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thorax Flashcards

1
Q

What is the transverse thoracic plane?

A

Imaginary horizontal plane at the level of sternal angle/rib 2 & T4/5

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2
Q

What happens at the level of the transverse thoracic plane?

A

Sternal angle
Trachea bifurcates
Pulmonary trunk birfucates
Aortic arch concavity

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3
Q

What are the different components of the mediastinum?

A

Superior

Inferior - anterior, middle, posterior

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4
Q

What are the boundaries of the mediastinum?

A

Anterior: sternum and costal cartilages

Posterior: Tx vertebrae

Inferior: diaphragm

Superior: superior Tx aperture (manubrium, ribs 1, T1)

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5
Q

What are the contents of the mediastinum?

A

All Tx viscera and structures except the lungs

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6
Q

What are the features of the mediastinum?

A

Central compartment in thoracic cavity between the lungs and above the diaphragm

Covered by mediastinal pleura

Very mobile region to accomodate movement, pressure and volume changes

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7
Q

What are the contents of each mediastinal compartment?

A

Superior:

  • trachea
  • oesophagus
  • aortic arch & branches
  • phrenic & vagus n

Inferior (anterior):
- thymus

Inferior (middle):

  • heart
  • great vessels
  • phrenic n

Inferior (posterior):

  • oesophagus
  • Tx aorta
  • vagus n
  • Tx duct & lymph nodes
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8
Q

What are the 4 types of muscles in the thoracic cage?

A

Respiration (1)
Intercostal (3)
Internal Cage (2)
External Cage (3)

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9
Q

What are the muscles of the thoracic cage?

A

There are 9 muscles in the thoracic cage:

Respiration:
- diaphragm

Intercostal:

  • external
  • internal
  • innermost

Internal Cage:

  • subcostal
  • transverse thoracis

External Cage:

  • serratus posterior superior
  • serratus posterior inferior
  • levator costorum
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10
Q

Describe the diaphragm

A

PA:

  • xiphoid process
  • internal surfaces of ribs and costal cartilages 1-6
  • Lx vertebrae and IVDs

DA:
- central tendon

NS:

  • motor: phrenic (C3-5)
  • sensory (central): phrenic (C3-5)
  • sensory (peripheral): intercostal nerves 5-11, subcostal nerve

A:
- contraction pulls dome inferiorly and increases thoracic cavity

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11
Q

Describe the anatomy of the intercostals:

A

3 layers:

  • external
  • internal
  • innermost

PA:
- inferior border of ribs

DA:
- superior border of inferior rib

NS:
- intercostal nerve of same level

Fibres:

  • external: anteriorly and inferiorly
  • internal and innermost: posteriorly and inferiorly

A:

  • external: elevates ribs during forced inspiration
  • internal: interossesous part depresses ribs and interchondral part elevates ribs
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12
Q

Describe the crura of the diaphragm

A

There are two crura (right and left).

Musculotendinous bundles that connect the diaphragm to L1-4 vertebrae, the IVDs, and the ALL.

Right:
- longer, attaches to L1-4, contains oesophagal hiatus

Left:
- shorter, attaches to L1-3

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13
Q

What are the 4 bony elements of the thoracic cage?

A

Ribs (12)
Costal cartilages (12)
Sternum
Thoracic vertebrae (12)

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14
Q

What are the 3 types of ribs?

A

1-7: true ribs (attach directly to sternum)

8-10: false ribs (attach to sternum via costal connection to superior rib)

11-12: floating ribs (no anterior attachment)

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15
Q

What are the 3 components of the sternum?

A

Manubrium (superior)

Body (middle)

Xiphoid process (inferior)

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16
Q

Which are the typical and atypical thoracic vertebrae?

A

T2-9: typical

T1, T10-12: atypical

17
Q

What are the characteristics of a typical thoracic vertebrae?

A

Body - heart shaped

Foramen - circular

Spinous processes - long and sharp, project inferiorly and overlap inferior vertebrae

Transverse processes - project posteriorly as well as laterally to accomodate ribs; T1-10 have costal facets for articulation with ribs

Articular facets:
- superior facets face posteriorly, inferior facets face anteriorly

18
Q

Describe the costal facets on the typical thoracic vertebrae

A

On typical vertebrae (T2-9):

Superior demifacet: large semicircle, articulates with same rib (head)

Inferior demifacet: small semicircle, articulates with inferior rib (head)

Transverse costal facet: articulates with tubercle of same rib

19
Q

Which vertebrae have a single circular facet to articulate with ribs?

A

T1, T10-12

20
Q

Which vertebrae have costal facets on the transverse processes to articulate with tubercle of ribs?

A

T1-10

21
Q

Which are the typical and atypical ribs?

A

Typical: 3-9
Atypical: 1, 2, 10, 11, 12

22
Q

Describe a typical rib

A

Ribs 2-9:
- wedge shaped head posteriorly made up of superior and inferior demifacets (articulate with facets of vertebrae) and crest of head for attachment of intra-articular ligament

  • neck (lateral to head)
  • tubercle (articulates with costal facets on transverse processes)
  • angle (where rib slants inferiorly)
  • costal groove (internal surface, for passage of neurovascular vessels)
  • costal cartilage anteriorly
23
Q

What are the 3 components of the sternum and their features?

A

Manubrium, body and xiphoid process

Manubrium:

  • widest and thickest part
  • suprasternal notch
  • clavicular notoch
  • costal notch for rib 2 at sternal angle

Body:
- costal notches for ribs 3-7

Xiphoid process:

24
Q

At what levels of the Tx spine are the components of the sternum located?

A

Manubrium: T3-4 level

Body: T5-9 level

Xiphoid: T10 level

25
Q

Which nerves innervate the thoracic wall?

A

The intercostal and subcostal nerves:

Source: ventral rami of Tx spinal nerves T1-11 (intercostal) and T12 (subcostal)

Course:

  • arise from ventral rami of spinal nerves to run between pleura and internal intercostal membrane
  • at angle of ribs, enters costal groove between innermost and internal intercostals
  • runs length of intercostal space (with intercostal artery and vein) in costal groove
26
Q

Which two major arteries does the thoracic cage receive blood supply from?

A

Subclavian
(Anterior Intercostal 1-9)

Thoracic Aorta
(Posterior Intercostal & Subcostal)

27
Q

What are the branches of the subclavian artery in the thoracic cage?

A 
Subclavian 
-
Internal Thoracic
- 
Anterior Intercostal 1-6 (direct branches)

musculophrenic
- Anterior Intercostal 7-9

28
Q

What is the venous drainage of the thoracic cage?

A

Venous drainage via:
- posterior & anterior intercostal veins (anastamose and drain into azygos venous system & superior vena cava)

  • internal thoracic veins drain into braciocephalic veins, which unite to form superior vena cava)
29
Q

What is the transverse thoracic plane?

A

Imaginary horizontal line between:

T4/5 & IVD posteriorly

Rib 2 / sternal angle anteriorly

At this level:

  • divides superior and inferior mediastinum
  • trachea bifurcates
  • pulmonary trunk bifurcates
  • aortic arch
  • azygous vein drains into SVC
30
Q

Describe the mediastinum

A

Central compartment in the thoracic cavity

Divided into superior and inferior mediastinum at the level of the sternal angle / transverse thoracic plane

Inferior mediastinum further divided into anterior, middle and posterior sections

Mobile compartment to accommodate volume and pressure changes of contents (structures accomodate fluid and air)

31
Q

What are the contents of the mediastinum (overall)?

A

All thoracic viscera and structures except the lungs:

  • heart (middle)
  • trachea (superior)
  • oesophagus (superior and posterior)
  • arch or aorta and branches (superior)
  • superior vena cava (superior)
  • descending aorta (posterior)
  • vagus nerves (superior and posterior)
  • phrenic nerves (superior and anterior)
  • thymus (superior and anterior)

cprs (13 decks)

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