Thorax Anatomy 1 + Medical Imaging

Question 1

What is the clinical name for the thoracic aperture?

Answer 1

Superior thoracic aperture :
Thoracic Outlet

Question 2

What are the boundaries of the thoracic outlet

Answer 2

Anterior: Manubrium
Posterior: T1 Spinous verterbrate
Lateral: 1st Rib

Question 3

What are the palpatable bony landmarks?

Answer 3

Clavicle (Prevents 1st rib palpation)
Manubrium
Jugular notch
Manubriosternal Joint
Costal Ridge

Question 4

At what level is the manubriosternal joint?

Answer 4

At the T4 / T5 level

Question 5

What is the area above the T4/T5 level called?

Answer 5

Superior Mediastinum

Question 6

What are anterolateral joints which concern the ribs called and classify:

Answer 6

Costochondral -> Primary Cartilagenous
Sternochondral -> Synovial Planar

Question 7

What are the common chest deformities and what are they caused by?

Answer 7

1. Barrel Chest -> Emphysema
2. Scoliosis -> Idiopathic or congenital
3. Pectus Carinatum -> Congenital
4. Pectus Excavatum -> Congenital
5. Kyphosis -> Compression Fracture (thoracic lordosis)

Question 8

What can occur due to strain or previous respiratory infection?

Answer 8

Chostocondritis

Question 9

What are the common symptoms of chostochondritis

Answer 9

Imflamed and painful costochondral joints which can be associated with “Tietze syndrome”
Sometime mistake as cardiac pain

Question 10

What is the main function of the chest during breathing?

Answer 10

To provide a rigid surrounding to the pleural cavity so the diaphragm can work

Question 11

What is the secondary function of the chest?

Answer 11

to move and assist in breathing

Question 12

Explain the movement of the ribs?

Answer 12

Ribs 2-7 will elevate and increase the dimension of the thorax using a pump handle mechanism
Lower ribs will elevate and also increase the dimension of thorax using a bucket handle mechanism

Question 13

Explain the concept of flail chest:

Answer 13

Flail chest is free moving of the chest wall which may occur due to external injury. For example a fracture of the ribs will cause a paradoxical movement:

Inspiration will call intact chest wall to expand and the site of the fracture to be sucked in and depress.

Expiration will cause the intact chest wall to depress and site of the fracture to exert air and expand.

Question 14

What are the palpable surface of the posterolateral thorax?

Answer 14

Spine of C7 -> Vertebra Prominens
Root of the Spine of Scapula -> T3 Spinous
Inferior angle of scapula -> T7

Question 15

Explain how you could map the fissures of the right lung :

Answer 15

**From an abducted arm postion: **
Oblique fissure: T4 spinous to rib 6 anterioly

Horizontal Fissure: T4 spinous to 5th rib mid axillary line then 4th rib

Question 16

Explain the concept of Shovelers Fracture:

Answer 16

Force from the upper limb is transmitted via the scapular which is held onto the thorax via the muscles which attach to the spine.

Excess force which is held by the trapezius or rhomboids can cause an avulsion fracture of the lower cervical or upper thoracic spinous processes (C7)

Question 17

Label

Answer 17

Question 18

Where is the common fracture point of the rib?

Answer 18

The body which is anterior to the angle

Question 19

What is a common occurrence due to a fractured rib?

Answer 19

Can puncture pleural cavity: Pneumothorax

Can also puncture abdominal organs

Question 20

Compare and Open vs tension Pneumothorax

Answer 20

Open pneumothorax occurs due to a perforation in lung which causes air to enter and exit.

Tension pneumothorax occurs due to perforation in lung which causes air to enter but not exit. This creates a buildup in pressure of the lung which compresses the heart onto the adjacent lung as well as pushing the trachea.

Question 21

Explain how to process a percutaneous liver biopsy:

Answer 21

A needle is inserted into the 7th -10th intercostal space in the mid/anterior axillary line.

This is done during held expiration to reduce the size of the diaphragmatic recess and hence be able to puncture the liver.