What are the thoracic apertures?
superior thoracic aperture
inferior thoracic aperture
What is the superior thoracic aperture bounded by?
first thoracic vertebra
first pair of ribs
top of sternum
What is the inferior thoracic aperture bounded by?
12th TV
12th ribs
anterior extremities of the 11th ribs
costal cartilages of teh 10th, 9th, 8th, and 7th ribs
xiphoid process
What encloses left and right sides of the cavity?
The pleura
What is the mediastinum?
a thick parition of tissue and structures between the lungs (between the left and right mediastinum)
What structures make up the mediastinum?
thymus
heart and its pericardium
great vessels
trachea and primary bronchi
esophagus
neerves and lymphatics
What encloses the lungs?
a double layer of pleura
What is the outer layer of the pleura called?
parietal pleura
How big is the parietal pleura?
large enough to allow the lung to expand
What are the parts of the parietal pleura?
costal
diaphragmatic
cervical
mediastinal
What innervates the parietal pleura?
sensory fibers from:
intercostal nerves
phrenic nerve
What are the reflections of the parietal pleura?
costomedistinal refection
costodiaphragmatic reflection
What is the costomedistinal refection?
a junction of costal and mediastinal portions
What does the costomedistinal refection contain?
costomediastinal recess
What is the costodiaphragmatic refection?
junction of the costal and diaphragmatic portions
What does the costodiaphragmatic refection contain?
costodiaphragmatic recess
the long does NOT extend into during quiet breathing
What is the inner layer of the pleura?
visceral pleura
Where is the visceral pleura?
fused to the lung to form its outer surface
What is a pleural cavity?
a serious cavity seperated by the visceral and parietal pleura
Where are the parietal and visceral pleura continuous?
at the root of the lung and pulmonary ligament
What is the root of the lung?
a short tubular collection of structures that together attach the lung to structures in the mediastinum
What is the pulmonary ligament?
a thin, blade-like fold of pleura projects inferiorly from the root of the lung and extends from the hilum to the mediastinum
Where does the mediastinum extend from?
the superior thoracic aperature above to the diaphragm below
from the sternum in front to the vertebral column posteriorly and between the mediastinal pleura of the two sides
What is the mediastinum divided into?
superior and inferior mediastinum
What divides the mediastinum into the superior and inferior mediastinum?
a horizontal plane extending through the sternal angle anteriorly and the disk between TV4 and TV5
What is the inferior mediastinum further subdivided into?
anterior
middle
posterior
What does the middle inferior mediastinum contain?
the heart
pericardial sac
roots of the greater vessels
What is in the superior mediastinum? anterior to posterior
thymus
brachiocephalic veins and superior vena cava
aortic arch
trachea
esophagus
thoracic duct
phrenic nerves
vagus nerves
What is the thymus?
the most anterior structure of the superior mediastinum
largely replaced by fat
What is the shape of the thymus?
bilobed
What is the blood supply to the thymus?
pericardiacophrenic vessel
How/where are the brachiocephalic veins forms?
by the confluence of the subclavian and internal jugular veins at the root of the neck
Is the right brachiocephalic vein horizontal or verticle?
verticle
Is the right or left brachiocephalic vein longer?
left
What is the course of the left brachiocephalic vein?
oblique and crossses the branches of the aortic arch
Where is the superior vena cava?
it continues the vertical course of the right brachiocephalic vein
receives the azygos vein before entering the pericardial sac
Where is the aortic arch?
it starts anterior and arches backward over the left primary bronchus
What is the ligamentum arteriosus connected to?
the inferior surface of arch to the left pulmonary artery
What is the first branch of the aortic arch?
brachiocephalic trunk
Where is the brachiocephalic trunk?
ascends in front of the trachea to its right side
What does the brachiocephalic trunk divide into?
right subclavian and right common carotid artery
What are the branches of the aortic trunk?
brachiocephalic trunk
right subclavian
left subclavian
right common carotid artery
left common carotid
Where is the left common carotid?
arise independently from the arch and run more or less vertically along the left side of the trachea
Where is the trachea?
behind the great vessels and immediately anterior to the esphagus
What is the most posterior structure of the mediastinum?
esophagus
Where is the thoracic duct?
left side of the esophagus and vertebral column
How does the thoracic duct get to its junction? What is the junction of the thoracic duct?
arches over subclavian artery from behind to reach the left subclavian vein at its junction
juntion: with the internal jugular vein
Where are the phrenic nerves? C3-5
pass anterior to both subclavian arteries and root of the lung, then between the pericardium and mediastinal pleura to reach the diaphragm
Where is the right phrenic nerve?
it runs on the lateral side of the great veins
What are the great veins?
brachiocephalic
superior vena cava
inferior vena cava
Where is the left phrenic nerve?
runs antero-lateral to the left common carotid artery and aortic arch
Where is the vagus nerve?
passes anterior to subclavian arteries and run posterior to the root of the lung
Where is the right vagus nerve?
lateral to the trachea
Where does the right recurrent laryngeal nerve pass?
under the right subclavian artery and then ascends to the larynx
Where is the left vagus nerve?
between the left common carotid and subclavian arteries and lateral to the aortic arch?
Where does the left recurrent laryngeal nerve pass?
under the aortic arch immediately to the left of the ligamentum arteriosus to ascend in the groove between trachea and esophagus
Where do the cardiac nerves descend from?
the cervical symphatic trunk and vagus nerve to reach the cardiac plexuses around aortic arch
What is in the anterior mediastinum?
some fat, connective tissue
What is the lowest extension of the thymus and some lymph nodes?
anterior mediastinum
What is in the middle mediastinum?
pericardial sac
heart
roots of the great vessels
Where is the pericardial sac?
pericardium
What is the pericardial sac?
double-walled sac that surrounds the hear and roots of the greater vessels
What are the layers of the pericardial sac?
fibrous pericardium
serous pericardium
What is the fibrous pericardium?
a stout external layer of the pericardial sac
What are the parts of the serous pericardium?
parietal and visceral
What is the parietal pericardium?
inner layer of the pericardial sac that is fused to the fibrous pericardium
Where is the visceral pericardium?
It covers the heart
What is the visceral pericardium also known as?
epicardium
Where does teh visceral pericardium reflect from?
the heart and great vessels to become continuous with the parietal pericardium
What does the reflections of the pericardium from the great vessels create?
spaces/sinuses
What are the sinuses of the pericardium?
transverse pericardial sinus
oblique pericardial sinus
Where is the transverse pericardial sinus?
space posterior to ascending aorta and plulmonary trunk and anterior to the superior vena cava
Where is the oblique pericardial sinus?
blind recess on posterior aspect of heart caused by pericardial reflections off the pulmonary veins and inferior vena cava
What are the roots of the great vessels?
pulmonary trunk (right and left)
ascending aorta
superior vena cava
inferior vena cava
right superior and inferior pulmonary veins
left superior and inferior pulmonary veins
What is pericarditis?
the inflamation of the serous pericardium when pericardial fluid accumulates that compresses the atria
What is mediastinitis?
deep infection of the neck that has spread to the thorax