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The Thorax > Thorax Anatomy > Flashcards

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
Q

Innervation of the 3 layers of intercostal muscles

A

All are innervated by the intercostal nerves of T1-11

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26
Q

Describe the subcostal muscles

A
  • Same plane as innermost intercostals
  • Span multiple ribs
  • Extend from innermost surface of one rib to internal surface of next
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27
Q

Describe the transversus thoracis muscles

A
  • 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
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28
Q

List the order of the neurovascular bundle from superior to inferior

A
  • V = intercostal vein
  • A = intercostal artery
  • N = intercostal nerve
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29
Q

Origin of the posterior intercostal arteries

A
  • Upper two = supreme intercostal, branch of costocervical branch of subclavian
  • Lower nine = posterior surface of thoracic aorta
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30
Q

Origin of the anterior intercostal arteries

A

Directly or indirectly as lateral branches of the internal thoracic arteries

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31
Q

Describe the course of the internal thoracic artery

A
  • 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
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32
Q

What artery supplies the intercostal spaces below the 6th rib

A

Musculophrenic artery

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33
Q

Describe the course and distribution of the anterior intercostal arteries

A
  • 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
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34
Q

Outline the venous drainage of the intercostal spaces

A
  1. Intercostal veins
  2. Azygous vein posteriorly or internal thoracic veins anteriorly
  3. Internal throacics drain into brachiocephalic and azygous drain into SVC
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35
Q

What supplies sensory innervation to the skin overlying the upper thoracic wall

A

Cutaneous branches of the supraclavicular plexus which descends from the cervical plexus

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36
Q

Origin of the subcostal nerve

A

Anterior ramus of T12

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37
Q

List the 3 divisions of the muscular diaphragm

A
  1. Sternal part
  2. Costal part
  3. Lumbar part
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38
Q

Attachment of the sternal part of the diaphragm

A

Xiphoid process

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39
Q

Attachment of the costal part of the diaphragm

A

Internal surfaces of the inferior 6 costal cartilages and their adjoining ribs and forms the domes of the diaphragm

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40
Q

Constituents of the lumbar part of the muscular diaphragm

A
  1. Medial arcuate ligament
  2. Lateral arcuate ligament
  3. Three superior lumbar vertebrae
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41
Q

Describe the medial arcuate ligament

A
  • 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
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42
Q

Origin of the right crus

A

Front of the bodies of L1-3 and their discs

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43
Q

Origin of the left crus

A

L1-2

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44
Q

Contents of the aortic opening

A
  1. Abdominal aorta
  2. Thoracic duct
  3. Azygous vein
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45
Q

Level of aortic opening

A

T12

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46
Q

Site of aortic opening

A

Behind medial arcuate ligament

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47
Q

Contents of oesophageal opening

A
  1. Oesophagus
  2. Vagus nerve
  3. Branches of the left gastric artery and veins
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48
Q

Level of the oesophageal opening

A

T10

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49
Q

Contents of the caval opening

A
  1. IVC

2. Right phrenic nerve

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50
Q

Level of the caval opening

A

T8

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51
Q

Describe the sternocostal triangle of the diaphragm

A
  • Situated between sternal and costal attachments of the diaphragm
  • Transmits lymphatic vessels and superior epigastric vessels
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52
Q

Arterial supply of the superior surface of the diaphragm

A
  • Superior phrenic arteries from thoracic aorta
  • Musculophrenic arteries
  • Pericardiophrenics
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53
Q

Arterial supply of the inferior surface of the diaphragm

A

Inferior phrenic arteries from the abdominal aorta

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54
Q

Venous drainage of the superior surface of diaphragm

A

Musculophrenic and pericardiphrenic veins drain into the internal thoracic veins

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55
Q

Venous drainage of the inferior surface of the diaphragm

A
  • Right inferior phrenic vein drains into IVC

- Left inferior phrenic vein drains into IVC and suprarenal vein

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56
Q

Lymphatic drainage of superior surface of diaphragm

A

In order of flow:

  1. Diaphragmatic nodes
  2. Phrenic nodes
  3. Parasternal nodes and posterior mediastinal nodes
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57
Q

Lymphatic drainage of inferior surface of diaphragm

A

Superior lumbar lymph nodes

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58
Q

Motor innervation of the diaphragm

A

Phrenic (C3-5)

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59
Q

Sensory innervation of the diaphragm

A
  • Centrally = phrenic

- Peripherally = intercostal nerves (T5-11) and sub-costal (T12)

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60
Q

Describe the bucket-handle action of the ribs

A

Raising of ribs 4-7 increases the transverse diameter of the thorax

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61
Q

What is the pulmonary ligament

A

Fold of loose pleura below the root of the lung which permits distension of the pulmonary vein

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62
Q

List the 3 parts of the parietal pleura

A
  1. Costal
  2. Mediastinal
  3. Diaphragmatic
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63
Q

What separates the costal parietal pleura from the thoracic wall

A

Endothoracic fascia

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64
Q

Where does the parietal pleura reflect to become visceral pleura

A

Root of the lung

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65
Q

What connects the diaphragmatic parietal pleura to the muscular part of the diaphragm

A

Phrenicopleural fascia

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66
Q

Describe the pleural cupula

A

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

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67
Q

Features of the costal surface of the lung

A
  • Large, smooth and convex
  • Related to the costal pleura
  • Posterior part is related to the bodies of the thoracic vertebrae
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68
Q

Features of the mediastinal surface of the lung

A
  • Concave

- Inclusive of the hilum

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69
Q

Features of the diaphragmatic surface of the lung

A
  • Base of the lung

- Concave

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70
Q

Describe the anterior border of the lung

A
  • Meeting of the costal and mediastinal surfaces anteriorly

- Indented by the cardiac notch on the left

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71
Q

Describe the inferior border of the lung

A

Circumscribes the diaphragmatic surface and separates it from the mediastinal and costal surfaces

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72
Q

Describe the posterior border of the lung

A

Meeting of the costal and mediastinal surfaces posteriorly

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73
Q

When during gestation is the diaphragm formed

A

Between 5th and 7th weeks

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74
Q

What is the diaphragm formed from embryologically

A

Progressive fusion of the septum transversum, pleuroperitoneal folds, and lateral muscular ingrowth

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75
Q

What is the origin of the central tendon of the diaphragm

A

Septum transversum

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76
Q

Which lung is larger

A

Right

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77
Q

Outline the structure of the right lung

A
  • Three lobes = superior, middle, inferior
  • Two fissures = right oblique, horizontal
  • Mediastinal surface contains groove for oesophagus and cardiac impression
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78
Q

Outline the structure of the left lung

A
  • 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
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79
Q

Describe the structure of the lung root

A
  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
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80
Q

Level of carina

A

Lower border of T4 (transverse thoracic plane)

81
Q

Structure of the trachea

A
  • 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
Q

Length of right main bronchus

A

2.5cm

83
Q

Anatomical relations of the right main bronchus

A
  • 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
Q

Course and divisions of right main bronchus

A
  • 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
Q

Length of left main bronchus

A

5cm

86
Q

Course of left main bronchus

A
  • 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
Q

List the order of bronchus division

A
  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
Q

How many bronchopulmonary segments are there

A

10

89
Q

What must a bronchopulmonary segment have

A

Its own:

  • Segmental bronchus
  • Segmental artery
  • Segmental vein
90
Q

Outline the course of de-oxygenated blood from the heart to the alveoli

A
  1. Right ventricle
  2. Pulmonary trunk
  3. Right and left pulmonary arteries
  4. Lobar arteries
  5. Tertiary segmental arteries
91
Q

What is the orientation of the pulmonary arteries to their corresponding bronchus

A

Artery is usually anterior

92
Q

Course of the right pulmonary artery

A
  • Passes in front of oesophagus
  • Behind ascending aorta and SVC
  • Divides into three branches
93
Q

Course of the left pulmonary artery

A
  • Connected at its origin to the arch of aorta by the ligamentum arteriosum
  • Runs in front of left main bronchus and descending aorta
94
Q

Which pulmonary vein does blood from the middle lobe drain into

A

Inferior pulmonary vein

95
Q

Describe the route of oxygenated blood from the lungs to the heart

A
  1. Superior and inferior pulmonary veins

2. Left atrium

96
Q

Outline the bronchial blood supply

A

Bronchial arteries are branches of the thoracic aorta (two left, one right)

97
Q

Outline the venous drainage of the bronchial tree

A
  • 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
Q

Innervation of the visceral pleura

A

Autonomic supply from branches of the vagus sensitive to stretch

99
Q

Innervation of the parietal pleura

A

Somatic innervation from the intercostal nerves

100
Q

Innervation of the diaphragmatic pleura

A

Phrenic nerve

101
Q

Which parts of the pleura are sensitive to pain

A
  • Parietal

- Diaphragmatic

102
Q

Surface anatomy of the lower border of the lung

A
  • 6th rib in MCL
  • 8th rib in mid-axillary
  • 10th rib at lateral border of erector spinae
103
Q

Surface anatomy of inferior edge of pleura

A

Two ribs lower than the corresponding lung level

104
Q

Anatomical relations of the hilum of the RIGHT lung

A
  • Above = azygous vein and above this is the groove for SVC
  • Behind = vertical groove for oesophagus
  • Anterior = SVC and right atrium
105
Q

Anatomical relations of the hilum of the LEFT lung

A
  • Above = furrow of aortic arch and above this groove for left subclavian
  • Behind = groove for descending aorta
106
Q

Describe the course of the LEFT phrenic nerve

A
  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
Q

Describe the course of the RIGHT phrenic nerve

A
  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
Q

What plane divides the mediastinum into superior and posterior compartments

A

Transverse thoracic plane (T4/T5)

109
Q

What are the further divisions of the inferior mediastinum

A
  1. Middle mediastinum
  2. Anterior mediastinum
  3. Posterior mediastinum
110
Q

What structure subdivides the inferior mediastinum

A

Pericardium

111
Q

List the contents of the superior mediastinum

A
  • SVC
  • Brachiocephalic veins
  • Arch of aorta
  • Thoracic duct
  • Trachea
  • Oesophagus
  • Thymus
  • Vagus nerve
  • Left recurrent laryngeal nerve
  • Phrenic nerve
112
Q

List the contents of the anterior mediastinum

A
  • Thymic remnants
  • Lymph nodes
  • Fat
113
Q

List the contents of the middle mediastinum

A
  • Pericardium
  • Heart
  • Aortic root
  • Arch of azygous vein
  • Main bronchi
114
Q

List the contents of the posterior mediastinum

A
  • Oesophagus
  • Thoracic aorta
  • Azygous vein
  • Thoracic duct
  • Vagus nerve
  • Sympathetic nerve trunks
  • Splanchnic nerves
115
Q

What are the two parts that make up the pericardium

A
  1. Fibrous pericardium

2. Serous pericardium

116
Q

Layers of the serous pericardium

A
  1. Parietal

2. Visceral (epicardium)

117
Q

Where are the parietal and visceral layers of the serous pericardium continuous with each other

A
  • Where the aorta and pulmonary trunks leave the heart

- Where the SVC and IVC enter the heart

118
Q

Describe the attachments of the fibrous pericardium

A
  • 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
Q

Where does the pericardial cavity lie

A

Between the two layers of serous pericardium (visceral and parietal)

120
Q

Arterial supply of the pericardium

A

Pericardiacophrenic artery (branch of the internal thoracic artery)

121
Q

Venous drainage of the pericardium

A
  1. Pericardiacophrenic veins (tributaries of brachiocephalic vein)
  2. Variable tributaries of the azygous vein
122
Q

Via what nerve is pain transmitted from the pericardium

A

Phrenic nerve (C3-5) - referred pain felt at the top of the shoulders

123
Q

List the 5 surfaces of the heart

A
  1. Anterior
  2. Posterior (base)
  3. Inferior (diaphragmatic)
  4. Right pulmonary
  5. Left pulmonary
124
Q

Contents of the anterior surface of the heart

A
  • Right atrium
  • Right ventricle
  • Narrow strip of left ventricle
125
Q

Contents of the base of the heart

A
  • Left ventricle
  • Left atrium
  • Four pulmonary veins entering left atrium
126
Q

Contents of the inferior (diaphragmatic) surface of the heart

A
  • Right atrium
  • IVC entering right atrium
  • Lower part of ventricles
127
Q

On the surface of the heart what demarcates the atria from the ventricles

A

Coronary sulcus (AV groove)

128
Q

On the surface of the heart what demarcates the right and left ventricles

A

Anterior and posterior interventricular sulci

129
Q

What forms the right heart border

A

Right atrium with IVC and SVC

130
Q

What forms the inferior border of the heart

A

Right ventricle and apex of left ventricle

131
Q

What forms the left border of the heart

A

Left ventricle and auricle of the left atrium

132
Q

Chest wall anatomical relations of the heart

A
  • Posterior sternum

- Medial ends of the 3rd-5th ribs on the left and their costal cartilages

133
Q

What causes the first heart sound

A

Closure of the atrioventricular (mitral and tricuspid) valves

134
Q

What causes the second heart sound

A

Closure of the aortic and pulmonary valves

135
Q

What are the layers of the heart wall

A
  1. Endocardium
  2. Myocardium
  3. Epicardium
136
Q

What anchors the cardiac muscle

A

Cardiac fibrous skeleton

137
Q

Internal features of right atrium

A
  • 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
Q

What separates the smooth and rough parts of the right atrium

A
  • Externally = sulcus terminalis

- Internally = crista terminalis

139
Q

Internal features of the right ventricle

A
  • 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
Q

Describe the tricuspid valve

A
  • 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
Q

Where does the auricle of the left atrium lie

A

Overlaps the commencement of the pulmonary trunk

142
Q

Interior features of the left atrium

A
  • Large smooth walled part
  • Muscular auricle of pectinate muscles
  • Thicker and smaller than right atrium
143
Q

Interior features of the left ventricle

A
  • 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
Q

How many cusps do both the aortic and pulmonary valves have

A

3

145
Q

Where are the aortic sinuses situated

A

Anatomical dilatation of the ascending aorta just above the aortic valve

146
Q

Function of the aortic sinuses

A

They give rise to the coronary arteries

147
Q

Where do the great, middle and small cardiac veins drain

A

Coronary sinus (which opens into right atrium)

148
Q

Course of the right coronary artery

A
  • Originates from right aortic sinus
  • Follows coronary sulcus between atria and ventricles
  • Anastomoses with circumflex and anterior IV branches of LVA
149
Q

Distribution of the right coronary artery

A
  • Right atrium
  • SAN, AVN
  • Posterior parts of IVS
150
Q

Course of the right marginal artery

A
  • Originates from RCA
  • Passes to inferior margin of heart and apex
  • Anastomoses with IV branches
151
Q

Distribution of the right marginal artery

A
  • Right ventricle

- Apex

152
Q

Course of the left coronary artery

A
  • 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
Q

Distribution of the left coronary artery

A
  • Left atrium
  • Left ventricle
  • IVS
  • AV bundles
154
Q

Course of the posterior interventricular artery

A
  • Originates from RCA
  • Runs in posterior IV groove to apex
  • Anastomoses with anterior IV branch of LCA
155
Q

Distribution of posterior interventricular artery

A
  • Right ventricle
  • Left ventricle
  • Posterior 1/3rd of IVS
156
Q

Course of the anterior interventricular artery (LAD)

A
  • Originates from LCA
  • Runs in anterior IV groove to apex
  • Anastomoses with posterior IV branch of RCA
157
Q

Distribution of the anterior interventricular artery (LAD)

A
  • Right ventricle
  • Left ventricle
  • Anterior 2/3rd of IVS
158
Q

Course of the circumflex artery

A
  • Originates from LCA
  • Passes to the left in AV sulcus and runs to posterior surface
  • Anastomoses with RCA
159
Q

Distribution of the circumflex artery

A
  • Left atrium

- Left ventricle

160
Q

Artery blocked in inferior MI

A

Right coronary artery

161
Q

Artery blocked in lateral MI

A

Circumflex

162
Q

Artery blocked in septal MI

A

LAD

163
Q

Artery blocked in anterior MI

A

Right coronary artery

164
Q

Location of the SAN

A
  • Anterolaterally
  • Just deep to epicardium
  • At junction of the SVC and right atrium
165
Q

Arterial supply of the SAN

A

SA nodal branch of RCA

166
Q

Location of the AVN

A

Posteroinferior region in the interatrial septum near the opening of the coronary sinus

167
Q

Arterial supply of the AVN

A

AV nodal artery (branch of the interventricular artery, branch of RCA)

168
Q

Function of AVN

A

Distributes the myogenic signal from SAN through the AV bundle (bridge between atrial and ventricular myocardium)

169
Q

Outline the innervation of the heart

A
  • 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
Q

Divisions of the left coronary artery

A
  1. LAD
  2. Circumflex
  3. Left marginal
171
Q

Superior mediastinum contents from anterior to posterior

A
  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
Q

Describe the thymus

A
  • Primary lymphoid organ
  • Flat gland with flask-shaped lobes
  • After puberty it undergoes involution and is replaced primarily by fat
173
Q

Blood supply of the thymus

A

Anterior intercostal and anterior mediastinal branches of the internal thoracic arteries

174
Q

Where is the brachiocephalic vein formed and by what

A
  • Posterior to the sternoclavicular joints

- Union of IJV and subclavian veins

175
Q

Where do the brachiocephalic veins unite to form the SVC

A

Level of 1st costal cartilage

176
Q

At what level does the SVC enter the right atrium

A

Level of 3rd costal cartilage

177
Q

At what level does the azygous vein join the SVC

A

Transthoracic plane (T4/5)

178
Q

Describe the course of the arch of aorta

A
  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
Q

Describe the ligamentum arteriosum

A
  • Connects root of left pulmonary artery to inferior surface of aortic arch
  • Remnant of fetal ductus arteriosus
180
Q

What constitutes the azygous venous system

A
  1. Azygous vein
  2. Hemiazygous vein
  3. Accessory hemiazygous veins
  4. Left superior intercostal vein
181
Q

Function of the azygous venous system

A

Drain the thoracic wall and upper lumbar region via the lumbar veins and posterior intercostal veins

182
Q

Describe the course of the azygous vein

A
  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
Q

What does the accessory azygous vein drain

A

Superior left hemithorax

184
Q

At what level does the hemiazygous vein join the azygous vein

A

Crosses under oesophagus to joint at T9

185
Q

Describe the course of the brachiocephalic trunk

A
  • 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
Q

Outline the course of the vagus nerve

A
  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
187
Q

Difference in path of phrenic and vagus nerves at lung root

A
  • Vagus passes POSTERIOR

- Phrenic passes ANTERIOR

188
Q

Outline the course of the right phrenic nerve

A
  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
189
Q

Outline the course of the left phrenic nerve

A
  1. Enters mediastinum between subclavian artery and brachiocephalic vein
  2. Descends between left subclavian and left common carotid
  3. Crosses the left surface of the aortic arch
  4. Runs anterior to lung root
  5. Descends along the fibrous pericardium superficial to the left atrium
190
Q

Vagus neck branches

A
  • Superior and inferior cervical cardiac branches

- Right RLN

191
Q

Vagus thoracic branches

A
  • Left RLN

- Thoracic and cardiac branches

192
Q

Histological structure of the oesophagus

A
  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)
193
Q

Where does the thoracic aorta commence

A

Left side of the body of T4

194
Q

Outline the course of the thoracic aorta

A
  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
195
Q

Where is the thoracic duct situated

A

Lies on the anterior aspect of the bodies of the inferior 7 thoracic vertebrae

196
Q

Where does the thoracic duct conduct lymph from

A
  • Lower limbs
  • Pelvic cavity
  • Abdominal cavity
  • Left upper limb
  • Left side of the thorax
  • Head and neck
197
Q

Where does the thoracic duct originate

A

Cisterna chyli

198
Q

Describe the course of the thoracic duct

A
  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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