

A

parasternal/internal thoracic

anterior mediastinal

38
Q

what does the azygous vein drain

A

posterior thorax wall

39
Q

where does the azygous vein begin?

A

begins from the lumbar and subcostal veins or a direct branch of the IVC

40
Q

where does the azygous vein lie on the vertebral column?

A

midline or to the right

41
Q

where does the azygous vein join the SVC

A

2nd right costal cartilage

42
Q

what vessels does the azygous vein receive?

A

veins equivalent to branches of the descending thoracic aorta

43
Q

what are the parts of the hemiazygous veins

A

lower and upper accessory hemiazygous veins

44
Q

what is the route of the lower hemiazygous vein

A

connects with left renal vein
passes through or behind left crus of diaphragm
crosses to azygous at T9

45
Q

what is the route of the upper accessory hemiazygous vein?

A

descend from the 4th intercostal space and crosses to azygous at T8

46
Q

what can cause pain on swallowing

A

oesophageal indentations caused by arthritic osteophytes

47
Q

what causes portal hypertension

A

cirrhotic liver disease

48
Q

what causes oesophageal varices

A

escaping of blood from portal vein to azygous vein via the submucosal portosystemic anastomosesin portal hypertension

49
Q

what is a danger of thoracic surgery

A

damage to thoracic duct
leakage of lymph
chylothorax

CV System (18 decks)

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