Posterior Mediastinum Anatomy Review
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Questions and Answers

What is the anatomical relationship between the descending thoracic aorta and the left lung?

  • The descending thoracic aorta is posterior to the left lung root. (correct)
  • The descending thoracic aorta is lateral to the left lung root.
  • The descending thoracic aorta is anterior to the left lung root.
  • The descending thoracic aorta is medial to the left lung root.

    • Which vessel supplies the 1st and 2nd posterior intercostal spaces?

  • The posterior intercostal arteries
  • The supreme intercostal artery (correct)
  • The internal thoracic artery
  • The superior intercostal artery

    • Which of these components is NOT found within the posterior mediastinum?

  • Descending thoracic aorta
  • Vagus nerve
  • Phrenic nerve (correct)
  • Thoracic duct

    • At what vertebral level does the descending thoracic aorta pass through the diaphragm?

    <p>T12 (A)</p> Signup and view all the answers

    What is the mnemonic used to remember the contents of the posterior mediastinum?

    <p>DATES In Vagus (D)</p> Signup and view all the answers

    Which of these structures is NOT considered a part of the azygos system?

    <p>Internal thoracic vein (B)</p> Signup and view all the answers

    The thoracic duct is located in the posterior mediastinum. Which of these structures does NOT pass through the same compartment as the thoracic duct?

    <p>Phrenic nerve (B)</p> Signup and view all the answers

    Where does the thoracic duct typically drain into?

    <p>Left venous angle (A)</p> Signup and view all the answers

    Which of the following is true regarding the blood supply to the spinal cord?

    <p>The anterior radiculomedullary artery, also known as the artery of Adamkiewicz, is a major blood supply to the spinal cord. (B)</p> Signup and view all the answers

    In the context of the thoracic aorta, what is the name of the branch that provides blood to the areolar tissues and lymph nodes of the mediastinum?

    <p>Mediastinal artery (D)</p> Signup and view all the answers

    Which of the following arteries directly arises from the posterior intercostal artery on the right side?

    <p>Bronchial artery (A)</p> Signup and view all the answers

    Based on the provided information, which of the following statements about thoracic aortic aneurysms is most accurate?

    <p>Thoracic aortic aneurysms are more likely to cause complications like dissection or rupture compared to abdominal aortic aneurysms. (B)</p> Signup and view all the answers

    Flashcards

    Intercostal arteries

    Supply blood to the intercostal spaces, including posterior intercostal and subcostal arteries.

    Radiculomedullary artery

    An artery that supplies the spinal cord, notable as the artery of Adamkiewicz.

    Bronchial arteries

    Arteries supplying the lungs, typically from the posterior intercostal arteries.

    Unpaired branches of aorta

    Arteries that arise anteriorly from the aorta, including oesophageal and pericardial arteries.

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    Thoracic aortic aneurysm

    A ballooning in a weakened part of the thoracic aorta, often asymptomatic but dangerous if ruptured.

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    Symptoms of blood vessel compression

    Hoarseness, dysphagia, cough, and dyspnoea may occur if thoracic aneurysm compresses nearby structures.

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    Abdominal aortic aneurysm (AAA)

    A much more common aneurysm than thoracic, leading to significant treatment scenarios.

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    Aneurysm treatment options

    Large abdominal aortic aneurysms are treated with endovascular stent grafts or open repair.

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    Azygos system of veins

    A network of veins that drains blood from the thorax and abdominal wall into the superior vena cava.

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    Thoracic duct

    A major lymphatic vessel that drains lymph from the body and empties into the left subclavian vein.

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    Sympathetic chain

    A series of interconnected ganglia that run alongside the vertebral column, part of the autonomic nervous system.

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    Descending thoracic aorta

    The part of the aorta that descends from the arch and travels down to the diaphragm, supplying blood to the chest.

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    Costocervical trunk

    A branch of the subclavian artery that gives rise to arteries supplying the upper back and neck area.

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    Hemiazygos veins

    Veins that complement the azygos system and drain the left side of the thoracic wall into the azygos vein.

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    Esophagus

    A muscular tube that conveys food from the throat to the stomach, located in the posterior mediastinum.

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    Intercostal vessels

    Arteries and veins that run between the ribs, supplying muscles and skin of the thoracic wall.

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    Study Notes

    Practical 5: Posterior Mediastinum & Review

    • Objectives: Identify and describe the azygos system of veins, the anatomy and course of the thoracic duct, and the sympathetic chain.
    • Posterior Mediastinum Contents: Descending thoracic aorta, azygos and hemiazygos veins, thoracic duct, esophagus, sympathetic trunk, and intercostal vessels (posterior). Vagal nerves are also mentioned.

    Azygos System of Veins

    • Arrangement: The arrangement of azygos veins is highly variable.
    • Connections: The azygos system connects to thoracic, abdominal, and back veins, providing alternate drainage routes if the superior vena cava (SVC) or inferior vena cava (IVC) are obstructed.
    • Accessory Hemiazygos Vein: Accessory and hemiazygos veins cross over the vertebrae at T7 and T9, connecting to the azygos vein.

    Thoracic Duct

    • Drainage Route: Lymph from most of the body drains to the thoracic duct. The right lymphatic duct drains lymph from the right thorax, upper limb, head, and neck.
    • Drainage Vessels: Lymph trunks drain into corresponding venous angles (junction of internal jugular vein and subclavian vein).
    • Chyle: Fat and lymph (chyle) from the intestine, collected in the cisterna chyli at the L1 level, drains superiorly into the thoracic duct.

    Sympathetic Chain

    • Structure: A pair of ganglia runs along the sympathetic chain at every spinal level except for three paired cervical ganglia which have fused into one.
    • Levels: Originates from spinal nerves T1 to L2.
    • Paths: Nerves enter at T1-L2, travel up or down the chain, exiting and joining other spinal nerves.
    • White & Gray Rami Communicantes: Nerves leave the T1-L2 ventral rami and join spinal nerves through white rami communicantes, which are myelinated. Nerves leave the sympathetic chain and join the spinal nerves through gray rami communicantes, which are unmyelinated.

    Pancoast Tumor & Compression of Sympathetic Trunk

    • Location: Lung cancer (Pancoast tumor) in the apex of the lung can compress the brachial plexus and the upper thoracic sympathetic chain (T1).
    • Signs: This compression might cause shoulder pain, upper limb pain, and weakness.
    • Horner's Syndrome: Compression symptoms might include ptosis (drooping eyelid), miosis (constricted pupil), and anhidrosis (lack of sweating).

    Descending Thoracic Aorta

    • Course: Runs posterior to the root of the left lung and esophagus, descending toward the midline through the aortic hiatus of the diaphragm at the T12 level.
    • Branches: Costocervical trunk, posterior intercostals, subcostals, bronchial, esophageal, mediastinal, and superior phrenic arteries.

    Aortic Aneurysms and Dissections

    • Aneurysms: Weak spots in the aorta (ballooning) can be asymptomatic until rupture, dissection, or compression of nearby structures.
    • Types: Aortic root and ascending aorta, aortic arch, and descending aorta are common types. Abdominal aortic aneurysms (AAAs) are more prevalent than thoracic.
    • Risk Factors: Atherosclerosis, hypertension, trauma, and connective tissue disorders like Marfan's syndrome can affect the aorta.
    • Dissections: A tear in a vessel's inner wall, allowing blood flow into the middle layer, can cause sudden, tearing chest pain.

    Other Pleural Cavity Masses

    • Fluid Types: Pleural fluid can involve blood (hemothorax), pus (empyema or pyothorax), fluid rich in proteins and fibrin (serothorax), abdominal organs in the chest (enterothorax), pleural fibrosis (fibrothorax), oil (oleothorax), or urine (urinothorax). Faeces as a mass in the pleural cavity is also mentioned.
      • Causes for some pleural cavity masses include trauma, malignancy, anticoagulant medication, aortic dissection.
    • Combines: Some pleural conditions might combine different causes such as pyopneumothorax (pus and air).

    Oesophagus

    • Position: Located posterior to the trachea, pericardium, and left atrium; it deviates to the left and travels to the T10 level before passing through the oesophageal hiatus.
    • Plexuses: Vagus nerves form anterior and posterior oesophageal plexuses by interacting with sympathetic branches. These plexuses deliver sensory and motor innervation to the esophagus, impacting pain sensation.

    Tracheoesophageal Fistula & Atresia

    • Septum: The trachea and esophagus are separated by a septal development that occurs during fetal development. Abnormalities in this can lead to atresia, a failure to develop a passage between structures, and/or fistulae, where a passage has developed improperly between two structures. There are different types of fistula depending on which structures are abnormally connected.
    • Malformations: These congenital malformations were often fatal before surgical intervention.

    Chylothorax

    • Cause: Injury to the thoracic duct, whether from malignancy, infection, trauma or iatrogenic surgery, can lead to leakage of lymphatic fluid into the pleural cavity, causing a chylothorax.
    • Symptoms: This can cause compression and collapse of the lung, hypovolemia, and immunosuppression. Management might be by conservative means with the condition potentially resolving spontaneously, or surgically by ligating the duct to stop the leak.

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    Practical 5 Posterior Mediastinum & Review PDF (Feb 10, 2021)

    Description

    This quiz focuses on the posterior mediastinum, including the azygos system of veins, the thoracic duct, and the sympathetic chain. Gain a deeper understanding of the anatomical structures and their functions within the thoracic cavity. Perfect for students studying anatomy or preparing for medical exams.

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