Mediastinum & Heart

• Space between pleural sacs? 


  Mediastinum
• Contents of the Superior Medianstinum

  Brachiocephalic trunk

  Aortic Arch

  Thymus

  Superior Vena Cava

  
  

  Trachea

  Esophagus

  Nerves (Phrenic, Vagus, Cardiac)

  Thoracic Duct
• Inferior Mediastinum (anterior) Contents:

  Internal Thoracic Artery & Vein

  Thymus Gland
• Inferior (Posterior) Mediastinum contents:

  Esophagus

  Thoracic Aorta

  Azygous veins

  Hemiazygous vein

  Acessory hemiazygous veins

  Vagus nerve

  Thoracic duct
• Blood supply of the thorax?

  Branches of thoracic aorta
• What structure drains to

  venous angle, between the

  left subclavian and left

  internal jugular vein?

  Thoracic Duct
• The right upper 1/4 of the body is drained by?

  Right lymphatic duct
• Path of the thoracic duct:


  R and L lumbar trunks

  Thoracic duct at T12

  Aortic opening of diaphragm

  Ascends posterior to aortic

  arch and passes anterior to

  anterior scalene
• If ETT extends too far past the carina,

  which bronchus is it most likely to

  enter?

  Right main bronchus
• Tracheal bifurcation occurs at?

  T4/T5 (posterior) and

  manubriosternal junction

  (anterior)
• 3 parts of the esophagus?

  Cervical (C6-T1)

  Thoracic (T1-esophageal opening)

  Abdominal (diaphragm to cardiac orifice)
• Sacs that develop in the weak

  spots of the mucosal lining?

  Diverticula
• Zenker’s diverticulum


  Common diverticulum at the proximal esophagus
• Innervation of the esophagus?

  sympathetic trunk to esophageal plexus

  vagus nerve to esophageal plexus
• Serous membrane of the heart?

  Pericardium
• Layer attached to the heart?

  Visceral layer
• Attached posteriorly to fibrous pericardium?

  Parietal layer
• Layers that contain serous fluid?

  Visceral and parietal layers
• Fibrous pericardium


  no serous fluid

  third layer

  purpose is to anchor the heart

  • anchors inferiorly to the diaphragm
  • anchors anteriorly to the sternum
• Another name for visceral pericardium?

  Epicardium
• Transverse pericardial sinus 


  passage within the pericardial cavity

  Runs between great vessels

  Forms during development

  Important landmark for cardiac surgery
• Oblique pericardial sinus


  posterior aspect

  Runs between pulmonary veins, IVC and esophagus
• Structure that guards atrioventricular opening?

  Tricuspid valve
• Incomplete closure of the oval foramen?

  Atrial septal defect (ASD)
• Atrial septal defect


  Only clinically significant if it causes enlargement of the right atrium and ventricle, due to left to right shunt of blood
• 25% of all forms of congenital heart disease?

  Ventricular septal defect
• Ventricular septal defect


  Left to right shunt of blood through ventricle, increases pulmonary blood

  flow causing pulmonary hypertension
• Causes more blood than normal to move through right side of the heart?

  atrial septal defect
• Openings for Coronary Arteries are within?

  Aortic sinuses
• Artery coming off an atrial branch?

  Nodal artery
• Why is a chest x-ray taken at low contrast? 

  Allows better visualization of soft tissues
• Why is the cardiothoracic ratio just an estimate that may require further testing?

  Any change in the position of the diaphragm could affect the ratio
• What clinical sign is seen in the image below?

  Collapse of right inferior lobe

  
• This image is a chest x-ray of a young woman. What clinical sign is present in this image?

  Elongated lung indicative of chronic obstructive pulmonary disorder 

  
• What image represents pleural effusion?

  D