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General Thoracic Surgery > Thoracic and Pulmonary Anatomy > Flashcards

Thoracic and Pulmonary Anatomy Flashcards

1
Q

Number of ribs

A

12

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2
Q

True ribs

A

Ribs 1-7

Articulate directly with sternum

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3
Q

False Ribs

A

Ribs 8-10

Articulate with costal cartilage

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4
Q

Floating ribs

A

Ribs 11-12

No anterior articulations (floating)

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5
Q

Rib that articulates with manubrial sternal junction (Angle of Louis)

A

2nd rib

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6
Q

Structures inserting on OR arising from the 2nd rib

A
  • Posterior scalene muscle (inserts onto 2nd rib)
  • Pectoralis major muscle (arises from 2nd rib)
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7
Q

Caval hiatus (level and structures passing through)

A
  • Level T8
  • Structures
    • IVC
    • Right phrenic nerve
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8
Q

Esophageal hiatus (level and structures)

A
  • Level T10
  • Structures
    • Esophagus
    • Anterior (left) vagus nerve
    • Posterior (right) vagus nerve
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9
Q

Aortic hiatus (level and structures)

A
  • Level T12
  • Structures
    • Aorta
    • Azygous vein
    • Thoracic duct
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10
Q

Course of sympathetic trunk

A

Runs posterior to diaphragm along lateral aspect of vertebral column

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11
Q

Thoracic inlet relationships of vessels and nerves

A
  • Anterior to Anterior Scalene muscle
    • Subclavian vein (over first rib, beneath clavicle)
  • Between Anterior and Middle Scalene muscle
    • Subclavian artery (over first rib, beneath clavicle)
    • Brachial plexus
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12
Q

Nerve that descends on anterior surface of Ant Scalene m

A

Phrenic n

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13
Q

Chest wall muscles utilized for tissue coverage

A
  • Pectoralis major (pectoralis branch of thoracoacromial artery)
  • Latissimus dorsi (thoracodorsal artery)
  • Serratus anterior (lateral thoracic artery)
  • Pedicaled intercostal muscle
  • Rectus abdominus for TRAM flap (superior epigastric artery)
    • Not appropriate if ipsilateral IMA has been harvested for CABG
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14
Q

Average length of the trachea?

Number of cartilagenous rings of trachea?

A

10-11 cm

17-21 incomple anterior cartilagenous rings

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15
Q

Blood supply to trachea

A

Inferior thyroid artery (anastomotic arcade on posterolateral aspect of trachea)

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16
Q

Individuals responsible for regional lymph node classification system

A

Mountain and Dresler

17
Q

Mediastinal lymph node levels

A

Levels 1-9 (single digit levels)

  • N2 disease (ipsilateral LN involvement)
  • N3 disease (contralateral LN involvement)
18
Q

MLN Level 1

A

Supraclavicular LN

19
Q

MLN Levels 2 and 4

A
  • Level 2: upper paratracheal
    • above Ao arch
  • Level 4: lower paratracheal
    • below Ao arch
20
Q

MLN Level 3

A

Prevascular or prevertebral (immediately adjacent to trachea)

21
Q

LN Levels 5 and 6

A
  • Level 5: aortopulmonary window (btw aorta and PA)
    • watch injury to recurrent laryngeal nerve
  • Level 6: anterior to Ao arch
22
Q

LN Levels 7, 8, 9

A
  • Level 7: Subcarinal
  • Level 8: Paraesophageal
  • Level 9: Along inferior pulmonary ligament
23
Q

Pulmonary LN

A
  • Levels 10-14
    • Level 10: hilar
    • Level 11: interlobar
    • Level 12: lobar
    • Level 13: segmental
    • Level 14: subsegmental
  • Ipsilateral involvement (N1 disease)
24
Q

Cervical mediastinoscopy allows sampling of which LN stations?

A

Levels 2, 4, 7

  • N2 disease (ipsilateral LN involvement)
  • N3 dieaese (contralateral LN involvement)
25
Q

LN levels sampled by Chamberlain procedure (anterior mediastinoscopy)

A

Levels 2,4,5,6,7

26
Q

LN levels sampled by EBUS

A

Levels 1, 2,3,4,7,10,11

27
Q

Can be used to sample Level 8 LN

28
Q

Number and distribution of bronchopulmonary segments in RIGHT LUNG

A
  • 10 total segments
  • RUL=3
    • apical, anterior, posterior
  • RML=2
    • medial, lateral
  • RLL=5
    • superior segmental
    • basilar (anterior, posterior, medial, lateral)
29
Q

Number and distribution of bronchopulmonary segments in LEFT LUNG

A
  • 8 total segments
  • LUL = 4
    • Apicoposterior
    • Anterior
    • Superior lingular
    • Inferior lingular
  • LLL=4
    • Superior segment
    • Basal segments
      • Anteromedial
      • Posterior
      • Lateral
30
Q

Course of RIGHT MAIN PA

A

Behind aorta and SVC and anterior to right main bronchus

31
Q

Braches of Right Main PA

A
  • RUL:
    • Trucus anterior (anterior and posterior segments)
    • Posterior ascending
  • RML:
    • Middle lobe branch at level of fissure
  • RLL:
    • Superior segmental branch (arrising posteriorly at level of RML artery)
    • Medial basal branch
    • Common basal trunk
32
Q

Course of Left Main PA

A
  • Runs anterior to descending aorta and left main bronchus
  • Attached to Aorta by ligamentum arteriosum (left recurrent LN)
33
Q

Typical branch pattern of Left Main PA

A
  • LUL: 4 branches (range 2-7)
    • Anterior
    • Apical
    • Several posterior
    • Lingula branch (arises anteriorly, single supply to linguala in 80% of pts)
  • LLL:
    • Superior segmental branch (arises posteriorly, usually proximal to lingula b)
    • Common basal trunk
34
Q

Anatomical relationships of Right Pulmonary Veins

A
  • Right superior pulmonary vein
    • Crosses anterior to bronchus intermedius
    • 3 branches to RUL (apical, anterior, posterior)
    • Single branch to RML
  • Right inferior pulmonary vein
    • Superior segmental vein
    • Common basal vein
35
Q

Anatomical relationships of Left Pulmonary Vein

A
  • Superior pulmonary vein
    • 3 branches: anterior, apical, lingular
  • Inferior pulmonary vein
    • Superior segmental vein (posterior to bronchus)
    • Common basal vein (anterior)

General Thoracic Surgery (36 decks)

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