Anterior Chest Wall

Question 1

Distal to left subclavian artery & Ligamentum arteriosum

⬆️ BP to upper extremities & ⬇️ femoral artery pulses

Collateral circulation:

• internal thoracic artery –> intercostal artery –> superior epigastric artery –> inferior epigastric artery –> external iliac artery
• these arteries become dilated –> rib notching in dilatation of intercostals artery

Answer 1

Postductual coarctation of aorta

Question 2

Less common, proximal to ductus arteriosus, blood reached the lower part of the body aneurysm of the aorta

• felt by palpitation the trachea at sternal notch (T2)

Answer 2

Preductal coarctation

Question 3

From deceleration

Aorta tears just distal to the left subclavian artery through tunica intima & media

Answer 3

Aortic disruption

Question 4

Knife wound above the clavicle may damage the ff structures

Answer 4

Subclavian artery

Brachial plexus, lower trunk –> loss of hand movement (ulnar nerve), sensory loss over medial aspect arm, forearm & last 2 digits (C8 & T1 dermatomes)

Cervical pleura & apex of the lung –> open pneumothorax, collapse of the lung

Question 5

Projection of diaphragm on the chest wall

Answer 5

Central tendon
- posterior to xiphoidsternal joint

Right dome
- arches superiorly to upper border of rib 5, MCL

Left dome
- arches superiorly to lower border of rib 5, MCL

Question 6

Cause: anomalous cervical rib –> compresses lower trunk of brachial plexus, subclavian artery or both

Answer 6

Thoracic outlet syndrome

Question 7

Located behind the clavicle

Surrounded by pleura, lymph ducts & phrenic nerve

Complications: pneumothorax, lymph leakage & diaphragm paralysis

Answer 7

Scalene lymph node biopsy

Question 8

Insertion of central venous catheter

Answer 8

Access to SVC & right side of the heart to monitor BP, long-term parenteral feeding, administer drugs

Internal jugular vein & subclavian vein usually

Complications: puncture of subclavian artery, pneumothorax, hemothorax, trauma to the trunks of brachial plexus, arrhythmia, venous thrombosis, erosion of catheter through SVC, tricuspid valve damage, infection