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62 Cards in this Set
- Front
- Back
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Mediastinum
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central compartment, highly mobile
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divisions of mediastinum
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Superior/ Inferior (anterior, middle, posterior)
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contents of superior mediastinum
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thymus, veins, arteries, trachea, esophagus, lymphatics, nerves
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transverse thoracic plane
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sternal angle to T4
divides mediastinum into superior and inferior sections |
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veins in superior mediastinum
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Superior vena cava, brachiocephalic, internal jugular
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arteries in superior mediastinum
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aorta, brachiocephalic trunk (on the right side), carotid, subclavian, internal thoracic (comes off subclavian)
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Aortic angiography
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radiographic visualization of arch of aorta by using a catheter into ascending aorta via femoral or brachial artery, and injecting a radiopaque contrast material
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nerves in the superior mediastinum
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vagus, phrenic, sympathetic chain
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phrenic nerve
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C3,4,5 - motor supply to diaphragm, sensory to pericardium, mediastinal pleura, diaphragm.
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Right phrenic nerve
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runs along SVC, against fibrous pericardium until diaphragm (near IVC)
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left phrenic nerve
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runs over arch of aorta, anterior to root of lung, into diaphragm behind apex of the heart
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vagus nerve
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CN X - supply parasym and general visceral afferent innervation of thoracic organs.
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right vagus nerve
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travels along the side of the trachea, behind the root of the lung, and onto the posterior surface of the esophagus.
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left vagus nerve
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over the arch of the aorta at the ligamentum arteriosum, behind the root of the
lung, and onto the anterior surface of the esophagus |
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azygous vein
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runs along the heads of the ribs, arches over the root of the right lung, and joins
the superior vena cava |
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hemiazygous vein
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runs up on the left along the
heads of the ribs, and crosses over to join the azygos between T5 to T8 |
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recurrent laryngeal nerve
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branch of vagus.
right - branches behind subclavian and common carotid. left - branches around ligamentum arteriosum |
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Trachea
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Anterior
Hyaline cartilage/muscle Inclines to the right Ends at sternal angle |
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esophagus
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Between trachea and vertebral bodies
Fibromuscular tube Inclines to the left Compressed by root of left lung and aortic arch |
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Anterior mediastinum contents
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Loose connective tissue
Fat Lymphatic vessels Branches of internal thoracic artery |
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middle mediastinum contents
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heart (pericardium, roots of great vessels, phrenic nerves, main bronchi)
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posterior mediastinum contents
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Descending thoracic aorta, esophagus and esophageal nerve plexus, lower thoracic splanchnic nerves, thoracic sympathetic trunks,
thoracic duct, azygos, accessory hemiazygos and hemiazygos veins |
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Thoracic aorta
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posterior to root of lung, terminates at T12, goes through aortic hiatus in the diaphragm
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aortic hiatus
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T12 - adjacent to vertebrae
aorta, thoracic duct, azygous/hemiazygous veins |
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branches of thoracic aorta
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esophageal arteries (unpaired)
paired bronchial arteries and intercostal arteries (9) |
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thoracic aortic aneurysm
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dilatation of a segment of thoracic aorta.
risk- rupture |
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causes of thoracic aortic aneurysm
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Artherosclerosis
Cystic medial necrosis Marfan syndrome Ehrlers-Danlos syndrome Pregnant women Hypertension Valvular heart disease Isolated condition Bacterial Infections Trauma Arteritis syndromes Congenital |
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thoracic splanchnic nerves
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T5-T12 These are preganglionic fibers and visceral afferent fibers to most of the abdominal organs.
greater - synapse at celiac ganglia (foregut, adrenals..) lesser - superior mesenteric ganglia (midgut) least - renal ganglia |
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esophageal plexus
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receives branches from vagus and sympathetic trunk
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esophageal hiatus
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T10 -
esophagus passes through diaphragm anterior to aorta vagal trunks and blood and lymphatics also pass through here |
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chyle cistern
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small sac lying between the aorta and the right crus
of the diaphragm. It receives lymph from all structures below the diaphragm. leads to thoracic duct |
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thoracic duct
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largest lymphatic channel of body, runs up through aortic hiatus in posterior mediastinum between azygous vein and aorta.
crosses over at T5 to left of vertebral bodies between esophagus and vertebral bodies. joins veins at left subclavian and jugular |
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function of thorax
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Protects thoracic and abdominal organs
Resists negative pressures generated by lungs during breathing Provides attachments for upper limb |
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true ribs
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1-7
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false ribs
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8-10
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floating ribs
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11-12
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costovertebral joints
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Articulations between rib and vertebra
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sternocostal joints
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Articulations between rib and sternum
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median sternotomy
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Used to gain access to thoracic cavity
Sternum split in median plane and retracted Flexibility of ribs and costal cartilage allows spreading Rejoined using wire sutures |
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thoracic apertures
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superior thoracic aperture
costal margin infrasternal (subcostal) angle - angle between the costal margins inferior thoracic aperture |
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innervation of diaphragm
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motor - phrenic
sensory - phrenic/intercostal/subcostal nerves |
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blood supply of diaphragm
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branches of the internal thoracic/thoracic aorta
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diaphragm
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Musculotendinous partition
Attaches to inferior margin of thoracic cage and superior lumbar vertebrae curves superiorly 5th rib on right, 5th intercostal space on left |
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caval opening
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T8
lymphatics and IVC |
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diaphragmatic openings
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caval, aortic, esophageal, small openings
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small openings of diaphragm
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sympathetic trunks, splanchnic nerves, blood and lymphatic vessels
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Muscles for inspiration
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pec major/minor, serratus anterior, scalene, external intercostal
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muscles for expiration
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usually do not need muscles but forced --> internal intercostal, innermost intercostal
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movement of thorax during inspiration
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diaphragm and accessory muscles
increase intrathoracic volume increase infrasternal angle increases both anterior/posterior and transverse diameter of thorax Vertical dimension also increases compressing abdominal viscera Air flows in direction of low pressure |
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movement of thorax during expiration
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Diaphragm, intercostal muscles, other muscles relax decreasing intrathoracic volume
Vertical dimension returns to neutral position Air flows in direction of low pressure |
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Dyspnea
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Difficult Breathing
Sensation of breathlessness Can be acute or chronic Cause by a myriad of factors patients prefer to sit up |
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use of accessory respiratory muscles to assist in breathing during dyspnea
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Suprasternal retractions above the clavicle and sternum
Intercostal retractions between the ribs Subcostal retractions below the lower costal margin of the rib cage Substernal retractions below the xiphoid process Compensatory respiratory mechanisms, such as nasal flaring during inspiration, grunting during expiration, or the use of accessory muscles in the neck and shoulders |
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nerves in thorax
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12 pairs of thoracic spinal nerves with mixed sensory and motor nerves formed by dorsal and ventral roots.
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anterior (ventral) rami
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T1-T11 form intercostal nerves
T12 forms subcostal nerve |
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posterior (dorsal rami)
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joints, deep back muscles, skin of the back
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herpes zoster infection
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migration of chicken pox to NS, reactivation results in migration down the sensory neurons to the skin.
pain itching and skin eruptions in the dermatome muscle weekness in the myotome treated with antivirals/steroids |
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blood supply of thorax
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thoracic aorta (posterior intercostal arteries)
Internal thoracic (anterior intercostal arteries) |
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posterior intercostal arteries
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from thoracic aorta, between innermost and internal intercostal muscles
costal grooves |
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anterior intercostal arteries
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anastomose with posterior intercostals
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Zostavax
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treats herpes zoster infection for those over 60
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intercostal veins drain into
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azygous vein
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directly below manubrium
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left brachiocephalic vein
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