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Thorax: Mediastinum Overview Flashcards

1
Q

Mediastinum Superior Boundary

A
  • Superior thoracic aperture (thoracic inlet)
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2
Q

Mediastinum Inferior Diaphragm

A
  • Diaphragm
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3
Q

Mediastinum Anterior Boundary

A
  • Sternum and costal cartilages (costal pleura)
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4
Q

Mediastinum Posterior Boundary

A
  • Vertebral bodies of T1-12
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5
Q

Mediastinum Lateral Boundary

A
  • Mediastinal pleura
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6
Q

Transverse Thoracic Plane

A
  • Manubriosternal joint > T4/5 disc

- Divides superior (purple) and inferior (rest of the colors) mediastinum

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7
Q

Superior Mediastinum

A
  • Superior to transverse thoracic plane
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8
Q

Inferior Mediastinum

A
  • inferior to transverse thoracic plane

- Includes anterior, middle, and posterior mediastinum

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9
Q

Superior Mediastinum

A
  • Thoracic inlet to transverse thoracic plane

- Between manubrium and T1-4

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10
Q

Content of Superior Mediastinum

A
  • Thymus (most anterior)
  • Brachiocephalic veins (posterior to thymus)
  • SVC (superior portion)
  • Aortic arch
  • Brachiocephalic artery (trunk)
  • Left Subclavian artery
  • Left common carotid artery
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11
Q

Superior Mediastinum Nerves

A
  • Left and right vagus
  • Left recurrent laryngeal
  • Left and right phrenic
  • Cardiac plexuses
  • Trachea
  • Esophagus
  • Thoracic duct
  • Sternothyroid and sternohyoid muscles
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12
Q

Thymus

A
  • Lymphoid organ
  • Superior and anterior mediastinum
  • Can extend above thoracic inlet
  • Most anterior structure in the mediastinum
  • Mostly replaced by fat by adulthood
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13
Q

Trachea

A
  • Passes through thoracic inlet

- Begins and level of C6 and ends at sternal angle (not found in the inferior mediastinum)

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14
Q

Esophagus

A
  • Passes through thoracic inlet
  • Begins at level of C6, passes through diaphragm at level of T10
  • Between trachea and vertebral column
  • Also found in posterior mediastinum
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15
Q

Brachiocephalic Veins

A
  • Pass through thoracic inlet
  • Formed by union of jugular and subclavian veins (posterior to SC joint)
  • Blood from head, neck, upper extremity
  • Left is longer, more horizontal
  • Anterior to the aortic arch branches
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16
Q

Tributaries

A
  • IJV
  • Subclavian veins
  • Internal thoracic veins
  • Inferior thyroid vein(s)
  • Vertebral veins
  • Supreme (highest) intercostal vein
  • Accessory hemiazygos vein
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17
Q

Superior Vena Cava (Superior Portion)

A
  • Union of brachiocephalic veins

- Spans 1st > 3rd costal cartilage (also in the middle mediastinum)

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18
Q

Tributaries

A
  • Veins
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19
Q

Branches

A
  • Arteries
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20
Q

Azygous

A
  • Candy cane structure on the right side of the heart
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21
Q

Hemiazygous

A
  • Located on left side
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22
Q

Aorta

A
  • Ascending
  • Arch
  • Thoracic descending
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23
Q

Ascending Aorta

A
  • Middle mediastinum
  • Aortic valve to sternal angle
  • Branches: left and right coronary
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24
Q

Arch of the Aorta

A
  • Superior mediastinum
  • Begins and ends at sternal angle
  • Branches: brachiocephalic trunk, left common carotid artery, subclavian artery
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25
Thoracic Descending Aorta
- Posterior mediastinum | - Cover the branches later
26
Nerves of the Superior Mediastinum
- Vagus nerves | - Recurrent laryngeal nerves
27
Vagus Nerves
- Originate in the brainstem - Enter mediastinum posterior to the brachiocephalic vein - Medial to phrenic nerve - Enters posterior mediastinum and passes posterior to the root of the lung - Contributes fibers to the cardiac, pulmonary and esophageal plexuses - Branches in the superior mediastinum - Exit posterior mediastinum and enter abdomen through esophageal opening
28
Branches in the Superior Mediastinum
- Left recurrent laryngeal nerves | - Cardiac branches
29
Right Recurrent Laryngeal Nerve
- Loops around the right subclavian artery (not in mediastinum)
30
Left Recurrent Laryngeal Nerve
- Loops around the aortic arch | - Posterior (lateral) to the ligamentum arteriosum (remnant of fetal ductus arteriosus)
31
Left/Right Recurrent Laryngeal Nerves
- Both ascend between trachea and esophagus to innervate the larynx - Injury or compression can alter voice (hoarseness)
32
Phrenic Nerves
- Formed from C3,4,5 - Passes posterior to subclavian vein, then enters superior mediastinum - Both nerves pass through middle mediastinum and pass anterior to the root of the lung - Between mediastinal pleura and fibrous pericardium
33
Phrenic Motor Innervation
- Diaphragm
34
Phrenic Sensory Innervation
- Central diaphragm - Pericardium - Mediastinal pleura
35
Right Phrenic Nerve
- Passes over pericardium over the right atrium | - Some branches passes through caval opening on the diaphragm
36
Left Phrenic Nerve
- Travels along fibrous pericardium over the left ventricle | - Pierces diaphragm
37
Anterior Mediastinum
- Between pericardium and parietal (coastal) pleura covering sternum/transversus thoracis muscle
38
Content of Anterior Mediastinum
- Thymus (infants and children) - Fat - Lymph vessels and nodes (anterior mediastinal nodes) - Branches/tributaries of internal thoracic artery/vein - Sternopericardial ligaments
39
Sternopericardial Ligaments
- Attach from pericardium to sternum | - Pass through anterior mediastinum
40
Middle Mediastinum
- Between ant/post borders of the pericardium | - Between mediastinal pleura laterally
41
Middle Mediastinum Contents
- Pericardium - Heart - Proximal end great vessels - Phrenic nerves - Pericardiophrenic vessels
42
Pericardium
- Closed sac | - Protects heart and prevents overdistension
43
2 Layers of Pericardium
- Fibrous pericardium | - Serous pericardium
44
Fibrous Pericardium
- Tough outer layer - Attached to central tendon of the diaphragm - Blends with connective tissue of great vessels
45
Serous Pericardium
- Formed by mesothelium – secretes serous fluid - Parietal layer - Visceral layer (epicardium)
46
Parietal Layer of Serous Pericardium
- Lines inside of fibrous pericardium
47
Visceral Layer of Serous Pericardium (Epicardium)
- Covers the heart
48
Pericardial Cavity
- Potential space between serous pericardium | - Contains small amounts of fluid
49
Transverse Pericardial Sinus
- Transverse passage between outflow and inflow vessels | - Provides access to clamping the aorta and pulmonary trunk
50
Oblique Pericardial Sinus
- Blind recess posterior to the heart base (left atrium) | - Between pulmonary veins
51
Blood Supply of Pericardium
- Pericardiophrenic artery & vein (from internal thoracic) - Coronary vessels supply visceral pericardium
52
Sensory Innervation of the Pericardium
- Phrenic nerve (C3-5) | - Visceral pericardium is supplied by autonomics
53
Cardiac Tamponade
- Buildup of fluid in the pericardial space that results in the compromised ventricular filling and hemodynamic compromise - Medical emergency - Causes Beck’s triad
54
Pericardiocentesis
- Aspiration of fluid from the pericardial space | - Infrasternal angle (subxiphoid) or left sterncostal or left 5th intercostal space (parasternal)
55
Basic Anatomy of the Heart
- Left and right atria - Left and right ventricles - Left and right AV valves - Aortic and pulmonary valves
56
Great Vessels of the Heart
- Superior Vena Cava - Inferior Vena Cava - Pulmonary Trunk/Arteries - Pulmonary Veins - Aorta
57
Layers of the Heart
- Endocardium - Myocardium - Epicardium
58
Endocardium
- Endothelium
59
Myocardium
- Thick myocardial muscle
60
Epicardium
- Visceral layer of serous pericardium

Gross Anatomy (50 decks)

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