Throax Flashcards
X-ray colouring explained
White- dense so rays don’t pass through
Grey- some pass through, soft tissue
Black- all pass through, air/fat
Contrasting agents
Barium
Iodine
3 planes in imagery
Sagittal
Axial
Coronal
Difference between T1 and T2 MRI
T1 fluid is black
T2 fluid is white
Difference in CT and MRI
Fat is black in CT and white in MRI
Bone marrow is grey in CT
Cortical bone is white in CT and black in MRI
PET scan shows
Which tissues are metabolically active, useful for showing cancers
Describe rib formation with sternum
Rib 1 costal cartilage joins to manubrium
Rib 2 joins at sternal angle
Ribs 3-7 joins to the body With 7th on xiphoid-body joint
8-10 join costal cartilages above
Categories the ribs
Ribs 1-7 are true ribs
Ribs 8-10 are false ribs
Ribs 11 and 12 are floating ribs
What is located in thoracic inlet
Subclavian arteries and veins Internal jugular veins Common carotid arteries Oesophagus Trachea Apex of lungs
External intercostal formation and direction
Form inferiorly and laterally from lower border of rib above
Run inferiorly and anteriorly from rib above in oblique direction
Internal intercostal formation and direction
Formations begin at lower border of rib above to the rib below
Are at 90degrees to external intercostal
Run inferiorly and posteriorly in oblique direction
Innermost Intercostal
Deepest and extend in same direction as internal intercostal
Intercostal nerve origins
Originate from ventral ramus of spinal nerve giving formation of lateral and anterior cutaneous branches
Intercostal bundles
Vein- most superior
Artery
Nerve
Intercostal artery origin
Posteriorly anastomoses with aorta
Anteriorly anatomoses with thoracic artery
Anterior branching of intercostal arteries
Spaces 1-6 have direct branches off of internal thoracic artery
7-9 have branches off the end branches
10-11 have no anterior branches
Mediastinum
Area between the two lungs in the thorax
Parts of the pectoralis major
Sternoclavicular head- originates from sternum and first 7 costal cartilage
Clavicular head- originates from anterior surface of medial half of clavicle
Join to humerus
Subclavius
Passes laterally from where rib 1 meets costal cartilage to middle third of clavicle
Contracts clavicle medially to stabilise joint
Pectoralis Minor
Passes from anterior surface of ribs 3-5 to carotids process of scapula
Trachea levels
From C6 to T4/5
Lobes and fissures of each lung
Right has inferior, middle and superior lobes
Oblique fissure separates superior from muddle and inferior and horizontal fissure separates middle and inferior
Left has an oblique fissure which separates superior and inferior
Spaces in pleural cavity
Costodiaphragmatic recess- inferior
Costomediastinal recess- medial
Margin of diaphragm
Attaches to xiphoid proces
Costal cartilage
Floating ribs
Lumbar vertebrae and median arcuate ligament
Breathing mechanics
Ribs are thrusted forward and upwards like a bucket handle
Increases transverse diameter of thoracic cavity
Contraction of diaphragm increases vertical diameter of thoracic cavity
Overall reduces pleural pressure and causes entry of air
Superior Mediastinum Outline
From thoracic inlet to line from sternal angle to between t4/5
Division of mediastinum
Above sternal angle is the superior
Below is inferior which is divided into anterior, middle(pericardial sac) and inferior
Azygous vein function and divisions
Drains posterior wall of thorax and abdomen arching over right lung root to sac
Provides veins for intercostal space
Produces hemiazygous and accessory hemiazygous (superior to hemiazygous)
Shunts that change at birth
Ductus arteriosis to ligamentus arterosis
Foreamen ovale to ovale fossa
Right Vagus Pathway
Lies beside trachea
Posterior to brachiocephalic vein and anterior to arteries
Crosses posterior to root of lung
Right recurrent laryngeal goes around right subclavian
Breaks up into batches on oesophagus
Left Vagus Pathway
Between left common carotid and subclavian artery
Crosses left side of aortic arch with recurrent laryngeal going underneath
Passes posterity to root of lung
Phrenic nerve functions
Motor to diaphragm Sensory to tendon of diaphragm Mediastinal pleura Peritoneum of central diaphragm Pericardium
Right phrenic nerve
Lies of right brachiocephalic vein and svc
and anteriorly to root of lung
Left phrenic nerve
Lies on left brachiocephalic vein
and left side of pericardium and anterior to root of lung
Borders of the heart
Right- RA
Inferior- mainly RV but some lV
Left- LV
Posterior- LA
Pericardial Sinuses
Formed by reflection of serous pericardium onto the heart
Transverse-between superior and posterior reflections
Posterior to aorta and pulmonary trunk but anterior to SVC
Oblique-between pulmonary veins
Where pericardium sticks out creating sinus that goes inwards
Drainage into right atrium
From SVC, IVC and coronary sinus
Valves attachments
Valves attach to papillary muscles via chordae tendineae
Parasympathetic Nerves
Oculomotor CN3 Facial CN5 Glossopharygeal CN9 Vagus CN10 Sacral nerves 2-4 spinal nerves
Autonomic afferent neurone
Travels up through the paraverterbral ganglia and white ramus communicans to the dorsal root
Movement of lymph
Maintained by skeletal muscle and arteries pulsating
Have valves to ensure unidirectional
Superficial Lymph drainage
Body is split into 4 quadrants divided at the midline and the umbilicus
Inguinal nodes are in the lower quadrants and axillary at upper
With cervical nodes that drain the head and neck
These then penetrate to deep adjacent nodes
Thoracic Nodes
Parasternal adjacent to sternum
Intercostal on posterior
Diaphragmatic underneath xiphoid process
Lymphatic drainage pathway form abdomen
Cisterna chyli drains the abdomen and the pelivs
Then forms thoracic duct at L2
Ascends between azygos and aorta
Then crosses over to left at T5 and empties into subclavian vein
Lymphatics of heart
Vessels follow coronary arteries and drain into brachiocepahllic and tracheobronchial
Lymphatics of posterior mediastinum
Pre and para aortic nodes drain the oesophagus, diaphragm and liver and go to the thoracic duct and posterior mediastinal
Lymphatics of lung
Tracheobronchial nodes which unite with parasternal and brochiocephalic to form broncho-mediastinal trunks
Lymphatic flow in thorax
Diaphragmatic go to parasternal and posterior mediastinal
Parasternal go to brachiocephalic which join with posterior intercostal and tracheobronchial to form broncho mediastinal trunks that drain into subclavian
Some posterior mediastinal drain into thoracic duct
Breast anatomy
15-20 lactiferous ducts and glandular lobules (ductal lobular unit)
4-18 Areola glands (open onto nipple and areola)
Fat lies interspersed between ductal lobular unit
Organ divided by fibrous septa that radiate from the centre called suspensory/coopers ligaments
Nervous innervation of the breast
Anterior and lateral branches of Intercostal nerves T2-6
Breast ultrasound
Glandular tissue-white
Dense tissue -black
Lymphatic drainage of breast
Medial- parasternal nodes
Lateral- axillary nodes- 75%
Relavent to metastases- brain, liver, bone, lungs
Breast Blood supply
Laterally by branches of axillary - lateral thoracic
Medially by internal thoracic- t2-4
4 Constrictions of oesophagus
Junction of pharynx
Crosses aortic arch
Compressed by left main bronchi
Oesophagus hiatus (enters diaphragm)
Arteries of oesophagus
From thoracic aorta
Broncial arteries
Posterior intercostal arteries
Ascending branches of left epigastric
Veins of oesophagus
Azygos
Hemiazygos
Accessory hemiazygos
Splanchnic Nerves
Greater- T5-9/10 goes to coeliac ganglion
Lesser- T9-10 or T10-11 goes to aorticorenal ganglion
Least- T12- renal plexus
Markings of pleura
Apex- above middle third of clavicle Medial- xiphoid process MCL- 8th riv MAL- 10th rib Posterior- T12
Markings of lungs
Apex-Above middle third of clavicle Front- xiphoid MCL- 6th MAL- 8th Post-T10
Markings of the fissures
Oblique- Post- T3
MAL-6
Anterior- 6th costal cartilage
Horizontal- 4th costal cartilage to meet oblique in MAL
Joints
Costovertebral- ribs and vertebrae
Costotransverse- transverse process
Sternocostal- synovial (rib 2 has 2 joints)
Interchondral- synovial- between costal cartilage
Manubrioxiphisternal-symphyses, moves in breathing
Manubriosternal- symphysis
Fibrocartilaginous joint- rib 1 and sternum
Vessels and nerves peneratrating the diaphragm at points
IVC- T8
Vagus and oesophagus -T10
Aorta, azygous, thoracic duct- T12
Muscle at anterior of thorax but posterior to sternum
Transversus thoracic muscles
Depresses costal cartilage
Drainage of anterior of thorax
Internal thoracic vein
Trachea level arise and end
C4-T4/5
Lungs- anatomy
2 surfaces- mediastinal and costal
3 borders- inferior, anterior and posterior
Phrenic nerve origination
C3, C4, C5
Aorta and bronchi relativity
Aorta hooks over left main bronchi
Aorta and SVC relativity
SVC is on the right of the aorta and the left brachiocephalic vein passes anteriorly to the aorta crossing it
Splanchnic nerves
Greater splanchinic nerve- T5-9- celiac ganglion
Lesser splanchnic nerve -T10-12-aorticorenal ganglion
Least splanchnic nerve- T12-Renal Plexus
Pelvic Splanchnic nerve- S2-4- Parasympathetic
Cardiac Tamponade
Fluid in parietal caitvity
Compresses heart
Difficulty pumping
Pericardicitis
Inflammation. of sac
Similar symptoms to MI
Right coronary branches
Sini-Atrial nodal branch
Marginal
Posterior intraventricualr
Bundles in the heart
Bachmanns bundle in left atrium
Right and left bundle of HIs
Left posterior bundle branches off of left
Cardiac Markings
Top right- 3rd CC, 1cm from sternal border
Bottom right- 6th CC 1 cm “”
Bottom left- 5th ICS at MC line
Top left - 2nd ICS- 2.5 cm form border
Valve auscultation
Aortic-2nd ICS right of border
Pulmonary- 2nd ICS left of border
Tricupsid- 5th ICS left of border
Mitral- 5th ICS- 2.5 cm out
Apex beat palpitation
5th ICS, palm and middle 3- middle in ICS
MAL-MCL
Lymphatic drainage of quadrants
UR- right subclavian
UL, LR,LL- left subclavian
Oesophagus levels
C7-T11
T7 deviates and goes anterior to aorta
Vertebrae facets
Demifacet/ costal facet- head ribs
Transverse- tubercle of ribs
Articular facets on articular processes
Breast innervation
Intercostal 2-6
Nipple 4th
