Thorax- thoracic wall/pleural cavities Flashcards by K D

Muscles of thoracic wall

External intercostal

Internal intercostal

Innermost intercostal

Subcostales

Transversus thoracis

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Origin and insertio of subcostales

Internal surface of lower ribs to internal surface of second or third rib below

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Origin and insertio of transversus thoracis

Inferior margin of 2-6th rib to inferior aspect of sternum, xiphoid and ribs 4-7

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Innervation of muscles of thoracic wall

Intercostal nerves

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Action of subcostales

May depress ribs

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Action of transversus thoracis

Depress costal cartilages

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Where do you find the vasculature in relation to ribs

Inferior border

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Arterial supply of thoracic wall

Internal thoracic artery gives

intercostal arteries
superior gastric artery
musculophrenic artery

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Venous drainage of thoracic wall

Intercostal veins either into azygous, hemiazygos and accessory hemiazygos veins or internal thoracic vein

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Chest drain insertion site

Lat dorsi, Pec major, apex of axilla and horizontal line across nipple

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Where is suprapleural membrane

Covers superior aspect of cervical pleura

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Where is the root of the lung

Mediastinal pleura between T5-T7 reflects off mediastinum

Covers lymph, vessels, nerves

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Structures at the hilum of the lungs

Anterior to posterior:

Pulmonary artery, pulmonary veins

Bronchus

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Ribs levels of lungs mid-clavicular, mid-axillary, and posteriorly

Anterior: 6th rib

Mid-axillary: 8th rib

Posteriorly: 10th rib

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Ribs levels of pleura mid-clavicular, mid-axillary, and posteriorly

mid-clavicular: 8th rib

mid-axillary 10th rib

posteriorly 12th rib

(2 spaces below the lungs)

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Trachea vertebral level

C6 to T4/5 (sternal angle)

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Bronchal tree from proximal to distal

Main bronchus

Lobular bronchus

Segmental bronchus (*10 segments each)

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Innervation of lungs

Vagus- constricts bronchioles

Sympathetic- dilates bronchioles

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Lymph drainage of lungs

Other lymphs drain into bronchomediastinal lymph nodes

Which drain into deep veins at the base of neck/thoracic duct/right lymphatic trunk

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Subclavian artery branches

VIT C&D

Vertebral

Internal thoracic

Thyrocervical

Costocervical

Dorsal scapular

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Branches of thyrocervical artery

Inferior thyroid

Suprascapular

Transverse cervical

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Branches of costcervical artery

Deep cervical

Highest intercostal

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Which muscles does the breast lay anterior to

Pec major

Serratus anterior

External oblique

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Arterial supply of breast

Internal mammary (thoracic) artery (subclavian a)

Lateral thoracic artery (axillary a)

Anterior intercostal arteries

Thoraco-acromial artery

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Extension of parietal pleura into cervical region

Cupola: extends 2.5 cm above clavicle

Fascia between innermost intercostal muscle and pleura

endothoracic fascia

Which ribs level is costophrenic angle found

8-10

Where is stellate ganglion situated

Inferior cervical ganglion fuses with suoerior thoracic ganglion, forming stellate ganglion at level of C7 Anterior to neck of first rib Anterior to scalene medius, posterior to subclavian artery Compression results in horner syndrome sx

Position of recurrent laryngeal nerve in relation to oesophagus and trachea

Runs in the middle

What is azygous lobe

Commonest accessory lobe seen in 1% of pts Azygous vein leaves a deep impression in the lung on that side during development

Azygous lobe appearance on xray

reverse comma sign

Where is aztgous lobe found

Right upper lobe

How many bronchopulmonary segments in each lung

Sympathetic ganglions

Paravertebral and prevertebral

Where are paravertebral ganglia located

anterior to abdo aorta Coeliac, Superior mesenteric and inferior mesenteric ganglia

Where are perivertebral ganglia found

Parallal to the spinal cord, from base of the skull down to pelvis, joining to form ganglia impar

Sympathetic innervation of head and neck

Branches of peri-arterial carotid nerve plexus T1-T3

Sympathetic innervation of thorax

Cardiopulmonary splanchnic nerves T4-T6

Sympathetic innervation of abdomen

Greater, lesser and least splanchnic nerves and Coeliac, SM, IM plexuses T7-T11

Sympathetic innervation of pelvis

Lumbar splanchnic nerve T12-L3

Parasympathetic innervation of body

CN3, 7, 9, 10 and Pelvic splanchnic nerve

Pelvic splanchnic nerve aka

nerve erigentes

Route of thoracic duct

Ascends through aortic opening of diaphragm, to the right of descending aorta Goes up posterior to oesophagus, when it crosses to the left side at T5 Ascends to the left of the oseophagus Crossess the left subclavian artery to enter left brachiochalic vein

Areas of the body drained by thoracic duct

3/4 of body except the top right

Path of azygous vein in relation to right main bronchus

First posterior Then arches superior to the right main bronchus

Sympathetic chain course through thorax and abdomen

Lateral to aorta and oesophagus Enters abdo posterior to medial arcuate ligament over psoas major

Relation of vagus nerve to oesophagus

Left vagus: anterior to oesophagus Right vagus: posterior to oesophagus

Sibsons fascia

Suprapleural fascia

Which artery at risk in level one axillary dissection

Thoraco-dorsal branch of subscapular artery

Which artery is at risk in level 3 axillary dissection

thoraco-acromial

Surface marking for lung fissures

Oblique → transverse process of T2 to 6th costal cartilage Horizontal → under the 4th rib

Name different parts of the sternum and their vertebral level

Jugular notch: T2-3 Angle of louis: T4-5 Xiphoid process: T9

Sensory nerve supply of diaphragm

Central: phrenic (C3-5) Peripheral: T5-T12 Central irritation such as splenic rupture refers to shoulder (C3-5)

Blood supply to diaphram

Superior and inferior phrenic from aorta Musculophrenic from internal mammary

Describe female breast anatomy

Ducts + Glands + fat Terminal duct-lobular units produce milk → 10-20 lactiferous ducts converging into the nipple with individual openings

Cooper ligament of breast

Supports the glandular tissue of the breast From Dermis to deep fascia/posterior capsule behind breast Support the shape of a young breast, but weaken with age

Lymph drainage of breast

Lateral parts mainly drained by axillary lymph nodes Medial parts mostly by internal thoracic nodes Multiple valveless channels connecting the 2 systems

Borders of the breast base

2nd to 6th intercostal space Lateral sternum to mid axillary line

Blood supply of breast

Laterally: lateral thoracic Medially: internal mammary Inferiolateral: intercostal vessels Deep: perforators to pec major (thoracoacromial trunk)

Nerve supply to breast skin

Supraclavicular (C3-4) branches of intercostal nerves intercostobrachial nerve

Which nerve supplies sensory to nipple

Fourth intercostal

Typical rib appearance

Facet on tubercle joins facet on transverse process Facet on head joins facet on vertebral body