Questions and Answers
Which of the following structures does the 2nd Intercostal nerve connect with?
What is the main function of the Azygos vein?
What happens to the margins of the base of the lung during deep inspiration?
What is the central tendon of the diaphragm?
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What is the name of the lower zone of the pleural cavity that the lung enlarges into during inspiration?
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What are the three components of the muscular part of the diaphragm?
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What is the primary function of the phrenic nerves?
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What is the name of the part of the parietal pleura that extends into the root of the neck?
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What is the function of the suprapleural membrane?
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What is the sensory supply of the central part of the diaphragm?
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Which artery rises above the subclavian artery?
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What is the relationship between the scalenus anterior muscle and the cervical pleura?
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What is the direction of the costocervical trunk?
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What is the location of the first thoracic sympathetic ganglion in relation to the dome of the pleura?
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Which of these structures reinforce the cervical pleura?
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Where does the sternal line of pleural reflection occur?
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Which of these lines of pleural reflection is described as gradual and round?
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Which of these structures is innervated by somatic afferent fibers?
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What is the main nerve innervating the diaphragmatic pleura?
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What is the main nerve innervating the costal pleura?
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Where does the visceral pleura become continuous with the parietal pleura?
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What is the relationship between the visceral pleura and the lung?
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What is the inferior boundary of the Superior Mediastinum?
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What is the main function of the thymus gland?
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Where does the Superior Vena Cava enter the right atrium?
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Which of the following is NOT a branch of the aortic arch?
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What is the Ligamentum arteriosum?
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Which of the following nerves is NOT found in the Superior Mediastinum?
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Which of the following is NOT a structure found in the Posterior Mediastinum?
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What is the correct order of structures in the Superior Mediastinum, from anterior to posterior?
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Where is the parietal pleura located?
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What is the clinical significance of the pleural surface projection?
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What is the location of the apex of the pleura relative to the clavicle?
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At what level does the pleura run toward the midline behind the angle of Louis?
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Where does the right pleura continue downward?
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Which rib does the lower limit of the costal pleura cross in the midaxillary line?
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What is the relationship between the surface markings of the lungs and the pleura?
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In quiet respiration, how much higher is the lower edge of the lung compared to the lower limit of the pleura?
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Study Notes
Intercostal Nerve and Angina Pectoris
- The 2nd intercostal nerve connects to the medial cutaneous nerve of the arm via the intercostobrachial nerve.
- Pain from angina pectoris and myocardial infarction can be referred to the medial side of the arm, following this nerve pathway.
- The upper six intercostal nerves innervate the skin, parietal pleura, and intercostal muscles within their respective spaces.
Azygos Vein
- Connects the inferior vena cava (IVC) with the superior vena cava (SVC).
- Originates in the abdomen from the IVC at the level of L2.
- Enters the thorax through the aortic opening of the diaphragm on the right side of the thoracic duct and aorta.
- Passes behind the right border of the esophagus and the root of the right lung in the posterior mediastinum.
- Crosses above the root of the right lung in the superior mediastinum and enters the back of the SVC.
Respiratory Diaphragm
- Separates the thoracic and abdominal cavities, consists of a peripheral muscular part and a central tendon.
- The muscular part is derived from vertebral, sternal, and costal components.
Nerve Supply to the Diaphragm
- Motor supply arises from the phrenic nerves (C3, C4, C5), primarily facilitating inspiration.
- Sensory innervation to the diaphragm's periphery comes from lower intercostal nerves, while central sensory information is supplied by phrenic nerves.
Pleural Reflection Lines
- Abrupt lines mark where parietal pleura shifts direction within the pleural cavity.
- Sternal line: where costal pleura meets mediastinal pleura anteriorly.
- Costal line: where costal pleura joins diaphragmatic pleura inferiorly.
- Vertebral line: a gradual transition point for costal pleura connecting with mediastinal pleura posteriorly.
Innervation of Parietal Pleura
- Somatic afferent fibers provide innervation to the parietal pleura.
- Costal pleura innervated by intercostal nerves, causing pain sensation related to the thoracic wall.
- Diaphragmatic and mediastinal pleura mainly receive sensory input from phrenic nerves, with referred pain to C3, C4, C5 dermatomes.
Visceral Pleura
- Continuous with parietal pleura at the lung hilum, firmly adheres to lung surfaces.
- The costodiaphragmatic recess is the space into which the lung expands during inspiration, found at the base.
Mediastinum Divisions
- Divided into superior and inferior mediastinum by the transverse thoracic plane.
- Superior mediastinum includes thymus, great vessels, vagus and phrenic nerves, trachea, esophagus, thoracic duct, and pleura.
- Inferior mediastinum is subdivided into anterior (thymus remnants), middle (heart and great vessels), and posterior (esophagus, great vessels, vagus nerves, sympathetic trunks).
Superior Mediastinum Contents
- Thymus gland located behind the manubrium, involutes post-puberty.
- Great vessels include Brachiocephalic veins and superior vena cava.
- Arch of the aorta spans from behind the 2nd right sternoclavicular joint to the 2nd left sternoclavicular joint; branches include Brachiocephalic trunk, left common carotid artery, and left subclavian artery.
Thoracic Inlet and Pleura Position
- The thoracic inlet is defined by the first rib, with the pleural apex lying 2.5 cm above the medial end of the clavicle and more at the apex.
- The pleura descends laterally towards the midline, with crucial surface projections detailed for clinical significance to avoid pneumothorax during procedures.
Lung Surface Markings
- Lung edges are typically above pleural edges due to fluid separation, with the excursion during deep respiration reaching 7.5 cm.
- The inferior lung border crosses the sixth rib at the midclavicular line, eighth rib at the midaxillary line, and tenth rib near the erector spinae.
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Test your knowledge of the human respiratory system, including nerves, veins, lungs, and diaphragm anatomy.
