Surface Anatomy - Thorax Flashcards
What does the clavicle articulate with anteriorly?
Manubrium of sternum
What structure lies between the medial ends of the two clavicles?
Jugular notch of the manubrium
What is the small ridge felt by moving your fingers down from the jugular notch? What is this notch?
Sternal angle (of Louis) Manubriosternal joint
What bones articulate at the sternal angle?
Manubrium
Body of sternum
Rib 2
What type of joint is the manubriosternal joint?
Secondary cartilaginous (symphysis)
What type of joint does rib 2 have with the sternal angle?
Synovial plane joint
If you palpate the sternal angle and palpate laterally, what bony structure do you palpate?
Rib 2
As you count down the ribs and intercostal spaces, what can help as you descend? Why?
Moving fingers laterally along thoracic wall with every rib
As costal cartilages of lower ribs (7-10) unite
Where can ribs 11 and 12 be palpated?
Posterior aspect of thoracic wall
Can rib 1 be palpated?
No
What is the pleural cavity?
The space between the parietal pleura lining the inside of the thoracic cage and the visceral pleura passing over the surface of each lung
Where does each pleural cavity extend above?
2-3cm above middle of medial third of the clavicle
Where does the anterior border of the pleural cavity reach?
Midline at the 6th costal cartilage
Where does the parietal pleura pass laterally away from the midline on the right?
6th costal cartilage
Where does the parietal pleura pass laterally away from the midline on the left?
4th costal cartilage:
- To accommodate heart
Where does the parietal pleura cross the following lines:
- Midclavicular line
- Midaxillary line
Midclavicular line = 8th costal cartilage
Midaxillary line = 10th costal cartilage
What line does the parietal pleura following horizontally along the posterior body wall?
Line of the 12th rib
Where do the domes of each hemidiaphragm reach?
5th costal cartilage on left
4th costal cartilage on right
What are the levels of the visceral pleura at:
- Midclavicular line
- Midaxillary line
- Posterior thoracic wall
Midclavicular line = 6th costal cartilage
Midaxillary line = 8th costal cartilage
Posterior thoracic wall = 10th costal cartilage
Does the visceral pleura pass into the costodiaphragmatic recess?
No
Where do the oblique fissures run?
T3 posteriorly
6th costochondral junction anteriorly
How can the level of the superior part of the oblique fissure be found?
Palpate C7 spinous process (vertebra prominens)
Count down to T3 spinous process
Where does the horizontal fissure run?
From the right oblique fissure posteriorly to the 4th costal cartilage anteriorly on the right
What do the oblique fissures do?
Separate superior and inferior lobes of lungs
What does the middle fissure do?
Divides the right superior and right middle lung lobes
What organs can be detected when percussing the text (except the lungs)? How?
Liver and heart borders:
- More dense than lungs so produce a duller sound
If we percuss the right side of the chest from the clavicle towards the 6th intercostal space, where will a change in resonance be heard and why?
Around 4th intercostal space:
- Nears upper border of liver
If you percuss from the left midaxillary line and move towards anterior midline, what will cause a change in percussion to a duller sound?
Left border of heart
Where can we auscultate the superior lung lobes?
Anterosuperiorly on the chest wall:
- Above the nipple
Where can we auscultate the right middle lobe?
Right mid axillary line (anterolaterally)
Where can the inferior lung lobes be auscultated?
Posteroinferiorly
Where does the apex of the heart lie?
Left midclavicular line in the 5th intercostal space
Where does the inferior border of the heart lie?
From apex in a horizontal line just to the right of the sternum
Where does the right heart border lie?
A bulge slightly beyond (1-2cm) the right border of the sternum
Where does the left heart border lie?
Extends from apex superiorly and medially to sternal end of the 2nd intercostal space
What chamber of the heart makes up each heart border?
Left border = Left ventricle (mainly)
Right border = Right atrium
Inferior border = Right ventricle
Superior border = Both atria and their auricles
Why is it not possible to place a stethoscope directly over the heart valves?
They lie underneath the sternum
Where can the mitral valve be auscultated?
Apex of heart:
- Midclavicular line
- 5th intercostal space
Where can the tricuspid valve be auscultated?
Left of sternum at 4th costal cartilage
Where can the pulmonary valve be auscultated?
2nd intercostal space, just to the left of the sternum
Where can the aortic valve be auscultated?
2nd intercostal space, just to the right of the sternum
What creates the “lub” (S1) heart sound?
Closure of the atrioventricular valves (tricuspid and mitral)
What creates the “dub” (S2) heart sound?
Closure of the semilunar valves (pulmonary and aortic)
What can be accessed in a median sternotomy?
Usually used for full mediastinal access
Allows access to entire thoracic cavity
What can be accessed in anterolateral thoracotomy incisions?
Lungs (both sides)
Heart (left side)
Oesophagus
Where does an anterolateral thoracotomy incision run?
From sternum to midaxillary line in the 4th or 5th intercostal space
Where is a pacemaker incision made? How long is the incision?
Left infraclavicular region
4-5cm long
Describe a posterolateral thoracic incision?
Starts between the scapula and the midline of the spine and extends to the anterior axillary line
What is a posterolateral thoracic incision used for?
Gold standard for thoracic procedures:
- Great access to lungs for pneumonectomy, lobectomy
- Chest wall excisions
- Oesophageal procedures
Where would a cannula be inserted to emergently relieve a tension or a large pneumothorax?
2nd/3rd intercostal space in the midclavicular line
Where is a chest tube inserted?
5th intercostal space in mid-axillary line:
- Guide superiorly for pneumothorax
- Guide inferiorly for haemothorax
When is a chest tube used?
Once a tension or large pneumothorax has been reduced by emergency thoracocentesis
OR
Haemothorax
Where is a needle insertion for pericardiocentesis?
0.5cm below and to the left of the xiphoid process
45 degrees to skin
Aim at left shoulder or nipple
