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31 Cards in this Set

  • Front
  • Back

Mediastinal narrowing (silhouetting)

1. Lung masses
2. Pleural effusion

1. Lung masses


2. Pleural effusion

Mediastinal widening

1. Tumors
2. Aneurysm
3. Pericardial effusion

1. Tumors


2. Aneurysm


3. Pericardial effusion

Sternal Angle (Angle of Louis) demarcates?

1. Separation of superior and inferior mediastinum
2. Aortic Arch (start and end)
3. Azygos vein arch to Superior Vena Cava
4. Bifurcation of trachea
5. Thoracic duct from left to right
6. RIb 2
7. T4/T5 vertebral bodies

1. Separation of superior and inferior mediastinum


2. Aortic Arch (start and end)


3. Azygos vein arch to Superior Vena Cava


4. Bifurcation of trachea


5. Thoracic duct from left to right


6. RIb 2


7. T4/T5 vertebral bodies



Superior Mediastinal Structures

A PVT Left BATTLE
Arch of Azygos
Phrenic n.
Vagus n.
Thoracic duct
Left Laryngeal n. (only L)
Brachiocephalic vein & SVC
Arch of Aorta (Brachiocephalic trunk, L common carotid artery, L subclavian artery)
Thymus
Trachea
Lymph
Esophagus

A PVT Left BATTLE


Arch of Azygos


Phrenic n.


Vagus n.


Thoracic duct


Left Laryngeal n. (only L)


Brachiocephalic vein & SVC


Arch of Aorta (Brachiocephalic trunk, L common carotid artery, L subclavian artery)


Thymus


Trachea


Lymph


Esophagus

Thymus

Newborns: active
Adults: useless connective tissue
Arteries and veins:
1. Internal thoracic arteries 
2. Anterior intercostal arteries
1. Internal thoracic vein
2. Brachiocephalic vein
3. Inferior thyroid vein

Newborns: active


Adults: useless connective tissue


Arteries and veins:


1. Internal thoracic arteries


2. Anterior intercostal arteries


1. Internal thoracic vein


2. Brachiocephalic vein


3. Inferior thyroid vein

Thymoma

cancer of thymus


Right lobe compresses SVC leading to Superior vena cava syndrome (SVCS): swelling of face, neck, chest wall, and upper limbs


Left lobe compresses L brachiocephalic vein


Tx: thymectomy- surgical removal of thymus

cancer of thymus




Right lobe compresses SVC leading to Superior vena cava syndrome (SVCS): swelling of face, neck, chest wall, and upper limbs




Left lobe compresses L brachiocephalic vein




Tx: thymectomy- surgical removal of thymus

Arch of azygos compression

Caused by Rt lung tumors or Trachea compressing the Arch of Azygos


Enlarges R superior tracheobroncial nodes and hilar nodes

Caused by Rt lung tumors or Trachea compressing the Arch of Azygos




Enlarged R superior tracheobroncial nodes and Hilar nodes (tracheobronchal nodes)

Compression of esophagus leading to dysphagia (difficulty swallowing)

1. Retroesophageal right subclavian a. - The R subclavian artery crosses posterior to the esophagus. 
2. DAA- double arch aorta (in cardio lec) Vascular ring anomaly. Ring around esophagus and trachea; congenital anomaly. Sx: Stridor (high pitched...

1. Retroesophageal right subclavian a. - The R subclavian artery crosses posterior to the esophagus. Brachiocephalic trunk not formed


2. DAA- double arch aorta (in cardio lec) Vascular ring anomaly. Ring around esophagus and trachea; congenital anomaly. Sx: Stridor (high pitched wheezing sound & dysphagia- difficulty swallowing)


(3. Mitral valve insufficency *** L atrium swelling)

Nerves to superior mediastinum

1. Vagus nerves
2. Recurrent laryngeal nerves
3. Phrenic nerves

1. Vagus nerves - btwn R brachiocephalic vein and trachea


2. Recurrent laryngeal nerves


3. Phrenic nerves

Injury to recurrent laryngeal nerves

Injury to recurrent laryngeal nerves

Compression of Left Recurrent Laryngeal n. by (between trachea and esophagus & under aortic arch):
Aortic Arch Aneurysm
Esophageal tumors
Treacheal tumors
Medistinal tumors
Symptoms: Voice hoarseness and Loss of voice (Aphonia)

Compression of Left Recurrent Laryngeal n. (between trachea and esophagus & under aortic arch) by:


Aortic Arch Aneurysm (affects left only)


Esophageal tumors


Tracheal tumors


Medistinal tumors


Symptoms: Unilateral damage- Voice hoarseness and Bilateral damage-Loss of voice (Aphonia)

Phrenic nerve --> referred pain

Pain from structures served by phrenic nerve are referred to the "somatic region" subserved by C3, C4, C5 spinal nerves (shoulder/neck area)




C3, C4, C5 keep diaphragm alive; motor nerve




Irritation of phrenic n. or tissues supplied by the nerve may elicit hiccup reflexes




accompany pericardiophrenic vessels

Trachea

Bifurcates into the R and L main bronchi


Overlies the esophagus


Begins at the larynx




Close relations with esophagus compression and recurrent laryngeal nerves!!

Esophagus- superior mediastinum

Superior mediastinal part:


Fibromascular tube from pharynx to stomach


Flattened anterioposteriorly


Lies behind trachea


more compressible than trachea




Left and right recurrent laryngeal n ascends between esophagus and trachea

Posterior Mediastinum

DATES In Vagus


Descending Aorta


Azygos/Hemizygos/Accessory Hemizygos


Thoracic duct


Esophagus


Sympathetic trunks and splanchnic nerves


Intercostal arteries --> Posterior


Vagus nerve (plexus and trunks)

Branches of thoracic aorta

Anterior unpaired
branches to the gut
pericardial branches
mediastinal arteries
Lateral paired
branches to visceral other than the gut e.g. bronchial arteries
Posterolateral paired
3-11 posterior intercostal arteries
1 subcostal a -->supply the d...

Anterior unpaired


branches to the gut


pericardial branches


mediastinal arteries


Lateral paired


branches to visceral other than the gut e.g. bronchial arteries


Posterolateral paired


3-11 posterior intercostal arteries


1 subcostal a -->supply the diaphragm

Why are the R posterior intercostal arteries longer than the left ones?

R posterior intercostal arteries  cross over the vertebral bodies

R posterior intercostal arteries cross over the vertebral bodies

Aortic aneurysms

Risk factors:
Artherosclerosis
Connective tissue disorders
Trauma (e.g. car accidents)

Risk factors:


Artherosclerosis (plaque in aorta)


Connective tissue disorders


Trauma (e.g. car accidents)



Aortic arch aneurysm- voice hoarseness

Abdominal Aortic Aneurysm

Abdominal Aortic Aneurysm

Most common aneurysm- artherosclerosis: men older than 65 overweight


Asymptomatic until rupture


Expanding AAA --> sudden severe constant low back, flank, abdominal, or groin pain


65% patients with ruptured AAA die of sudden cardiovascular collapse before arriving to hospital


High risk in surgery- Aortic dissection

Esophagus - posterior mediastinum

Located behind pericardium and L atrium


Main posterior part of the the base of the heart


Close to diaphragm, deviates to left




Exits through ESOPHAGEAL HIATUS in the diaphragm at T10 vert level together with Anterior and Posterior vagal trunks ("Ten Eggs")

3 esophageal sites prone to constrictions

1. Level of aortic arch
2. L main bronchus
2. Level of diaphragmatic esophageal hiatus

1. Level of aortic arch


2. L main bronchus


2. Level of diaphragmatic esophageal hiatus

Esophageal diverticula

Parabrochial "True"
Epiphrenic "False"

Parabrochial "True"-tumors- protrusion of layers - pull out




Epiphrenic "False"-neuromuscular -herniation of mucosa thru weak muscle-push in




//zoom into picture

Thoracic duct

LARGEST LYMPH IN ENTIRE BODY
empties at l venous angle of left internal jugular and subclavian vein
"duck between two gooses" duct between azyGOUS and esophaGOUS

LARGEST LYMPH IN ENTIRE BODY


empties at LEFT venous angle of left internal jugular and subclavian vein


"duck between two gooses" duct between azyGOUS and esophaGOUS

Laceration of Thoracic Duct

Vulnerable to injuries during investigative or surgical procedures (hard to spot, dull whitish, thin)




Chylothorax- lymph from thoracic duct ENTERS pleural cavity

Troiser's sign

Troiser's sign

Virchow's nodes are lymph nodes in L supraclavicular fossa

Virchow's nodes enlarged: 
GI (gastric) cancer that has metastasized through thoracic duct

Virchow's nodes are lymph nodes in L supraclavicular fossa



Virchow's nodes enlarged:


GI (gastric) cancer that has metastasized through thoracic duct

Azygos vein

Coarses R side T5- T12
Drains the back, thoracoabdomonal wall, mediastinal viscera
Collateral circulation between SVC and IVC when there is an absence of hepatic segment in IVC embryology (R vitelline vein formed this)

Coarses R side T5- T12


Drains the back, thoracoabdomonal wall, mediastinal viscera


Collateral circulation between SVC and IVC when there is an absence of hepatic segment in IVC (R. vitrelline vein-embryology)

Azygos venous drainage to posterior intercostal veins (study this slide thoroughly!!)

1 L brachiocephalic v
2-4 L sup intercostal
5-8 accessory hemiz
9-12 hemiz

1 L brachiocephalic v


2-4 L sup intercostal


5-8 accessory hemiz


9-12 hemiz



Posterior mediastinum nerves

1. Sympathetic trunk


2. Splanchnic nerves


3. Vagus -esophageal plexus

Thoracic sympathetic trunks & splanchnic nerves

Greater splanchnic T5-T9
Lesser splanchnic T10 -T11
Least splanchnic T12

Pass through pre-vertebral ganglia--> splanchnic nerve

Greater splanchnic T5-T9


Lesser splanchnic T10 -T11


Least splanchnic T12




Pass through pre-vertebral ganglia--> splanchnic nerve

Esophageal vagal plexus

LARP




Left Vagus- Anterior


Right Vagus - Posterior

Diaphragmatic openings

I ATE TEN EGGS AT 12
Inferior Vena Cava: T8 -- vena caval hiatus
Esophagus: T10 -- esophageal hiatus
Aorta: T12 -- aortic hiatus

I ATE TEN EGGS AT 12


Inferior Vena Cava: T8 -- vena caval hiatus


Esophagus: T10 -- esophageal hiatus


Aorta: T12 -- aortic hiatus

Paradoxical motion of diaphragm

**rmr flail chest in thoracic lecture


Damage to phrenic nerve results in paradoxical motion of the diaphragm




inspiration: rib cage goes inward; diaphragm ascends


expiration: rib cage goes outward; diaphragm descends