Anatomy- Lung

Front 1

Superior Thoracic aperture (Thoracic inlet)

Back 1

-contains trachea, esophagus, vessels, nerves
-bound superiorly by T1
-laterally by first pair of ribs
-anteriorly by superior border of manubirum

Front 2

Inferior Thoracic aperture (thoracic outlet)

Back 2

-bounded posteriorly by T12
-posterolaterally by ribs 11 and 12
-anterolaterally by ribs 7-10 forming costal margin
-anteriorly by xiphisternal joint

Front 3

True (vertebrocostal) Ribs

Back 3

-1-7th ribs
-attach directly to sternum

Front 4

False (vertebrochondral) ribs

Back 4

-8-10th ribs
-have cartilages that are joined to the cartilage of the rib just superior to them

Front 5

Floating (free) Ribs

Back 5

-11th and 12

Front 6

Typical Ribs

Back 6

-3rd-9th
-Head
-Neck
-Tubercle
-Body with costal groove that protects the intercostal nerves and vessels

Front 7

Atypical RIbs

Back 7

-1, 2,10, 11, 12
-RIb 1: has 2 grooves for subclavian vessels
-Rib 2: has 2 facets for T1 and T2 vertebrae
-Ribs 10-12: have only 1 facet
-Ribs 11+12: have no necks or tubercles

Front 8

Manubrium

Back 8

-superior part of sternum
-lies at T3 and T4
-has jugular notch

Front 9

Sternal angle of Louis

Back 9

-opposite 2nd pair of costal cartilages
-at level of IV disc between T4 and T5

Front 10

Body of the sternum

Back 10

T5-T9

Front 11

Xiphoid process

Back 11

T10
-cartilaginous in young people but become ossified in older people
-midline marker for superior level of liver, central tendon of diaphragm, and inferior border of heart

Front 12

Intervertebral joints

Back 12

-Symphasis (secondary cartilaginous joint)

Front 13

Costovertebral and costotransverse joints

Back 13

-Synovial

Front 14

Sternocostal joint

Back 14

1st: primary cartilaginous joint
2nd-7th: synovial joints

Front 15

Costochondral joint

Back 15

-Primary cartilaginous joint

Front 16

Xiphisternal joint

Back 16

-Primary cartilaginous joint (synchondrosis)

Front 17

Expiration

Back 17

-diaphragm and muscles relax
-intrathoracic volume decerases
-intrathoracic pressure increases
-lungs recoil
-vertical diameter returns to normal position
-domes of the diaphragm ascend

Front 18

Inspiration

Back 18

-vertical dimension of the central thoracic cavity increases
-contracting diaphragm descends
-abdominal viscera are compressed

Front 19

Breast

Back 19

-extends from lateral border of sternum to midaxillary line and vertically from 2nd-6th ribs

Front 20

Paralysis of Diaphragm

Back 20

-paralysis of half of the diaphragm because of injury to its motor supply from the phrenic nerve does not affect other dome
-Instead of descending on inspiration, the paralyzed dome is pushed up by the abdominal viscera; the paralyzed dome descends during expiration

Front 21

Posterior thoractomy incisions

Back 21

posterolateral aspects of the 5-th to 7th intercostal spaces

Front 22

Breast location

Back 22

-2/3 of the breast rests on the pectoral fascia covering the pec major
-the last 1/3 rests on the fascia covering the serratus anterior muscle

Front 23

Suspensory Ligaments of Cooper

Back 23

-attaches the mammary glands to the dermis
-they also help support the mammary gland lobules

Front 24

Breast lobules

Back 24

-breast contains 15-20 lobules
-each lobule is drained by a lactiferous duct which opens on the nipple

Front 25

Arterial Supply of the Breast

Back 25

1. Medial mammary branches of perforating branches and anterior intercostal branches of the internal thoracic artery originating from the subclavian artery
2. Lateral thoracic and thoraco-acromial arteries from the axillary artery
3. Posterior intercostal arteries from the thoracic aorta

Front 26

Venous drainage of the breast

Back 26

-axillary vein

Front 27

Lymphatic drainage of the breast

Back 27

-most lymph drains to the axillary nodes--> infraclavicular/supraclavicular nodes--> subclavian lymphatic trunk
-lymph from the medial breast--> parasternal nodes or to the opposite breast
-lymph from the inferior breast drains to the abdominal nodes

Front 28

Nerves of the breast

Back 28

-derive from the anterior and lateral cutaneous branches of the 4th-6th intercostal nerves

Front 29

Intercostal spaces have 3 layers

Back 29

1. External intercostals (superficial layer)
2. Internal intercostals
3. Innermost intercostals (deepest)

Front 30

Nerves of Thoracic Wall

Back 30

-anterior rami of T1-T11 form the intercostal nerves and the anterior rami of T12 forms the subcostal nerve
-Posterior rami supplies the deep back muscles

Front 31

Costal grooves

Back 31

VAN
-vein, artery, nerve (on bottom)

Front 32

7th-11th intercostal nerves

Back 32

-go on to supply the abdominal skin and muscles

Front 33

Sympathetics

Back 33

-Presynaptic fibers leave the anterior ramus of each thoracic nerve via a white rami and pass to a sympathetic ganglion
-Postsynaptic fibers distribute to the body wall and limbs via gray rami

Front 34

Arteries of the thoracic wall

Back 34

1. Posterior intercostals: from supreme intercostal arteries and thoracic aorta
2. Anterior intercostals: internal thoracic arteries and musculophrenic arteries
3. Internal thoracic: from subclavian artery
4. Subcostal artery: from thoracic aorta

Front 35

Veins of the thoracic wall

Back 35

-lie most superior in the costal grooves
-the posterior intercostal veins end in the azygous-hemiazygous venous system--> superior vena cava

Front 36

Manubrium of the sternum

Back 36

-lies at level of T3 and T4 vertebrae
-anterior to arch of aorta
-has a jugular notch
-has a sternal angle at level of T4-T5 Iv disc

Front 37

Sternal angle

Back 37

-lies at level of 2nd pair of costal cartilages
-main bronchi pass inferiolaterally from bifurcation of trachea at level of sternal angle
-also marks the beginning of the arch of the aorta

Front 38

Superior vena cava

Back 38

-passes inferiorly deep to the manubrium

Front 39

Body of sternum

Back 39

-anterior to the right border of the heart and vertebrae T5-T9

Front 40

Xiphoid process

Back 40

-lies in the epigastric fossa where the converging costal margins form the infrasternal angle

Front 41

Costal margin

Back 41

-formed by the 7th-10th costal cartilages

Front 42

Xiphisternal joint

Back 42

T9

Front 43

Nipple in men

Back 43

anterior to the 4th intercostal space

Front 44

Endothoracic fascia

Back 44

-thin layer between the internal aspect of the thoracic cage and the parietal pleura

Front 45

Pulmonary ligament

Back 45

-the continnuity between the parietal and visceral pleura

Front 46

Pleural cavity

Back 46

-potential space between the visceral and parietal pleura with serous fluid
-lubricates the pleural surfaces so the 2 layers of pleura slide smoothly over one another

Front 47

Parietal pleura has 4 parts

Back 47

1. Costal part: covers the internal surfaces of the thoracic wall; seperated from the wall by endothoracic fascia
2. Mediastinal part: covers lateral aspect of mediastinum
3. Diaphragmatic part
4. Cervical pleura: extends into root of neck superior to the level of the medial 1/3 of the clavicle

Front 48

Anterior border of the left lung

Back 48

-more deeply indented due to the cardiac notch

Front 49

the parietal pleura extends __ ribs inferior to the lung

Back 49

2

Front 50

Oblique fissure

Back 50

-extends from the level of the spinous process of the T2 vertebrae to the 6th costal cartilage

Front 51

Horizontal fissure of the right lung

Back 51

-extends from the 4th rib

Front 52

Right lung

Back 52

-has 3 lobes
-shorter and wider because the right dome of the diaphragm is higher

Front 53

Left lung

Back 53

-has cardiac notch which indents on the superior lobe
-this creates the lingula

Front 54

Left lung root

Back 54

-Pulmonary artery (1) is superior
-Bronchi are located behind the pulmonary veins

Front 55

Right lung root

Back 55

-Pulmonary artery is anterior to bronchi
-pulmonary veins are at the bottom

Front 56

right main bronchus

Back 56

-wider, shorter and runs more vertically

Front 57

left main bronchus

Back 57

-passes inferiolaterally
-inferior to the arch of the aorta
-anterior to the esophagus and thoracic aorta

Front 58

Pulmonary Arteries

Back 58

-each lung has a large pulmonary artery
supplying blood to it
-they arise from the pulmonary trunk at the level of the sternal angle
-they carry poorly oxygenated blood to the lungs for oxygenation

Front 59

Pulmonary veins

Back 59

-2 on each side
-carry well-oxygenated blood from the lungs to the left atrium of the heart
-veins from the visceral pleura drain into the pulmonary veins

Front 60

Bronchial arteries

Back 60

-supply blood to the structures making up the root of the lungs, and the visceral pleura

Front 61

left bronchial arteries

Back 61

-arise from the thoracic aorta

Front 62

Bronchial veins

Back 62

-drain only part of the blood, primarly that distributed to or near the proximal part of the root of the lung
-right bronchial vein--> azygous vein
-left bronchial vein--> accessory hemiazygous vein

Front 63

Superficial lymphatic plexus of the lung

Back 63

-drains the lung parenchyma and visceral pleura
-lymph than --> bronchopulmonary (hilar) nodes

Front 64

Deep lymphatic pleuxus of the lung

Back 64

-located in the submucosa of the bronchi and in connective tissue
-drains structures that form the root of the lung
-drain into pulmonary nodes and then into hilar nodes

Front 65

Lymph from both the superficial and deep plexuses ultimately drain into?

Back 65

tracheobronchial nodes--> right and left bronchomediastinal lymph trunk
-right bronchomediatinal tunk--> right lymphatic duct
-left trunk--> thoracic duct

Front 66

Nerves of the lung and visceral pleura

Back 66

-Parasympathetics: vagus
-Sympathetics: Paravertebral sympathetic ganglia

Front 67

azygous lobe

Back 67

-accessory lobe that is more common in the right lung

Front 68

Thoracentesis

Back 68

-insert neede superior to the rib

Front 69

Visceral pleura

Back 69

-insensitive to pain because its innervation is autonomic (motor and visceral afferent)

Front 70

Parietal pleura

Back 70

-sensitive to pain due to somatic intercostals and phrenic nerve
-can produce referred pain to the shoulder C3-C5

Front 71

Carina

Back 71

-between the orifices of the main bronchi
-a cartilagenous projection of the last tracheal ring

Front 72

Dermatome around nipple

Back 72

T4

Front 73

Vertebral level at inferior angle of scapula

Back 73

T7

Front 74

Structure that lies immediately posterior to manubrium

Back 74

Thymus

Front 75

Vertebral level associated with sternal angle

Back 75

IV disc between T4-T5

Front 76

Rib paralleled by horizontal fissure of right lung

Back 76

4th

Front 77

Inferior extent of lung at mid-clavicular line

Back 77

6th rib

Front 78

Inferior extent of pleura at mid-clavicular line

Back 78

8th rib

Front 79

Inferior extent of lung at mid-axillary line

Back 79

8th rib

Front 80

Inferior extent of pleura at mid-axillary line

Back 80

10th rib

Front 81

Inferior extent of lung posteriorly

Back 81

10th rib

Front 82

Inferior extent of pleura posteriorly

Back 82

12th rib

Front 83

Innervation of costal pleura

Back 83

Intercostal nerve

Front 84

Innervation of mediastinal pleura

Back 84

Phrenic nerve

Front 85

Level where ascending aorta is continous with arch of aorta

Back 85

T4-5

Front 86

Level where arch of aorta is continous with descending aorta

Back 86

T4-5

Front 87

Effect of Sympathetic nerves on lungs

Back 87

Bronchodilation, vasoconstriciton

Front 88

Effect of Parasympathetic nerves on lungs

Back 88

Bronchoconstriction, vasodilation

Front 89

Needle location for therapeutic pleural tapping

Back 89

-Superior to 12th rib, posteriorly

Front 90

Termination of azygous vein

Back 90

superior vena cava

Front 91

Thoracic structures that can compress the esophagus

Back 91

-left bronchus, aorta, and diaphragm

Front 92

T8, T10, T12

Back 92

T8: Inferior vena cava
T10: Esophagus, vagus
T12: aortic, thoracic duct, azygous vein

Front 93

Aspirate a peanut

Back 93

While upright: lower portion of right inferior lobe
While supine: superior portion of right inferior lobe