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Questions and Answers
Which vein receives the right sup intercostal vein?
Which structure lies posterior to the root of the left lung, pericardium, and esophagus?
What is the result if the IVC is blocked?
Which vein is formed by the union of the left ascending lumbar vein and left subcostal vein?
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Where does the thoracic duct lie?
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What is the name of the lowest ganglion of the sympathetic trunk?
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Which structure bifurcates in the superior mediastinum?
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Which vein forms the Superior Vena Cava?
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Which nerve crosses the left side of the arch of aorta?
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Which structure is located in the neck and anterior part of the superior mediastinum?
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Which vein rises above the superior border of the manubrium in infants and children?
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Which nerve descends in a posterior direction towards the trachea?
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Which structure is NOT found in the Anterior Mediastinum?
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Which nerve is found in the Superior Mediastinum?
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Which structure is palpable in the jugular notch?
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Which vein is formed by the union of internal jugular and subclavian veins?
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What is the name of the vein that is found in the Middle Mediastinum?
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Which structure is found in the Posterior Mediastinum?
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Which nerve enters the superior mediastinum between the right brachiocephalic vein and brachiocephalic trunk?
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What is the name of the ganglia where the greater splanchnic nerve synapses?
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Which structure connects the pulmonary trunk to the arch of aorta?
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Which structure is shared by the Superior and Middle Mediastinum?
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Study Notes
Cardiac Plexus
- Located in the middle mediastinum
- Formed by the bifurcation of the trachea
Great Vessels in the Middle Mediastinum
- Thoracic aorta
- Thoracic duct
- Posterior mediastinal lymph nodes
- Azygos, hemiazygos, and accessory hemiazygos veins
- Esophagus
- Esophageal plexus
- Thoracic sympathetic trunks
- Thoracic splanchnic nerves
Thoracic Aorta
- Lies posterior to the root of the left lung and pericardium
- Changes its name at the T12 level
- Gives rise to:
- Left two bronchial arteries
- Posterior intercostal arteries (3-11)
- Superior phrenic artery
- Esophageal artery
- Mediastinal artery
- Subcostal artery
Thoracic Duct
- Largest lymphatic channel
- Located in the posterior mediastinum and superior mediastinum
- Receives lymph from the esophagus, pericardium, and diaphragm
Posterior Mediastinal Lymph Nodes
- Located posterior to the pericardium
- Receives lymph from the esophagus, pericardium, and diaphragm
Azygos System of Veins
- Azygos vein: formed by the union of the ascending lumbar vein and subcostal vein
- Right crus of the diaphragm
- Level of T4 venous arch anteriorly
- Receives:
- Right superior intercostal vein
- Right posterior intercostal veins
- Hemiazygos vein
- Right bronchial vein
- Opens into the superior vena cava
Hemiazygos Vein
- Formed by the union of the left ascending lumbar vein and left subcostal vein
- Left crus of the diaphragm
- Receives:
- Inferior three posterior intercostal veins (9-11)
- Inferior esophageal vein
- Mediastinal veins
- Level of T9
- Opens into the azygos vein
Accessory Hemiazygos Vein
- Receives:
- Posterior intercostal veins (4-8)
- Left bronchial vein
- Opens into the azygos vein at the level of T7
Clinical Importance
- If the IVC is blocked, venous blood drains into the SVC through the azygos vein and hemiazygos vein
Sympathetic Trunk
- Extends from the base of the skull to the coccyx
- Has 22-23 ganglia
- Composed of longitudinal and transverse fibers
- Unites with the opposite side at the ganglion impar
Preganglionic Fibers
- First way: terminate at their corresponding ganglia
- Second way: enter the sympathetic trunk without making a synapse at their corresponding ganglia
Mediastinum
Organization of Mediastinum
- Central part of the thoracic cavity
- Covered by mediastinal pleura
- Contains thoracic viscera
Clinical Importance of Sternal Angle
- Bifurcation of the trachea
- Azygos vein → SVC
- Ascending aorta → arch of aorta → descending aorta
- 2nd rib joins with the sternum
- Transverse plane between the superior and inferior mediastinum
Superior Mediastinum
- Posterior to the manubrium and anterior to the first four thoracic vertebrae
- Superior border: superior thoracic aperture
- Inferior border: transverse thoracic plane (sternal angle and IV disc of T4 and T5)
- Laterally: mediastinal pleura
Contents of Superior Mediastinum
- Thymus
- Right and left brachiocephalic veins
- Left superior intercostal vein
- Superior vena cava
- Arch of aorta with its three large branches
- Trachea
- Esophagus
- Phrenic nerves
- Vagus nerves
- Left recurrent laryngeal nerve
- Thoracic duct
- Other small vessels and nerves
Thymus
- Lymphoid organ
- Located in the neck, anterior part of the superior mediastinum, and inferior mediastinum
- Plays an important role in the development of the immune system
- Diminishes at puberty
Right and Left Brachiocephalic Veins
- Formed by the union of internal jugular and subclavian veins posterior to the medial end of the clavicle
- Left vein crosses the midline
- Union of the two veins forms the SVC posterior to the lower border of the right first costal cartilage
Superior Vena Cava
- Terminates at the lower margin of the right third costal cartilage
- Receives:
- Azygos vein
- Pericardial and mediastinal veins
- SVC and IVC are oriented along the same vertical axis
Arch of Aorta and its Branches
- Aorta has three parts: arch, ascending, and descending
- Ascending aorta emerges from the heart and forms the arch of aorta
- From right to left:
- Brachiocephalic trunk
- Left common carotid
- Left subclavian
Ligamentum Arteriosum
- In the superior mediastinum
- Fetal circulation: ductus arteriosus
- Connects the pulmonary trunk to the arch of aorta and permits the blood to bypass the lungs during development
Trachea and Esophagus
- Trachea is the midline structure that is palpable in the jugular notch
- Posteriorly: esophagus
- Crossed by the azygos vein on the right side and arch of aorta on the left side
- Bifurcation of trachea, whereas esophagus continues
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Description
Test your knowledge of the mediastinum, a central part of the thoracic cavity, including its organization, clinical importance, and anatomical features. Take this quiz to learn more about the mediastinum and its components.
