Anatomy(Thorax) Flashcards
Eisenmenger syndrome
Cyanosis from pulmonary hypertension with right to left shunt
Parts fused to form abdominal diaphragm
- septum transversum
- the mesentery of the foregut
- ingrowth from the body wal
- the pleuroperitoneal membrane (a small dorsal part).
These close the primitive communications between
pleura and peritoneal cavities.
Posterolateral hernia through the foramen of Bochdalek
(the pleuroperitoneal membrane)—more common on
the left
• A hernia through the foramen of Morgagn
anteriorly
between xiphoid and costal origins.
Why is the 10th rib an atypical rib?
Only one articular facet on head
Mnemonic of hilum of the lung
(AP<V{AB)V>SI}
V-VEIN
A-ARTERY
B-BRONCHUS
AP-ANTERIOR POSTERIOR
SI-SUPERIOR INFERIOR
Level of apex of lung above clavicle
Along a curved line 2.5 cm above inner third of clavicle
Meeting point of pleural reflexions anteriorly
Angle of Louis at midline coming down from sternoclavicular joint
Division point of pulmonary artery into right and left main branches
Anterior to left main bronchus
Which nerve is in contact with the ligamentum arteriosum?
Left recurrent laryngeal nerve
Origin of bronchial arteries
Descending aorta
Where does the visceral pleura continue with the parietal layer?
over the
root of the lung.
Where do collateral vessels develop in case of Coarctation of the Aorta?
between vessels above and
below the block
The superior intercostal artery, derived from?
Subclavian artery
Where intercoastal spaces are not covered by pleura?
Medial end of the fourth and fifth left intercostal spaces
Where does the pleura descends below the twelfth rib?
at its medial extremity (in mediastinum)
{So caution not to open during adrenal of kindness surgery}
Lower border of pleural vs lung vs ribs
Pleura Lung
8th mid clavicular 6th
10th mid axillary 8th
12th lateral of erector spinae. 10th
Nerve supply of visceral pleura and it’s sensitive
Vagus nerve, only sensitive to stretching not for pain
Which pleura is sensitive to pain
Parietal(referred to abdomen), mediastinal(referred to tip of shoulder), diaphragmatic pleura(tip of shoulder C4)
Position of psoas and lumborum
Psoas medial(arcuate ligament)
Lumborum lateral(arcuate ligament)
Which ribs give origin to abdominal diaphragm?
Lower 6 ribs (inner aspect)
Muscle originated from xiphoid process
Diaphragm
Transversus thoracis
Structures passing through aortic opening of diaphragm
Descending aorta(thoracic>abdominal)
Azygos vein
Thoracic duct
Structures passing through oesophageal opening (lying in right crus)
Oesophagus,
vagus,
Branches of left gastric artery and vein.
Structures passing through vagal opening
IVC
Right phrenic nerve
Which nerves pierce crura of diaphragm
Splanchnic nerves
(Both greater and lesser)
Structures passing behind the medial arcuate ligament (lying on psoas major)
Sympathetic chains
mechanism of paradoxical movement of diaphragm in phrenic nerve injury
Sure to raised intra abdominal pressure during inspiration and vice versa
Surfaces and borders of heart
Surfaces
Anterior -right atrium, right ventricle, strip of left ventricle
Posterior -left atrium, left ventricle
Inferior -right atrium with IVC entering, lower part of ventricles
Borders
Right. -SVC, right atrium, IVC
Left -auricle, left atrium, left ventricle
Inferior -right ventricle, apex of left ventricle
Extension and function of moderator band of heart
Extending from interventricular septum to anterior wall of ventricle
Function is to prevent overdistension,
To conduct right branch of AV bundle to anterior wall of ventricle
Cusps of-
Mitral valve
Tricuspid valve
Pulmonary valve
Aortic valve
Mitral -anterior, posterior
Tricuspid - anterior, posterior, septal
Pulmonary - anterior,right, left
Aortic - anterior,right posterior, left posterior.
Origin points of right and left coronary arteries
Right -anterior aortic sinus
Left -left posterior aortic sinus
What does Crista Terminals of heart devide?
Atrial part firm sinus venosus and atrial part from true ariam
Which muscle contact first in heart
Papillary muscle
Veins of heart
Venae cordis minimae >right atrium
Anterior cardiac>right atrium
Great cardiac>coronary sinus
Middle cardiac>coronary sinus
Small cardiac>coronary sinus
Coronary sinus>right atrium left to the mouth of IVC
Nerve supply of heart
Sympathetic (cardio accelerator)
Vagus (cardio inhibitor)
Why anginal pain is experienced in chest and inner aspect of left arm
Due to excitation of spinothalamic tract via dermatomes T1-T4
Why anginal pain is experienced in neck and jaw
Vagus>nucleus tractus solitarius of medulla>upper cervical spinothalamic tract
Fusion of apex and base of pericardium
Apex with tunica adventitia of great vessels
Base with central tendon of diaphragm
Which coastal cartilages are related to pericardium
3rd to 6th
Which vertebrae are related to pericardium
T5-8
Why do Oblique and Transverse Sinuses form
At the pericardial reflections, veins are surrounded by one
sleeve of pericardium and arteries by another.
Clinical Points
For Fibrous pericardium
Fibrous pericardium can stretch gradually if there is
gradual enlargement of the heart.
But Sudden increase in pericardial contents as in sudden
bleeds: stretching does not occur and cardiac function
is embarrassed (cardiac tamponade).
Surface anatomy of heart(easy points)
Superior-
1.2cm 2nd left 3rd right
Inferior-
9cm 5th left 1.2cm 6th right
Left-
Joining above lefts
Right-
Joining above rights
Vertebrate behind superior mediastinum
T1-4
Which one is inominate artery
One and only brachyocephalic artery
Important of The Angle of Louis
• second costosternal joint
• junction of superior and inferior mediastinum
• commencement and termination of aortic arch
• ligamentum arteriosum lies on this plane.
• confluence of azygos vein with superior vena cava
• bifurcation of trachea
• thoracic duct runs from right to left
• plane of T4
Direction of rotation of primitive heart tube
Inferior part goes to superolaterally on right side
Which is sinus venosus
Origin of interventricular septum
From Apex to endocardial cushion
Relation of septum primum and septum secundum
Primum is inferomedial
With foramen secundum superiorly
In Septum secundum case vice versa with a free lower edge
Which septum is pushed to close the foramen ovale.
P—P
• At birth, where there is an increased blood flow through
the lungs and a rise in left atrial pressure, the septum PRIMUM is pushed across to right side to close the foramen ovale.
Maintaining position of foramen ovale of heart
septum ➡
RA ⬇ secundum ⬆ septum ⬇ LA
➡ primum
arches by Truncus arteriosus
Truncus arteriosus gives off six pairs of arches.
Ultimate form of sinus venosus of primitive heart
The sinus venosus joins the atria, becoming the two venae cavae on the right and the four pulmonary veins on the left.
Connection of ductus venous
Umbilical vein Anne IVC
Connection of ductus arteriosus
Left pulmonary artery to arch of aorta just before its termination
PDS increases load of which chamber of heart
Left ventricle
Pulmonary and systemic sides of heart and
Eisenmenger syndrome
Pulmonary Right
Systemic Left
In eisenmenger syndrome first pathology causing raised right side overload. Then right to left shunt causing mixing of oxygenated and deoxygenated blood. Resulting in cyanosis
Relation of blood shunting with eisenmenger syndrome
LR shunt>RL shunt>cyanosis
Relation of cyanosis in tetralogy of Fallot
Because there is a right-to-left shunt due to pulmonary trunk stenosis across the VSD there is usually cyanosis at an early stage.
Determinant of cyanosis in Fallot’s Tetralogy
The degree of cyanosis depends mainly on the severity of the pulmonary outflow obstruction.
Origin of crural part of diaphragm
Mesentery of foregut
Parts of primitive abdominal diaphragm
The diaphragm develops from the fusion of four parts:
Defect in Posterolateral congenital diaphragmatic hernia
pleuroperitoneal membrane
Called hernia through the foramen of Bochdalek
Name of hernia anteriorly
between xiphoid and costal origins
A hernia through the foramen of Morgagni
Number of ‘true’ ribs
14
Number of false rib
6
Why called floating rib
Ribs 11 and 12 are free anteriorly. These are ‘floating ribs’ as they have no anterior articulation.
Articulation of head of rib
A head has two articular facets for articulation with the CORRESPONDING vertebra and the vertebra ABOVE
Ligament attached to neck of rib
Costotransverse
Why is the subclavian groove on 1st rib for
Subclavian artery &
Lowest trunk of brachial plexus
Ribs with single articular facet on head
10
11
12
Rib without subcostal groove
12
Origin of superior intercostal artery
Costocervical trunk of subclavian artery
Reason for notching which can be seen on X-ray in Coarctation of aorta
superior intercostal artery supplies blood to the intercostal arteries, vessels dilate and become more tortuous eroding the lower border of the ribs
vascular symptom of seventh cervical rib
poststenotic dilatation of the subclavian artery
Subclavian aneurysm
subclavian vein thrombosis
Effect of 7th cervical rib on hand
• Pressure on the lower trunk of the brachial plexus may result in paraesthesia of dermatomal distribution of C8/T1 together with wasting of small muscles of hands
(myotome T1).
Type of cartilage of ribs
Hyaline
Relation of manubrium
• Lowest part is related to arch of aorta.
• Upper part is related to left brachiocephalic vein; left
brachiocephalic artery; left common carotid artery; left subclavian artery
Extension of trachea and length
C6 -T5 (11cm)
Lining of trachea with special cell
Ciliated columnar epithelium with goblet cells
Peculiar bronchus
wider, shorter and more vertical always right
Vessels in front of right bronchus
Ascending aorta
SVC
Azygos vein arches over it from behind to enter SVC
Pulmonary artery lies first below and then anterior to it
Relation of vessels with left bronchus
It passes downwards and laterally below arch of aorta,
in front of descending aorta
pulmonary artery lies at first anterior to, and then
above, the bronchus
What indicates distortion and widening of the carina
enlargement of the tracheobronchial lymph nodes
at the bifurcation by carcinoma.
What about platysma in Tracheostomy
in the transverse incision, platysma will be located in the lateral part of the incision
Relation of stap muscles with thyroid in tracheostomy
After splitting the pretracheal fascia and retracting the strap muscles, the isthmus of the thyroid will be encountered
What to do with thyroid during tracheostomy
may be either retracted upwards or divided between clamps to expose the cartilages of the trachea.
Part of left lung equivalent to midday lobe of right lung
The equivalent of the middle lobe of the right lung in the left lung is the lingula, which lies between the cardiac notch and oblique fissure.
Marking of intersegmental lung boundary
marked by intersegmental veins
Division point of pulmonary trunk
Below the concavity of the aortic arch divides in front of the left main bronchus into right and left branches.
Relation of right pulmonary artery with ascending aorta and SVC
Passes to the root of the right
lung behind the ascending aorta and SVC.
Origin and function of bronchial artery
• Supply the air passages.
• Branches of the descending aorta.
Which part of diaphragm has vena canal opening
Central tendon
Relation of sympathetic chain with diagram
• Sympathetic chain passes behind the medial arcuate ligament lying on psoas major.
Sensory and motor innervation of diaphragm
The sensory innervation of the central tendon of the diaphragm is via the phrenic nerve but the periphery of the diaphragm is supplied by the lower six intercostal nerves.
Phrenic nerve (C3, 4, 5): the phrenic nerve is the sole motor nerve supply to the diaphragm.
Points of injury of phrenic nerve at neck
Percussion dullness
Absent breath sounds
Paradoxical movement of diaphragm
Reason of lung expansion during inspiration
The negative intrapleural pressure is increased and the lung expands.
Does Latissimus dorsi help during respiration
It is one of the muscles required to use during forced expiration
Surfaces of heart
Anterior
Posterior (base)
Inferior
Location of pericardiophrenic vessels
Middle mediastinum
drainage of thoracic duct
The thoracic duct drains lymph from most of the body into the venous system at the junction of the left subclavian and jugular veins. The thoracic duct is the larger of the two lymphatic ducts in the body, and is responsible for draining lymph from the following areas:
Lower extremities
Pelvis
Abdomen
Left side of the thorax
Left upper extremity
Left side of the head and neck
Origin of thoracic duct
The thoracic duct typically starts at the second lumbar vertebra at the cisterna chyli. It contains smooth muscle that propels lymph upward, as well as white blood cells, eosinophils, and a high protein content.
Cause of chylothorax
Diagram
Anatomy
Mnemonic
Steps
Pdf
Radiology
Wikipedia
Lymph
Left
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The thoracic duct drains lymph from most of the body into the venous system at the junction of the left subclavian and jugular veins. The thoracic duct is the larger of the two lymphatic ducts in the body, and is responsible for draining lymph from the following areas:
Lower extremities
Pelvis
Abdomen
Left side of the thorax
Left upper extremity
Left side of the head and neck
The thoracic duct typically starts at the second lumbar vertebra at the cisterna chyli. It contains smooth muscle that propels lymph upward, as well as white blood cells, eosinophils, and a high protein content.
A leak in the thoracic duct, known as chylothorax, can cause lymph to collect in the pleural space. This can lead to significant morbidity, including loss of lymph and respiratory distress. A number of conditions can cause a thoracic duct rupture, including trauma, malignancies, tuberculosis, sarcoidosis, and superior vena cava obstruction.
Location of base and apex of pericardium
Base with central tendon
Apex with great vessels
