Download Quiz 3 Critical Structures

Thoracic Wall, Pleura & Lungs – Critical Structures
* = structures that can be found on RADIOGRAPHS
internal thoracic artery*
anterior intercostal arteries
external intercostal m.
internal intercostals m.
innermost intercostals m.
transversus thoracis m.
intercostal vein
intercostal artery
intercostal nerve
cupola (lung apex) *
costodiaphragmatic recess*
root of lung
lung*
upper lobes
lower lobes
major (oblique) fissure
minor (horizontal) fissure
right middle lobe
lingual
cardiac notch
trachea*
main bronchi*
carina*
sternum*
retrosternal space*
ribs
brachiocephalic veins (left & right) *
azygos vein & arch*
arch of aorta*
brachiocephalic trunk*
left common carotid artery*
right common carotid artery*
left subclavian artery*
right subclavian artery*
superior vena cava
ascending, descending and arch of
aorta
pulmonary trunk
ligamentum arteriosum
left vagus nerve
left recurrent laryngeal nerve
phrenic nerve
Q1. The intercostal nerves and vessels run in the space between which muscles?
Q2. What artery is running with the phrenic nerve?
Q3. Imagine that during a tooth extraction, the tooth was accidentally dropped down the trachea.
Into which main bronchus would it be most likely to lodge?
Q4. Which bronchus is also called the "eparterial bronchus"?
Q5. What is a cardiac tamponade?
Q6. What is pericardiocentesis?
ANS. 1. internal & innermost; 2. pericardicophrenic artery; 3. Rt.; 4. Rt. upper/superior, it is usually
located superior to the pulmonary artery; 5. may result from bleeding into the pericardial sac & leads to
compression of the encased heart; 6. withdrawing fluid from the pericardial sac.
Middle Mediastinum and Heart – Critical Structures
* = structures that can be found on RADIOGRAPHS
outer fibrous layer of pericardium – outermost and toughest pericardium layer, most visible in chest cavity
oblique sinus – area of the pericardium where the heart sits (posterior to the L atrium) in the chest cavity
transverse sinus – behind the aorta and pulmonary trunk, separates inflow and outflow vessels
superior vena cava* - largest vein running into the superior right edge of the right atrium
inferior vena cava* - largest vein running into the inferior right edge of the right atrium
pulmonary trunk* - large artery emanating from the superior portion of the right ventricle
L & R pulmonary arteries* - 2 on each side (L and R anatomically) split from pulmonary trunk
pulmonary veins – bring blood back from the lungs to the heart into the
ascending aorta* - the section between the heart and the arch of aorta
descending aorta* - the section from the arch of aorta to the point where it divides into the
common iliac arteries
right coronary artery – off of the aorta, runs between the R ventricle and R atrium
atrial branch and nodal artery – branch running to R atrium, and splits to SA Node
marginal artery – branch running on R margin of R ventricle, w/small cardiac vein
posterior interventricular artery – branch running on post. between the ventricles with
the middle cardiac vein
left coronary artery – off of the aorta, runs between the L atrium and pulmonary trunk
anterior interventricular artery – branch running on ant. Between the bentricles with
the great cardiac vein
circumflex branch – runs between L atrium and L ventricle to posterior
coronary sinus – large vein on post. between L atrium and L ventricle, sm mid great drain into
great cardiac vein – runs with the L ant. interventricular artery, becomes the coronary sinus
middle cardiac vein – runs with the R post. interventricular artery, into the coronary sinus
small cardiac vein – runs with R marginal artery, into the coronary sinus
anterior cardiac veins – feed directly into R atrium (only visible veins not going to coronary
sinus, the only others are the microscopic smallest or “thebesian” veins)
left auricle* - “ear” or left atrial appendage, on the perimeter of L atrium towards L ventricle
right auricle – “ear” or right atrial appendage, on the perimeter of R atrium towards R ventricle
pectinate muscles – “comb-like”, on the inner anterior wall of the R atrium
crista terminalis – separates pectinate muscle from smooth muscle ant./post. in the R atrium
tricuspid valve – AV valve, three cusps, between R atrium and R ventricle
fossa ovalis – thin tissue remnant of foramen ovale between the R and L atriums
valve (Eustachian) of IVC – remnant in adult heart, in fetal heart directed blood from Inferior
Vena Cava into the L atrium from the R atrium via the foramen ovale
mitral valve – AV valve, bicuspid valve, two cusps, between L atrium and L ventricle
aortic semilunar valve – three cusps, no chordae tendinae, between the L ventricle and aorta
chordae tendinae – connect leaflets of AV valves to papillary muscles on the ventricular floor
papillary muscles* - secure chordae tendinae of AV valves to ventricular floor, & moderates tension
trabeculae carneae* - “beams of meat” on interior ventricular walls, rounded irregular muscular projections
moderator band – runs in the R ventricle from the base of the ant. papillary muscle to the interventricular
septum, as part of the electrical transmission system of the heart
infundibulum (of R ventricle)* - aka – conus arteriosis, cone shaped smooth muscle outflow from R ventricle
to the pulmonary trunk, just inferior to the pulmonary semilunar valve
pulmonary semilunar valve – three cusps, no chordae tendinae, between the R ventricle and pulmonary trunk
interventriclular septum* - the wall between the R and L ventricles
Q1. Which veins do NOT drain into the right atrium via the coronary sinus?
ANS. 1. anterior cardiac and smallest (thebesian - microscopic) veins
POP QUIZ for group A
The RIGHT side of the body comes in threes and the LEFT in twos
R Atrium to R Ventricle = Tricuspid Valve
L Atrium = Mitral Valve (bicuspid)
R Lung = three Lobes
L Lung = two Lobes
R Coronary Artery = three Branches (we need to know)
LCA = two Branches (we need to know)
Posterior Mediastinum & Autonomics – Critical Structures
* = structures that can be found on RADIOGRAPHS
esophagus*
ligamentum arteriosum
left vagus nerve
left recurrent laryngeal nerve
anterior vagal trunk
right vagus nerve
posterior vagal trunk
esophageal plexus
descending (thoracic) aorta*
posterior intercostal arteries
azygos vein*
hemiazygos vein*
accessory hemiazygos vein
posterior intercostal veins
superior intercostal vein
thoracic duct
sympathetic trunk
greater splanchnic nerve
lesser splanchnic nerve
rami communicans
Q1. From what regions do parasympathetic fibers emanate?
Q2. An aneurysm of the arch of the aorta stretches the area of the ligamentum arteriosum; what
may be a clinical sign of damage to nerves in the area?
Q3. What structure does the right recurrent laryngeal nerve loop around and pass posterior to on
its course to the larynx?
Q4. Where does the left superior intercostal vein drain?
Q5. Where does the descending aorta begin?
Q6. Does the descending aorta pierce the diaphragm?
Q7. At what level does the thoracic duct usually cross from the right side to the left?
Q8. What areas does the thoracic duct normally drain?
Q9. Which rami communicans carries preganglionic fibers?
Q10. Which rami may be found over the entire length of the sympathetic trunk?
Q.11 The greater, lesser and least splanchnic nerves supply what area?
ANS. 1. Cranial-sacral; 2. May cause the patients voice to be hoarse (see clinical note in MD
176); 3. right subclavian artery; 4. left brachiocephalic vein; 5. At the sternal angle, 2nd rib, 4-5th
thoracic vertebra; 6. NO, passes behind the crus of the diaphragm at thoracic level 12; 7. Sternal
angle; 8. lower extremities, pelvic & abdominal cavities, left sides of the thorax, head & upper
limb; 9. White; 10. Gray; 11. sympathetics to most of the abdominal viscera