Breast and Axillary Flashcards
1
Q
The axilla is essentially the region that we
think of as the
A
deep compartment of the
armpit
2
Q
It is a complex region located inferior to
the — joint (shoulder joint), at
the junction of the
A
glenohumeral
arm and the thorax
3
Q
The axilla is an important passageway for
A
neurovascular structures to the upper
limb
4
Q
It is a “— shaped” space that
invested in
A
pyramid
layers of fascia
5
Q
Some of these fascial layers are also continuous with the (2)
A
thorax and upper limb
6
Q
The fascia of the pectoral region consists of
A
superficial and deep layers that define borders,
invest muscles, and create potential spaces
7
Q
Superficial fascia is (2)
A
Subcutaneous; fatty
8
Q
Deep fascia (3)
A
•Compartmentalizing
•Surrounds muscles
•Attaches to bone in
most cases
9
Q
superficial fascia contains (2)
A
skin
subcutaneous fatty tissue
10
Q
Platysma muscle (2)
A
Muscle over lower mandible, neck and upper thoracic/shoulder region
a very superficial skeletal muscle that is mostly subcutaneous
11
Q
Supraclavicular nerves
A
cutaneous branches from C3 & C4 cervical spinal nerves
12
Q
Anterior & lateral branches of intercostal nerves
A
come up through deeper layers of fascia to subcutaneous layers
13
Q
superficial fascia contains (4)
A
- Skin and subcutaneous fatty tissue
- Platysma muscle
- Supraclavicular nerves
- Anterior & lateral branches of intercostal nerves
14
Q
pectoral fascia attaches to (2)
A
clavicle
sternum
15
Q
pectoral fascia invests
A
pectorals major muscle
16
Q
pectoral fascia is continuous with
A
fascia of anterior abdominal wall
17
Q
pectoral fascia will become the
A
axillary fascia
18
Q
axillary fascia forms the
A
floor of axilla
19
Q
clavipectoral fascia is deep to
A
pectorals major muscle
20
Q
clavipectoral fascia invests (2)
A
subclavius
pectoralis minor muscles
21
Q
costocoracoid membrane connects
A
subclavius to pectoralis minor
22
Q
clavicoectoral fascia attaches to
A
clavicle
23
Q
clavicpectoral fascia becomes
A
suspensory ligament of axilla
24
Q
deltoid fascia
A
surface of deltoid muscle
25
deltoid fascia attaches to (3)
clavicle
acromion
spine of scapula
26
deltoid fascia is continuous with
pectoralis fascia
27
deltoid fascia compartmentalizes
scapular muscles
28
clavipectoral triangle aka
deltopectoral triangle
29
clavipectoral triangle allows passage of
neuromuscular structures between axilla and pectoral region
30
borders of the calvicpectoral triangle (3)
deltoid
pectoralis major
middle 1/3 of clavicle
31
clavipectoral triangle contents (3)
cephalic vein
deltopectoral lymph nodes
deltoid branch of thoracoacromial a (axillary a)
32
boundaries and contents of the axilla (7)
```
pyramid shaped space
apex
base
anterior wall
lateral wall
medial wall
posterior wall
```
33
apex (3)
clavicle
scapula
1st rib
34
the apex contains the
cervicoaxillary canal
35
this space is the passageway for
neuromuscular structures (axillary vessels and brachial plexus components) from the neck to the upper limb
36
base contains (4)
skin and superficial fascia
anterior axillary fold
posterior axillary fold
chest wall
37
skin and superficial fascia
axillary fossa; aka armpit
38
anterior axillary fold (1)
pectoralis major muscle
39
posterior axillary fold (2)
latissimus dorsi muscle
| trees major muscle
40
chest wall (1)
serratus anterior muscle
41
anterior wall (4)
clavicle (superior)
subclavius muscle (superior)
pectoralis major muscle
pectorals minor muscle
42
posterior wall (4)
scapula
subscapularis muscle
latissimus dorsi muscle
trees major muscle
43
lateral wall (3)
```
• intertubercular sulcus
(bicipital groove)
• tendon of long head
of biceps
• coracobrachialis tendon
```
44
the axilla region transmits
neuromuscular structures to the upper limb
45
within the axilla is a separate fascial compartment called the
axillary sheath
46
the axillary sheath is an extension of the
prevertebral layer of deep cervical fascia into the cervicoaxillary canal (apex) of the axilla
47
the contents of the axillary sheath include (3)
* Vascular: axillary artery & vein
* Neurological: cords of the brachial plexus
* Lymphatic: axillary lymph nodes
48
contents of the axilla (2)
axillary artery
| axillary vein
49
The axillary artery is the continuation
| of the
subclavian artery
50
The axillary artery is the continuation
of the subclavian artery and it has
tributaries that provide blood to the
(4)
shoulder, thorax, and axillary region.
It continues into the arm as the
brachial artery
51
The axillary vein is formed by the
| coming together of the
brachial
| vein(s) and the basilic vein
52
It will eventually be joined by the
| cephalic vein as it becomes the
subclavian vein
53
The --- --- is a network of spinal
nerves C5-T1 that emerge from the neck and
travel into the axilla
brachial plexus
54
The cords of the brachial plexus are within
the --- --- (with the axillary artery &
vein)
axillary sheath
55
The brachial plexus provides innervation to
| the (4)
shoulder, pectoral region, scapular
| region and upper limb
56
Within the fibrofatty connective tissue of the axilla, there are
numerous axillary lymph nodes
57
The axillary lymph nodes can be grouped together based on their
location within the pyramidal cone of the axilla
58
Pectoral (anterior) lymph nodes (2)
* Medial wall of axilla
| * Cluster around lateral thoracic vein
59
Subscapular (posterior) lymph nodes (2)
* Posterior axillary fold
| * Cluster around subscaplular vessels
60
Humeral (lateral) lymph nodes (2)
* Lateral wall of axilla
| * Near axillary vein
61
Central (center/base) lymph nodes (2)
* Base of axilla
| * near axillary vein
62
Apical (apex) lymph nodes (2)
* Apex (cervicoaxillary canal)
| * Near axillary vein
63
In humans, the breasts are
bilateral glandular structures found in both males and females
64
In females the breast is much more
| developed and is capable of
producing nourishment for young
65
The mammary glands are modified
sweat glands
66
the breast is a cutaneous structure, which rests on
pectoral fascia
67
--- space is potential space
| between breast and pectoral fascia
Retromammary
68
Blood supply from tributaries of
| 2
subclavian and axillary arteries
69
breast is innervated by
intercostal nerves (4th-6th)
70
Attaches to dermis of overlying skin via
suspensory ligaments (aka Cooper’s Ligaments)
71
--- --- --- converge on the nipple
Mammary gland lobules
72
Lactiferous ducts drain into --- ---
| which open at nipple
lactiferous sinuses
73
The nipple is surrounded by a --- ---
pigmented areola
74
innervation of the breast mainly from the anterior and lateral branches of
the
4th – 6th intercostal nerves
75
may also receive some innervation
from
| supraclavicular nerve branches as well as branches of other intercostal nerves
76
somatosensory to --- and autonomic to (2)
skin
| blood vessels and smooth muscle
77
primary blood supply to the breast (2)
medial mammary branches
| lateral mammary branches
78
Medial Mammary Branches
From internal thoracic artery
| from subclavian artery
79
Lateral Mammary Branches
From lateral thoracic artery
| from axillary artery
80
Venous Drainage (primary) mainly to (2)
axillary vein via lateral thoracic veins and medial mammary veins via internal thoracic vein
81
some drainage to internal thoracic vein (and then subclavian v.) via
anterior intercostal veins
82
lymphatic drainage is especially important due to its role in
metastasis of cancer cells
83
Nipple, Areola, Lactiferous Lobules
• subareolar lymph nodes
84
> 75 % of lymph from breast
• axillary lymph nodes (pectoral, central,
| apical)
85
Remaining lymph
• Parasternal (internal mammary) and
| abdominal lymph nodes
86
```
Accessory nipple (polythelia) and/or
breast tissue (polymastia) can occur in
```
both males and females
87
May include --- tissue
glandular
88
May be mistaken for a --- (nevus)
mole
89
Appear along the embryonic mammary
| crest, which extends from
axilla to groin
| area
90
A --- characteristic
mammalian
91
Lymphatics of importance when considering
metastases of cancer cells
92
---- (arise from glandular tissue,
| epithelial cells of lactiferous ducts)
Adenocarcinomas
93
Most metastasis is to
axillary lymph nodes
94
Examples of Retraction Signs:
Cancer may cause lymphedema (excess
subcutaneous fluid) by blocking flow of lymph,
leading to “dimpling” of the skin of the breast
(edema of skin; Peau d’orange sign)
95
Invasion of glandular tissue and fibrosis can
| cause
larger, fingertip sized dimpling
96
Invasion of retromammary space and pectoral
| fascia will cause the breast to elevate when
pectoral muscles contract, a clinical sign of
| advanced cancer
97
Metastatic cancer cells from breast
tissue can also spread via parasternal
lymph node communication with
```
internal
thoracic (internal mammary) veins,
which drain to intercostal veins
```
98
These eventually drain to the azygos
venous system in the posterior thorax
and provide the route by which
cancers
of the breast can spread to thoracic
and skeletal structures
99
Involvement of vertebral venous plexus
also provides a route for cancer cells to
spread to the (2)
brain and cranium
100
Spread to the --- may also be
| involved
liver
