Thorax Surface Anatomy

Question 1

Which rib and costal cartilage can be found in the MCL?

Vertebral position of the

• carina
• sup mediastinum
• suprasternal notch
• xiphoid joint

Location of the

• aortic arch
• SVC
• pulmonary bifurcation
• lung apices
• costodiaphragmatic recess of pleura
• cardiac notch of LL
• cardiac notch of L pleura

Locating the lung lobes accurately

• Upper
• Middle
• Lower

Answer 1

8th

Carina - T5
Sup mediastinum - T4
Suprasternal notch - T2-3
Xiphoid joint - T9

Aortic arch - T4, sternal angle
SVC - 1 RCC
Pulmonary bifurcation - under aortic arch
Apex - above clavicles
Costodiaphragmatic recess - R8-10 MAL
Cardiac notch of LL - 4 LCC 3.5cm away from sternum
Cardiac notch of left pleura - 4 LCC 2.5cm away from sternum

Upper - above R4 at sternum from front
Middle - below R4 at sternum from front
Lower - from behind under scapulas, with arms crossed

Question 2

How would you assess respiratory movements

• which ribs are involved in each movement
• what muscles are involved in forceful chest movements

Answer 2

Place thumbs on sternum
Wrap hands around chest
See how far each thumb moves from midline

R1-7 - pump handle
R8-12 - bucket handle

SCM
RA, EO, IO, TA
Scalenes
Serratus ant
Traps
Pec maj, min
Lats

Question 3

Locations of the heart valves and ausculation points for each one

Answer 3

Tricuspid
4RICS => 4LICS

Pulmonary
3LCC => 2LICS

Mitral
4LCC => 5LICS MCL

Aortic
3LICS => 2RICS

Question 4

Route of a central line into the heart

• L SC vein
• R SC vein

Why use a central line

Answer 4

L SC => L BC => SVC
-less straightforward route
R SC => R BC => SVC
-easier to insert central line

Central line

• take bloods
• long term IV access needed - IV ABx, chemo, nutrition, transfusions
• large volumes of fluid, medications that may irritate peripheral veins

Question 5

Where would you insert a needle in the

• intercostal space
• biopsy liver
• pericardial cavity

Answer 5

Intercostal space - away from the rib above due to presence of NVB in costal groove

Biopsy liver - R8-10 MAL RHS

• avoid piercing lung
• access via CPA and peritoneum

Pericardial cavity - left of xiphisternum, point needle towards left shoulder
-access via cardiac notch without piercing pleura and lung

Question 6

How to identify type of patient from the CXR

Answer 6

Can’t tell L and R - dextrocardia, situs inversus

Child -

• thymus outline
• horizontal ribs
• ossification centers

Older patients
-osteoporosis

Question 7

Nerve roots involved in

• MI chest pain
• moving the diaphragm

Answer 7

MI chest pain - T1-4

Moving the diaphragm - phrenic