Chapter 16 - Bony Thorax and Chest

Question 1

thorax

Answer 1

refers to the upper portion of the trunk, the chest. It consists of the 12 thoracic vertebrae, 12 pairs of ribs, and the breastbone, which is called the sternum.

Question 2

jugular notch

Answer 2

also called the manubrial notch or suprasternal notch

Question 3

true ribs

Answer 3

The first seven pairs of ribs

Question 4

false ribs

Answer 4

The lower five pairs of ribs are called false ribs because they do not completely surround the thorax.

Question 5

floating ribs

Answer 5

Ribs 11 and 12 are also called floating ribs. They have no cartilage and are not attached anteriorly.

Question 6

diaphragm

Answer 6

The diaphragm is a large sheath of muscle that expands and contracts with breathing.

Question 7

The thoracic cavity (Fig. 16.3) is divided into three parts:

Answer 7

two pleural cavities that contain the lungs and the space between the lungs, which is called the mediastinum.

Question 8

mediastinum

Answer 8

The principal structures within the mediastinum are the heart, with its associated great vessels; the trachea or “windpipe”; and the esophagus.

Question 9

The heart is divided into four hollow chambers:

Answer 9

the right and left atria, which are receiving chambers, and the right and left ventricles, which are discharging chambers.

Question 10

vena cava

Answer 10

The vena cava is the large vein that brings oxygen-depleted blood from the body to the right atrium.

Question 11

aorta

Answer 11

The aorta is the largest artery of the body. It leaves the heart in a superior direction and makes a “U turn” through what is called the aortic arch.

Question 12

The right lung has three lobes:

Answer 12

superior, middle, and inferior

Question 13

The left lung has only two lobes:

Answer 13

superior and inferior

Question 14

cardiophrenic angles

Answer 14

The inferomedial corners

Question 15

costophrenic angles

Answer 15

The inferolateral corners

Question 16

carina

Answer 16

The trachea divides into right and left primary branches at the carina (tracheal bifurcation), found at about the level of the sternal angle and the T4-T5 interspace.

Question 17

sthenic

Answer 17

The sthenic body habitus is considered to be “average.” About 50% of the population has this body type. The size, shape, and location of organs correspond to classic textbook descriptions and illustrations.

Question 18

hyposthenic

Answer 18

The hyposthenic body type might be thought of as “slender normal.” About 35% of the population has a hyposthenic build. The organs tend to be longer, narrower, and more vertical in position.

Question 19

asthenic

Answer 19

The asthenic body type is very slender. The organs are long and narrow, and the abdominal organs are located much lower in the body. About 10% of the population has this body type.

Question 20

hypersthenic

Answer 20

The hypersthenic body type is a massive and stocky. About 5% of the population has this body type. The thorax is short, broad, and deep. The organs tend to be high and more horizontal in position.

Question 21

Chest - PA and left lateral projections

Answer 21

Body position

Standing, facing IR holder.

Part position

PA

Anterior surface of chest is against upright Bucky with coronal plane parallel to IR. Backs of hands are placed on hips, and shoulders are rotated anteriorly (Fig. 16.13A). The purpose of arm position is to rotate scapulae out of the way so that they will not be superimposed on lungs. As an alternative, patients who are unsteady may wrap their arms around the Bucky to prevent movement and decrease the potential for a fall. IR is aligned so that upper margin is 1.5 to 2 inches (3.8 to 5cm) above level of spinous process of C7.

AP

Patient supine with arms at side (Fig. 16.13B). IR is aligned so that upper margin is 1.5 to 2 inches (3.6 to 5cm) above level of shoulders.

Lateral

Both arms are raised overhead, with the patient grasping opposite elbows. As an alternative, patients who are unsteady can grasp an overhead bar, if incorporated into the upright Bucky, or an intravenous pole to prevent movement and decrease the potential for a fall. Left side of body is in contact with upright Bucky, and midcoronal plane of thorax is perpendicular to center of IR (Fig. 16.15). IR placement is unchanged from PA projection.

Central ray

PA

Perpendicular to center of IR. Center point should be at the level of T7, which corresponds to the level of the inferior angle of the scapulae.

AP

Perpendicular to center of IR. Center point should be on the midsagittal plane at a level 3 inches below the jugular notch.

Lateral

Perpendicular to center of IR. Center point should be on the midcoronal plane at the level of T7.

Structures seen

Heart, lungs, and mediastinum. No rotation of the sternoclavicular joints on the PA projection (Fig. 16.14). Superimposition of the posterior ribs, indicating no rotation, on the lateral projection (Fig. 16.16).

Question 22

Chest (Lung Apices)

AP Axial Projection (Lordotic Position)

Answer 22

Body position

Standing

Part position

Patient stands facing tube, 8 to 12 inches (20 to 30cm) in front of upright Bucky. Patient then arches back and places shoulders against Bucky. Sagittal plane is perpendicular to IR. Backs of hands are placed on hips and shoulders rotated anteriorly (Fig. 16.19). The purpose of the arm position is to rotate the scapulae out of the way anteriorly so that they will not be superimposed on lungs. IR is aligned so that upper margin is 3 inches above upper border of shoulder.

Central ray

Perpendicular to center of IR. Center point should be at the level of the midsternum.

Structures seen

Apices of both lungs, free of superimposition by the clavicles (Fig. 16.20).

Question 23

UPPER POSTERIOR RIBS: AP AND AP OBLIQUE PROJECTIONS

Answer 23

Body position

Standing or recumbent.

Part position

AP

Supine on table or upright with posterior surface of chest against upright Bucky or grid holder (Fig. 16.21). Coronal plane is parallel to IR. Upper margin of IR is 1.5 to 2 inches (3.8 to 5cm) above level of spinous process of C7.

AP oblique

RPO position for right ribs or LPO position for left ribs. Coronal plane forms an angle of 45 degrees with IR plane (Fig. 16.22). Upper margin of IR is 1.5 to 2 inches (3.8 to 5cm) above level of spinous process of C7.

Central ray

AP

Perpendicular to center of IR. Center point should be in midclavicular line at approximate level of axillary fold.

AP oblique

Perpendicular to center of IR. Central ray enters at a point on midline of anterior surface at approximate level of axillary fold.

Structures seen

Ribs 1 through 10. Posterior portions are best seen on AP projection (Fig. 16.23); axillary portions are best seen on oblique projection (Fig. 16.24).

Question 24

Upper Anterior RIBS: PA and PA Oblique Projections

Answer 24

Body position

Standing or recumbent.

Part position

PA

Prone on table or upright with anterior surface of chest against upright grid cabinet (Fig. 16.25). Coronal plane is parallel to IR. Upper margin of IR is 1.5 to 2 inches (3.8 to 5cm) above level of spinous process of C7.

PA oblique

RAO position for left ribs or LAO position for right ribs. Coronal plane forms angle of 45 degrees with IR plane (Fig. 16.27). Upper margin of IR is 1.5 to 2 inches (3.8 to 5cm) above level of spinous process of C7.

Central ray

PA

Perpendicular to center of IR. Center point should be in midclavicular line at approximate level of axillary fold.

PA oblique

Perpendicular to center of IR. Central ray enters at point on posterior surface midway between spine and midaxillary line of affected side at approximate level of axillary fold.

Structures seen

Ribs 1 through 10. Anterior portions are best seen on PA projection (Fig. 16.26); axillary portions are best seen on oblique projection (Fig. 16.28).

Question 25

Lower Posterior RIBS: AP and AP Oblique Projections

Answer 25

Body position

Standing or recumbent.

Part position

AP

Supine on table (Fig. 16.29) or upright with posterior surface of chest against upright grid cabinet. Coronal plane is parallel to IR. Lower margin of IR is at level of iliac crest.

AP oblique

RPO position for right ribs or LPO position for left ribs. Coronal plane forms angle of 45 degrees with IR plane (Fig. 16.30). Lower margin of IR is at level of iliac crest.

Central ray

AP

Perpendicular to center of IR. Center point should be in midclavicular line at approximate level of tip of xiphoid process.

AP oblique

Perpendicular to center of IR. Central ray enters at point on midline of anterior surface at approximate level of tip of xiphoid process.

Structures seen

Ribs 8 through 12. Posterior portions of ribs are best seen on AP projection (Fig. 16.31); axillary portions are best seen on oblique projection (Fig. 16.32).

Question 26

Osteochondroma (exostosis)

Answer 26

a benign bone tumor, is also seen in the ribs.

Question 27

atelectasis

Answer 27

Trauma to the chest may result in lung collapse

Question 28

pneumothorax

Answer 28

The presence of air in the pleural cavity

Question 29

Pneumonia

Answer 29

an inflammation of the lung that is usually caused by bacterial or viral infection.

Question 30

Emphysema

Answer 30

a chronic lung condition, is a type of chronic obstructive pulmonary disease. It is characterized by obstruction and destruction of the small airways and alveoli of the lungs, which results in overinflation of the lungs and the inability to exhale stale air effectively.

Question 31

Tuberculosis (TB)

Answer 31

an infectious lung disease

Question 32

pneumoconiosis

Answer 32

The term pneumoconiosis refers to a group of chronic occupational lung diseases caused by the inhalation of irritating dust.

Question 33

silicosis

Answer 33

the inhalation of silicone dioxide