Organization of the thoracic viscera
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| What the top opening of the thorax called? | Superior Thoracic Outlet
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| What passes through the STO? | Trachea, esophagus, vessels and nerves
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| What the major boundaries of the STO? | Manubrium, T1 vertebra, First pair of ribs and cartileges
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| What is the bottom opening of the thorax called? | Inferior thoracic aperture
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| What are the boundaries of the ITA? | T12 vertebra, coastal margin (ribs 7-10), and the xiphosternal joint; bound at the bottom by the diaphragm and the abdominal viscera
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| What are the major areas of the thoracic cavity? | 1) the pleural cavities (with lungs and mediasteinum), 2) the thoracic wall, 3) the diaphragm, and 4) the suprapleural membrane
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| What prevents the lungs from bulging out through the superior thoracic outlet? | The suprapleural membrane
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| What is the definition of the pleura? | Thin sereous membrane covering the surface of the lungs and lining the walls, roof, and floor of the pleural cavities
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| What is the major tissue of the pleura? | mesothelium (simple squamous epithelium) and connective tissue
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| What pleura lines the walls, roof, and floor of the pleural cavities? | Parietal pleura
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| What pleura covers the lungs? | Visceral pleura
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| Where are the parietal and the visceral pleurae continuous? | At the root of the lung
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| Where are the major division lines of the parietal pleura? | Costal pleura (thoracic wall), cervical pleura (through thoracic inlet into neck), diphragmatic pleura (covers diaphragm), mediastinal pleura (mediastinum of the pleural sac)
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| What is the pulmonary ligament and where is it located? | It is a double layer of pleura formed with part of the mediastinal perietal pleura and the visceral pleura; it is located at the root of the lung
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| What (definition) are the lines of pleural reflection? | They are sharp lines of reflection where the pleura becomes continous with the mediastinal and the diaphragmatic pleura
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| Trace the path of the right pleura | Goes straight down close to midline; swings outward and downward along the 7th costal cart
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| Trace the path of the left pleura | Anterior reflection deviates laterally at the level of the 4th rib; lateral to the sternum at the level of 5th and 6h intercostal spaces; swings out and down along 7th costal cartilage; cardiac notch
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| Where is the cardiac notch located? | (I) An indentation in the left pleural sac that wraps around the heart
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| What is the mobile septum between the pleura and the lungs called? | The mediastinum
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| What are the divisions of the mediastinum? | The superior and the inferior mediastinum (which is divided into the anterior, the, the middle, and the posterior mediastinum)
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| Where does the superior mediastinum become the inferior mediastinum (e.g. major landmark/border?) | At the imaginary plane level with T4 (and Angle of Louis)
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| What is the middle mediastinum composed of? | The pericardial sac and its contents
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| Where are most of the structures of the superior mediastinum located? | Chiefly between the manubrium sterni and the first four thoracic vertebrae
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| Name the main contents of the superior mediastinum anterior to posterior | Thymus, brachiocephalic veins and superior vena cava, aortic arch and its three branches, the vagus and the phrenic nerves, cardiac plexus of nerves, left recurrent laryngeal nerve (not the right), trachea, esophagus, thoracic duct, lymph nodes
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| What are the main contents of the posterior mediastinum? | Thoracic aorta, thoracic duct, Azygous veins, esophagus and esophageal plexus, thoracic sympathetic trunks, thoracic splanchnic nerves
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| What vertebrae does the posterior mediastinum span? | Thoracic vertebrae 5 through 12
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| Where is the thymus located | In the anterior mediastinum; immediately behind the manubrium, though it may extend to the base of the neck
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| Where (relative to what landmark) is the bifurcation of the trachea? | Behind the sternal angle
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| What two structures lie immediately to the left and right of the esophagus and the trachea above the root of the lung? | The azygous vein (right) and the arch of the aorta (left)
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| Where is the arch of the aorta start? | To the right border of the sternal angle
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| What path does the (arch of the) aorta follow? | Begins at the right border of the sternal angle, runs upward, backwards, and to the left IN FRONT of the trachea; passes down to the left of the trachea, and ends at the sternal angle
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| What two structures are located in its concavity? | The right pulmonary artery and the left principal bronchus
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| What are the usual branches ("downstream" order) of the arch of the aorta? | Brachiocephalic trunk, left common carotid artery, left subclavian artery
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| What is the path of the brachiocephalic trunk? | Branches from the arch of the aorta, passes upwards to the right of the trachea, divides into the right subclavian and the right common carotid artery BEHIND the sternoclavicular joint.
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| What is the path of the left common carotid artery? | Passes up to the left of the trachea and enters neck behind left sternoclavicular joint
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| What is the path of the left subclavian artery? | Arise from the arch of the aort right past the left common carotid artery branches off
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| What structure lies anterior to the aortic arch structures? | All are crossed anteriorly by the left brachiocephalic trunk.
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| What is the coarctation of the aorta? | Condition where the aortic arch is abnormally narrow just beyond the left subclavian branch
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| What is the basic pathway that supplies lower body structures if there is a coarctation? | Subclavian arteries-->internal thoracic arteries-->anterior intercostal arteries-->posterior intercostal arteries (backward flow)-->descending aorta
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| What clinical signs are present in a coarctation of the aorta? | Intercostal space pulse felt, lack of femoral pulse, notching of the inferior border of the ribs (on X-ray); these occur because of increased pressure-->dilation of arteries
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| What two veins come together to give the brachiocephalic vein? Where do they join up? | subclavian and the internal jugular vein; right and left sternoclavicular joint
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| Where does the superior vena cava enter the right atrium of the heart? | Behind the third coastal cartilage; it receiveds the azygous vein just before entering the atrium
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| Describe the position of the vagus nerves in the 1) root of the neck, 2) at the level of the root of the lung | At root of the neck: posterior to the internal jugular vein and the common carotid artery; descend in front of the 1st part of the subclavian arteries; descent in the thorax BEHIND the roots of the lungs
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| Where are the recurrent laryngeal nerves? | arise from vagus nerves and ascend to supply larynx; LEFT: hooks around left side of the arch of aorta BEHIND ligament arteriosum and ascends groove between trachea + esophagus; RIGHT: hooks around right subclavian in root of neck (not in mediastinum)
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| What nerves supply tributaries to the Phrenic nerves? | Ventral rami of C3, C4, C5
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| What is the path of the Phrenic nerves? | Both enter superior mediastinum between subclavian artery and vein and lateral to vagus nerves; both descend in front of the roots of the lung
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| What functions do the phrenic nerves supply? | Somatic efferent (motor): diaphragm; somatic afferent: fibrous pericardium, parietal serous pericardium, mediastinal parietal pleura, central part of the diaphragmatic parietal pleura, central part of diaphragmatic parietal peritoneum
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| What is the path of the esophagus? | From pharynx (C6), enters superior mediastinum (between trachea and vert. column and behind left principal bronchus); enters post. medias. to right of aorta behind pericardium and left atrium; turns left crossing front of aorta; crosses diaphragm at T10
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| What are the four major points of esophageal constriction? | At pharynx/esophageal joint (C6), contact with arch of the aorta, contact with left principal bronchus, esophageal hiatus of diaphragm; runs directly behind the left atrium
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| What is the esophageal plexus? | Vagus nerves form branching network on esophagus to exchange fibers; above diaphragm, plexus gives rise to two nerve trunks: anterior (left) and posterior (right)
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| Where does the descending thoracic aorta begin? What path does it follow? | Continues from the arch of the aorta (behind the sternal angle); descends down at first on left side of vertebral bodies-->approaches midline; passes through aortic hiatus of the diaphragm at T12
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| What are the thoracic branches of the aorta? | Lower nine posterior intercostal arteries, subcoastal arteries, bronchial arteries, esophageal arteries, superior phrenic arteries
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| What is the primary purpose of the azygous venous system? | It is mean to drain the blood from the body wall; can receive from thoracic viscera. Can also provide alternative root for venous return from lower parts of body
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| What are the left/right assymetries of the azygous venous system? | Right: azygous vein ; on left, hemiazygous and accessory hemizygous
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| What are the major tributaries of the azygous vein? | Most of the posterior intercostal veins, bronchial veins, esophageal veins, pericardial veins, mediastinal veins
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| Where is the thoracic duct located? | Begins in abdomen as dilated sac (aka Cysterna chyli); ascends through aortic hiatus --> goes upward o the right of the aorta, between aorta and azygous vein; at T5, crosses to left and reaches border of esophagus at sternal angle
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| Where does the thoracic duct empty? | Runs up to the root of the neck and empties at the junction of the left subclavian and the left internal jugular veins
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