Thorax Flashcards
Retromammary space
space b/w breasts and investing layer (fascia) of pec major
Breast arterial supply
Internal thoracic branches
Lateral thoracic
Post intercostal aa (cutaneous branches)
Spaces on post surface of heart
Transverse pericardial sinus
Oblique pericardial sinus
Pericardium layers
Fibrous (outer)
Serous (inner)
1. Parietal (wall)
2. Visceral (surface of heart) AKA epicardium
What are the layers of the heart?
Epicardium (visceral pericardium)
Myocardium (majority of heart)
Endocardium (membranous layer continuous with lining of vessels)
Fibrous pericardium attached to diaphragm via…
pericardiacophrenic ligament
Blood vessels that run on pericardium
Pericardio-phrenic a and v
Apex of the heart points in what direction
Down to left
What kind of blood on
Right side
Left side
of heart?
Right: venous return from body
Left: oxygenated from lungs
Cardiac circuit blood vessel
What chamber does vessel dump into?
Coronary sinus (blood from heart itself enters right atrium)
Branches of Arch of Aorta
Brachiocephalic a
Left common carotid a
Left subclavian a
Valves of heart
Atrioventricular valves (R: Tricuspid, L: Mitral)
Pulmonary valve
Aortic valve
Right and left fibrous ring
Outline tricuspid and mitral valves
Fibrous coronet outline what valves?
Pulmonary and aortic valves
2 AV valves
Tricuspid (R)
Mitral (L)
2 Semilunar valves
Pulmonary
Aortic
Septum of heart
Interatrial (b/w atria)
Interventricular (b/w ventricles)
AV (b/w atrium and ventricle)
Pectinate muscle
Rough wall of right atrium
Crista terminalis
Border where pectinate muscles of right atrium end
Sinus venarum
Remnant of…
Smooth wall of right atrium
Remnant of sinus venosus
Oval fossa
Remnant of…
Depression on interatrial septum
Remnant of foramen ovale
What structures are located in right atrium?
Pectinate muscle
Crista terminalis
Sinus venarum
Oval fossa
Cusps of tricuspid (right AV valve)
Anterior
Septal
Posterior
Structure of tricuspid valve
Cusps –> tendinous cords –> papillary muscles
Septomarginal trabecula (moderator band)
Conduit for electrical sys of heart
Compare pulmonary and tricuspid valves
Both have 3 cusps
Tricuspid has chordae tendineae and papillary muscles
Pulmonary has neither
Branches of thoracic aorta
Bronchial Mediastinal Esophageal Pericardial Celiac trunk
Branches of arch of aorta
Brachiocephalic a
Left common carotid a
Left subclavian a
Celiac trunk located
below diaphragm
Right or left? Aorta Azygos Hemiazygos Accessory hemiazygos
Aorta: left
Azygos: right
Hemiazygos: left
Accessory azygos: left
Vessels that drain to right atrium
Sup and inf vena cava
Coronary sinus
Cusps of mitral valve
2 (left side–bishop is never right)
Number of cusps of pulmonary and aortic valves
both have 3 cusps
Walls of right atrium
Walls of left atrium
Right: pectinate and sinus venarum (rough and smooth)
Left: only smooth
Chordae tendineae and papillary muscles are characteristic of what chamber of the heart?
R and L ventricles
Branches of R Coronary Artery
(MAPS) Post interventricular branch SA nodal branch AV nodal branch Marginal branch
Branches of L Coronary Artery
(CALM) Ant interventricular branch Lateral diagonal branch Left marginal artery Circumflex branch
Blood supply of myocardium by coronary aa
2/3 left coronary a
1/3 right coronary a
Where does coronary sinus run?
Coronary sulcus
Runs on back of heart
What vessels run into coronary sinus?
Great cardiac vein
Left marginal vein
Left post ventricular vein
Middle cardiac vein
SA node located
AV node located
SA: right atrium
AV: interatrial septum
Mediastinum
Everything left after remove heart and lungs
Mediastinum: Sup Inf Ant Post
Sup: T1 - above sternal angle
Inf: below sternal angle - diaphragm
Ant: heart
Post: area behind heart
Contents of sup mediastinum
Sup vena cava Arch of aorta and branches Pulmonary aa and vv Azygos v Phrenic nerve Vagus nerve (recurrent laryngeal nerve branch) Ductus arteriosus Thymus Trachea
Ligamentum ateriosum
Remnant of…
Solid piece of connective tissue
Remnant of ductus arteriosus (connected pulmonary trunk to aorta)
Location where recurrent laryngeal branch of vagus makes loop on right side?
Left side?
Right side: R recurrent laryngeal loops around brachiocephalic trunk (higher than left side)
Left side: L recurrent laryngeal loops under aorta, in front of ligamentum arteriosum (lower than right side)
Thymus gland location
behind manubrium of sternum
Lung bypasses in fetus
Ductus arteriosus
- -Connects pulmonary trunk and aorta
- -Adult: ligamentum arteriosum
Foramen ovale
- -Connects right and left atrium
- -Adult: oval fossa
Ligamentum arteriosum
Remnant of…
Solid piece of connective tissue
Remnant of ductus arteriosus
Structures located in both the sup and post mediastinum
Arch of aorta
Azygos v
Vagus nerve
Recurrent laryngeal nerves
Contents of post mediastinum
Arch of aorta Sympathetic trunk Thoracic duct Vagus nerve Recurrent laryngeal branch Azygos v Esophagus
True ribs
1-7
Articulate directly with sternum
False ribs
8-10
Costal cartilages join up with that of rib 7
Floating ribs
11-12
No costal cartilages
Parts/characteristics of typical rib
Bicipetal Head w/ sup and inf facets Neck Tubercle w/ articular facet Costal groove: NAV run here
What are the facets of a typical rib and to where do they attach?
Sup and inf facets: articulate with body of vertebra with the same number and the vertebra above it
Articular facet on tubercle: articulates with transverse process of vertebra with same number
Structures of 1st rib
Grooves for subclavian a and v Scalene tubercle (for ant scalene muscle)
Structure of 2nd rib
Tuberosity for serratus ant
3 parts of sternum
Joints of sternum
Manubrium --Manubriosternal joint (sternal angle) Body --Xiphisternal joint Xiphoid process
Sup and inf thoracic apertures…open or closed?
Sup: open
Inf: closed by diaphragm
What kind of joints do ribs have?
Synovial
Ligaments of ribs
Radiate: around head of rib (which is attached to vert body)
Costotransverse: b/w transverse process and rib
Motion of upper ribs
Lower ribs
Upper: rounded joints rotate up and down
– “pump handle”
Lower: plane joints which elevate and depress
– “bucket handle”
Muscles of thorax
Pec major and minor Serratus anterior and posterior External intercostals Internal intercostals Transversus thoracis
Serratus post sup action
Serratus post inf action
Post sup: elevate ribs
Post inf: depress ribs
Levator costarum action
Elevate ribs
External intercostal action
Elevate ribs during forced inspiration
Internal intercostal action
Depress ribs during forced respiration
Transversus thoracic action
Weakly depresses ribs
Levatores costarum run…
From transverse process –> rib below
3 holes in diapragm for…
Aorta (splanchnic nerves travel through here)
Inf vena cava
Esophagus
Parts of parietal pleura lining lung cavity
Cervical
Costal
Diaphragmatic
Mediastinal
Endothoracic fascia located between
Parietal pleura and body cavity
Are visceral and parietal pleura of lung continuous?
Yes
Costodiaphragmatic recesses
spaces at bottom corners of lung cavity
allow for lung expansion
Cardiac notch
In left lung
Where heart is located
Hilum
Area of lungs that is entrance for vessels and air passageways
Lingula
tongue-like part of left lung
part of sup lobe
Lobes of Right lung
Left lung
R: sup, mid, inf
L: sup, inf
Fissures of Right lung
Left lung
R: horiz and oblique
L: oblique
Surface of Right Lung
Groove for sup vena cava
Groove for azygos v
Impressions for vagus and phrenic
Surface of Left Lung
Cardiac impression
Impression from arch of aorta
Impression from subclavian
Root of lung
area b/w lung and trachea
Airpassageways of lung
Trachea
R and L primary bronchi
Secondary bronchi
Broncho-pulmonary segments
How many secondary bronchi in right lung?
Left lung?
Right: 3 secondary bronchi (1 per lobe)
Left: 2 secondary bronchi
3 types of bronchioles
Conducting
Terminal
Respiratory
Parts of alveoli
alveolar duct
alveolar sac
3 things that pass through diaphragm
Inf vena cava (T9)
Esophagus (T10)
Aorta (T11)
Nerves of lungs
Sym
Parasym
Sym: sym trunks
Parasym: vagus
Central tendon of diaphragm
Large tendon in middle of diaphragm muscle
Function of serous pericardium
secretes lubriant to prevent heart from getting caught on inside of pericardium
Bronchial arteries originate from…
Thoracic aorta
Bronchial veins drain to…
Azygos
Hemiazygos
Pulmonary vv
Lymph nodes in lungs drain to…
lymph nodes around trachea
Thoracic duct
Drains into…
All lymph fluid from body (except rt upper limb and head) drains through thoracic duct (left side)
Drains into left brachiocephalic v at bifurction into L jugular and L subclavian
Right lymphatic duct
Drains into…
Lymph fluid from rt upper limb drains here
Drains into right brachiocephalic v
Pulmonary plexus
combo of parasym (from vagus–runs on esophagus) and
sym (from sym trunk)
Cardiac plexus
nerves to heart
Esophageal plexus
runs on esophagus – innervation to gut
vagus joins with esophageal plexus
Another name for nerve T2
Anterior intercostobrachial nerve
Name of fused ganglion (inf cervical ganglion + 1st thoracic ganglion)
Cervicothoracic (stellate) ganglion
Rami communicantes
Connects ganglion with spinal nerves
- -White ramus
- -Gray ramus
Sympathetic ganglion are close/far to origin
Close to origin (spinal cord)
Another name for T2 nerve
Anterior intercostobrachial nerve