HSF - Anatomy Mediastinum
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76 terms
Terms | Definitions |
|---|---|
 divisions of mediastinum | superior (above IV disc between T4 and T5) inferior (below IV disc between T4 and T5) |
| superior mediastinum boundaries | a: manubrium sterni p: T1-T4 vertebrae L: mediastinal and apical pleura |
| inferior mediastinum boundaries | A: body of sternum and xiphoid process P: T5-T12 vertebral bodies Lateral: Mediastinal pleura Lower: diaphragm |
| divisions of inferior mediastinum | anterior, middle, posterior |
| Contents of superior mediastinum | • thymus • R & L brachiocephalic veins • SVC • Arch of Aorta and branches - brachiocephalic trunk - L common carotid artery - L subclavian artery) • trachea and bifurcation • esophagus • thoracic duct • R and L phrenic and vagus nerves • sympathetic chains |
| Right and Left brachiocephalic veins | formed by union of internal jugular and subclavian vein behind sternoclavicular joint |
| left brachiocephalic vein runs | obliquiely downards to right and lies immediately behind manurbium sterni |
| thoracic duct entry into left brachiocephalic vein at | junction between left internal jugular and left subclavian veins |
| right lymphatic duct drains | into R brachiocephalic vein atformation of the vein |
| SVC formed by | right and left brachiocephlaic veins |
| SVC formed behind | right first costal cartilage |
| SVC opens into | right atrium |
| SVC opens into RA at | behind right 3rd costal cartilage |
| Azygos vein drains into | drains into SVC |
| Arch of Aorta | • in superior mediastinum • behind lower half of manubrium stern • forms impression above hilum of left lung • important for bone marrow biopsy sternal puncture • seen as aortic knuckle in plain x ray |
| branches of aorta | Brachiocephalic trunk L common carotid L subclavian arteria thyroidea ima - (may arise from brachiocephalic trunk too) |
| Ligamentum Arteriosum | remnant of ductus arteriosus; connects Arch of aorta to LEFT PULMONARY artery; left recurrent laryngeal nerve hooks below it |
| Descending Aorta | in posterior mediastinum • passes through aortic opening at T12 vertebral level |
| branches of descending aorta | • posterior intercostal arteries 3-11 intercostal spaces • subcostal artery • bronchial arteries • esophageal arteries • superior phrenic arteries |
| path from ascending aorta | brachiocephalic trunk (right carotid, right subclavian); left carotid, left subclavian, descending aorta |
| Anterior mediastinum contents (2) | thymus gland, sternopericardial ligaments |
| thymus gland | active lymphatic organ in first 5-6 years in maturation of T lymphocytes, atrophies after puberty and replaced by fat |
| Superior and Inferior sternopericardial ligaments | fibrous connective tissue connecting body of sternum to pericardium |
| Middle mediastinum contents: | pericardium, heart and roots of great vessels, right and left bronchi, pulmonary arteries, pulmonary veins, Right and Left phrenic nerves |
| R and L phrenic nerves roots | from ventral rami of C3-5, pierce diaphragm to supply diaphragm from below |
| Phrenic nerves area of supply | diaphragm motor (phrenic); sensory (central portion of diaphragm by phrenic and peripheral part by T7-T12 spinal nerves; sensory pericardium, mediastinal pleura, central part of diaphragmatic pleura, peritoneum (abdominal cavity pleura) on diaphragm |
| diaphragm referred pain to | shoulder |
| pericardiacophrenic artery origin | as branches of Internal thoracic artery |
| pericardiacophrenic veins | drain into brachiocephalic vein or internal thoracic vein |
| Phrenic nerve | runs with pericardiacophrenic vessels |
| Mediastinal structures | Phrenic Nerves and pericardiacophrenic vessels • vagus nerves (PS branches to thoracic and some abdominal viscera) • Ligamentum arteriosum (left recurrent laryngeal nerve hooks below it) |
| left recurrent laryngeal nerve | hooks below ligamentum arteriosum |
| right recurrent laryngeal nerve | hooks below right subclavian artery (not seen) |
| posteior mediastinum contents | • esophagus • descending thoracic aorta • R and L vagus nerves • L recurrent laryngeal • sympathetic chain and branches • thoracic duct • posterior intecostal vessels • intercostal nerves • azygos and hemiazygos system of veins • mediastinal lymph nodes and areaolar tissue |
| Sympathetic chain and branches | greater, lesser and least splancnic nerves |
| esophagus | • muscular tube in neck superior and posterior mediastinum • continuation of pharynx and lower border of cricoid cartilage / C6 vertebra passes through diaphragm at T10 vertebral level • related to LA • enlargement of LA from mitral stenosis can be diagnosed by barium swallow |
| barum swallow | to detect LA enlargement from mitral stenosis |
| Esophageal Hiatus | T10 vertebra level • trasnmits esophagus, L and R vagus nerves, esophageal branches of left gastric vessels |
| hiatal hernia | stomach enters chest through esophageal hiatus, sliding hernia, rolling hernea |
| constrictions of esophagus | • at beginning opposite C6 Vertebram 6" from incisor teeth • by arch of aorta opposite T3 Vertbera 9" from incisor teeth • by left principal bronchus opposite T5 vertebra 11" from incisor teeth • at esophageal hiatus, opposite T10 vertebra 16" from incisor teeth |
| Innervation of esophagus | esophageal plexus by branches of sympathetic ganglia and vagus nerves, supply smooth muscles of lower 2/3rd of esophagus |
| esophageal plexus | formed by L vagus nerve passing in front of esophagus and R vagus nerve passing behind esophagus |
| R and L vagus nerves thru esoph hiatus | enter abdomen and supply abdominal viscera |
| Thoracic Duct area of drainage | • lower limbs • abdomen and pelvis • left upper limb (let subclaian trunk) • left side of head and neck ( left jugular trunk) • left side of chest cavity (left bronchomediastinal trunk) |
| Thoracic Duct | lymphatic channel with multiple valves giving it beaded appearance |
| contents of thoracic duct | lymph is milky full of chylomicrons (fat) from intestines |
| Beginnning of thoracic duct | cisterna chyli |
| path of thoracic duct | begins at cisterna chili, enters posterior mediastium behind esophagus through aortic opening at T12 vertebral level, passes through superior mediastinum and into neck, opens to let brachiocephalic vein at jan of let internal jugular vein and left subclavian vein |
| chylothorax | laceration of thoracic duct |
| Right lymphatic duct area of drainage | right subclavian trunk from upper limb • right jugular trunk from right side of head and neck • right bronchomediastinal trunk from right side of chest cavity |
| drainage of right lymphatic duct | right brachiocephalic vein at jan between right internal jugular vein and right subclavian vein |
| Aortic opening at | T12, arota thoracic duct and azygos vein |
| Posterior Intercostal veins | first posterior intercostals drain into brachiocephalic vein directly |
| superior intercostal vein | formed by 2,3,4 posterior intercostal veins, drains into brachiocephalic vein on left, azygos on right |
| azygos vein | right 5-11 posterior intecostal veins and subcostal vein drain into azygos vein, also hemiazygos vein and accessory hemiazygos vein. Azygos vein itself drains into SVC. |
| hemiazygos vein | receives blood from lower left 3-4 (9-11) posterior intercostal veins and subcostal vein |
| accessory hemiazygos vein | Left 5-6-7-8 posterior intercostal veins drain into it |
| Azygos vein | connects SVC and IVC, formed by subcostal vein with ascending lumbar vein |
| azygos vein path | passes through aortic opening in diaphragm, ascends up posterior mediastinu and drains into SVC |
| Veins draining into azygos vein | hemiazygos, accessory hemiazygos vein, formed by joining of subcostal vein with ascending lumbar vein, right superior intercostal, right 4-11 posterior intercostal veins |
| Thrombosis of SVC and IVC | azygos, hemiazygos, and accessory hemiazygos veins become engorged and form alternate routes of drainage |
| Sympathetic chain | contains 12 thoracic sympathetic ganglia made of postganglionic sympathetic neurons |
| Communicantes | white rami (preganglionic sympathetic) and grey rami (postganglionic sympathetic that connect with spinal nerves from sympathetic chain |
| postganglionic sympathetic branches to | cardiac plexus, pulmonary plexus and esophageal plexus |
| preganglionic branches | greater, lesser and least splanchnic nerves pass through diaphragm to supply abdominal viscera |
| greater splanchnic nerve | preganglionic sympathetic nerve rivers from T5-9 sympathetic ganglia |
| lesser splanchnic nerve | preganglionic sympathetic fibers from T10-11 sympathetic ganglia |
| Least splanchnic nerve | preganglionic sympathetic fibers from T12 sympathetic ganglion |
| Thoracoabdominal diaphragm openins | cavil opening, esophageal opening, aortic opening, |
| 2 parts of diaphragm | muscular and central tendon |
| aortic opening of diaphragm | T12 • aorta • thoracic duct • azygos vein |
| esophageal opening of diaphragm | T10 • esophagus • R & L vagus nerves • branches of left gastric vessels |
| cavil opening of diaphragm | T8 • inferior vena cava • branches of right phrenic nerve |
| motor nerve supply of diaphragm | phrenic |
| sensory nerve supply of central diaphragm | phrenic |
| sensory nerve supply of peripheral diaphragm | ventral rami of lower 6 Thoracic nerves |
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