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24 Cards in this Set
- Front
- Back
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Role of Costal Cartilages
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-prolong ribs anteriorly and contribute to the elasticity of the thoracic wall, preventing many many blows from fracturing the sternum and/or ribs. C. cartilages calcify in older people, making them radiopaque and less resilient
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Rib Fractures
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-the weakest part of the rib is just anterior to its angle.
-rib fractures commonly result from direct blows or indirectly from crushing injuries. -the middle ribs are most commonly fractured. -broken ends of fractured ribs may injure organs such as the lung. |
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Flail Chest
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-flail chest occurs when a sizable segment of the anterior/lateral thoracic wall moves freely because of multiple rib fractures.
-this condition allow the loose segments of the wall to move paradoxically (inward/out) -this is extremely painful injure and impairs ventilation -- decreasing O2 input. -Tx: usually fixed by hooks and/or wires to fix it in place |
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Supernumerary Ribs
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-the number of ribs on each side may be increased by the presence of cervical and/or lumbar ribs or decreased by failure of the 12th pair to form.
-cervical ribs= articulate with the C7 vertebra. this may compress spinal nerves C8 and T1 or the inferior trunk of the brachial plx.. Tingling and numbness may occur along the medial border of the forearm. -they may also compress the subclavian artery, resulting in ischemic muscle pain (from poor blood supply). -lumbar ribs = less common than the cervical ribs,, but have clinical significance in that they may confuse the identification of vertebral levels in diagnostic images. |
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Sternal Fractuers
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-not common. but can result from traumatic compression of the thoracic wall. (eg. car accident)
-when the body of the sternum is fractured it is usually a comminuted fracture. - the most common site of sternal fracture is the sternal angle (of Louis), resulting in dislocation of the manubriosternal joint. --> clinical concerns are heart and pulmonary injuries. |
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Median Sternotomy
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-sternum is divided ("spit") in the median plane, and retracted. Used during surgical procedures to gain access to the thoracic cavity.
-wire sutures are used to hold together the sternum after the surgery |
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sternal biopsies
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-the sternal body is often used for bone marrow needle biopsy because of its breadth and subcutaneous position. the needle pierces the thin cortical bone and enters the vascular trabecular spongy bone.
-sternal biopsies are used to obtain specimens of bone marrow for transplantation and for detection of metastatic cancer. |
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Paralysis of Diaphragm (p.54)
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-one can detect this radiographically by noting its paradoxical movement.
-paralysis of half of the diaphragm because of injury to its motor supply from the phrenic nerve does not affect the other half because each dome has a separate nerve supply. -instead of descending on inspiration the paralyzed dome is pushed superiorly by the abdominal viscera that are being compressed by the active side. - the paralyzed dome descends during expiration as it is pushed down by the positive pressure in the lungs. |
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Anterior Thoracotomy, intercostal space incisions, and rib excision.
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Thoracotomy - the surgical creation of an opening through the thoracic wall to enter a pleural cavity.
-anterior thoractomy involves making H-shaped cuts through the perichondrium of one or more costal cartilages to gain entrance to the thoracic cavity. - surgeons use an H-shaped incision to incise the superficial aspect of the periosteum that ensheaths the rib, strip the periosteum of the rib, and then remove a huge chunk of the rib to gain better access as might be required when removing lung (pneumonectomy) - in the rib;s absence, entry into the thoracic cavity can be made through the deep aspect of the periosteal sheath, sparing the adjacent intercostal muscles. missing pieces of the ribs can regenerate from the intact periosteum. |
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Posterior Thoracotomy, intercostal space incisions, and Rib Excision
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-Pos. Thoracotomy = sites for incisions are the posterolateral aspects of the fifth to seventh intercostal spaces.
- the lateral approach is most satisfactory for entry through the thoracic cage. - pt. will be lying on the contralateral side with arm fully abducted, and forearm besides the pt's head. this elevates and laterally rotates the inferior angle of scapula, allowing access as high as the fourth intercostal space. |
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Thoracic Outlet Syndrome
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-important nerves and arteries pass through this outlet/aperture into the lower neck and upper limb.
-various types or thoracic aperture syndrome exist, such as the Costoclavicular syndrome - pallor and coldness of the skin of the upper limb and diminisehd radial pulse resulting from compression of the subclavian artery between the clavicle and the first rib. esp. when angle b/w the neck and shoulder is increased |
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Dislocation of Ribs
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-aka "slipping rib syndrome" or "dislocation of sternocostal joint"
-displacement of a costal cartilage from the sternum. -causes severe pain, esp. during deep respiratory movements. - produces a lump-like deformity at the dislocation site. - common in body contact sports, and possible complications are pressure on or damage to nearby nerves, vessels, and muscles. -rib separation refers to dislocation of a costochondral junction between the rib and its costal cartilage (separation of the 3rd-10th ribs, tearing of the perichondrium and periosteum usually occurs. As a result, the rib may move superiorly, and overriding the rib above and causing pain. |
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Breast Quadrants
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-4 divisions: Superolateral (includes axillary tail), Superomedial, Inferomedial, and Inferolateral
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Changes in Breasts
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-such as branching of the lactiferous ducts, occur in the breast tissues during the menstrual cycle and pregnancy.
-milk is only produced until shortly after the baby is born (induced by oxytocin) -Colostrum aka beestings aka first milk = creamy white to yellowish premilk fluid, may secrete from the nipples during the last trimester of pregancy and during initial episodes of nursing. rich in protein, immune agents, and a growth factor affecting the infant's intestines. - in multiparous women (have already given birth two or more times), the breast is often become large and pendulous. -elderly women have smaller breast because of decrease in fat and atrophy or glandular tissue |
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Supernumerary Breasts and Nipples
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-Supernumarary (exceeding two) breast (polymastia) or nipples (polythelia) may occur superior or inferior the normal breasts.
-usually consists of only a rudimentary nipple and areola. -may appear anywhere along a line extending from the axilla to the groin, the location of the embryonic mammary crest (ridge) |
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Carcinoma of Breast
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-breast cancer are malignant tumors, usually adenocarcinomas arising from the epithelial cells of the lactiferous ducts in the mammary gland lobules.
-cancer usually pass trough two or three groups of lymph nodes before entering the venous system. it can spread via lymphatics and veins and as well as by direct invasion. -understand lymphatic drainage of breasts |
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Carcinoma of Breast cont'd
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-lymphedema = edema, excess fluid in the subcutaneous tissue caused by interference with the lymphatic drainage by cancer -can result in deviation of the nipple and a thickened leather like appearance of the skin.
-peau d'orange sign = prominent/puffy skin between dimpled pores which gives it an orange-peel appearance. larger dimples result from cancer and fibrosis (fibrous degeneration). these causes shortening of the supersensory ligaments. |
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Subareolar breast cancer
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causes inversion of the nipple
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Metastasis of cancer of the breast
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-breast cancer spreads by means of lymphatic vessels (lymphogenic matastasis), which carry cancer cells from the breast to the lymph nodes, chiefly those in the axilla. the cells lodge in the nodes, producing nests of tumor cells (metastases). May travel to supraclavicular lymph nodes, the opposite breast, or the abdomen.
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Most common site of metastasis from a breast cancer
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Axillary lymph nodes, because most of the lymphatic drainage of the breast is to this area.
-enlargement of axillary lymph nodes suggest the possibility of breast cancer. -also check for other nodes such as infraclavicular and supraclavicular lymph nodes, as sometimes they travel that area. |
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Azygos/hemizygos system of viens
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-cancer cells can also spread from the breast by these venous routes to the vertebra and from there to the cranium and brain. this is where posterior intercostal veins drain into
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A clinical sign of advanced cancer of the breast
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breast elevates when pectoralis major contracts.
happens when cancer invades the pectoral fascia overlying the pects. or metastasize to the interpectoral nodes. |
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Mammography
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-radiographic exam of the breasts. one of the techniques to detect breast masses
-a carcinoma appears as a large, jagged density in the mammogram -used as a guide when removing breast tumors, cysts, and abscesses. |
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Surgical Incisions of Breast
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-incisions are placed in the inferior breasts quadrants when possible because these quadrants are less vascular than the superior ones.
-incisions made in the inferior cutaneous crease will be least evident and may actually be hidden by overlap of the breast. -incisions that must be made near the areala or on the breast itself are usually directed radially to either side of the nipple or circumferentially. |
