MSK 24 - Imaging and Clinical Anatomy of the Thorax Flashcards
What does the sternum articulate with?
Clavicle
Costal cartilages 1-7
Discuss what the sternal angle is a landmark for.
What runs through the costal groove of a rib?
A neurovascular bundle
Which ribs are atypical?
1, 2, 10, 11, 12
Describe the joints that the ribs take part in.
What are the three types of ribs and which ribs are which?
What are the inferior thoracic aperture boundaries?
What are the boundaries of the superior thoracic aperture? What structures pass through this aperture?
Label picture and say what condition it is showing.
Thoracic outlet syndrome. Extra rib attaching to C7
What is thoracic outlet syndrome? What typically causes it? What are the symptoms?
Thoracic outlet syndrome is a condition in which there is compression of the nerves, arteries, or veins passing between the thorax and axilla. It is usually caused by an extra rib attaching to C7, muscular abnormalities, or an injury. Symptoms include pain, numbness, weakness, palor, and edema (from vascular compression). The hand is most commonly affected and symptoms may be consistent or intermittent.
List the intercostal muscles, the direction of their fibers, their actions, and their associated neurovasculatures.
List the deep muscles of the thoracic cage and describe their function and neurovasculature?
Internal and Innermost intercostal muscles -
Transversus thoracis muscles - the radiate out from the posterior surface of the sternum and attach to the posterior surfaces of the ribs close to the costal cartilages. They depress the ribs to aid in forced expiration. They are innervated by the intercostal nerves
Subcostal muscles - found posteriorly near the rib angles and span 1 or more intercostal spaces. Their function is unclear but are thought to aid in forced expiration. They are innervated by the intercostal nerves
List and explain the different scapular movements.
List the anterolateral thoracic wall muscles, their innervations, and actions.
Pectoralis Major - innervated by the medial and lateral pectoral nerves. Acts to adduct and flex shoulder as well as medially rotate the humerus.
Subclavius - innervated by the subclavian nerve. Acts to depress clavicle
Serratus Anterior - innervated by the long thoracic nerve. Acts to rotate scapula upward (allowing for should abduction >90 degrees) and keep it held against the thoracic cage
Pectoralis Minor - innervated by the medial pectoral nerve. Acts to depress shoulder and proctract (abduct) scapula.
Discuss the movement of the ribs during respiration.
What are the three regions of thoracic pleura and what innervates each region.
What is a Thoracocentesis? What is a Thoracostomy?
Discuss the location and purpose of the thoracic pleural recesses.
At rest, how does the inferior border of the visceral and parietal thoracic pleuras differ?
The visceral pleura is 2 rib levels higher than the parietal
What is a pleural reflection?
A pleural reflectionis a line or curvature that occurs when a fold is made so that the pleura can change direction.
In what order superiorly to inferiorly do the neurovascular vessels run in the neurovascular bundle of the costal groove?
VAN
Intercostal Vein
Intercostal Artery
Intercostal Nerve
What region of the spinal nerves gives rise the nerve supply of the thoracic wall? Which nerves innervate the thoracic wall and what structures do they provide sensory innervation for?
What are some important dermatome levels to remember?
What arteries supply the thoracic parietal pleura?
What is unique about the venous drainage of the first two intercostal spaces?
Describe the lymphatic drainage of the thoracic wall
Facts to know about the thoracic duct.
General facts to know about the mammary gland
Facts to know about patient positioning during a thoracic x-ray.
- Typically chest x-rays are taken in the PA view; this means the film is “in front” of the patient and the x-rays travel through starting from the back. The x-ray bean is oriented so that the upper 4 thoracic spinous processes appear half way between the clavicles on the radiograph (refer to picture).
- Lateral view images are taken with the investigation side towards the film (typically left)
How should a thoracic x-ray be evaluated?
How can you tell if a thoracic radiograph is of good quality?
How can you tell what phase of respiration a patient is in on a radiograph?
How do you differentiate between the anterior and posterior aspects of ribs on a radiograph?
What is the hilum of the lung and why is it important for thoracic imaging.
The hilum is the large triangular depression where the connection between the parietal pleura and the visceral pleura is made, and this marks the meeting point between the mediastinum and the pleural cavities. This also where the pulmonary vessels enter/exit the lungs.
This portion of the lung is less dense and therefore appears as an empty space on a lateral thoracic x-ray
Describe how a normal lateral thoracic x-ray should appear?
What is the weakest area of the rib and therefore the most likely to fracture?
The angle of the rib
What are the common causes, symptoms, and treatments for a single point rib fracture?
How do you identify rib fracture on a radiograph?
Describe the common causes and results of a multiple point rib ribfracture.
What is flail chest?
Facts to know about pleurisy/pleuritis.
What will pleurisy/pleuritis look like on a radiograph?
Facts to know about shingles
What/where are the milk lines and what is their clinical significance?
What is polythelia, polymastia, and gynecomastia?
How does a regular mammogram appear?
How will “lumps” appear on a mammogram?
How do you determine if a breast lump is cancer? What are some signs that it is not cancer? Give examples of lumps that are non-malignant.
Facts to know about a breast self examination.
What are the visible indicators of breast cancer?
Describe the peau d’ orange appearance of a cancerous breast.
What does a radical mastectomy involve? What remaining structures are usually damaged and why? What are some of the long term symptoms of a mastectomy?
