Study Boxes Thorax Pleura & Lungs Flashcards
Are the ribs completely parallel?
NO, the ribs are 15 degrees tilted anteriorly
so you don’t see one to one correspondence of ribs
the manubrium of sternum corresponds to what level of vertebra?*
T4, T5 and vertebral disk
The superior thoracic aperture is aka*
Inlet or CLINICAL OUTLET
the inferior thoracic aperture aka *
outlet
the xyphoid process corresponds to what level*
T10 T11
contents of thoracic inlet
apex of lungs* trachea esophagus vagus nerve CN X phrenic nerve C3 4 5 cervical plexus
what is the angle of luis
manubriosternal joint
what is the infrasternal angle *
junction where xyphoid process and costal margin
costal groove location and contents*
located on inferior aspect of ribs,
shelters the intercostal neuromuscular bundle
VAN - Vein artery nerve
the intercostal nerve is from where
VENTRAL rami of spinal nerve
what is the weakest part of rib
costal angle
the intercostal VAN is located where?
in between internal and innermost intercostal muscles
innermost intercostal muscles
sternocostalis- on sternum
innermost proper- in between
subcostalis- at angle of rib
Aortic opening- level and contents*
T12 thoracic aorta thoracic duct greater splanchnic nerves ( T5-T9) azygos vein
esophageal opening L and Contents*
T10
esophagus
right and left vagus nerves
esophageal branches of left gastric artery and vein
caval opening Level and contents*
T8
IVC
phrenic nerves ( c3c4c5)
lymphatic vessels
Anterior intercostal arteries ICS 1-6 come from *
internal thoracic artery
anterior intercostal arteries ICS7 8 9 come from*
musculophrenic artery ( branch of internal thoracic)
intercostal space 10 11
NO anterior intercostal arteries
directly from aorta
anterior aspect of thorax is drained by ?
internal thoracic v – into brachiocephalic v
posterior aspect of thorax is drained by?
azygossystem
R side posteriorly 1 ICS by?*
highest intercostal vein into brachiocephalic
R side posteriorly 2-3 ICS
highest intercostal vein into azygos
R side posteriorly 4-11 ICS
azygos vein
R side post 12 ICS by
subcostal veins into azygos
L side post 1 ICS by
highest intercostal vein — into brachiocephalic vein
L side post 2 3 4 ICS by
accessory hemiazygos vein
L side post 5-11 + 12 ICS by
hemiazygos
Azygos is on what side
R side
hemyazygos is on what side
L side
what happens to accessory hemi and hemiazygos?
they cross over independently or join as an unit and drain into azygos
accessory hemi can also drain into brachiocephalic vein
where does the thoracic duct drain into*
junction between Left internal jugular and left subclavian
right lymphatic duct drains what
right arm part of thorax and right side of head
Thoracic duct drains everything else
thoracic duct sandwiched in between what
azygos on right and aorta on left
What is the endothoracic fascia?*
connective tissue layer that functions to prevent the parietal pleura from rubbing agains innermost intercostal muscles
sibsons fascia
thickening of the endothoracic at the APEX of the lungs
Importance of the first rib
it has superior grooves for the subclavian vein and artery
flail chest is due to*
multiple rib fractures
paradoxical chest movement
paradoxical movement of flail ches
chest goes inward with inspiration
outward with expiration
(this is not normal )
rib dislocation occurs where*
on the ribs that ATTACH to the sternum ( 2-7)
rib separation occurs where*
(dislocation) of chostochondral join between rib and costal cartilage
Thoracentesis
surgical puncture of chest
thoracostomy
needle
tube
at ICS 4 /5 anterior axillary line
used to decompress fluid or air in lung
thoracotomy
surgical incision of chest ICS 4 /5 from lateral margin of sternum to anterior axillary line ( think greys anatomy)
Where does the parietal pleura become continuous with the visceral pleura
at the HILUM of each lunch - ( makes an indentation)
what is the cupula*
area of parietal pleura reflected over the APEX of lung
what is the costodiaphragmatic recess*
at the junction of the costal and diaphragmatic parietal pleura at the mid axillary line
LOWEST area of pleural cavity into which the lungs expand during inspiration
costodiaphragmatic recess level***
ICS 9
estenssions of costoparietal pleura and their levels*
anteriorly ICS 8
med axillary ICS 9
posteriorly ICS 10
is the parietal pleura sensitive to pain
VERY SENSITIVE TO PAIN
is the visceral pleura sensitive to pain
NO- no sensory innervation
cardiac notch level *
costal cartilages 4 5 6
oblique fissure level
from apex of lung and ends at COSTAL CARTILAGE 6
horizontal fissure level
COSTAL CARTILAGE 4
lingula
modified middle lobe of the LEFT lung
where does the trachea begin*
continuation of larynx at lower border of CRICOID CARTILAGE C6
what happens to the trachea at angle of louis
descends anteriorly to esophagus
deviates slightly to RIGHT side of medial plane at angle of lous
where does the trachea end
divides into L and R primary bronchi between T4 and T5
what is the carina
bifurcation of the trachea into right and L bronchi
angle of carina
90 degrees
> 90- indicate presence of mediastinal mass
Location of L ( primary bronchus) WRT aorta and esophagus
passes to left BELOW arch of aorta
IN FRONT of esophagus
blood supply of the bronchi
bronchial arteries- two on left from thoracic aorta
one on right from posterior intercostal artery
branching of the brachial tree
trachea– primary bronchi– secondary– tertriary— bronchioles– terminal bronchioles