20 Questions
What is the arterial supply of the cervical part of the esophagus?
Inferior thyroid arteries
Which of the following lymph nodes drain the abdominal part of the esophagus?
Left gastric nodes
What is the length of the thoracic duct?
45 cm/18 inch
Which of the following veins drains the upper part of the esophagus?
Brachiocephalic veins
What is the parasympathetic nerve supply to the lower half of the esophagus?
Vagus nerve
Which of the following is a feature of the thoracic duct?
It is the largest lymphatic vessel in the body
What is the venous drainage of the lower end of the esophagus?
Left gastric vein
What is the sympathetic nerve supply to the upper half of the esophagus?
Middle cervical ganglion
What is the level of the thoracic vertebra where the esophagus pierces the diaphragm?
Tenth thoracic vertebra
How many constrictions does the oesophagus normally show?
Four
At what level does the esophagus open into the stomach?
Eleventh thoracic vertebra
Where does the esophagus begin in the neck?
At the lower border of the cricoid cartilage
What is the approximate length of the esophagus?
25 cm
What is the course of the esophagus in the thorax?
It descends in front of the vertebral column through the superior and posterior parts of the mediastinum
What is the structure most likely to be damaged when the posterior wall of the esophagus is punctured?
Thoracic duct
During an exploratory surgery, the surgeon is looking for a structure between the azygos vein and descending aorta. What is it likely to be?
Thoracic duct
Which vein is closely related to the posterior wall of the esophagus?
Hemiazygos vein
What is the primary route of lymphatic drainage of the esophagus?
Thoracic duct
Which structure is responsible for the majority of the venous drainage of the esophagus?
Azygos vein
What is the location of the Thoracic duct in relation to the esophagus?
Posterior to the esophagus
Study Notes
Esophagus
- The esophagus is a tube that extends from the lower part of the neck to the upper part of the abdomen (25 cm long).
- It is flattened anteroposteriorly and the lumen is kept collapsed, dilating only during the passage of food.
- It begins in the neck at the lower border of the cricoid cartilage, where it is continuous with the lower end of the pharynx.
- It descends in front of the vertebral column through the superior and posterior parts of the mediastinum, and pierces the diaphragm at the level of the tenth thoracic vertebra.
- It ends by opening into the stomach at its cardiac end at the level of the eleventh thoracic vertebra.
Relations
- Anteriorly: trachea, right pulmonary artery, left bronchus, pericardium with left atrium, and the diaphragm.
- Posteriorly: vertebral column, right posterior intercostal arteries, thoracic duct, azygos vein with the terminal parts of the hemiazygos veins, thoracic aorta, right pleural recess, and diaphragm.
- To the right: right lung and pleura, azygos vein, and the right vagus.
- To the left: aortic arch, left subclavian artery, thoracic duct, left lung and pleura, and left recurrent laryngeal nerve.
- In the posterior mediastinum, it is related to the descending thoracic aorta and the left lung and mediastinal pleura.
Arterial Supply
- Cervical part: inferior thyroid arteries.
- Thoracic part: esophageal branches of the aorta.
- Abdominal part: esophageal branches of the left gastric artery.
Venous Drainage
- Upper part: brachiocephalic veins.
- Middle part: azygos veins.
- Lower end: left gastric vein and vena azygos via hemiazygos vein.
Lymphatic Drainage
- Cervical part: deep cervical nodes.
- Thoracic part: posterior mediastinal nodes.
- Abdominal part: left gastric nodes.
Nerve Supply
- Parasympathetic nerves:
- Upper half: recurrent laryngeal nerves.
- Lower half: Vagus.
- Sympathetic nerves:
- Upper half: middle cervical ganglion.
- Lower half: upper four thoracic ganglia.
Constrictions
- The esophagus shows four constrictions:
- At its beginning, 15 cm/6-inch from the incisor teeth, where it is crossed by the cricopharyngeus muscle.
- Where it is crossed by the aortic arch, 22.5 cm/9-inch from the incisor teeth.
- Where it is crossed by the left bronchus, 27.5 cm/11-inch from the incisor teeth.
- Where it pierces the diaphragm, 37.5 cm/15-inch from the incisor teeth.
Thoracic Duct
- The thoracic duct is the largest lymphatic vessel in the body.
- It is 45 cm/18 inch long and extends from the upper part of the abdomen to the lower part of the neck.
- It is a crucial structure that needs to be considered during surgery.
A patient undergoes transesophageal echocardiography and develops an infection. Doctors are concerned about potential damage to a nearby vessel. Identify the vessel and its location.
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