Thoracic wall and pleural cavities Flashcards
thorax is bounded by _______
superior thoracic aperture (opening or space) which is a anterior (front) wall formed by superior (toward the head) border of manubrium, the posterior (back) wall is formed by T1
inferior (away from head) thoracic aperture is a (anterior front) wall formed by xiphisternal joint which wall is formed by T12
posterior (back) wall
thorax can be divided into three compartments
right lateral (away from midline)
left lateral
central compartment
lateral (away from midline) thoracic compartments consist of their respective
pleural sac and lungs
why is the right lateral thoracic compartment more wider and shorter than left
the liver is pushing up on the right side / and or heart is pushing down on the left
which compartment of thorax consists of mediastinum and its contents
central compartments
bones of the anterior (front) of thoracic wall include
clavicle
sternum
ribs
Subcutaneous
felt along its length under skin
clavicle
largest breast done in midline
consists of manubrium
body and xiphoid (spear like in Greek)
sternum
“roof over”
helps to give shape to the cavity of the thorax
ribs
which ribs are directly attached to the sternum by their own costal cartilage
the first 7 ribs
which ribs dont attach to the sternum by costal cartilage but instead to the costal cartilage of the rib above
ribs 8-10
because this helps to create the costal margin of thoracic cavity
what are the floating ribs and dont have anterior (front) attachment to sternum - anchored by abdominal wall muscles
Ribs 11-12
what are the bones of the posterior (back) thoracic wall
scapula
whats the major bone associated with the thorax but its more important for muscle attachment in the upper limbs
scapula
important structures as landmarks for the thorax
vertebrae
what provides resilience to ribs
costal cartilages
cartilage has elasticity so compression may cause injury to organs but ribs will not be broken
in old age costal cartilages may undergo progressive ossification
which rib is mostly to be broken or fractured and which is least likley
1st rib is least
ribs 2-7 mostly break
whats flail chest
multiple rib fractures , paradoxical movement of ribs during breathing
___ is rarely cracked
easy access most common site for bone marrow extraction
sternum
extrinsic muscles include the following anterior (front) muscles
pectoralis major
pectoralis minor
serratus anterior
extrinsic muscles include the following posterior (back) muscles
trapezius
rhomboids
latissimus dorsi
which all have to do with movement of upper limbs
main action of intrinsic muscles
responsible for moving the ribs during respiration
main action of extrinsic muscles
movement of upper limbs
what projects posteriorly (back) onto T2 and T3
suprasternal notch/jugular notch
where the manubrium and body of sternum join
projects posteriorly (back) to T4 and T5
sternal angle aka Angle of louis
sternum is directly anterior (front) to the ____
heart
like during CPR you pump over the sternum to compress the heart and pump blood
if you do it to left side that would crack ribs
projects to T9 posteriorly (back)
xiphisternal joint
in males nipple is in which intercostal space
4th
it varies in females
whats in the 5th intercostal space
3 1/2 from midline on the left side
apex beat of heart
describe the location of the breast
superficial to the pectoralis major and serratus anterior; extends
superiorly (up towards head) to the clavicular edge, laterally (side) to the edge of the latissimus dorsi, medially to
the sternum, and inferiorly (towards bottom) to the rectus sheath
what are the tissue types located in the breast and what do they do
the breast has glandular tissue including the breast lobules
rounded segments/unit) produce milk transported through the
lactiferous duct to the sinus and out through the nipple
-Composed of 12-15 ductal openings into the nipple
what is suspensory ligaments of cooper
is the connective tissue that connects between skin and fascia of pectoralis major
what are the 5 arteries that supply blood to the breast
a. Internal mammary artery branches (to intercostals)
b. Lateral thoracic artery
c. Thoracodorsal artery
d. Intercostal artery (perforators)
e. Thoracoacromial artery
which lymph nodes are responsible for majority of lymphatic drainage
axillary lymph nodes
which lymph nodes are at a greater risk of cancer metastases
supraclavicular
cancer may infect one breast and then move to the other breast via _____
internal mammary lymph nodes
what are the typical ribs and why are they called that
ribs 3-9
These have head (w/ 2 facets), neck (connects
head and rest of body), tubercle (at head/body junction) and body (which has
costal groove at concave internal surface)!
* One facet of the head articulates with the vertebra superior to it and the
other facet articulates with the vertebra that has the same #/is on the
same plane as the ribs.
* The tubercle articulates with the transverse process of the vertebra on
the same plane as rib
what are a typical ribs and why are they called that
*Atypical ribs include ribs 1, 2, 10, 11, 12. These are called atypical because
they are distinct and do not have all the features that typical ribs do
superior large fan shaped muscle . Innervated by medial and lateral pectoral
nerves
pectoralis major
inferior smaller triangular muscle. Innervated by medial pectoral nerve
pectoralis minor
lateral fan shaped muscle (at sides of thoracic wall;!). Innervated by long
thoracic nerve
serratus anterior
whats the direction of fibers of external intercostal (outermost)
infero-anteriorly
(hands in pocket)
innervates intercostal nerve
elevates ribs during inspiration
direction of fibers innervation and action of internal intercostal (middle)
infero-posteriorly
(praying hands)
intercostal nerve
active during expiration
Expiration involves gases leaving the lungs. During inspiration, the diaphragm and intercostal muscles contract allowing air to enter the lungs. During expiration, the ______
During expiration, the inspiration muscles relax forcing gases to flow out of the lungs
direction of fibers innervation and action of innermost intercostal
infero-posteriorly
(praying hands)
intercostal nerve
active during expiration
what are the 2 types of nerves innervating the thoracic wall
and define them
intercostal and subcostal
This is made up of anterior rami of spinal nerves T1-T11. They run long the intercostal
spaces and divide into anterior and lateral cutaneous branches. They carry somatic motor
in nervation to thoracic wall muscles, somatic sensory innervation from skin to parietal
pleura (dermatomes!) and postganglionic sympathetic fibers to the periphery.
intercostal nerves
describe the aterial supply of the thoracic wall
The arterial supply to the thoracic wall derives from the thoracic aorta through the posterior
intercostal arteries, and from the internal thoracic arteies which give rise to anterior intercostal
arteries (terminate at 6th intercostal space and bifurcates (divides or goes into) into musculophrenic & superior
epigastric arteries).
* The anterior and posterior intercostal arteries anastomose (direct connection b/w vessels)
within intercostal spaces.
this consists of the anterior ramus of spinal nerve T12 (subcostal as not
between ribs but instead below final rib in this case!
subcostal nerve
describe the veins of the throacic wall and remember that Venous drainage from the thoracic wall generally parallels the pattern of arterial supply.
Anteriorly: anterior intercostal veins drain into internal thoracic veins which drain into
brachiocephalic veins in the neck.
- Posteriorly: posterior intercostal veins drain into the azygos system of veins (azygos vein,
hemiazygos vein and accessory hemiazygos vein) which then drains into the superior
vena cava
The neurovascular plane is protected by the costal groove (which is a duvet in the rib) and
consists of the neurovascular bundle. The bundle components can be remembered as intercostal
VAN. V - Vein, A - Artery, N - Nerve.
The superior thoracic aperture is an opening at the top of the thoracic cavity that is bordered by the
T1 vertebra, Ribs 1 and the manubrium. It hosts the ______
trachea, esophagus, apices and nerves/vessels (of
head/neck/upper limbs).
The inferior thoracic aperture is an opening at the bottom of the thorax bordered
by the costal margin, xiphisternal joint and
ribs 12
describe the vasculature of the breast
it has an arterial supply and a venous drainage
The mammary glands (of breast) are supported by suspensory ligaments of Cooper. When lactation occurs,
the lobule drains into the
lactiferous ducts and accumulates in the lactiferous sinus
Arterial Supply. (breast)
* The mammary gland is supplied by perforating branches of the
internal thoracic artery
(medially) and by the axillary artery (laterally).
- Venous Drainage. (breast)
- Venous drainage parallels arterial supply and is to the
the axillary vein and internal thoracic
vein.
what are the different divisions of the thoracic cavity
left pleural cavity
mediastinum
right pleaural cavity
houses the right lung.
* Note that the left and right pleural cavities are DISTINCT from one another. Therefore,
pathology in one cavity doesn’t necessarily spread to other
right pleural cavity
located centrally and separates the left and right pleural cavities. The heart sits
in the middle mediastinal compartment
mediastinum
houses the left lung
left pleural cavity
The _______ is a double layer serous membrane that lines the lung and the
thoracic wall
pleura
The 2 layers are visceral pleura and parietal pleura.
Visceral pleura - layer lining the lung.
* Parietal pleura - layer lining the thoracic wall.
* Has 4 subdivisions.
* The layers connect (aka reflect) at the hilum of the lung
this is the potential space formed by the pleural layers. Under normal
circumstances, the space is small and there is a little serous fluid present (to reduce friction).
Under pathological circumstances, fluid can accumulate (pleural effusion).
pleural cavity
what are the 4 types of pleural effusions and describe them
Hydrpthorax - fluid in the pleural cavity
* Hemothorax - blood in the pleural cavity
* Chylothorax - lymph fluid in the pleural cavity
* Pneumothorax - air in the pleural cavity leading the lungs to collapse because negative
pressure necessary for lung expansion is not there anymore.
fluid in the pleural cavity
hydrpthorax
blood in the pleural cavity
hemothorax
lymph fluid in the pleural cavity
chylothorax
air in the pleural cavity leading the lungs to collapse because negative
pressure necessary for lung expansion is not there anymore.
pneumothorax
procedure used to address pleural effusion. The patient is made to
sit upright so that gravity pulls the fluid downwards. A syringe is inserted at an
thoracentesis
angle through the 9th intercostal space at midaxillary line and into the
costodiaphragmatic recess and the excess fluid id removed.
what are recessess and how many are there
spaces where the pleural cavity isn’t completely filled up by the lung. There are 2
recesses:
costomediastinal recess and costodiaphragmatic
located posterior to the sternum where the costal pleura is in
contact with the mediastinal pleura. Smaller recess.
costomediastinal recess
soft, spongy, elastic organs used to oxygenate blood. They both have:
* An apex - the apex of the lung is the blunt superior tip and it ascends above the 1st rib
into the root of the neck.
* A base - the base of the lung is concave and is located inferior to the apex. It
rests on the diaphragm
lungs
located at the inferior end of the thoracic cavity. It is the
largest recess and is more clinically relevant.
costodiaphragmatic recess
what are the three surfaces of lungs and describe them
costal - the surface next to ribs
* mediastinal - the surface between mediastinum and lungs. This includes the
hilum of the lung, in which structures forming the root of the lung enter and
exit.
* diaphragmatic - the surface facing the diaphragm
3 borders (anterior, inferior and posterior).
* Multiple lobes
what are the structures that make up the root of the lung
1 Pulmonary artery
* Superior pulmonary vein (most anterior)
* Inferior pulmonary vein (most inferior)
* Bronchi (thick cartilaginous wall)
Bronchial vessels
* Nerves
* Lymphatics
for the left lung the pulmonary artery is —- to the bronchus
SUPERIOR (UP)
For the right lung, the pulmonary artery is _____ to the bronchus.
*
ANTERIOR (front)
RALS mnemonic for remembering ________
RALS: Right Anterior | Left Superior
* Knowing RALS will help you on test day. Once you pick out the bronchus (easy to identify),
you will be able to find pulmonary arteries, then use RALS to help you determine left vs right
lung then you can identify the other structures of the root in relation to each other
the right lung is divided into 3 lobes _____
Right lung is divided into 3 lobes (superior, middle and inferior) by 2 fissures (a superior
‘horizontal’ fissure and an inferior ‘oblique fissure).
left lung is divided into 2 lobes
- Left lung is divided into 2 lobes (superior and inferior) by 1 fissure (oblique fissure).
The anterior border of the left leg has a _____ notch
Cardiac notch
which is an indentation caused by the apex pot the
heart. This indentation shapes the most anterior and inferior part of the superior lobe into a tongue-like
projection called the lingula
think of contact impressions
right lung impressions include
smaller cardiac impression, superior vena cava, right brachiocephalic
vein, arch of azygos vein, esophagus
think of contact impressions
left lung impressions include
Left Lung Impressions: larger cardiac impression, aortic arch, thoracic aorta
describe the anatomy of the trachea it is important and there are many steps
first the tracheobronchial tree is often considered as our airway
it starts with the trachea at C6 then descends to the _____
sternal angle (T4/T5) where it bifurcates into 2 main primary bronchi (1 to each lung)
each bronchus divides further into ______
secondary lobar bronchhi
3 to the right lung and 2 to the left lung
each lobar bronchus divides even further into multiple tertiary segmental bronchi
the _____ supply the bronchopulmonary segments
segmental bronchi
At the sternal angle where we have the tracheal bifurcation, we have a structure called the ______
which is an internal ridge of cartilage positioned slightly to the left of the median plane (making
R main bronchus wider and more vertical - food tends to fall in here). This ridge is a useful
landmark in bronchoscopy!
carina
trachea is made up by series of incomplete C shaped cartilaginous rings with the incomplete portion located ______
posteriorly and is filled in by the smooth muscle of the esophagus
know the differences between the left main primary bronchus and the right main primary bronchus
left or right primary bronchus
Longer, narrower, runs inferolaterally (inferior to
aortic arch, anterior to esophagus and thoracic
aorta)
left
left or right primary bronchus
Divides into 2 secondary lobar bronchi ->
segmental bronch
left
left or right primary bronchus
the ____ superior lobar bronchus gives off singular
bronchus
left
left or right primary bronchus
Wider, Shorter, runs more vertically (passes
directly to hilum - courses inferior to azygos vein
arch and anterior to right pulmonary artery)
right
left or right primary bronchus
Divides into 3 secondary lobar bronchi ->
segmental bronchi
right
left or right primary bronchus
The right superior lobar bronchus passes superior
to pulmonary artery
right
what are bronchopulmonary segments
large pyramid-shaped subdivisions of a lobe
bronchopulmonary segments are supplied by a segmental _____ bronchus and tertiary segmental ____
tertiary bronchus
pulomnary artery
usually humans have about ___ bronchopulmonary segments in total
18-20 segments in total, 10 in the right lung and 8-12 in the left lung
Pulmonary vasculature connects to the heart and is involved in the oxygenation of blood.how many veins and arteries does each lung have
1 pulmonary artery and 2 pulmonary veins
we know pulmonary arteries arise from pulmonary trunk but at what levels and what do they drain
level of the sternal angle and they drain oxygen poor blood from the right ventricle and carry it to the lungs for oxygenation
which pulmonary artery divides into 3 lobar arteries: superior, middle and
inferior secondary lobar arteries. These further divide into tertiary segmental
arteries
RIGHT
which pulmonary artery divides into 2 lobar arteries: superior and inferior
secondary lobar arteries. These further divide into tertiary segmental arteries
LEFT
_____ drain oxygen rich blood from the
lobes of each lung and carry it to the left atrium of the heart. These veins run
independently of arteries and bronchi in the lungs.
Pulmonary veins (superior and inferior on each side)
for which lung is the superior lobe drained by the right superior vein, the middle
lobe is drained by the middle lobe vein (an offshoot of the right superior vein) and
the inferior lobe is drained by the right inferior vein
right lung
for which lung is the superior lobe drained by the left superior vein and the
inferior lobe is drained by the left inferior vein
left lung
bronchial arteries supply oxygen and nutrition rich blood to the lungs
true or false
true
there are two left
bronchial arteries and one right bronchial artery.
T or F
true
the left bronchial arteries arise from
thoracic aorta and the right bronchial artery arises from various sources
Bronchial veins partially drain blood supplied to the lungs (rest drained by pulmonary
veins).
T or F
T
right bronchial vein drains into the
azygos vein
left bronchial vein
drains into the
accessory hemiazygos vein or the left superior intercostal vein
The lungs and visceral pleura are innervated by
anterior and posterior pulmonary plexuses
which originate from sympathetic trunks and vagal nerves
parietal pleura is innervated somatically by
intercostal and phrenic nerves
Lymph from the lungs drains along the root of the lung and into the
tracheobronchial lymph
nodes.
