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31 Cards in this Set
- Front
- Back
Mediastinal narrowing (silhouetting) |
1. Lung masses 2. Pleural effusion |
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Mediastinal widening |
1. Tumors 2. Aneurysm 3. Pericardial effusion |
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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 |
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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 |
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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 |
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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 |
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Arch of azygos compression |
Caused by Rt lung tumors or Trachea compressing the Arch of Azygos Enlarged R superior tracheobroncial nodes and Hilar nodes (tracheobronchal nodes) |
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Compression of esophagus leading to dysphagia (difficulty swallowing) |
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) |
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Nerves to superior mediastinum |
1. Vagus nerves - btwn R brachiocephalic vein and trachea 2. Recurrent laryngeal nerves 3. Phrenic nerves |
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Injury to recurrent laryngeal nerves |
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) |
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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 |
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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!! |
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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 |
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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) |
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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 diaphragm |
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Why are the R posterior intercostal arteries longer than the left ones? |
R posterior intercostal arteries cross over the vertebral bodies |
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Aortic aneurysms |
Risk factors: Artherosclerosis (plaque in aorta) Connective tissue disorders Trauma (e.g. car accidents)
Aortic arch aneurysm- voice hoarseness |
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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 |
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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") |
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3 esophageal sites prone to constrictions |
1. Level of aortic arch 2. L main bronchus 2. Level of diaphragmatic esophageal hiatus |
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Esophageal diverticula |
Parabrochial "True"-tumors- protrusion of layers - pull out Epiphrenic "False"-neuromuscular -herniation of mucosa thru weak muscle-push in //zoom into picture |
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Thoracic duct |
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 |
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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 |
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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 |
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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 (R. vitrelline vein-embryology) |
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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 |
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Posterior mediastinum nerves |
1. Sympathetic trunk 2. Splanchnic nerves 3. Vagus -esophageal plexus |
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Thoracic sympathetic trunks & splanchnic nerves |
Greater splanchnic T5-T9 Lesser splanchnic T10 -T11 Least splanchnic T12 Pass through pre-vertebral ganglia--> splanchnic nerve |
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Esophageal vagal plexus |
LARP Left Vagus- Anterior Right Vagus - Posterior |
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Diaphragmatic openings |
I ATE TEN EGGS AT 12 Inferior Vena Cava: T8 -- vena caval hiatus Esophagus: T10 -- esophageal hiatus Aorta: T12 -- aortic hiatus |
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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 |