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60 Cards in this Set
- Front
- Back
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What is inside the thoracic cavity? Three division?
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-Left and right pleural cavity
-Mediastinum (area that separates pleural cavities) |
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Borders of Thoracic cavity?
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-Vertebrae, ribs, costal cartilages, sternum
-Superior and inferior thoracic apertures |
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Why do ribs normally exist?
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-To assist with breathing and creating negative pressure inside the chest
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The 12 ribs and anterior attachments, not joint type
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-Upper 7 attach to sternum via costal cartilages. True Ribs.
-Ribs 8-10 attach to sternum indirectly. False Ribs. -Ribs 11-12 do not have costal cartilage and do not attach to sternum. Floating Ribs. |
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Primary cartilaginous joint
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-Bones are connected by hyaline cartilage, sites of growth
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Secondary cartilaginous joint
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-Articulating bones covered with hyaline cartilage and have a thick, fairly compressible pad of fibrocartilage between them.
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Anterior attachments of ribs and joint types
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-1st costal cartilage to sternum is primary cartilaginous joint
-2-7th costal cartilage to sternum = synovial joints -6-10 interchondral joints = synovial joints |
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Division between abdomen and thorax
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Created by diaphragm (vertebrae, xyphoid process, medial (vertebrae) and lateral arcuate ligaments (12th rib))
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Posterior attachment of ribs and joint type
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-Head of rib attaches to its own vertebrae and to the vertebrae above (eg rib 6 = T6 and T5)
-Ribs 1,10-12 attach to vertebrae of same number only -Attaches to Inferior and Superior demifacet/costal facet -Neck of rib has tubercle that attaches to transverse process (has facet) -Synovial joints |
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What connects vertebrae together?
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-Superior and Inferior Articular facets
-Secondary cartilaginous joints connecting vertebrae |
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Thoracic inlet cross section, anterior to posterior
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-Sternal notch, trachea, oesophagus, 1st thoracic vertebrae
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Basic vertebrae
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Body, pedicle, lamina, transverse process, spinous process
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What happens do demifacet position as you increase vertebra number?
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They become more posterior and move toward the pedicle
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Rib Structure
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-Head, Neck, tubercle, and shaft
-Costal groove on bottom of internal surface -Head has superior, inferior articular facets (synovial joints), and a crest -Tubercle also has articular facet -First rib atypicial |
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First Rib Structure
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-Same rib structure but different shape
- has two grooves with scalene tubercle in between -Scalenus anterior attaches to scalene tubercle |
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Why is the scalenus important?
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Important landmark for structures that lie around it
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Important structures around first rib, 6 things
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-Phrenic nerve lies on SA
-Fracture of neck can involve C3,4,5 and difficulty breathing -Subclavian artery (above rib) passes in groove posterior to scalene tubercle -Subclavian vein passes in groove anterior to scalene tubercle -T1 root of brachial plexus in between subclavian artery and bone -Sympathetic trunk passes near neck -Apex of lung |
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What divides subclavian artery into three parts?
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Anterior scalene muscle (c3-c6 to first rib) (up to medial border, behind, lateral border to outer border of first rib)
First rib separates subclavian artery/vein from axillary artery/vein |
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Tumor in apex of lung
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-Can impact T1 and or thoracic sympathetic trunk going into neck
-Wasting of interosseus muscles or Horners syndrome -If one of these things then you look for the other -Also phrenic nerve |
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Horners syndrome
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-Droopy eye lids (ptosis)
-constricted pupils -lack of sweating on the face |
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In between which intercostal muscles is the neurovascular bundle (intercostals vessels and nerve/APR)
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-between internal and innermost
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What do the intercostals nerves innervate
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-Intercostal muscles, skin
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Angle of Louie
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-Sternal angle or Sterno-manubrial joint (secondary cartilaginous)
-Allows movement in anterior and posterior plane (allows proper breathing) -At level of T4 -Articular demifacets for rib 2 costal cartilage (on manubrium and sternum) -important landmark for finding other ribs and body structures |
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What level is jugular/sterna notch at?
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T2, put fingers on notch to check for deviation of thorax
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Three parts of sternum
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Manubrium, body, xiphoid process (can break off in pregnancy)
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Murphys point indicated by what?
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-Linea semilunaris and costal margin
-gallbladder |
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Where does sympathetic trunk/chain/ganglia begin and end
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-Runs from base of skull to coccyx
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Joint of rib with vertebral body
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-costovertebral joint = head of rib to vertebrae and costotransverse joint (tubercle to transverse process)
-tri-radiate ligament supports costovertebral joint from head of rib to vertebra above, intervertebral disc, vertebra below -superior, lateral, and costotransverse ligaments between tubercle and vertebral transverse processes -synovial |
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Movements of ribs to allow breathing
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-Pump handle action (Superior and Anterior movement of Sternum)
-Bucket handle movement (Elevation of lateral shaft of rib) occurs lower down. Lower transverse processes are flatter and allow this movement -Helps create negative pressure relative to atmosphere -Positive pressure used in artificial ventilation |
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Layers of muscle between ribs
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-External, Internal, Innermost intercostals muscles
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Neurovascular plane between ribs
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-Intercost vein, artery, nerve (VAN) top to bottom in costal groove of top rib
-Collateral branches near bottom rib -to insert needle find rib at lower edge of space and go in just above it |
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Spinal Nerves, their supply
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-Carries sensory, SNS, and motor fibers
-Posterior primary ramus (PPR) supplies erector spinae and skin over back -Anterior Primary Ramus (APR) supplies intercostals muscles (T3-T6) and PNS -Also T1 = brachial plexus, T2 = intercostobrachial nerve, T7-T12 = abdomen and thorax |
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Blood supply of intercostals muscles
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-Anterior and posterior intercostals arteries
-From internal thoracic arteries (left and right) and aorta, respectively -Anterior and posterior intercostals arteries have anastamosis in intercostals space |
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Where does internal thoracic artery come from and where does it run? Divisions?
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-Comes from subclavian artery
-Runs down sternum just posterior to the costal cartilages -Divides into two near thorax (Superior epigastric and musculophrenic arteries). Supply rectus abdominus and diaphragm? |
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Posterior intercostals arteries
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-Arise from aorta
-Right and Left superior intercostals arteries (1 & 2) from right and left subclavian artery -3-12 from aorta, subcostal artery = #12 |
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Posterior intercostals veins
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-1st intercostals vein drains into brachiocephalic veins
-left superior intercostals vein (2,3) goes into LBV -Posterior intercostals veins drain into azygos vein (right) and hemiazygos vein (left) -Azygous system goes into SVC, Hemiazygous drains into azygous and left renal vein |
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Anterior venous drainage
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-Anterior intercostals veins drain into internal thoracic veins
-both go to subclavian -> R&L brachiocephalic -> superior vena cava |
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Anterior lymph nodes in between ribs
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-Parasternal nodes
-important in drainage of breast, medial breast cancers can spread here -lateral breast cancers spread to axilla -breast cancer can spread by veins or lymph |
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What to examine for breast cancer?
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-Axilla and chest lymph
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Mediastinum divisions
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-Superior (wedge shaped) and Inferior divided by sterna angle at level of T4
-Inferior mediastinum divided into anterior, middle, and posterior divisions |
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Azygous vein
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- has intercostals veins
-Goes through diaphragm at T12 with aorta -Goes behind root of lung into SVC -hemiazygous counterpart on left side, starting at left renal vein |
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Path of thoracic duct? Lymph drainage
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-begins as cysterna chili (L2) goes through diaphragm at T12 /w azygos vein and aorta
-drains into l brachiocephalic vein/junction b/w LIJV and LSV -gets lymph from below and above diaphragm, drains most of upper body |
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Where does right superior bronchus/ eparterial bronchus come off?
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-before bronchi enter root of the lung
-arises above pulmonary artery |
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Cirrhosis of liver
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-veins blocked in liver
-blood travels backward via splenic vein to spleen, splenomegaly -goes up left gastric vein into oesophageal region, oesophageal varicosities -can also get pancreatic cirrhosis from alcoholism |
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What is inside the inferior mediastinum
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-Anterior = internal thoracic artery and thymus gland
-Middle = heart lying in pericardium, left and right phrenic nerves -Posterior = aorta (descending then becoming abdominal), trachea, and oesophagus -Posterior divisions comes a long way down due to diaphragm |
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Color of air on xray?
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Black and bones/tissue looks white
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Cervical rib?
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-normally above first rib
-The developmental costal cartilage of C7 becomes abnormally enlarged. -It can be a small protuberance or a complete rib that forms bilaterally. - It can put pressure on the subclavian artery or the inferior trunk of the brachial plexus causing klumpke’s paralysis. |
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Level of nipple in men and women
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- In male at 4th intercostals space
- In female at 5th intercostals space |
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Lobes of lung
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-Right lung has three lovbs (superior, middle, inferior)
-Left lung has two lobes (heart) |
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Where is the root of the lung?
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-Located behind the SVC and infront of oesophagus
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Pneumothorax, X-ray? Treatment?
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-collection of air or gas in the pleural space that separates the lung from the chest wall
-may interfere with normal breathing. -from collapsed lung, looks black on xray -Treat with chest drain at bottom of intercostals space, air bubbles out. 4th /5th ICS + Mid Axillary Line (MAL) -if tension pneumothorax then puncture at 2nd ICS and midclavicular line |
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Phrenic and vagal nerve position with respect to lungs
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-Phrenic nerves are anterior to root of lung. Run down pericardium along right atrium and left ventricle
-Vagus nerves are posterior to the root of the lungs, run in carotid sheath, posterior to bronchi |
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Innervation of Pleura? Pain radiation?
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-Parietal = intercostals nerves, phrenic nerve (motor,sensory,sns). Pain radiates to shoulder.
-Visceral = ANS -Pericardium = phrenic, referred pain to shoulder |
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How do thoracic spinal nerves branch? Subcostal nerve?
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-Nerve leaves spinal cord as anterior and posterior branches that combine.
-After the nerve leaves the vertebral canal, it splits into posterior and anterior rami -The posterior passes to the back to supply muscles and skin around the spine -The anterior travels with the intercostal neurovascular bundle as the intercostal nerve. -The subcostal nerve comes from T12, and runs below the 12th rib. |
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What does mediastinum mean?
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-Middle standing
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What is the pleural cavity?
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-Double layer of fibrous membrane
-Visceral layer covers lung, parietal layer covers inner lining of chest wall -Pleural fluid exists to maintain adhesion through surface tension |
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Hemothorax
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-blood accumulating in pleural cavity
-traumatic -Fluid tends to accumulate in upper part of lower lobe when patient lies down |
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What will a fractured rib do?
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-Cut internal intercostals arteries
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What connects the pulmonary trunk and aorta?
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-Ligamentum arteriosus, previously known as truncus arteriosus (allows blood to bypass lungs)
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Where is the thoracic duct after it ascending through diaphragm with aorta?
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-Runs between oesophagus and thoracic vertebrae
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