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9: Thorax > Chapter 104 Thoracic Wall > Flashcards

Chapter 104 Thoracic Wall Flashcards

1
Q

Where does the diaphragm originate?

A

L4

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2
Q

What artery does the thoracodorsal artery arise from?

A

Subscapular

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3
Q

What type of cartilage connects sternebrae?

A

Fibrocartilage

TAJ says fibrocartilage, anatomy book says hyaline!

Also TAJ says 9 sternebrae but is 8

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4
Q

Where does the lat dorsi originate and insert?

A

Origin: last few ribs and thoracodorsail fascia (spinous processes of last few thoracic and lumbar vertebrae)

Insertion: Teres major tuberosity of humerus

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5
Q

What is the origin and insertion of serratus ventralis?

A

Origin: Transverse processes of last 5 cervical vertebrae and lateral surface of first 7/8 ribs

Insertion: Medial/axial serrated surface of scapula

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6
Q

Label diagram

A
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7
Q

How many intercostal arteries are there? Where do they arise from?

A

12 intercosatl arteries (none behind rib 13)

Arise from aorta and internal thoracic arteries (first 3-4 are branches of vertebral artery cf aorta)

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8
Q

Where dothe internal thoracic arteries arise from?

A

R and L subclavian arteries

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9
Q

Which parts of heart are best acesses via:

Left ICT

Right ICT

Med. Sternotomy

Trans-diaphragmatic

A

Left ICT: L atrium and ventricle, pulmonary artery

Right ICT: R atrium, vena cavae, azygous,

Med. Sternotomy: R ventricular outflow tract, pulmonary artery (or L ICT)

Transdiaphragmatic: Apex i.e. for epicardial pacemaker

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10
Q

What does V0 refer to (in context of thorax)

A

V0 is volume of thorax when passive elestic structures of the thoracic wall are relaxed

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11
Q

List the layers incised during 4 ICT

A

Skin

Sc

Cutaneous trunci

Lat dorsi

Scalenus

Serratus ventralis

(+- lateral edge of deep pectoral)

(+- external abdominal oblique)

External intercostal

Internal intercostal

Pleura

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12
Q

Does rib retraction provide better cranial or caudal exposure

A

Better cranial exposure

(i.e. if unsure which spoace err on caudal side)

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13
Q

Where does the external abdominal oblique muscle originate?

A

Origin: Lateral aspect of 4/5- 12th rib and along last rib and thoracolumbar fascia.

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14
Q

What does tobias recommend re sternotomy closure?

A

PDS in patients <10kg

Sternal wire or 0 PDs if >10kg

Alternating figure of 8 pattern

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15
Q

List 7 possible approaches to the thoracic cavity

A
  • ICT
  • MS
  • Thoracoscopy
  • Transdiaphragmatic
  • Paracostal
  • Xiphoid resection
  • Trans-sternal thoracotomy
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16
Q

Breed ‘predilection’ for pectus excvatum?

A

Bengal and Burmese

17
Q

List 3 options for pectus excavatum intervention

A
  • External splint
  • Internal splint (VCP secured with PDS reported)
  • Osteotomy of sternebrae and costochondral junctions + external splint
18
Q

In a group of cats with traumatic rib fractures, how many had concurrent intra-thoraci injury?

A

87%

19
Q

When is exploratory thoracotomy indicated according to Scheepens bite wound paper (3 factors)?

A

Rib fractures, pulmonary contusions, pneumothorax

20
Q

Name a method for stabilisation of multiple rib fractures

A

Basket weave

21
Q

List 4 most common thoracic wall neoplasias

A
  • Osteosarcoma
  • Chondrosarcoma
  • Fibrosarcoma
  • STS (haemagiopericytoma, PNST, malignant schwannoma)

Others inc haemangiosarc, MCT,

May see other clinical signs eg chylothorax, BUdd0Chiari like syndrome, lameness

22
Q

What is reported MST for osteosarcoma following curative intent surgery + chemo

and reported MST chondrosarcoma (?if same paper)?

A

10 months

Chondrosarcoma 5 years!

23
Q

What are recommended margins for most thoracic wall tumours?

What is considered upper limit for number of ribs removed?

A

3cm and one normal ribe either side (can preserve skin if tumour is deep and facial layer between it and skin).

6 ribs max

24
Q

List 4 muscular flaps used in closure of thoracic wall defects

A
  • Lat dorsi
  • External abdominal oblique
  • Diaphragm
  • Transverse abdominis
  • (cadaver study suggests deep pectoral may also be an option)
25
Q

List 3 types of mesh available for closure of thoracic wall defects

What is reported infection rate with polypropylene mesh?

What is most commonly used biologic graft?

A
  • Polypropylene (Marlex (resists stretching) and Prolene)
  • PTFE (sheet so occlusive, strong, expensive)
  • Polyglactin (absorbable)

Polypropylene mesh infection rate approx 0-6%

Porcine SI submucosa

9: Thorax (2 decks)

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