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CT Sectional Anatomy > Esophagus, thoracic & Breast > Flashcards

Esophagus, thoracic & Breast Flashcards

1
Q

How far does the esophagus extend

A

Extend from the laryngopharynx to the cardiac offices of the stomach

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2
Q

What are the 4 divisions of the esophagus

A

Cervical
Upper thoracic
Middle thoracic
Lower thoracic

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3
Q

How are the divisions of the esophagus measured

A

Measure from the patient’s incisors

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4
Q

Describe the cervical esophagus

A

Starts roughly at C6-T2/3
18cm from incisors
Begins at cricoid cartilage to thoracic inlet at suprasternal notch

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5
Q

Where is the thoracic esophagus

A

Begins at the suprasternal notch and extends to the carina
24cm from incisors
Roughly 6cm long

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6
Q

Where is the middle thoracic esophagus

A

Begins at the carina and extends down to the EG junction of stomach

Roughly 32cm from incisions
Roughly 8cm long

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7
Q

Where is the lower thoracic esophagus

A

The abdominal esophagus
Roughly 8cm long
40cm from incisors

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8
Q

What’s is the esophagus’s location in reference to the trachea and vertebral column

A

Esophagus is posterior of the trachea and anterior of the vertebral column

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9
Q

What are the layers of the esophagus

A

Mucosa (innermost)
Muscularis mucosa
Sub-mucosa
Thin loose connective adventitia (no serosal) - outer most

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10
Q

Esophageal wall greater then ______ is considered abnormal

A

5mm

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11
Q

T/F

Esophageal cancer is 3 times greater in female than males

A

False

Esophageal cancer is 3 times greater in males than females due to drinking and smoking

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12
Q

Esophageal cancer that are found in the upper and middle thoracic is what type of cell (histology)

A

Squamous cell carcinoma

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13
Q

Esophageal cancer that are found in the distal 1/3 of the esophagus is what type of cance (histology)

A

Distal 1/3 esophagus is Adenocarcinoma

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14
Q

Why is esophageal cancer more common in Asia

A

More common found in asia due to diet

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15
Q

What is Barrette’s esophagus

A

Is commonly due to GERD
It’s a change in the distal esophagus from stratified squamous epithelium to columnar epithielium
Associated with Adenocarcinoma (distal 1/3 esophagus)

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16
Q

What is Achalasia

A

The lower 2/3 of the esophagus loses peristaltic activity
EG junction sphincter fails to relax and food fails to pass into the stomach

5-20 percent risk for squamous cell carcinoma

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17
Q

What s the EG Junction

A

Junction where the esophagus meets the stomach

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18
Q

When treating a patient with esophageal cancer, why might consider treating the patient in prone position?

A

So that gravity can pull the esophagus away from the spinal cord and other critical structures

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19
Q

What are the radiation treatment fields for esophageal cancer

A

AP/PA with posterior obliques with wedges or laterals
Come off the cord at 45Gy
Total of 50Gy; patient and stage dependent

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20
Q

The thyroid/thyroid cancer is cancer of what gland

A

Endocrine gland

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21
Q

Thyroid produces what kind of hormones

A

Several kind but the most common is T3 and T4 for metabolic regulations

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22
Q

What regulates thyroid function

A

Thyroid functions are regulated by the pituitary gland and hypothalamic hormones

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23
Q

What is TSH

A

It is a thyroid stimulating hormone (TSH)
TSH stimulates the thyroid cells to produce and releases hormones that are critical for carbohydrate and protein metabolism

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24
Q

Describe the location of the thyroid gland

A

It’s located inferior to the larynx at the level of the cricoid cartilage
Connected at the midline by the isthmus
Consist of right and left lobes (lateral lobes)

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25
Q

What and where are the parathyroid glands

A

Parathyroid glands are located on the posterior aspect of the thyroid lobes
It’s involved with the metabolism of calcium and phosphorus

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26
Q

What are examples of hyperthyroidism

A

Grave’s disease ( muscular weakness, abnormal weight loss, exophthalmos- bulgy eyes)

Goiter disease (enlarge thyroid gland caused by enlarged thyroid cells caused by overstimulation of TSH)

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27
Q

Thyroid cancer is the most common type of endocrine cancer. 2 percent of all cancer is papillary but ___________ is the most common

A

Mixed papillary follicular

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28
Q

What is the only documented factor that causes thyroid cancer

A

External radiation at a young age (multiple dental X-rays or some diagnostic X-rays)

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29
Q

What are the treatment type for thyroid cancer

A

Surgery
Radioactive iodine I-131 for papillary, mixed papillary follicular or follicular
XRT combined with I-131 and/or surgery (3DCRT or IMRT to include entire gland, neck and superior mediastinal nodes

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30
Q

XRT for grave’s disease

A

Use to treat the inflammation of the eye muscles due to hyperthyroidism to shrink the muscles
Using opposed fields
2000cGy (20Gy) for 2 weeks

31
Q

What and where is the thymus gland

A

It is a triangular shaped bi-lobed gland of the lymph tissues and is located. In the superior mediastinal behind the sternum

32
Q

What is the function of the thymus gland

A

Responsible for cellular immunity
Site for T-lymphocytes to mature
Produces Thymosin- responsible for the development/maturation of the lymphocytes

33
Q

What happens to the thymus as one ages?

A

It’s reaches it maximum size during puberty

It diminishes as an adult and is replaced by mediastinal fat

34
Q

What is the most common mediastinal tumor in adults and how is it treated

A

Thymoma
Usually with just surgery
May require chemo or XRT but treatment is based upon CT biopsy

35
Q

What are the muscle associated with respiration

A

Inter costal
Serratus
Diaphragm

36
Q

How does the intercostal muscles aid in respiration

A

Consist of 3 layers (external, internal, innermost)

The intercostal muscles help elevate the ribs and expand thoracic cavity

37
Q

How does the serratus muscle aide in respiration

A

The serratus posterior SUPERIOR muscle assists in forced INSPIRATION. The serratus posterior INFERIOR muscle assist in forced EXPIRATION

38
Q

How can you tell the difference between the serratus posterior superior muscle to the serratus posterior inferior muscle on a CT

A

SP Superior- no lungs visible

SP Inferior- lungs are visible

39
Q

________ is the chief muscle of respiration

A

Diaphragm

40
Q

What and where is the diaphragm

A

A dome shaped muscle spans entire thoracic outlet.
It separates thoracic and abdominal cavities
And is attached to the lumbar spine via the 2 tendinous structures (CRURA) or left and right crus

41
Q

CT Scan of normal diaphragm shows the diaphragm is at the level of the _____

A

Xiphoid

42
Q

What other muscle aid in the expansion of the thoracic cavity on deep inspiration besides the thoracic muscles

A

Pectoralis major

43
Q

Pectoralis _______ connects the sternum and clavicle with the humerus while pectoralis ______ connects ribs 3-5 to the coracoid process of the scapula

A

Major- sternum and clavicle to humerus

Minor- ribs 3-5 to the coracoid process of scapula

44
Q

The breast is a _____ gland that overlies on the _______ muscle

A

Breast is a mammary gland that overlies the pectoralis major muscle

45
Q

The breast consist of how many quadrants

A

4 quadrants (Upper inner, upper outer, lower inner, lower outer) plus the Tail of Spence

46
Q

Main function of the breast

A

To produce and store milk. Dispenses milk during breast feeding

47
Q

What are the 3 layers of the Breast

A

Subcutaneous- skin and subcutaneous fat
Mammary- glandular tissue, lactiferous ducts and connective tissue

Retro-mammary- muscle, deep connective tissue and retromammary fat

48
Q

An adult female breast is consisted with ____ lobes per breast

A

15-20 lobe per breast

49
Q

An adult female breast consists of _______ lobules per breast

A

20-40 lobules per breast

50
Q

The lobules drain into the _____ which leads the milk to the surface of the nipple

A

Ducts

51
Q

The axillary lymph nodes drain lymphatics from __–

A

Breast, arm, and ski of back

52
Q

The axillary lymph nodes frequently clustered around

A

The axillary vessels and the low portion of pectoralis major

53
Q

The fat plane between the pectoralis major and minor houses the ______ lymph nodes

A

The interpectoral lymph nodes (Rotter’s nodes)

54
Q

When breast cancer spreads, it is frequently spreads to heat lymph nodes

A

Axillary
Intermammary
Supra-clavicular

55
Q

What is a PAB breast field

A

Posterior axillary boost field. It is a field posteriorly tha uses the same isocenter but the field is smaller to treat deep axillary nodes

56
Q

How much dose is normally given to a supra-clavicular

A

45-50 Gy

57
Q

How does DBH for breast help

A

The lung volume expands and this moves the heart posteriorly, away from the chest wall, so decreases does to the heart (especially the left ventricle) and even lung

58
Q

How are sentinel lymph node identify

A

2 ways
Weak radioactive dye (technetium labeled sulfur colloid)
Blue dye (isosulfan blue)

59
Q

_____ is the removal of the entire breast, nipple/areolar region, pectoralis major and minor and also all lymph nodes. It’s rarely performed today

A

Radical mastectomy

60
Q

What is the difficulty a patient have encounter with radial mastectomy

A

Lymphedema to the arm and hand of the breast removal. This is due to no lymph nodes being available to drain fluids. No needle sticks or BP measurements can be done to that arm/hand

61
Q

_____ is the most common form of mastectomy performed today

A

Modified radical mastectomy

62
Q

______ is the removal of entire breast, nipple/areolar region and lymph nodes

A

Modified radical mastectomy

63
Q

_____ is a wide excision. It’s the removal of breast cancer tumor and margin of normal tissue

A

Lumpectomy

64
Q

How are breast implants placed

A

Sub-glandular placement

Sub-muscular placement

65
Q

______ implant is positioned posteriorly to the pectoral muscles

A

Silicone implants

66
Q

What is a TRAM flap technique

A

Transverse rectus abdominis musclocutaneous flap technique. It is the most common surgical procedure for autologous tissue breast reconstruction.

67
Q

A ______ is an accumulation of fluid in a tissue or organ that can occur after surgery or sometimes after a nut trauma and some times requires aspiration (removal of fluid)

A

Seroma

68
Q

_____ is a very aggressive breast cancer. It affects the lymphs and thickens the skin it is warm to the touch and will require a Bolus during XRT

A

Inflammatory breast

69
Q

“Peau d’orange”

A

A pitted or dimpled appearance of the skin, like that of an orange especially a characteristic of inflammatory breast cancer.

70
Q

______ is a 2cm or more subareolar tissue in a non-obese male. It’s not cancer. Instead is associated with prostate cancer. Amle will be given female hormones to help with the prostate cancer and hence lead to this.

A

Gynecomastia

71
Q

How is gynecomastia treated

A

With low dose radiation to reduce swelling from the hormonal therapy. Normally treated with 3-5 fractions with electrons.

72
Q

What are the level one lymph nodes

A

Anterior pectoral
Posterior sub scapular
Lateral humeral

73
Q

What are the level 2 lymph nodes

A

Central
Some apical
Rotter’s

74
Q

What are level 3 lymph nodes

A

Apical

CT Sectional Anatomy (3 decks)

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