ANATOMY MNEMONICS AND OTHER HELPFUL TIDBITS

• SVC, 123, CC
Superior Vena Cava (SVC) surface anatomy markings: At the
1st Costal Cartilage (CC) the Left and Right Brachiocephalic veins join to
form the SVC; At the 2nd CC (Also, incidentally, at the Angle of Louis/Sternal
Angle), the Azygos vein arches anteriorly to join the SVC; At the 3rd CC, the
SVC joins the Right Atrium of the heart.

• C3, 4, 5, KEEP THE DIAPHRAGM ALIVE
The right and left phrenic nerves
supply motor function to the diaphragm. Its main origin is C4, but also
receives contributions from C3 and C5. If the spinal cord is seriously
damaged or cut about C3, spontaneous breathing would be most likely
inhibited. The phrenic nerves also supply sensation to the mediastinal
pleura and pericardium.

• RIGHT AND LEFT PHRENIC NERVES
In the Mediastinum, the LEFT Phrenic
nerve passes over arterial (‘red’) structures , whilst the RIGHT Phrenic nerve
passes over venous (‘blue’) structures. LEFT: Passes over Ascending Aorta,
and LV. RIGHT: Passes over SVC, RA, and to some small extent, RV. Both
Phrenic nerves have one ‘goal’ – To supply the diaphragm, and they do this
relatively directly, hence their relatively simple pathways. Branches are
given off at the mediastinal pleura, and the pericardium along the way.

• V A N
In the Costal Groove (On the inferior, medial part of the ribs), the
three structures that are to be found, in order from most superior, to most
inferior, are: The VEIN, ARTERY, NERVE (Therefore, VAN). The Nerve is the
most inferior structure, and is usually not protected by the costal groove,
and is most susceptible to being damaged, hit, cut, etc.
• I O A, 8 10 12
IVC pierces the central tendon of the diaphragm at TVIII at
the Caval opening (Vena CAVA, therefore – CAVAL opening), the
Oesophagus exits the thorax at the Oesophogeal hiatus at TX, and the Aorta
exits the thorax at the Aortic hiatus at TXII. Therefore, IVC = 8, Oesophagus
= 10, Aorta = 12; I O A, 8 10 12.

• THE DUCK BETWEEN TWO GOOSES
The Thoracic Duct (‘duck’) is found
between the Azygos and the Oesophagus (‘gooses’)

• V I C A R S
The vessels that drain into the right atrium are: SVC, IVC,
Coronary Sinus, Anterior Cardiac Veins (anterior veins of right ventricle),
Venae Cordis Minimae (Veins of Thebesius), and, sometimes, the Right
Marginal Veins. In order according to the Mnemonic VICARS: Venae Cordis
Minimae, IVC, Coronary Sinus, Anterior Cardiac Veins, Right marginal Veins
(sometimes), SVC.

• SVC – No Valve, IVC – Valve
The SUPERIOR Vena Cava, being ‘superior’
(both in an anatomical sense, and also for the mnemonic’s sake, a more
class-oriented sense), does not need a Valve, and therefore doesn’t have
one. The INFERIOR Vena Cava, being ‘inferior’, cannot cope otherwise, and
has a valve. (The valve is found before it enters the RA, so as to prevent
backflow as it is at a very low pressure. Since the SVC has gravity aiding its
flow, backflow won’t happen, therefore it doesn’t need a valve). NOTE: The
Coronary Sinus also has a valve.

• CHEST DRAIN (TUBE THORACOTOMY)
A chest drain is usually inserted in

what is known as the ‘safe triangle’. This is an imaginary triangle formed by
 the lateral border of the pectoralis major, the anterior border of the
latissimus dorsi, and the apex below the axilla, at a level superior to an
imaginary line drawn horizontal to the level of the nipple. It is termed ‘safe’
as it contains no major vessels or structures which could be hit or cut whilst
performing the thoracotomy. The drain is usually inserted at the 5th
intercostal space, ALWAYS DIRECTLY ABOVE (touching) THE SUPERIOR
BORDER OF THE RIB BELOW (Therefore, just above the 6th rib), just anterior
to the midaxillary line. A tube thoracotomy is conducted in cases of
pneumothorax (AIR in the pleural space), pleural effusion (all types of FLUID
in the pleural space, Haemothorax (Blood), Haemopneumothorax (blood
and air), Hydrothorax (Serous fluid), Hydroheamothorax (Serous fluid and
blood), Chylothorax (Chyle), Empyma/Pyothorax (Pus).

• LAYERS A CHEST DRAIN/SYRINGE PIERCES IN THE THORACIC WALL

(From more superficial layers, to deeper ones) Skin, superficial fascia
(subcutaneous fat), External Intercostal Muscles, Internal Intercostal
Muscles, Innermost Intercostal Muscles, Endothoracic Fascia, Parietal
Pleura. NOTE: The Tube should not pierce the Visceral pleura, as the fluid
needs to be drained from the pleural space, not the lung (which lies
immediately deep to the visceral pleura).

• IMPORTANT STRUCTURES & FEATURES FOUND AT THE ANGLE OF LOUIS /

STERNAL ANGLE
Mediastinum is split into superior and inferior, 2nd
Costal Cartilages, Manubriosternal symphysis, Intervertebral disk betweem
TIV & TV, Bifurcation of Trachea, start and end of the Aortic Arch (start of
Ascending Aorta anteriorly, and start of thoracic aorta posteriorly), Arch of
the Azygos vein (where Azygos vein travels anteriorly to join the SVC),
Thoracic Duct, Superior margin of the Pulmonary trunk, Thymus gland
(middle of it, more or less), Ligamentum Arteriosum, Left Recurrent
Laryngeal Nerve. NOTE: There are more ‘obvious’ structures too, such as
 the SVC, Oesphagus, lungs, vagus nerves, phrenic nerves, etc, but these are
assumed to be a given.

• OESOPHOGEAL CONSTRICTIONS
(From most superior, moving inferiorly)

Junction of oesophagus with pharynx, where oesophagus is crossed by
aortic arch, where oesophagus is crossed by left main bronchus, at the
oesophageal hiatus at TX (where it leaves the thorax, into the abdomen).

• BRONCHI
The right main bronchus is slightly wider, and lies in a more
vertical orientation than the left. Clinically, this means that any foreign
bodies and pathogens inhaled tend to lodge themselves and gain access to
the body in the right lung more often and more easily than the left.