Thorax Esophageal Pathway Notes

1. Esophagus Pathway 
1. Blood Supply 
1. Aorta  Aortic arch  
1. Left subclavian or brachiocephalic to right subclavian  thyrocervical  esophageal branches 
2. Aorta  bronchial arteries  esophageal branches 
3. Thoracic aorta  aortic esophageal arteries 
4. Descending aorta  celiac trunk  left gastric  esophageal branches 
2. Blood Drainage 
1. Esophageal venous plexus 
1. Upper esophagus 
1. Inferior thyroid  brachiocephalic  SVC 
2. Right side 
1. Highest intercostal  azygous  SVC
2. Azygous  SVC 
3. Left side 
1. Highest intercostal  brachiocephalic  SVC 
2. Accessory hemiazygos  
1. Highest intercostal  brachiocephalic  SVC 
2. Azygous  SVC 
3. Hemiazygos  azygous  SVC 
2. Lower esophagus 
1. Esophageal branches  left gastric  hepatic portal  liver  central veins  hepatic veins  IVC
3. Nerve Supply 
1. Afferent 
1. Somatic 
1. N/A
2. Autonomic 
1. Parasympathetic 
1. Stretch and pain receptors  vagal fibers  ascend parallel to efferent parasympathetic fibers  jugular foramen  medulla 
2. Sympathetic 
1. N/A
2. Efferent 
1. Somatic 
1. N/A
2. Autonomic 
1. Parasympathetic 
1. Medulla  jugular foramen  
1. Recurrent laryngeal  upper esophagus plexus for swallowing 
2. Anterior posterior vagal trunks  lower esophagus plexus 
2. Sympathetic 
1. IML  ventral root  thoracic spinal nerves  white rami  sympathetic ganglion  
1. Cervical ganglia (upper esophagus)  Ach synapse  esophageal plexus 
2. Thoracic ganglia  Ach synapse  esophageal plexus 
3. Greater thoracic splanchnic nerve  ach synapse  esophageal plexus 

Thorax Posterior Heart Pathways Notes

1. Posterior Heart Pathways 
1. Blood Supply 
1. Left ventricle  aortic valve  right or left coronary arteries 
1. Right coronary artery  posterior descending artery 
2. Left coronary artery  posterior left ventricle 
2. Blood Drainage 
1. `Middle cardiac vein  coronary sinus  RA
2. Posterior vein of left ventricle  coronary sinus  RA
3. Nerve Supply 
1. Afferent 
1. Somatic 
1. N/A
2. Autonomic 
1. Parasympathetic 
1. Chemoreceptors and baroreceptors in great vessels  ascending fibers of vagus  jugular foramen  CV and respiratory centers of medulla 
2. Sympathetic 
1. Pain receptors in myocardium  ascending fibers through sympathetic cardiac nerves  sympathetic trunk ganglion  white rami  thoracic spinal nerves  dorsal root of spinal cord  anterolateral paths
2. Efferent 
1. Somatic 
1. N/A
2. Autonomic 
1. Parasympathetic 
1. Medulla  vagus  jugular foramen  thoracic vagal cardiac nerves  cardiac plexus  syn to postganglionic fiber  SA node, AV node, coronary arteries 
2. Sympathetic 
1. IML  ventral root  thoracic spinal nerves  white rami  sympathetic ganglion  ach synapse  postganglionic fiber  SA node, AV node, coronary artery, myocardium 

Thorax Anterior Heart Pathway Notes

1. Anterior Heart Pathways 
1. Blood Supply 
1. Left ventricle  aortic valve  right and left coronary arteries 
1. Right coronary  marginal branches 
2. Left coronary  left anterior descending 
2. Blood Drainage 
1. Anterior cardiac vein  small cardiac vein  right AV sulcus  coronary sinus  RA
2. Great cardiac vein  left AV sulcus  coronary sinus  RA
3. Nerves 
1. Same as posterior heart 

Thorax Diaphragm Pathway Notes

1. Diaphragm Pathways 
1. Blood Supply 
1. Aorta  aortic arch  left subclavian or brachiocephalic to right subclavian  internal thoracic  pericardiophrenic  superior surface of diaphragm 
2. Descending aorta  inferior phrenic 
2. Blood Drainage 
1. Inferior diaphragm  inferior phrenic  IVC
2. Superior diaphragm  pericardiophrenic  brachiocephalic  SVC
3. Nerves 
1. Efferent 
1. Somatic 
1. Respiratory center in medulla  spinal cord  C345  cervical plexus  phrenic nerve
2. Autonomic 
1. N/A
2. Afferent 
1. Somatic 
1. Upper and lower surface of diaphragm  upward through phrenic nerve C345 dorsal roots  spinal cord  medulla 
2. Lower diaphragm  intercostal nerve  dorsal root T spinal nerves 

Thorax Pleural Pathways

1. Parietal Pleura Pathway 
1. Blood Supply 
1. Aorta  aortic arch 
1. Descending aorta  posterior intercostal  costal pleura 
2. Left subclavian or brachiocephalic to right subclavian  internal thoracic  anterior costal pleura
1. Mediastinal pleura 
2. Pericardiophrenic  diaphragmatic pleura
2. Blood Drainage 
1. Diaphragmatic pleura  pericardiophrenic  brachiocephalic  SVC
2. Mediastinal pleura  internal thoracic  brachiocephalic  SVC 
3. Costal pleura  internal thoracic  brachiocephalic  SVC
4. Costal pleura  intercostal vein  
1. Right  azygous  SVC 
2. Left hemiazygos  highest intercostal  brachiocephalic  SVC 
3. Left hemiazygos  azygous  SVC 
3. Nerves 
1. Afferent 
1. Pain 
1. Costal pleura  intercostal nerve  dorsal root  anterolateral 
2. Diaphragmatic and mediastinal pleura  phrenic  cervical plexus  C345  anterolateral paths