Thorax Flashcards
Jugular notch is at vertebral level of
T2
Sternal angle is at vertebral level of
T4/t5
Xiphoid process is at vertebral level of
T9
True ribs:
1-7
False ribs attach to
costal cartilage ABOVE
False ribs:
8-10
Floating ribs have
and are
no attachment anteriorly
11 and 12
Typical ribs
3-9
Head of the rib articulates with
Vertebral body superiorly
Corresponding vertebral body
Tubercle articulates with
Corresponding transverse process
Atypical ribs
1,2
10, 11, 12
Rib fractures commonly occur
anterior to angle of the rib
Tx for rib fracture
Intercostal nerve block
Most commonly fractured rib
5-10
Fracture of these ribs indicate severe injury
1 and 2
Lower rib fracture, suspect
Liver or splenic injury
Paradoxical chest movement
Flail chest
Flail chest
2 separate fractures in more than or equal to 3 contiguous ribs
1 costochondral junction
2 angle
Compression of C8, TI, inferior trunk of brachial plexus or subclavian artery by cervical rib may result in
TOS
V5 lead placement
AAL 5th ICS
V6 lead placement
MAL 5th ICS
V4 lead placement
MCL 5th ICS
Elevates ribs
Inspiration
External intercostals
Depresses the ribs
Internal intercostals
Occupies costal groove
Intercostal Vein, Artery, Nerve
Supplies thorax
Internal thoracic artery 1-6 (anterior intercostal)
One fingerbreadth lateral to sternal margin
Musculophrenic artery supplies
7-9 intercostal space
Posterior supply of thorax
Superior intercostal artery (1-2) from Posterior intercostal artery
Thoracic aorta:
Internal costal artery (3-11)
Subcostal artery
Associated with Turner’s
Upper extremity hypertension with radiofemoral delay
Coarctation of aorta
Coarctation of aorta radiographically reveals
Ribnotching from collaterals
3 sign because of distal constriction
One way valve with displacement of mediastinum to opposite side and subsequent decrease in venous return
Tension pneumothorax
Management for tension pneumothorax emergency
Needle thoracostomy
Needle thoracostomy anterior and lateral approach
2nd ICS MCL (anterior)
2nd ICS AAL (lateral)
Definitive management for tension pneumothorax
Chest tube AAL or MAL above the 5th (4th or 5th) rib since diaphragm reaches this high during expiration
Incision site for emergent thoracotomy
4th or 5th ICS
Lateral margin of sternum to the AAL
Indication for CTD
> 1500 ml
> 200ml/h x 4 hours
Site of thoracentesis for pleural fluid
9th ICS MAL
Done at end of expiration
Needle angled upwards
Breast innervation
2nd to 6th intercostal nerves
Duct development hormone
Estrogen
Lobule development hormone
Progesterone
Nipple level and dermatome
4th ICS
T4 dermatome
Sebaceous breast glands
Glands of Morgagni tubercles/Montgomery
Rare most common on axilla
Polymastia
Accessory nipple
Most common congenital breast anomaly
Failure of complete regression of milk streak
Most common location: inferior to breast
Polythelia
90% of amastia is associated with
Poland syndrome
Unilateral congenital absence of pectoralis major (most common), pectoralis minor, ribs and breast or nipple
Poland syndrome
Lack of both breast tissue and nipple
Amastia
With breast tissue but lacks nipple
Athelia
Without breast tissue but with nipple
Amazia
Most abdundant breast tissue hence most common location of beast cancer
Upper outer quadrant
Less vascular area of breast
Inferior quadrant
Most common cause of amazia
Iatrogenic
Dimpling of skin is attributed to
retraction of Cooper’s ligament
Edema, obstruction of subcutaneous lymphatics
Orange peel Pea de orange
Supplies breast medially
Internal thoracic artery
Supplies breast laterally
Axillary artery and lateral thoracic a
Thoracoacromial branch
Highest thoracic artery
Paget’s disease histology
Rete pegs of breast
Epithelial extension
Regional breast nodes
75% of the breast drains to the
Axillary nodes
others Internal mammary node
Nodes beneath pecs minor Level II
Interpectoral rotter node
Mammography is done annualy for screening at age
40
Annual mammography and PE
40 years and older
No removal of NAC, Levels I, II and III and pectoralis major and minor
Removal of only the breast tissue containing lesion with small rim of external tissue
Lumpectomy
No removal of NAC, breast tissue and pectoralis major and minor
Only removed are levels I and II
Axillary node dissection for staging
No removal of NAC, Levels I, II and III and pectoralis major and minor
Only removed is breast tissue
Subcutaneous with nipple sparing mastectomy
No removal of Levels I, II and III and pectoralis major and minor
Only removed are NAC and breast tissue
Total/Simple Mastectomy
Removal of NAC, breast tissue, Levels I and II
Sparing of level III and pectoralis major and minor
Modified radical mastectomy
Removal of NAC, breast tissue and Levels I, II and III and pectoralis major and minor
Radical Mastectomy
Halstead Mastectomy
Boundaries of chest
Superior: clavicle Inferior: diaphragm Lateral: rib cage Anterior: sternum Posterior: vertebral body and ribs
Most common sign of blunt chest injury also in fracture of scapula, first rib, sternum suggesting massive force of injury
Rib fracture
50% of flail chest injuries are accompanied by
pulmonary contusion
Major cause of respiratory compromise
Pulmonary contusion
Tx: PEEP
Costochondritis
Teitz syndrome
Vit D deficiency in children
Rachitic rosary
Harrison groove
Rickets
External intercostal action:
Elevates ribs
Expands thoracic cavity
Inspiration
Creates partial vacuum causing inflow of air extending downward and anterior from rib to rib
Pulls ribcage upward and outward during inspiration
Internal intercostals action:
Depress and retracts ribs Compresses thoracic cavity Expels air Extends upward and inferiorly Pulls ribcage downward during forced expiration
Sine qua non breast cancer
Spiculated density with ill defined margin
