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Thorax Anatomy Flashcards

1
Q

Borders of the superior thoracic aperture

A
  • Posterior = body of T1
  • Lateral = medial border of 1st rib
  • Anterior = manubrium
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2
Q

Borders of the inferior thoracic aperture

A
  • Posterior = body of T12
  • Posterolateral = rib 12 and distal end of rib 11
  • Anterolateral = distal ends of ribs 7-10 and costal cartilage
  • Anterior = xiphoid process
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3
Q

Characteristics of a thoracic vertebrae

A
  • Heart-shaped body
  • Long spinous process
  • Circular foramen
  • Broad lamina
  • Flat superior articular surfaces
  • Club-shaped transverse processes
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4
Q

What are the true ribs and why

A
  • Ribs 1-7

- Articulate with the sterum directly

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5
Q

What are the false ribs and why

A
  • Ribs 8-10

- Articulate anteriorly with the costal cartilage of the ribs above

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6
Q

What are the floating ribs and why

A
  • Ribs 11 and 12

- Free anteriorly

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7
Q

List the 3 articulations of ribs 2-9

A
  • Superior costal facet (with head of its own rib)
  • Inferior costal facet (with head of rib below)
  • Transverse costal facet (with tubercle of its own rib)
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8
Q

Describe the posterior formation of a typical rib

A
  • Head - expanded with two articular facets
  • Neck - separates head from tubercle
  • Tubercle
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9
Q

Which rib border contains the costal groove

A

Inferior border

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10
Q

Describe the scalene tubercle of the 1st rib

A
  • Two grooves present on superior surface
  • Anterior caused by subclavian vein
  • Posterior by subclavian artery and lowest trunk of brachial plexus
  • Functions as attachment of scalenus anterior
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11
Q

What structures are attached to the 1st rib

A
  • First digitation of serratus anterior

- Sibson’s fascia to inner border

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12
Q

Fracture of which ribs risk splenic trauma

A

9-11

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13
Q

Why does rib notching occur in coarctation of the aorta

A
  • Collateral vessels develop above and below the blockage
  • Superior intercostal artery supplies blood to intercostal arteries of aorta to bypass blockage
  • Intercostal vessels dilate and erode the lower border of the ribs
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14
Q

Compromise caused by cervical rib

A
  • Post-stenotic dilatation of the subclavian artery
  • Subclavian aneurysm
  • Subclavian vein thrombosis
  • C8/T1 paraesthesia
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15
Q

Which costal cartilages articulate with the manubrium

A

First and upper parts of sternum

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16
Q

What is the angle of Louis

A

Articulation between body of sternum and manubrium

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17
Q

Anatomical relations of the manubrium

A
  • Anterior boundary of superior mediastinum
  • Lowest part related to arch of aorta
  • Left brachicephalic artery and vein, left common carotid, left subclavian
  • Laterally to pleura
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18
Q

Which ribs does the body of the sternum articulate with

A

Contains facets for ribs 2-7 (demifacets for 2 and 7)

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19
Q

What type of cartilage is costal cartilage

A

Hyaline

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20
Q

Describe the costovertebral joints

A
  • Facets of the rib head with facets of the vertebrae above and below
  • Contain two synovial compartments divided by the intra-articular ligament
  • It is a synovial plane joint
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21
Q

Describe the costotransverse joints with its ligaments

A
  • It is a synovial plane joint
  • Between rib tubercle and transverse process of corresponding vertebrae
  • Costotranverse ligament
  • Lateral costotransverse ligament
  • Superior costotransverse ligament
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22
Q

Describe the sternocostal joints

A
  • Between rib and sternum
  • 1st is a primary cartilaginous jount (symphysis)
  • 2nd to 7th are plane synovial joints
  • Joint between 2nd rib and sternum has two compartments separated by an intra-articular ligament
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23
Q

What type of joint is the manubriosternal joint

A

Secondary cartilaginous joint (symphysis)

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24
Q

Outline the 3 muscles contained within the intercostal spaces

A
  1. External intercostal - fibres pass downwards. Most active on INSPIRATION. Moves ribs superiorly.
  2. Internal intercostal - fibres pass backwards. Most active on EXPIRATION. Moves ribs inferiorly.
  3. Innermost intercostals - may cover more than one intercostal space
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25
Innervation of the 3 layers of intercostal muscles
All are innervated by the intercostal nerves of T1-11
26
Describe the subcostal muscles
- Same plane as innermost intercostals - Span multiple ribs - Extend from innermost surface of one rib to internal surface of next
27
Describe the transversus thoracis muscles
- Found on deep surface of anterior thoracic wall - Same plane as innermost intercostals - Originate from xiphoid process, inferior part of body of sternum, adjacent costal cartilages of lower true ribs - Pass superiorly and laterally to insert into costal cartilages of ribs 3-6
28
List the order of the neurovascular bundle from superior to inferior
- V = intercostal vein - A = intercostal artery - N = intercostal nerve
29
Origin of the posterior intercostal arteries
- Upper two = supreme intercostal, branch of costocervical branch of subclavian - Lower nine = posterior surface of thoracic aorta
30
Origin of the anterior intercostal arteries
Directly or indirectly as lateral branches of the internal thoracic arteries
31
Describe the course of the internal thoracic artery
- Branch of subclavian - Passes anteriorly over dome of pleura and through superior thoracic aperture - Descends down deep aspect of thoracic wall 1cm lateral to the sternum - Divides into superior epigastric and musculophrenic artery at level of 6th intercostal space
32
What artery supplies the intercostal spaces below the 6th rib
Musculophrenic artery
33
Describe the course and distribution of the anterior intercostal arteries
- Supply the upper 6 ribs - Have two branches: 1. Passes below margin of upper rib in subcostal groove 2. Passes above margin of lower rib to meet collateral branch of posterior intercostal
34
Outline the venous drainage of the intercostal spaces
1. Intercostal veins 2. Azygous vein posteriorly or internal thoracic veins anteriorly 3. Internal throacics drain into brachiocephalic and azygous drain into SVC
35
What supplies sensory innervation to the skin overlying the upper thoracic wall
Cutaneous branches of the supraclavicular plexus which descends from the cervical plexus
36
Origin of the subcostal nerve
Anterior ramus of T12
37
List the 3 divisions of the muscular diaphragm
1. Sternal part 2. Costal part 3. Lumbar part
38
Attachment of the sternal part of the diaphragm
Xiphoid process
39
Attachment of the costal part of the diaphragm
Internal surfaces of the inferior 6 costal cartilages and their adjoining ribs and forms the domes of the diaphragm
40
Constituents of the lumbar part of the muscular diaphragm
1. Medial arcuate ligament 2. Lateral arcuate ligament 3. Three superior lumbar vertebrae
41
Describe the medial arcuate ligament
- Condensation of fascia over psoas major - Spans between lumbar vertebral bodies and tip of L1 transverse process - Medial borders join over aorta to form median arcuate ligament
42
Origin of the right crus
Front of the bodies of L1-3 and their discs
43
Origin of the left crus
L1-2
44
Contents of the aortic opening
1. Abdominal aorta 2. Thoracic duct 3. Azygous vein
45
Level of aortic opening
T12
46
Site of aortic opening
Behind medial arcuate ligament
47
Contents of oesophageal opening
1. Oesophagus 2. Vagus nerve 3. Branches of the left gastric artery and veins
48
Level of the oesophageal opening
T10
49
Contents of the caval opening
1. IVC | 2. Right phrenic nerve
50
Level of the caval opening
T8
51
Describe the sternocostal triangle of the diaphragm
- Situated between sternal and costal attachments of the diaphragm - Transmits lymphatic vessels and superior epigastric vessels
52
Arterial supply of the superior surface of the diaphragm
- Superior phrenic arteries from thoracic aorta - Musculophrenic arteries - Pericardiophrenics
53
Arterial supply of the inferior surface of the diaphragm
Inferior phrenic arteries from the abdominal aorta
54
Venous drainage of the superior surface of diaphragm
Musculophrenic and pericardiphrenic veins drain into the internal thoracic veins
55
Venous drainage of the inferior surface of the diaphragm
- Right inferior phrenic vein drains into IVC | - Left inferior phrenic vein drains into IVC and suprarenal vein
56
Lymphatic drainage of superior surface of diaphragm
In order of flow: 1. Diaphragmatic nodes 2. Phrenic nodes 3. Parasternal nodes and posterior mediastinal nodes
57
Lymphatic drainage of inferior surface of diaphragm
Superior lumbar lymph nodes
58
Motor innervation of the diaphragm
Phrenic (C3-5)
59
Sensory innervation of the diaphragm
- Centrally = phrenic | - Peripherally = intercostal nerves (T5-11) and sub-costal (T12)
60
Describe the bucket-handle action of the ribs
Raising of ribs 4-7 increases the transverse diameter of the thorax
61
What is the pulmonary ligament
Fold of loose pleura below the root of the lung which permits distension of the pulmonary vein
62
List the 3 parts of the parietal pleura
1. Costal 2. Mediastinal 3. Diaphragmatic
63
What separates the costal parietal pleura from the thoracic wall
Endothoracic fascia
64
Where does the parietal pleura reflect to become visceral pleura
Root of the lung
65
What connects the diaphragmatic parietal pleura to the muscular part of the diaphragm
Phrenicopleural fascia
66
Describe the pleural cupula
Dome of cervical pleura at the apex of the lung - reinforced by Sibson's fascia (suprapleural membrane) that attaches to the internal borders of the 1st rib and transverse process of C7
67
Features of the costal surface of the lung
- Large, smooth and convex - Related to the costal pleura - Posterior part is related to the bodies of the thoracic vertebrae
68
Features of the mediastinal surface of the lung
- Concave | - Inclusive of the hilum
69
Features of the diaphragmatic surface of the lung
- Base of the lung | - Concave
70
Describe the anterior border of the lung
- Meeting of the costal and mediastinal surfaces anteriorly | - Indented by the cardiac notch on the left
71
Describe the inferior border of the lung
Circumscribes the diaphragmatic surface and separates it from the mediastinal and costal surfaces
72
Describe the posterior border of the lung
Meeting of the costal and mediastinal surfaces posteriorly
73
When during gestation is the diaphragm formed
Between 5th and 7th weeks
74
What is the diaphragm formed from embryologically
Progressive fusion of the septum transversum, pleuroperitoneal folds, and lateral muscular ingrowth
75
What is the origin of the central tendon of the diaphragm
Septum transversum
76
Which lung is larger
Right
77
Outline the structure of the right lung
- Three lobes = superior, middle, inferior - Two fissures = right oblique, horizontal - Mediastinal surface contains groove for oesophagus and cardiac impression
78
Outline the structure of the left lung
- Two lobes = superior and inferior - One fissure = left oblique - Infero-anterior tongue-like projection = lingula - Anterior border contains cardiac notch - Contains continuous groove for arch and descending aorta
79
Describe the structure of the lung root
1. Pulmonary artery - superior left 2. Superior pulmonary vein - anterior-most 3. Inferior pulmonary vein - inferior-most 4. Main bronchus - against and in the middle of the posterior boundary
80
Level of carina
Lower border of T4 (transverse thoracic plane)
81
Structure of the trachea
- Fibroelastic tissue and U-shaped cartilaginous rings that are open posteriorly - Trachealis (smooth muscle) connects the edges - Lined by columnar epithelium containing numerous goblet cells
82
Length of right main bronchus
2.5cm
83
Anatomical relations of the right main bronchus
- Passes down/lateral and behind the ascending aorta and SVC - Azygous vein arches over it to enter SVC - Pulmonary artery lies first below and then anterior
84
Course and divisions of right main bronchus
- Passes down/lateral and behind the ascending aorta and SVC - Gives off the upper lobe bronchus before entering the lung - Divides into middle and lower lobe bronchi within the lung
85
Length of left main bronchus
5cm
86
Course of left main bronchus
- Passes down and lateral below the arch of aorta - Passes in front of the oesophagus and descending aorta - Pulmonary artery lies first anterior to and then above the bronchus
87
List the order of bronchus division
1. Main bronchus 2. Lobar bronchi 3. Segmental bronchi (to bronchopulmonary segments) 4. Conducting bronchioles 5. Terminal bronchioles 6. Respiratory bronchioles 7. Alveolar ducts 8. Alveolar sacs 9. Alveoli
88
How many bronchopulmonary segments are there
10
89
What must a bronchopulmonary segment have
Its own: - Segmental bronchus - Segmental artery - Segmental vein
90
Outline the course of de-oxygenated blood from the heart to the alveoli
1. Right ventricle 2. Pulmonary trunk 3. Right and left pulmonary arteries 4. Lobar arteries 5. Tertiary segmental arteries
91
What is the orientation of the pulmonary arteries to their corresponding bronchus
Artery is usually anterior
92
Course of the right pulmonary artery
- Passes in front of oesophagus - Behind ascending aorta and SVC - Divides into three branches
93
Course of the left pulmonary artery
- Connected at its origin to the arch of aorta by the ligamentum arteriosum - Runs in front of left main bronchus and descending aorta
94
Which pulmonary vein does blood from the middle lobe drain into
Inferior pulmonary vein
95
Describe the route of oxygenated blood from the lungs to the heart
1. Superior and inferior pulmonary veins | 2. Left atrium
96
Outline the bronchial blood supply
Bronchial arteries are branches of the thoracic aorta (two left, one right)
97
Outline the venous drainage of the bronchial tree
- Bronchial veins drain blood proximally near the hilum (remainder drained by pulmonary veins) - Right bronchial vein drains into azygous vein - Left bronchial vein drains into the accessory hemi-azygour veins or the left superior intercostal vein
98
Innervation of the visceral pleura
Autonomic supply from branches of the vagus sensitive to stretch
99
Innervation of the parietal pleura
Somatic innervation from the intercostal nerves
100
Innervation of the diaphragmatic pleura
Phrenic nerve
101
Which parts of the pleura are sensitive to pain
- Parietal | - Diaphragmatic
102
Surface anatomy of the lower border of the lung
- 6th rib in MCL - 8th rib in mid-axillary - 10th rib at lateral border of erector spinae
103
Surface anatomy of inferior edge of pleura
Two ribs lower than the corresponding lung level
104
Anatomical relations of the hilum of the RIGHT lung
- Above = azygous vein and above this is the groove for SVC - Behind = vertical groove for oesophagus - Anterior = SVC and right atrium
105
Anatomical relations of the hilum of the LEFT lung
- Above = furrow of aortic arch and above this groove for left subclavian - Behind = groove for descending aorta
106
Describe the course of the LEFT phrenic nerve
1. Passes with IJV across anterior scalene and deep to prevertebral fascia 2. Crosses anterior to 1st part of subclavian 3. Runs posterior to subclavian vein and posterior to internal thoracic artery 4. Passes lateral to left subclavian, aortic arch and left ventricle 5. Passes anterior to root of lung 6. Pierces diaphragm alone
107
Describe the course of the RIGHT phrenic nerve
1. Passes with IJV across anterior scalene deep to preverterbal fascia 2. Crosses anterior to 2nd part of subclavian artery 3. Runs posterior to subclavian vein and posterior to internal thoracic artery 4. Runs anterior to right vagus and lateral to SVC 5. Travels to right of pericardium 6. Passes over right atrium to exit diaphragm at T8 with the vena cava
108
What plane divides the mediastinum into superior and posterior compartments
Transverse thoracic plane (T4/T5)
109
What are the further divisions of the inferior mediastinum
1. Middle mediastinum 2. Anterior mediastinum 3. Posterior mediastinum
110
What structure subdivides the inferior mediastinum
Pericardium
111
List the contents of the superior mediastinum
- SVC - Brachiocephalic veins - Arch of aorta - Thoracic duct - Trachea - Oesophagus - Thymus - Vagus nerve - Left recurrent laryngeal nerve - Phrenic nerve
112
List the contents of the anterior mediastinum
- Thymic remnants - Lymph nodes - Fat
113
List the contents of the middle mediastinum
- Pericardium - Heart - Aortic root - Arch of azygous vein - Main bronchi
114
List the contents of the posterior mediastinum
- Oesophagus - Thoracic aorta - Azygous vein - Thoracic duct - Vagus nerve - Sympathetic nerve trunks - Splanchnic nerves
115
What are the two parts that make up the pericardium
1. Fibrous pericardium | 2. Serous pericardium
116
Layers of the serous pericardium
1. Parietal | 2. Visceral (epicardium)
117
Where are the parietal and visceral layers of the serous pericardium continuous with each other
- Where the aorta and pulmonary trunks leave the heart | - Where the SVC and IVC enter the heart
118
Describe the attachments of the fibrous pericardium
- Pericardiophrenic ligament = continuous inferiorly with central tendon of diaphragm - Continuous superiorly with the tunica adventitia of the great vessels - Sternopericardial ligament = anterior attachment to posterior surface of the sternum
119
Where does the pericardial cavity lie
Between the two layers of serous pericardium (visceral and parietal)
120
Arterial supply of the pericardium
Pericardiacophrenic artery (branch of the internal thoracic artery)
121
Venous drainage of the pericardium
1. Pericardiacophrenic veins (tributaries of brachiocephalic vein) 2. Variable tributaries of the azygous vein
122
Via what nerve is pain transmitted from the pericardium
Phrenic nerve (C3-5) - referred pain felt at the top of the shoulders
123
List the 5 surfaces of the heart
1. Anterior 2. Posterior (base) 3. Inferior (diaphragmatic) 4. Right pulmonary 5. Left pulmonary
124
Contents of the anterior surface of the heart
- Right atrium - Right ventricle - Narrow strip of left ventricle
125
Contents of the base of the heart
- Left ventricle - Left atrium - Four pulmonary veins entering left atrium
126
Contents of the inferior (diaphragmatic) surface of the heart
- Right atrium - IVC entering right atrium - Lower part of ventricles
127
On the surface of the heart what demarcates the atria from the ventricles
Coronary sulcus (AV groove)
128
On the surface of the heart what demarcates the right and left ventricles
Anterior and posterior interventricular sulci
129
What forms the right heart border
Right atrium with IVC and SVC
130
What forms the inferior border of the heart
Right ventricle and apex of left ventricle
131
What forms the left border of the heart
Left ventricle and auricle of the left atrium
132
Chest wall anatomical relations of the heart
- Posterior sternum | - Medial ends of the 3rd-5th ribs on the left and their costal cartilages
133
What causes the first heart sound
Closure of the atrioventricular (mitral and tricuspid) valves
134
What causes the second heart sound
Closure of the aortic and pulmonary valves
135
What are the layers of the heart wall
1. Endocardium 2. Myocardium 3. Epicardium
136
What anchors the cardiac muscle
Cardiac fibrous skeleton
137
Internal features of right atrium
- Sinus venarum = smooth posterior aspect where vena cava and coronary sinus open - Rough anterior wall of pectinate muscles - Fossa ovalis - Crista terminalis (opening of right atrial appendage)
138
What separates the smooth and rough parts of the right atrium
- Externally = sulcus terminalis | - Internally = crista terminalis
139
Internal features of the right ventricle
- Infundibulum = outflow tract to pulmonary artery - Trabeculae carnae = muscular projections - Moderator band prevents over-expansion of the ventricle - Anterior, posterior and septal papillary muscles
140
Describe the tricuspid valve
- 3 cusps (septal, anterior, posterior) - Smooth atrial surface - Ventricular surface attached to chordae tendinae - Chordae tendinae attach to papillary muscles of the ventricular wall
141
Where does the auricle of the left atrium lie
Overlaps the commencement of the pulmonary trunk
142
Interior features of the left atrium
- Large smooth walled part - Muscular auricle of pectinate muscles - Thicker and smaller than right atrium
143
Interior features of the left ventricle
- Twice as thick as the right ventricle - Much thicker and more numerous trabeculae carnae - Papillary muscles to the chordae tendinae of the anterior and posterior mitral cusps
144
How many cusps do both the aortic and pulmonary valves have
3
145
Where are the aortic sinuses situated
Anatomical dilatation of the ascending aorta just above the aortic valve
146
Function of the aortic sinuses
They give rise to the coronary arteries
147
Where do the great, middle and small cardiac veins drain
Coronary sinus (which opens into right atrium)
148
Course of the right coronary artery
- Originates from right aortic sinus - Follows coronary sulcus between atria and ventricles - Anastomoses with circumflex and anterior IV branches of LVA
149
Distribution of the right coronary artery
- Right atrium - SAN, AVN - Posterior parts of IVS
150
Course of the right marginal artery
- Originates from RCA - Passes to inferior margin of heart and apex - Anastomoses with IV branches
151
Distribution of the right marginal artery
- Right ventricle | - Apex
152
Course of the left coronary artery
- Originates from left aortic sinus - Courses between pulmonary trunk and left atrial appendage - Runs in AV groove to give off anterior IV and circumflex branches - Anastomoses with RCA
153
Distribution of the left coronary artery
- Left atrium - Left ventricle - IVS - AV bundles
154
Course of the posterior interventricular artery
- Originates from RCA - Runs in posterior IV groove to apex - Anastomoses with anterior IV branch of LCA
155
Distribution of posterior interventricular artery
- Right ventricle - Left ventricle - Posterior 1/3rd of IVS
156
Course of the anterior interventricular artery (LAD)
- Originates from LCA - Runs in anterior IV groove to apex - Anastomoses with posterior IV branch of RCA
157
Distribution of the anterior interventricular artery (LAD)
- Right ventricle - Left ventricle - Anterior 2/3rd of IVS
158
Course of the circumflex artery
- Originates from LCA - Passes to the left in AV sulcus and runs to posterior surface - Anastomoses with RCA
159
Distribution of the circumflex artery
- Left atrium | - Left ventricle
160
Artery blocked in inferior MI
Right coronary artery
161
Artery blocked in lateral MI
Circumflex
162
Artery blocked in septal MI
LAD
163
Artery blocked in anterior MI
Right coronary artery
164
Location of the SAN
- Anterolaterally - Just deep to epicardium - At junction of the SVC and right atrium
165
Arterial supply of the SAN
SA nodal branch of RCA
166
Location of the AVN
Posteroinferior region in the interatrial septum near the opening of the coronary sinus
167
Arterial supply of the AVN
AV nodal artery (branch of the interventricular artery, branch of RCA)
168
Function of AVN
Distributes the myogenic signal from SAN through the AV bundle (bridge between atrial and ventricular myocardium)
169
Outline the innervation of the heart
- Supplied by autonomic fibres of the cardiac plexus which lies anterior to bifurcation of trachea - Sympathetics from cell bodies in the intermediolateral cell columns of T1-5/6 which send post-synaptic cardiopulmonary splanchnic nerves - Parasympathetic is via vagus nerve
170
Divisions of the left coronary artery
1. LAD 2. Circumflex 3. Left marginal
171
Superior mediastinum contents from anterior to posterior
1. Thymus 2. Great vessels (with veins anterior to arteries) 3. Trachea 4. Left recurrent laryngeal 5. Oesophagus 6. Thoracic duct and lymphatic trunks
172
Describe the thymus
- Primary lymphoid organ - Flat gland with flask-shaped lobes - After puberty it undergoes involution and is replaced primarily by fat
173
Blood supply of the thymus
Anterior intercostal and anterior mediastinal branches of the internal thoracic arteries
174
Where is the brachiocephalic vein formed and by what
- Posterior to the sternoclavicular joints | - Union of IJV and subclavian veins
175
Where do the brachiocephalic veins unite to form the SVC
Level of 1st costal cartilage
176
At what level does the SVC enter the right atrium
Level of 3rd costal cartilage
177
At what level does the azygous vein join the SVC
Transthoracic plane (T4/5)
178
Describe the course of the arch of aorta
1. Begins posterior to 2nd right sternocostal joint at the level of the sternal angle 2. Arches superiorly, posteriorly, and left anterior to right pulmonary artery 3. Turns inferior and descends posterior to left lung root 4. Becomes descending aorta at 2nd sternocostal joint
179
Describe the ligamentum arteriosum
- Connects root of left pulmonary artery to inferior surface of aortic arch - Remnant of fetal ductus arteriosus
180
What constitutes the azygous venous system
1. Azygous vein 2. Hemiazygous vein 3. Accessory hemiazygous veins 4. Left superior intercostal vein
181
Function of the azygous venous system
Drain the thoracic wall and upper lumbar region via the lumbar veins and posterior intercostal veins
182
Describe the course of the azygous vein
1. Arises from union of right ascending lumbar vein and right subcostal vein at T12 2. Enters thorax via aortic hiatus 3. Ascends on right side of vertebral bodies, arching over right main 4. Enters SVC at T4
183
What does the accessory azygous vein drain
Superior left hemithorax
184
At what level does the hemiazygous vein join the azygous vein
Crosses under oesophagus to joint at T9
185
Describe the course of the brachiocephalic trunk
- First branch of aortic arch - Arises posterior to manubrium and anterior to trachea - Posterior to left brachiocephalic vein - Divides into right subclavian and common carotid at level of SC joint
186
Outline the course of the vagus nerve
1. Exits cranium via jugular foramen 2. Descends in carotid sheath posterolateral to common carotid 3. Enters mediastinum posterior to SC joint and brachiocephalic vein 4. Right vagus enters thorax anterior to subclavian and gives off right RLN that hooks around right subclavian 5. Left vagus enters mediastinum between left common carotid and left subclavian (separated from phrenic by left superior intercostal vein). Gives of left RLN which passes inferior to arch of aorta lateral to ligamentum arteriosum
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Difference in path of phrenic and vagus nerves at lung root
- Vagus passes POSTERIOR | - Phrenic passes ANTERIOR
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Outline the course of the right phrenic nerve
1. Enters mediastinum between subclavian artery and brachiocephalic vein 2. Pass anterior to roots of the lungs 3. Passes alongside right brachiocephalic vein, SVC and pericardium over the right atrium
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Outline the course of the left phrenic nerve
1. Enters mediastinum between subclavian artery and brachiocephalic vein 2. Descends between left subclavian and left common carotid 4. Crosses the left surface of the aortic arch 5. Runs anterior to lung root 6. Descends along the fibrous pericardium superficial to the left atrium
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Vagus neck branches
- Superior and inferior cervical cardiac branches | - Right RLN
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Vagus thoracic branches
- Left RLN | - Thoracic and cardiac branches
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Histological structure of the oesophagus
1. Mucosa = non-keratinised stratified squamous epithelium 2. Submucosa = glandular tissue 3. Muscularis externa 4. Adventitia (5. Loose connective tissue outer covering in the thorax)
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Where does the thoracic aorta commence
Left side of the body of T4
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Outline the course of the thoracic aorta
1. Begins at T4 2. Descends down the left side of T5-12 (surrounded by aortic plexus) 3. Lies posterior to the root of the right lung, pericardium, oesophagus 4. Passes through aortic hiatus with thoracic duct and azygous vein on its right side
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Where is the thoracic duct situated
Lies on the anterior aspect of the bodies of the inferior 7 thoracic vertebrae
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Where does the thoracic duct conduct lymph from
- Lower limbs - Pelvic cavity - Abdominal cavity - Left upper limb - Left side of the thorax - Head and neck
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Where does the thoracic duct originate
Cisterna chyli
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Describe the course of the thoracic duct
1. Originates at cisterna chyli 2. Ascends through aortic hiatus of diaphragm 3. Ascends through posterior mediastinum - Aorta on its left - Azygous vein on its right - Oesophagus anteriorly 4. Crosses to the left under oesophagus to ascend superior mediastinum 5. Drains into venous system near union of left IJV and subclavian veins

The Thorax (5 decks)

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