Thoracic Wall and Lungs Flashcards
Order of intercostal muscles and membrane
External Intercostal muscle (membrane on anterior side)
Internal Intercostal muscle (membrane on posterior side)
-V
-A
-N
Innermost intercostal membrane ( no membrane)
Subcostal m.
Posterior thoracic cavity, connects every other rib
Transverse thoracic m.
Anterior thoracic cavity, connects posterior surface of sternum to ribs 2-6
Endothoracic Fascia
Cleavage plane allowing the surgeon to separate the parietal pleura from the thoracic wall, providing access to intrathoracic structures.
Landmarks at T4-T5
Horizontal fissure right lung, Manubrium, branch of trachea into bronchi, aorta
Landmarks at T7
4th rib, cardiac notch of right lung, oblique fissure of left lung, mid heart
Landmarks at L2
Lower ribs, below liver, abdominal aorta
Parts of rib
Costal groove Angle Tubercle Anterior facet Head Neck Inferior/Superior articular facet
Right Bronchus
Shorter, wider , more veritical.
Aspiration of foreign bodies
T4/T5 landmarks
Bifurcation of trachea
Eternal angle
Lobes and their Fissures - Right lung
Superior/Middle/Inferior
Horizontal/Oblique
Lobes and their Fissures - Left Lung
Superior/Inferior
Oblique
Other features of left lung
Lingula
Cardiac notch
Innervation of pleura
Visceral pleura - No Pain
Parietal pleura - Pain fibers
Pulmonary arteries vs veins in the hilum
Pulmonary arteries tend to be superior to the pulmonary veins
Structures in R and L Hila
pulmonary a., pulmonary v., bronchopulmonary lymph nodes, bronchus
Left hilar point often more superior
Thoracentesis in Midaxillary Line
Between 9th and 10th rib (8th or 9th intercostal space)
To empty fluid buildup in Costodiaphragmatic recess
-Right lung between costal, diapgragmatic, and visceral pleura.
Sternal angle
Landmark for second costal cartilage
Cupola
The portion of the parietal pleura that extends above the first rib (aka cervical pleura)
Phrenic Nerve
Path between the anterior medial aspect of the lung and the medastinum, anterior to hilum. Innervates diaphragm.
Nerves at risk during mastectomy
Long thoracic
Intercostobrachial
Thoracodorsal
Greys Q.
DRG
Contain nerve cell bodies for general somatic visceral afferent processes.
Grey’s Q.
Intercostal Arteries Anastamosis
Anterior intercostal arteries anastomose with the posterior intercostal arteries
Divisions of parietal pleura
Costal
Diaphragmatic
Medisastinal
Cervical (Cupola)
Hemothorax
collection of blood in the space between the chest wall and the lung
Rib Fracture
Weakest just anterior to its angle. Middle ribs most commonly fractured
Supernumerary Ribs
Extra cervical ribs near C7 vertebrae. May compress spinal nerves C8 and T1, or the inferior trunk of BP
Sternal fractures
Most likely sternal angle, dislocating manubriosternal joint
Sternal Biopsy
Used for bone marrow need biopsy; wide and subcutaneous.
Paralysis of Diaphragm
Damage to phrenic nerve = ipsilateral paralysis of half of diaphragm.
Intercostal space incisions
Posterior thoracotomy incsisions made on posterolateral aspects of 5th to 7th IC spaces
