Thorax, Plueri, And Lungs Flashcards
What are the two apertures in the thorax, and which one is more clinically significant?
- Superior thoracic aperture (Inlet) - Clinical outlet
2. Inferior Thoracic Aperture
What are the contents of the thoracic inlet?
- Trachea
- Esophagus
- Vagus and phrenic nerve
- Apex Of lungs
What does the angle of Louie?
- notch from manubrium to sternum
- at 2nd costal cartilage
Which rib is longest? Shortest? Which are your typical ribs?
- 7 is longest
- 12 is shortest
- 3-9 are typical
What are the contents of the costal groove superior to inferior?
VAN
Vein
Artery
Nerve
What are the Openings of the diaphragm and the associated structures and spinal level?
Caval Opening (T8)
- Inf Vena Cava
- Phrenic Nerve
- Lymphatics
Esophageal opening (T10)
- Esophagus
- Vagus Nerves
- Esophageal branch of left gastric artery and vein
Aortic opening (T12)
- Thoracic Aorta
- Thoracic Duct
- Greater Splanchnic Nerves
- Azygos Vein
Which intercostal spaces have Anterior intercostal arteries, and what are the supply?
- ICS 1-6 come from anterior intercostal arteries f/m Internal thoracic artery
- ICS 7-9 come from musculophrenic arteries from internal thoracic artery
*ICS 10-11 have no anterior intercostal arteries
What is the blood supply of the posterior aspect of the thoracic wall?
- ICS 1: Costocervical trunk of subclavian
- ICS 2-11: Posterior intercostal arteries by the thoracic aorta
- ICS 12: Subcostal artery via thoracic aorta
What is the venous drainage of the anterior aspect of the thorax?
Internal thoracic vein of the BrachioCephalic vein
What is the venous drainage of the posterior aspect of the thorax?
Azygos vein system
What is the venous drainage of the right side of the thorax?
ICS1 —> BrachioCephalic vein
ICS 2/3 —> higher intercostal to Azygos
ICS 4-11 —> Azygos
12th (subcostal) —> Azygos
What is the venous drainage of the left side of the thorax?
ICS 1 —> BrachioCephalic
ICS 2-4 —> Accessory hemiazygos
ICS 5-12 —> Hemiazygous
What prevents the parietal pleura from rubbing against the innermost intercostal muscles?
Endothoracic fascia
AKA SIBSON’s Fascia
What is the weakest point of the rib that is most fractured in adults?
Angle of the rib
What is Flail chest?
multiple rib fractures leading to paradoxical chest movement (i.e. inward with inspiration and outward with expiration); it impairs ventilation.
Differentiate Rib dislocation and separation?
Rib dislocation: displacement of the costal cartilage from the sternum (2-7); contact sports
Rib Separation: dislocation of the costochondral joint between the rib and its costal cartilage.
What is Pectus Excavatum
“Funnel Chest”
Body of sternum projects inferiorly and posteriorly pressing in the heart which widens it making it look large on AP radiograph
What is Pectus Carinatum?
“Pigeon Chest”
Sternum projects anteriorly
At which levels are Thoracentesis and Thoracostomy done?
ICS 4 to 5
What is the Cupula?
The area of parietal pleura reflected over the apex of the lung (Cervical pleura)
What are the three pleural recesses?
- Costodiaphragmatic: Junction of costal and diaphragmatic parietal pleura; lowest area of pleural cavity during inspiration
- Costomediastinal: Lie along anterior margin of pleura
- Costovertebral
How low does the costal parietal pleura extend?
Anteriorly: ICS 8
Mid-axillary: ICS 9
Posteriorly: ICS 10
What is a pneumothorax? What are the two types?
When the pleural cavity is breached.
Open:
- Air can enter and leaves to oppose inspiration and expiration
Tension:
- Tessie forms a flap that covers wound which prevents air from escaping during expiration
- ** life threatening
What are the blood supply for the pleura?
Parietal -> Intercostal and internal thoracic arteries
Visceral -> Bronchial arteries
Differentiate pain innervation in the pleura
Parietal -> Very sensitive to pain
Visceral -> Insensitive to pain
What attaches lungs to pericardium?
Pulmonary ligaments
What forms the anterior border of the left lung?
Cardiac notch
What are the two fissures of the lugs and what costal level are they at?
Oblique fissure runs inferior and ends at CC 6
Horizontal fissure is at CC4
Differentiate anatomical features of left/right lungs.
Right: superior, middle, and inferior lobes
Left: Superior and inferior lobes, lingula
Where does the trachea begin? How does it run inferiorly?
- A continuation of the larynx at lower border of cricoid cartilage (C6)
- Descends anterior to esophagus and deviating right of midline at angle of Louis
- Ends in thorax by deciding into right and left bronchi at T4/T5 vertebrae
What is the carina?
The bifurcation of the trachea at the sternal angle (T4/T5) into primary bronchi
What is the blood supply to the trachea?
- Superior thyroid artery
- INf thyroid artery
- Bronchial arteries
- Internal thoracic artery
What is significant regarding the passage of the left primary bronchus?
- Passes to the left below the arch of aorta and in front of esophagus
What is the blood supply to the primary bronchi?
Brachial arteries:
- Two on the left from the thoracic aorta
- One of the right from 3rd posterior intercostal artery
What are Bronchopulmonary segments? How many are there?
Anatomic, functional, and surgical units of the lung
Right - 10 segments
Left - 8 segments
What is Pleuritis?
Inflammation of pleura - “Pleural rub” heard
What is Atelectasis?
Lung collapse
