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34. Mediastinum and Thoracic Cavity
Blutt
29
Anatomy
Graduate
10/08/2011

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Term
True Ribs
Definition
1-7, articulate directly with the coastal cartilage attaching to the sternum.
Term
False ribs
Definition
8-10, articulate with rib directly above.
Term
Floating ribs
Definition
11-12, posterior ribs that don't attach to anything anteriorly.
Term
Jugular notch
Definition
Notch in the middle of the superior border of the manubrium.
Term
Blood supply of the diaphragm
Definition
Branches of the internal thoracic artery and thoracic aorta.
Term
Nerve supply of the diaphragm
Definition
Phrenic nerve. C3,4,5 keeps you alive.
Term
Anterior surface markings for the diaphragm
Definition
1. Left dome is smaller, found on 5th rib.
2. Right dome is larger, curves up to the 4th intercostal space.
Term
Accessory musculature for inspiration
Definition
1. Pectoralis major and minor
2. Serratus Anterior
3. Scalene
4. External intercostals
Term
Accessory musculature for expiration
Definition
1. Internal intercostals
2. Innermost intercostals
Term
Dyspnea
Definition
Difficulty breathing creates heavy use of the accessory muscles for inspiration and expiration.
Patients prefer to sit up rather than lye down because gravity assists diaphragm flattening for inspiration.
Term
Thorax spinal nerves
Definition
12 pairs of nerves innervate the thorax.
T1-11 go along intercostal spaces with arteries and veins.
T12 is subcostal.
Mixed motor and sensory nerves.
Term
Herpes Zoster
Definition
Migration of of varicella-zoster virus (chickenpox) to the nervous system. Reactivation results in migration down the sensory neurons to the skin

Presents with burning pain/itching in dermatome supplied by involved sensory nerve and skin eruptions

Can be associated with weakness of muscles innervated by associated myotome

Treated with antivirals/steroids

Zostavax approved in 2006 for individuals over 60
Term
Blood supply of the thorax
Definition
1. Mostly supplied by te posterior intercostal arteries. Branch from the descending aorta and run along costal grooves of ribs between the internal and innermost intercostal muscles.
2. Anterior intercostal muscles: anastamos with posterior intercostal muscles.
Right and left subclavian->internal thoracic->anterior intercostals
Located just deep to the sternum.
Term
Thoracocentesis
Definition
Hypodermic needle is inserted into the intercostal space and pleural cavity to draw out fluid in the costodiaphragmatic recess.
Needle inserted superior to the rib to avoid damage to nerve, artery, and vein at the 9th intercostal (avoids inferior border of the lung).
Term
Divisions of the mediastinum
Definition
Transverse thoracic plane divides the mediastinum into superior and inferior divisions.
The inferior division is further divided into anterior, middle, and posterior divisions.
Term
Superior mediastinum components
Definition
1. Veins (SVC, R/L Brachiocephalic, R/L subclavian, R/L Jugular)
2. Arteries (Aorta, Brachiocephalic trunk, R/L carotid, R/L subclavian, R/L Internal Thoracic)
3. Nerves (R/L Vagus, R/L Phrenic, Sympathetic Trunk)
4. Trachea
5. Esophagus
Term
Aortic Angiography
Definition
Radiographic visualization of the aorta through injection of contrast material.
Term
Trachea
Definition
Located in superior mediastinum.
Inclines to the right, ends at the sternum.
Term
Esophagus
Definition
Between the trachea and vertebral bodies, inclines to the left. Compressed by aortic arch and the root of the left lung.
Term
Anterior mediastinum contents
Definition
Smallest subdivision
Contents:
Loose connective tissue
Fat
Lymphatic vessels
Branches of internal thoracic artery
Term
Middle mediastinal contents
Definition
Heart
Term
Posterior Mediastinum Contents
Definition
1. Esophagus
2. Veins: Azygous system (Accessory hemiazygous is superior to hemiazygous, both drain to azygous)
3. Arteries: Thoracic descending aorta
4. Lymphatics: thoracic duct
5. Nerves: Posterior intercostal nerves, Sympathetic trunk, splanchic nerves, esophageal plexus
Term
Descending aorta
Definition
Part of the posterior mediastinum.
Branches:
1. Esophageal arteries (1 branch)
2. Bronchial arteries (paired branches)
3. Intercostal arteries (paired branches)
Posterior to root of the left lung, terminates at T12.
Term
Thoracic duct
Definition
Located between azygous and descending aorta.
Begins with chyle cistern to go through the aortic hiatus.
Empties into the left subclavian vein at the junction of the internal jugular vein.
Term
Sympathetic spinal cord segments
Definition
T1-L3
Term
Parasympathetic spinal cord segments
Definition
CIII, CVII, CX and S2-4
Term
Types of post-ganglionic cell bodies
Definition
1. Paravertebral: forms sympathetic trunk
2. Prevertebral: Located in esophgeal plexus around unpaired esophageal arteries. Splanchnic nerves synpase with prevertebral neurons.
Term
Directions of nerve impulse in sympathetic trunk
Definition
Preganglionic nerve exits anterior rootlet along with somatic motor neurons, forms spinal nerve and passes via white rami communicates to sympathetic trunk where it:
1. Ascends to synapse higher in the trunk, goes to higher ganglia
2. Descends to synapse lower in the trunk, goes to lower ganglia
3. Synapses right in that ganglion, returns to spinal nerve via gray ramus communicates
4. Passes through without synapsing to reach a prevertebral ganglion (splanchnic)

Those nerves synapsing within the paravertebral ganglion rejoin the anterior spinal nerve rami via the grey rami communicantes
Term
Openings in diaphragm surface
Definition
From superior to inferior:
1. Caval opening: IVC and lymphatics pass through, located at T8.
2. Esophageal hiatus: Esophagus vagal trunks, blood, and lymphatic vessels pass through (T10)
3. Aortic Hiatus: aorta, thoracic duct, and azygous system pass through, located at T12.
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