Thorax Flashcards
Angle of Louie
Very important landmark esp if we need to count the rib or to find interspaces; corresponds to the second rib
Tells us where the bifurcation of trachea is
Where to insert chest tube?
Fourth intercostal space
Behind manubrium
arteries of aorta
Ribs
May be typical or atypical
Typical rib
round body
Atypical rib
flat
True ribs
Attached to the sternum; first to the 7th rib
False ribs
Below the 7th rib; not attached to the sternum; only attached to the ribs above
Inferior angle of rib
Costal Groove; where you find inTercostal VAN - vein arteries nerves
Insert needle just above the superior part of rib
First rib
There’s an elevation for tubercle where a muscle is attached.
There is a groove behind tubercle - for subclavian and brachial plexus: a network of nerves
Clavicle
Round end - attaches to sternum
Flat end - scapular; forms a joint with the acromion of scapula
How to know the inferior surface? Look for conoid tubercle.
Scapula
Not part of thoracic bony cage;
Spine of scapula on posterior; glen lid cavity: forms a joint with humerus; acromion (where clavicle is attached)
Boundaries of breast
Superior - once you reach clavicle
Along sternum
Inferior - six to the 7thrib; midaxillary line/latissimus Doris
Breast
15 to 20 lobules; divided into compartments by fibrous septa which are actually attached to the dermis of skin (suspensions ligament)
Breast
extension of breast - axillary tail of spens
Lobes will produce milk and
Suspenseful ligaments are attached to lobules. Tumor within the duct will pull down suspensory ligament - dimpling of skin; lymph vessels of breast will be obstructed by the tumor cells - orange fruit appearance of breast
3 major arterial supply for breast
- Axillary artery - continuation of subclavian artery
Branches coming from internal mammary artery
Arteries between interspaces/intercostal arteries
Axillary fat
Where lymph nodes are found
Attachments of pectoral is muscle
Medial clavicle, sternum
Attached to clavicle is the muscle that moves arm -deltoid muscle which forms a groove with pectoralis major — along the groove is the cephalic
Attachments should be separated to be able to see structure behind it
Sublca
Small muscle ends on first rib
Lift pectoral is minor
Intercostal muscles will be seen
First layer of intercostal muscles - extend from rib above to rib below
Outermost later - external intercostal muscle
Costafonrral
Joint formed by cartilaginous
External intercostal membrane/ anterior ICM
Starts from posterior thoracic wall continues forward to sternum
Downward and backward
Internal intercostal membrane/posterior intercostal membrane
Layer of muscles between the ribs after the internal intercostal
Fibers are oriented downward forward
EndS up along angle of rib and continues as membrnae
Internal intercostal muscles
3rd later - inner most intercostal muscles - can span more than one interspace; can occupy two or more interspaces
Thoracic wall muscles
Serratus anterior - lateral thoracic artery; long thoracic nerve; exposed during removal of breast - cut - paralysis
Posterolateral - latissimus dorsi; thoracodoral artery/nerve - cut - paralysis of lats
Layers of thoracic wall that will be traversed in tube insertion
Skin, fasciae, serrated I
Innermost intercostal
2 terminal branches
One branch would follow costal margin - usculoclinic artery
Other would go towards central portion of abdominal wall to become superior episgastric artery
These will be accompanied by veins with the same name .
Wins drain into azygous system before they drain to the vena cava.
2 terminal branches
One branch would follow costal margin - usculoclinic artery
Other would go towards central portion of abdominal wall to become superior epigastric artery
These will be accompanied by veins with the same name .
Wins drain into azygous system before they drain to the vena cava.
Jugular or Suprasternal notch
Superior most margin of the manubrium sternae
Below skin
Subcutaneous connective tissue, which may be infiltrated by fat especially among females.
Fatty tissue of breast is part of SUBQ fat
Sternal Angle or angle of Louie
Bump along the sternum
Joint formed between the manubrium of the sternum and body of sternum
allows us to count the rib levels and intercostal spaces
At the same level with second costal Cartilage and second rib
IMPORTANCE:
Important for invasive procedures - thoracentesis, thoracostomy tube insertion
Auscultation of heart sounds - there are areas of chest where we can hear heart sounds coming from four main valves of the heart
Aortic valve
Sound is heard best at the level of second intercostal space (Right parasternal)
Left parasternal (second intercostal space)
Auscultation area for pulmonic valve
Right side - 5th intercostal space parastenal
Auscultation area for tricuspid valve (between right atrium and right ventricle)
5th intercostal space - left midclavicular line
Auscultation area for the mitral valve;
it produces the loudest heart sound.
Large and wide muscles that cover anterior chest wall
- pectoralis major (mainly move upper extremities)
Pectoralis muscles are responsible for adduction and flexion fo shoulder joint.
Groove between deltoid and pectoralis major
Cephalic vein passes through her. It’s a large superficial vein that starts from dorsal palmar arch of the hand (radial side) and courses up, passing through forearm and brachium. Also courses on lateral aspect for forearm (antebrachium).
Drain into the AXILLARY VEIN
Aka DELTOPECTORAL GROOVE
Another important triangle found in the area of deltoid and pectoralis major - what are its boundaries?
Base of triangle as the clavicle
Lateral margin of triangle - medial border of deltoid muscle
Medial margin of triangle - margin of pectoralis major
