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What is the dividing line for the mediastinum
An imaginary line passing from the sternal angle to the lower border of the 4th thoracic vertebrae
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In the inferior mediastinum, what are the borders of the Anterior end
- Sternum (anterior)
- Anterior wall of the pericardium (posterior)
- Diaphragm (inferior)
- Imaginary line (superior)
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In the inferior mediastinum, what are the borders of the middle mediastinum
- Anterior and posterior wall of pericardium
- Imaginary line (superior)
- Diaphragm
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In the inferior mediastinum, what are the borders of the posterior mediastinum
- Posterior pericardial wall (anterior)
- T5-T12 vertebrae (posterior)
- Imaginary line (superior)
- Diaphragm (inferiorly)
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Thyomoma
A mass in the mediastinum that originates from the epithelial cell population in the thymus
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Germ cell tumors in the mediastinum are usually located where
Anterior mediastinum
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Where does the arterial supply and venous drainage to the thymus originate
- Branches of the internal thoracic arteries
- Internal thoracic and inferior thyroid to the brachiocephalic
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Where are the brachiocephalic veins, and what veins merge to make it
- Posterior to the sternoclavicular joints
- Formed by the union of the internal jugular and subclavian veins
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How can the recurrent laryngeal nerve be used as an important landmark
It travels directly under the aorta inferior to the ligamentum arteriosum
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What nerve passes behind the brachiocephalic veins
Vegus nerve
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What does the blood from all of the structures from above the diaphragm drain into (besides the heart and lungs)
Superior vena cava
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The superior vena cava ends at what costal landmark
3rd costal cartilage on the right side where it enters the right atrium
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Superior vena cava syndrome
- Compression of the vena cava by enlarged structures
- Symptoms include adema in the arm and face, enlarged neck veins, and difficulty breathing
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What often happens to the circulation around the superior vena cava when its syndrome exists
Collateral circulation forms with the Azygos, Internal thoracic, Lateral thoracic, and esophageal veins
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What is significant about the covering of the ascending portion of the aorta
It is covered in pericardium
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Why is the distal ascending aorta subject to aneurysms
Because it is not reinforced by fibrous pericardium
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What symptoms would follow an aortic aneurysm in the distal part of the ascending aorta
Compression of the trachea and esophagus causing difficulty breathing and swallowing
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Where does the ascending part of the aorta begin in respect to the ribs
Posterior to the right 2nd sternocostal joint
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Where is the descending part of the aorta located in respect to the vertebrae
Left side of the 4th thoracic vertebrae
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What are the branches of the aortic arch first to last
- Brachiocephalic trunk
- Left common carotid art.
- Left subclavian art.
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Retroesophageal Right Subclavian artery
- Artery crosses posterior to esophagus to reach the right upper limb
- May compress esophagus
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Dysphagia
Difficulty swallowing
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What does the left vegus nerve give rise to from superior to inferior
- Part of the cardiac plexus
- Recurrent laryngeal nerve
- Right pulmonary plexus
- Esophogeal plexus
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The left vegas nerve passes the aorta and and lung how
Over the arch of the aorta and posterior to the root of the lung
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Where is the cardiac plexus
On the anterior surface of the tracheal bifurcation
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The cardiac plexus is formed by what type of nerve fibers
Both sympathetic and parasympathetic
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What nerves feed the SA an AV nodes
Post ganglionic sympathetic fibers from the cardiac plexus
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What is located on the right side of the trachea
- Azygos vein
- Right vegus nerve
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What structures are located anterior to the trachea
- Left brachiocephalic vein
- Arch of aorta
- Origins of left common carotid and brachiocephalic art.
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What is located on the left side of the trachea
- Arch of aorta
- Left common carotid art.
- Subclavian art.
- Left vegus and phrenic nerves.
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The esophagus enters the superior mediastinum between what structures
Trachea and vertebral column
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What external landmark can be used to identify the the bifurcation of the trachea
Sternal angle
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What structures are located just anterior to the esophagus
- Trachea
- Left recurrent laryngeal nerve
- Left principle bronchus
- Left atrium
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The thoracic duct enters the venous drainage where
At the junction of the internal jugular and subclavian veins
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What structures are located just posterior to the esophagus
- Thoracic duct
- Azygos vein
- Right posterior intercostal arteries
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What is located directly to the left side of the esophagus
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What is Esophageal Diverticula, and what are the three types
- Sac or pouch arising from the esophagus
- Hypopharyngeal (pouching at pharyx/esophagus)
- True traction (protrusion at all wall layers)
- False pulsion (herniation of the mucosa and submucosa in weak spots)
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The descending aorta lies posterior to
- Root of left lung
- Pericardium
- Esophogus
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The aorta enters the abdomen by passing through the aortic hiatus at what vertebral level
12 thoracic vertebrae
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What nerve is at a high risk of being damaged in an aortic arch aneurysm and mediastinal lymph enlargement
Left recurrent pharyngeal
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Where are the posterior mediastinal lymph nodes located
Around the esophagus and thoracic aorta
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Where do the mediastinal lymph get feeds from
- Esophagus
- Posterior pericardium
- Diaphragm
- Middle posterior intercostal spaces
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Where is lymph drained from the mediastinal lymph
Thoracic duct or right lymphatic duct
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The azygos vein creates a collateral circulation between what important veins
SVC and IVC
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How far does the hemiazygos vein extend vertically
T9 vertebrae
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The thoracic duct carries lymph from what areas
- Lower limb
- Pelvic cavity
- Abdominal cavity
- Upper left limb
- Left side of the thorax, head and neck
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Chylothorax
Leakage of thoracic duct in the thoracic cavity
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Thoracic splanchnic nerves contain presynaptic nerve fibers from
5th through 12th sympathetic ganglia
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The posterior and anterior esophageal plexus are formed by what nerves
- Right vegus (Posterior)
- Left vegus (Anterior)
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Inferiorly the anterior esophageal plexus forms
Anterior vegal trunk
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Posteriorly, the posterior esophageal plexus forms the
Posterior vegal trunk
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