Thoracic Wall Flashcards
Thoracocentesis
Remove fluid between ICS 8 or 9 in midaxillary line to avoid lungs, superior to rib 9 or 10
Superior to upper border
Intercostal nerve block
In ICS, blood 2 adjacent nervesT
Thoracostomy
Remove fluid (down) or air (down) in ICS 4 or 5, midaxillary
Superior to upper border
Sternectomy
To access thorax
Sternum
Used for bone marrow graft
Pectus carinatum
Sternum protrudes
Pectus excavatum
Sternum caves in
Paradoxical movement of hemidiaphragms
Damage to phrenic nerve
Cervical supernumeral rib
C7 vertebrae
Can compress inferior trunk (C8-T1) or subclavian artery, causing ischemia
Lumbar supernumeral rib
Often misdiagnosed as L1 transverse process fracture
Flail chest
Caused by multiple rib fractures, paradoxical lung movement
True ribs
1-7
False ribs
Do not articulate directly with sternum, connected to seventh costocartilage at costochondral join
8-10
Floating ribs
11-12
Do not articulate with sternum at all
Ribs 1&2
Muscle attachment sites for ant & mid (1) and post (2) scalene muscle
Anterior scalene
Anterior = subclavian vein
Posterior = subclavian artery
Polymastia
Extra breasts
Amastia
Missing breast
Polythelia
Extra nipples
Carcinoma effect on lymph nodes
Removal of axillary nodes to prevent spread of cancer BUT can lead to arm swelling
Athelia
No nipples
Sentinel lymph node biopsy
Done to prevent total removal of lymph nodes
Sternal angle
Starts at second rib - T4
Divides superior and inferior mediastinum
Bifurcation of trachea into bronchi
Arch of aorta
Arch of azygos enters SVC
Thoracic duct crosses to left side
Nerves of thoracic wall
ICN part of ventral rami
11 pairs plus subcostal nerve
Typical IC nerves
3-6 btwn internal and innermost muscles
Atypical IC nerves
1 part of brachial plexus
2 intercostal brachial n
7-11 thoracoabdominal n
Blood supply of thoracic wall
Internal thoracic a
Post and ant intercostal arteries and veins
Supreme intercostal arteries
1st and 2nd posterior intercostals coming off costocervical trunk
Lymphatic drainage of thoracic wall
Thoracic duct on left receives all lymph except right thorax, arm, head and neck which goes to right lymphatic duct
Breast
Glandular tissues, 15-20 lobules
Supported by suspensory ligament of Cooper
Retromammary bursa = posterior
Nipple is around T4
Breast location
Between ribs 2-6, nipple at 4, axillary tails extends
Breast blood supply
Internal thoracic, lateral thoracic and post intercostal a.
Breast innervation
ICN 4-6
Diaphragm
Dome shaped muscle
Diaphragm innervation
Innervated by phrenic nerve, peripherally by intercostal and subcostal
Diaphragm openings
Caval = IVC, r. phrenic (T8)
Esophageal hiatus = esophagus, vagal trunk (T10)
Aortic hiatus = aorta, thoracic duct, azygos (T12)
Superior thoracic aperture
T1, rib 1, manubrium
Contains carotids and subclavian
Inferior thoracic aperture
T12, ribs 11-12, xiphisternal joint
External intercostals
Hands in pocket
Internal intercostals
Hands to chest
Herpes zoster
Invades spinal ganglion and affects thoracic wall dermatomes
Posterior intercostal arteries
3-11 come off descending thoracic aorta
1-2 come off supreme intercostal a
Anterior intercostal arteries
1-6 come off internal thoracic
7-9 come off musculophrenic
Azygos vein
Unpaired on right side
Inspiratory muscles
EI, II
Deep breathing - diaphragm
Accessory - sternoclediomastoid and scalenes
Expiratory muscles
Quiet breathing - recoil of muscles
Forced - innermost, abs
Parietal pleura
Sensitive to pain, innervated by intercostal nerves
Must be anesthetized
Anterior and posterior intercostal arteries
Anastomose, can be collateral
