Thoracic cavity, pleura and lungs (anat) Flashcards by Yin Yin Khaing Kathrine

What does the mediastinum contain?

Heart, large vessels, trachea, esophagus and nerves

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What does the pulmonary cavities contain?

Lungs and pleurae

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Thoracic cavity vs pulmonary cavity

Thoracic cavity is within the thoracic cage while pulmonary cavity is part of the thoracic cavity

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Are the 2 layers of the pleura continuous?

Yes

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What is the inner layer of the membrane?

Visceral pleura

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What is the outer layer of the membrane?

Parietal pleura

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Where is the costo-diaphragmatic recess located?

On both sides of the lung in the space btw costal and diaphragmatic pleura

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Purpose of costo-diaphragmatic recess

Allows for expansion of lungs during inspiration

Clinical: use this recess to aspirate pleural fluid for diagnostic purpose

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Purpose of costo-mediastinal recess

During respiratioin, anterior borders of lungs slide in and out of recess

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Where does the cervical pleura extend into?

Root of the neck (2cm above clavicle) and meet behind the sternal angle at the 2nd intercostal cartilage -> continues down to 4th costal cartilage

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What are the reflections of the left parietal pleura?

Diverge 1cm away from sternum at 6th costal cartilage -> curves laterally and reaches 8th rib at midclavicular line, 10th rib at midaxillary line and 12th rib at paravertebral line

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What are the reflections of the right parietal pleura?

Same as the left parietal pleura except that the right layer continues to run till 6th costal cartilage behind sternum

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Where is the lower limit of the lungs?

2 ribs above parietal pleura at midclavicular, midaxillary and paravertebral lines at level of 6th, 8th and 10th ribs respectively

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Where is the upper limit of the lungs?

Follow outline of pleura

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What kind of blood does pulmonary vein carry?

Oxygenated blood
- pulmonary vein is an exception to the rule

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Which part of the lung does bronchial artery supply?

Lung tissue

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What kind of blood does the pulmonary artery carry?

Deoxygenated blood
- exception to the rule

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How do healthy lungs feel?

Light, soft and spongy

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Which lung is larger and heavier?

Right lung

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Why is the right lung shorter and wider?

Right dome of diaphragm is slightly higher

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What are the 2 groups of blood vessels and what do they supply?

Pulmonary circulation -> supply lung

Systemic circulation -> supply rest of the body

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Does systemic and pulmonary circulation happen simultaneously?

Yes

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What does the pulmonary artery transport?

Deoxygenated blood from heart to lungs

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What does the pulmonary vein transport?

Oxygenated blood from lungs to heart

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What is the hilum of the lung?

Area on the mediastinal surface of the lung through which structures enter/leave the lung

What is the root of the lung?

Short tubular collection of structures that emerge at the hilum of each lung

What makes up the root of the lung?

Main bronchus, 2 pulmonary veins and 1 pulmonary artery

What surrounds the root of the lung?

Mediastinal pleura

Are the lungs inside the pleural cavity?

No, it is surrounded by the pleural sac

Which lung has a cardiac notch?

Left lung

Arrangement of vessels entering the lungs respectively (superior to inferior)?

Right 1) bronchus 2) pulmonary artery 3) pulmonary vein Left 1) pulmonary artery 2) bronchus 3) pulmonary vein

What are the impt structures in close contact w/ the left lung in the apex region?

Thoracic spinal nerve Sympathetic trunk Phrenic nerve

What are the impt structures in close contact w/ the left lung in the hilar region?

Heart Esophagus Thoracic aorta Arch of aorta and it's branches

What are the branches of the arch of aorta (medial to lateral)?

1) Brachiocephalic trunk 2) Left common carotid artery 3) Left subclavian artery.

What are the impt structure in relation to the right lung?

SVC Heart IVC Esophagus Azygos vein

Phrenic vs vagus nerve

Phrenic nerves pass anterior to the root of the lungs while vagus nerves pass posterior to the root of the lungs

What does the phrenic nerve comprise of?

Motor, sensory and sympathetic nerve fibers

What does phrenic nerve provide?

Motor innervation to diaphragm Sensory innervation to central part of the diaphragm, mediastinal and diaphragmatic pleura Sympathetic innervation to the blood vessels

What innervates the visceral structures in the thorax?

Cardiac, pulmonary and esophageal plexuses - contain both sympathetic and parasympathetic nerve fibers

What does the cardiac plexus innervate?

Heart

What does the pulmonary plexus innervate?

Lungs w/ visceral pleura Trachea Bronchioles

What does the esophageal plexus innervate?

Esophagus

Innervation of parietal vs visceral pleura and lungs

Parietal pleura receives somatic afferent innervation -> sensitive to pain Visceral pleura and lungs receives visceral afferent innervation (autonomic) -> insensitive to pain

What is the source of innervation for the parietal pleura?

Intercostal nerves T1 - T11 Phrenic nerve (C3 - C5)

What is the source of innervation for the visceral pleura and lungs?

Pulmonary plexus

What is a dermatome?

Area of skin that is mainly supplied by a single spinal nerve where each nerve relays sensation from a particular region of skin to the brain

What is referred pain?

Pain felt at a site diff from the injured/diseased organ/body part

Which spinal nerve supplies the skin over the neck and the shoulder?

C3 and C4

Which spinal nerve supplies the mediastinal and central part of the diaphragmatic pleura?

Phrenic nerve aka C3 to C5

Why does the brain mistake pain from the internal organ for pain from the skin?

Pain pathways from the skin surface and from internal structure/organ pass very close to each other at dorsal root via ephatic transmission -> brain mistakes pain

Where does the trachea begin and end in terms of spinal level?

Begins at cervical vertebra 6 (C6) and ends at sternal angle (btw thoracic vertebrae 4 and 5)

What are tracheal rings made of and how are they connected?

Hyaline cartilage (strong and flexible tissue) Interconnected by fibroelastic tissue

How are tracheal rings shaped?

C-shaped

Fn of tracheal rings

Maintain mechanical stability of trachea -> keeps trachea open and prevent its collapse under negative pressures of respiratory cycle

What happens to the cartilage from superior to inferior?

Gradually reduces and disappear distally -> no cartilage in the bronchioles but smooth muscle fibres relatively more

Anterior relations to the trachea

Sternum, left brachiocephalic vein, brachiocephalic trunk and left common carotid artery and arch of aorta

Posterior relations to the trachea

Esophagus, left recurrent laryngeal nerve

Right side relations to the trachea

Azygos vein, right vagus nerve

Left side relations of the trachea

Arch of aorta, left common carotid and left subclavian arteries, left vagus and phrenic nerves

How is each bronchopulmonary segment supplied and the clinical relevance?

Has their own arterial supply Venous and lymphatic vessels pass through the intervening septae that separate the segments from each other Can remove a segment in event of a tumor w/o affecting other segments as they have their own arterial supply

How does movement of chest wall change when a lung is collapsed?

Movement is decreased -> chest wall moves inequally

How does sound differ when you percuss different parts?

Air containing organs (i.e: lungs) -> resonant note Solid organ (i.e: heart) -> dull note

What is heard during auscultation if there is a collapsed lung?

Nothing -> breath sounds are absent in a collapsed lung

Where to place steth to listen to the apex of the lung?

Space above the clavicle

Where to place steth to listen to the superior lobe of the lung?

Ard the 4th rib

Where to place steth to listen to the middle lobe of the right lung?

Btw 4th and 6th rib

Where to place steth to listen to the inferior lobe of the lung?

Below 6th rib

Complication with lower ribs fracture

Tear diaphragm

What is a pneumothorax?

Entry of air into pleural cavity

What does a collapsed lung indicate on a chest x-ray?

Hyperlucency and absent vascular markings

What is pleural effusion?

Accumulation of fluid into pleural cavity

What is seen on chest x-ray in the event of paralysis of right hemidiaphragm?

Right hemidiaphragm higher than the left during inspiration

What is thoracentesis?

Insertion of needle through an intercostal space into pleural cavity

Precaution to take during thoracentesis

Needle to be inserted superior to the rib, high enough to avoid damage to collateral branches

What is a bronchogram?

Radiological examination of bronchus and its branches

What is a bronchoscopy?

Examination of the bronchus by illuminated scope