Thorax: Breast, Lungs, Thoracic Wall Flashcards
breast (8 structures)
Level: ribs 2-6
Features:
- lactiferous ducs & sinuses
- nipple-areolar complex
- lobes
- lobules
- alveolar glands
- suspensory ligaments
- retromammary space
- axillary tail
Relations:
2/3 bound to fascia of pectoralis major
1/3 pound to fascia of serratus anterior muscle
lactiferous ducs & sinuses
openings of milk glands
nipple-areolar complex
the opening of the milk duct and surrounding area of pigmented skin
lobes
secretory units
lobules
smaller secretory units
alveolar glands
milk producing glands. Production occurs through an apocrine mechanism
suspensory ligaments
“Cooper’s” Ligaments- fibrous septa that attach the underlying gland to overlying skin
retromammary space
a layer of superifical fascia
deep to the breast but superficial to the deep fascia of the muscle
axillary tail
the superiolateral region of the breast
sternum (parts)
- manubrium
- body
- xiphoid process
- sternal angle
visceral pleura
interior aspect of pleura in contact with organs
parietal pleura
superficial aspect of pleura
pleura cavity
the area between the pleura. Important for maintaining pleural pressure
true ribs
def. attach to sternum directly through costal cartilage
location: ribs 1-7, sometimes also 8
false ribs
def. cartilages are joined to rib just superior
location: ribs 8-10
floating ribs
def. cartilages ends in posterior abdomen
ribs 11 & 12
costal margin
defined by cartilage of ribs 7-10
typical ribs
- features
- location
- a. head- posterior aspect, wedge shaped structure, articulates with vertebral body
b. neck: posterior aspect, separates head and tubercle
c. tubercle: posterior aspect, articulates with a corresponding transverse process - ribs 3-9
Rib 1
- articulates with T1
- broad and short, the brachial plexus and subclavian artery pass superior. Presence of a “cervical” rib may compress the structures (thoracic outlet syndrome)
Rib 2
- thinner than Rib 1
2. articulates with T1 & T2
Rib 10
only on “facet” only articulates with T10
Ribs 11&12
short
have a large facet
lack necks and tubercles
manubrium
- level
- surface features
- key relations
- level- T3/T4
- features
a. clavicular notch
b. jugular (suprasternal) notch
* c. sternal angle: at the level of T4/T5 interverebral disc - articulates with clavicle
body (sternum)
- level
- surface features
- level: T4-T9
2. not many
xiphoid process
cartilagenous, inferior aspect of sternum
comminuted sternal fracture
def. the sternal body is usually fractured into several pieces
common causes: steering wheel crash
superior thoracic apeture (thoracic outlet)
- borders
- structures
1 . first thoracic vertebrae, first pair of ribs and cartilages, superior border of manubrium
2. lungs, subclavian artery, brachial plexus
inferior thoracic aperture
- borders
- structures
- 12 thoracic vertebrae and ribs, costal cartilages of ribs 7-12, xiphisternal joint
- diaphragm closes, aorta, vena cava, other structures pass through
rib dislocation v. separation
dislocation: detachment from sternum
separation: detachment from costal cartilage
common causes: contact sports
explain thoracocentesis
Goldie Locks: insert a needle just above the inferior part of an intercostal space
in the superior part there are intercostal vessles
in the inferior part, there tend to be collaterals
cervical pleura
parietal pleura that extends above the thoracic outlet
costal pleura
parietal pleura in contact with ribs
diphragmatic pleura
borders the inferior thoracic oulet
costodiaphragmatic reces
?
right lung has __ lobes
3, faces away from heart
left lung has ___ lobes
2, due to heart
carina
site at which trachea divides into two bronchi
transverse throacic plane
level: T4-T5
significance:
costal surface of lung
adjacent to ribs
mediastinal surface of lung
related to mediastinum and posterior aspect of ribs
diaphragmatic surface
convex dome of diaphragm
base of lung
anatomically: the diaphragm
clincally: the inferior part of the posterior costal surface
horizontal fissure
only in the right lung, divides superior and middle lobes
Thoracic Wall: VAN is a pneumonic for:
Intercostal neurovasculature, from superior to inf
Vein
Artery
Nerve
anterior vessels of thoracic wall
arise from: internal thoracic artery
drain into: internal thoracic vein
posterior vessels of thoracic wall
arise from: thoracic aorta
drain into: the azygous system
endothoracic fascia
thin fibroareolar layer between internal aspect of the thoracic cage and the lining of the pulmonary cavities
lymph drainage of breast (2)
- inferior jugular lymph nodes- above clavicle
2. axillary lymph nodes- below clavicle (75%)
medial mammary branch (artery)
arises from: subclavian artery
supplies: breast
drains into:
internal thoracic branch (artery)
arise from: branch of the axillary artery
supply: breast
drain into:
posterior intercostal arteries
arise from: thoracic aorta
supply: breast
drain into:
subareolar lymphatic plexus
collects: lymph from nipple, areola, and lobules
drains into:
1. lateral quadrants: axillary lymph nodes (75%)
2. medial quadrants: parasternal lymph nodes or opposite breast
3. inferior quadrants: inferior phrenic lymph nodes
hierarchy: lymphatic drainage, breast
axillary nodes> right lymphatic duct or tho. duct
parasternal nodes. . . .
axillary nodes< subclavian lymphatic drunks< jugular lymphatic trunk< right lymphatic duct or thoracic duct (left side)
