Thoracic Wall; Pleural Cavities and Lungs Flashcards
1
Q
What are the body wall layers of the thorax, superficial to deep?
A
- Skin
- Superficial Fascia
- Muscles of the upper limb
- Intercostal muscles
- Endothoracic fascia (areolar CT)
- Paretal Pleura
- Thoracic Cavity
2
Q
Intercostal Muscles
A
- Muscles of respiration
- From superifical to deep:
- External Intercostals
- Internal Intercostals
- Innermost Intercostals and Transversus Thoracis
- Contents of Intercostal Spaces (Costal Groove of Inferior Rib):
- Vein
- Artery
- Nerve
3
Q
Transversus Thoracis Muscle
A
- At the same “depth” as the innermost intercostals
- On anterior thoracic wall
- Attaches from sternum to 2nd-6th costal cartilages
4
Q
Innervation of Thoracic Wall
A
-
Anterior rami of intercostal nerves (T1-T11)
- **T12 is the subcostal nerve and doesn’t innervate thoracic wall, it innervates the abdominal wall
5
Q
Thoracic Wall Blood Supply Overview
A
-
Intercostal vessels (anastomose with one another to form vessel arc)
- 9 Anterior Intercostal Vessels
- 11 Posterior Intercostal Vessels (more as a result of floating ribs)
6
Q
Internal Thoracic Artery
A
- Branch of subclavian a.
- Runs along the lateral sternum
- Branches:
- First 6 anterior intercostal aa.
-
Musculophrenic a. (follows line of ribcage)
- 7-9th intercostal aa.
-
Superior Epigastric a.
- Continuation of internal thoracic a.
- Anastomoses with inferior epigastric a.
7
Q
Posterior Intercostal Arteries
A
-
Superior Intercostal Artery
- Gives rise to 1st and 2nd posterior intercostal aa.
-
Descending Thoracic Aorta
- Gives rise to 3rd-11th posterior intercostal aa.
Posterior intercostal aa. give rise to radicular aa. to inferior spinal cord
8
Q
Veins of Thoracic Wall
A
- Anterior intercostal vv. drain into internal thoracic v.
-
Posterior intercostal vv. drain into:
- Azygos v. (right side)
- Hemiazygous v. (left side)
9
Q
Boundaries of the Thorax
A
- Boundaries:
- Superior Thoracic Aperture
- Diaphgram
- Sternum/Costal Cartilages
- Thoracic Vertebral Bodies
- Central mediastinum
- Lateral pleural cavities
10
Q
Thoracic Diaphgram
A
- Separates thorax and abdomen
- Muscular and tendinous components
- Primary Muscle of Respiration
Openings:
-
Aortic Opening (T12)
- Descending Aorta
- Thoracic Duct
- Azygos Vein
-
Esophageal Opening (T10)
- Esophagus
- Left and right vagus n.
-
Caval Opening (T8)
- Inferior vena cava
Innervation:
- L/R Phrenic nn. (C3, C4, C5)
11
Q
Movements of Respiration
A
Inspiration:
-
Expand thoracic cavity in all three dimensions
-
Superior to Inferior: Diaphgram
- Moves from dome shape to flat to increase space in thoracic cavity
- Laterally: Ribs
- Anterior to Posterior: Sternum
-
Superior to Inferior: Diaphgram
Expiration:
-
Compress thoracic cavity
- Superior to Inferior: Diaphragm
- Laterally: Ribs
- Anterior to Posterior: Sternum
12
Q
Flail Chest
A
- Multiple rib fractures in multiple places produce separate wall segment
- Will show paradoxical breathing movements (opposite of regular breathing movements)
13
Q
Pleural Cavities
A
Pleura: a serous “sac” that consists of 2 continuous membranes
-
Parietal Pleura: lines the thoracic wall
- Blood Supply: intercostal vessels
- Innervation: intercostal nerves
-
Visceral Pleura: covers the lung
- Blood Supply: pulmonary and bronchial vessels
- Innervation: autonomic nervous system
Pleural Cavity:
- Between parietal and visceral pleura “potential space”
- Contains serous fluid
14
Q
Pleural Effusion
A
- Fluid inside pleural cavity
- Use thoracocentesis to remove fluid (above rib)
15
Q
Lungs
A
Right Lung
- 3 Lobes (Superior, Middle, Inferior)
- Separated by horizontal (b/w superior and middle) and oblique fissures (b/w middle and inferior)
Left Lung
- 2 Lobes (Superior and Inferior)
- Separated by oblique fissure
- Lingula is homologous to middle lobe of R lung (doesn’t develop due to heart)
16
Q
Surfaces of Lungs
A
- Costal (in contact with ribs)
- Diaphragmatic (in contact with diaphragm)
- Mediastinal (in contact with mediastinum)
Costadiaphragmatic Recess**
Costamediastinal Recess**
**Where fluid can accumuluate. Location of thoracocentesis
23
Q
Respiratory Diverticulum
A
- In earyl 4th week, ventral projection occurs off of the foregut (pharynx) called the respiratory diverticulum
- Endoderm
- Esophagotracheal septum forms dividing future trachea from foregut
24
Q
Tracheoesophageal Fistula
A
- Abnormal communication b/w trachea and esophagus
Esophageal Atresia:
- Where esophagus ends in blind pouch
- Prenatal indicator: polyhydramnios (too much amniotic fluid, normally the fetal circulation requires “swallowing” this fluid)
26
Q
Lung Vascular Supply
A
-
Pulmonary System:
- Arteries and veins that transport blood to/from lungs for reoxygenation
-
Bronchial System:
- Supply bronchi and larger bronchioles
- 3-4 Bronchial Arteries branch from descending thoracic aorita
- Bronchial Veins: drain into azygos vein or accesory hemizygos vein; sometimes into pulmonary veins
28
Q
Lung Lymphatics
A
- Lymph from bronchopulmonary lymph nodes goes to:
-
Tracheobronchial lymph nodes (near carina), then to:
-
Left/Right Bronchomediastinal Lymph Trunks:
- Right Lymphatic Duct** or **Thoracic Duct
-
Left/Right Bronchomediastinal Lymph Trunks:
-
Tracheobronchial lymph nodes (near carina), then to:
