thorax 1 and 2 Flashcards
true ribs: numbers and attachment
ribs 1-7
attach directly to sternum w/ costal cartilages (vertebrocostal)
floating ribs: numbers and attachments
11-12
end in posterior abdominal musculature
bony features of typical ribs
wedge-shaped head w/ 2 facets separated by crest for intervertebral articulation
neck, tubercle, @ junction of neck and shaft w/ articular facet portion, non-articular portion
false ribs: numbers and attachments
8-10
attach to cartilage superior to them, indirectly to sternum (vertebrochondral)
typical rib shaft features
costal groove for intercostal nerve and vessels
costal angle
distal end articulates w/ costal cartilage
common rib fracture location
anterior to costal angle
costovertebral joints
rib head articulates w/ superior costal facet of same number, inferior costal facet of above vertebra
(ex: rib 7 articules w/ superior facet of T-7, inferior facet of T-6)
costotransverse joints
- tubercle of typical rib articulates w/ transverse costal facet of same number vertebra
bucket-handle movement
costovertebral synovial joints
- move laterosuperiorly on inspiration, inferomedially on expiration
- increase, decrease transverse diameter of thorax
pump-handle movement
costotransverse synovial joints
- superoanterior on inspiration, inferoposterior on expiration
- increase, decrease anterior-posterior diameter
bony features of atypical ribs: rib 1
single facet on head, scalene tubercle for anterior scalene insertion
grooves for subclavian vein, artery
bony features of atypical ribs: rib 2
head has 2 facets that articulate w/ T1, T2
superior tubercle for posterior scalene insertion
tuberosity for serratus anterior insertion
bony features of atypical ribs: ribs 10-12
head has single facet
11, 12 don’t have neck or tubercles
manubrium: features
superiorly: jugular/suprasternal notch
laterally: notched for clavicle, 1st costal cartilage, portion of 2nd costal cartilage
manubriosternal joint (sternal angle): symphysis between manubrium and body of sternum
3 bones of sternum
manubrium, body, xiphoid
body of sternum: features
laterally: notched for 2-7 costal cartilages
xiphoid: features
xiphisternal joint: synchondrosis (hyaline cartilage) between xyphoid process and body of sternum
costochondral joints: location
hyaline cartilage joints between ribs and costal cartilages
sternocostal joints: location
1st: articulates w/ manubrium
2nd-7th: synovial joints articulating w/ body of sternum
*2nd w/ both manubrium and body
interchondral joints: location
6th-9th: synovial joints
volume changes during inspiration/expiration
increase in intrathoracic volume during inspiration
decrease in intrathoracic volume during expiration
diaphragm: characteristics
- primary muscle of inspiration
- dome-shaped w/ central tension
diaphragm: peripheral origins
sternal: xiphoid process
lumbar: crura (L1-L3 vertebral bodies)
costal: inferior 6 costal cartilages and ribs
diaphragm: movements
descends during inspiration
- central part moves caudally
- periphery (origins) are fixed
rises during expiration (relaxation)
musculophrenic artery
supplies diaphragm
branch of internal thoracic a.
superior phrenic arteries
supply diaphragm
branches of thoracic aorta
inferior phrenic arteries
supply diaphragm
branches of abdominal aorta
pericardiacophrenic artery
supplies diaphragm
branch of internal thoracic artery
diaphragm: vasculature
pericardiacophrenic artery, inferior phrenic arteries, superior phrenic arteries, musculophrenic arteries
internal intercostal muscles: location, function
from angle of rib posteriorly to sternum anteriorly
depresses ribs
external intercostal muscles: location, function
tubercle of rib posteriorly to costochondral junction anteriorly
elevates ribs
innervation of diaphragm
phrenic nerve: motor and sensory
intercostal nerve: sensory
levator costarum: location, function
originate @ transverse processes of T1-T11, passes inferolaterally to insert @ tubercles of ribs
elevate ribs
subcostalis muscle: location, function
angle of rib crossing 1-2 intercostal spaces
elevates ribs
innermost intercostal muscles: location, function
depresses ribs
deeper than internal
transverse thoracis: location, function
originate from body of sternum, run superolaterally to insert on 2-6th costal cartilages
depress ribs
branches of axillary artery that supply thoracic wall
superior and lateral thoracic
thoracic aorta: branches and supply
9 intercostal arteries, 1 subcostal artery
spaces 3-11
left superior intercostal vein: function
drains upper 1-3 posterior intercostal veins into left brachiocephalic
anterior intercostal veins drain to
internal thoracic vein
right posterior intercostal veins drain to
azygos vein
left posterior intercostal veins drain to
accessory hemiazygos and hemiazygos veins
innervation of thoracic wall: anterior rami
T1-2: sends fibers to brachial plexus
T1-11 intercostal nerve: motor, sensory
T12 subcostal nerve: motor and sensory
T4 dermatome
nipple level
T10 dermatome
umbilicus level
intercostal space: superficial to deep
skin
superficial, deep fascia
external, internal intercostal muscles
neurovascular bundle
- intercostal veins, arteries, nerves
- collaterals
innermost intercostal muscles
endothoracic fascia
parietal pleura, pleural space
thoracocentesis
pleural tap between 9th and 10th ribs, posterolaterally
- costodiaphragmatic recess
- analysis and drainage of pleural effusion
pneumothorax
air in pleural cavity
hemothorax
blood in pleural cavity
surface anatomy: jugular notch
T2
surface anatomy: manubrosternal angle
T4
surface anatomy: xiphisternal angle
T9
esophagus is at vertebra
T10
aorta is at vertebra
T12
superior thoracic aperture
bounded to:
- T1 posteriorly
- 1st pair of ribs and costal cartilages laterally
- manubrium anteriorly
structures pass thru neck, thoracic cavity:
- trachea, esophagus, nerves, blood
inferior thoracic aperture
bounded to:
- T12 posteriorly
- ribs 11-12 posterolaterally
- costal margin 7-10 and xiphisternal joint anterolaterally
structures passing thru diaphragm:
- esophagus, IVC, aorta
thoracic outlet syndrome
mechanical compression of brachial plexus and subclavian artery
three compartments of thoracic cavity
- right and left pulmonary
- central mediastinum
sternal line: pleura
costal pleura becomes continuous w/ mediastinal pleura anteriorly
costal line: pleura
costal pleura becomes continuous w/ diaphragmatic pleura
vertebral line: pleura
costal pleura becomes continuous w/ mediastinal pleura
pleural cavity: function
serous fluid lubricates pleural surfaces
visceral pleura: location, function
invests all surfaces of lungs, deeper layer
parietal pleura: location, function
lines pulmonary cavity (thoracic wall, mediastinum, diaphragm), superficial layer
diaphragmatic pleura: location, features
part of parietal pleura that lines diaphragm
thin layer of endothoracic fascia (phrenicopleural), connects w/ muscle fibers
cervical pleura: location, features
part of parietal pleura that lines superior thoracic aperture into root of neck
reinforced by fibrous endothoracic fascia
suprapleural membrane attaches internal surface of rib 1, C7
innervation of parietal pleura
phrenic nerve C3-C5
- referred pain to C3-C5 dermatomes
vascularization of parietal pleura
intercostal and pericardiacophrenic arteries
potential pleural space
lungs don’t occupy pulmonary cavity completely during expiration
- space w/ costomediastinal and costodiaphragmatic recesses
right lung: lobes, features
3 lobes
- horizontal fissure divides superior and middle
- oblique fissure divides superior and inferior
larger, shorter, wider, dome of diaphragm is higher bc of liver
heart bulges to left
left lung: lobes, features
2 lobes
- oblique fissure divides superior, inferior
cardiac notch indents superior lobe for apex
lingula on superior lobe
lung surfaces
costal: large, convex
mediastinal: concave, includes hilum
diaphragmatic: base
pulmonary arteries: location
anterior and superior to bronchus in R lung
most superior in L lung
pulmonary veins: location
most anterior and inferior in R and L lung
pleural sleeve
continuation of parietal and visceral pleura
pulmonary ligament
hangs inferiorly from pleural sleeve
trachea: location, features
begins @ larynx, bifurcates @ level of sternal angle
primary bronchus divides into
lobar (secondary) bronchi, which supply each lobe
lobar bronchi divide into
segmental (tertiary) bronchi, which supply bronchopulmonary segments
segmental bronchi divide into
bronchioles, via distal branching
- conducting, terminal, respiratory
respiratory bronchioles continue into
alveolar ducts, sacs, alveoli
pulmonary plexuses
parasympathetic: vagus nerve, bronchoconstriction and vasodilation
sympathetic: sympathetic trunk, bronchodilator and vasoconstrictor
pulmonary arteries: function, course
bring deoxygenated blood from pulmonary trunk
- divides into lobar arteries, segmental arteries
bronchial arteries: function, course
supply root of lungs, wall of bronchial tree, visceral pleura
anastomose w/ pulmonary arteries in walls of bronchioles and visceral pleura
- 2 left, branch of thoracic aorta
- 1 right, branch of posterior intercostal
pulmonary veins: function, course
bring oxygenated blood to L atrium
- courses in septum between segments
