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WEEK 16:
Anatomy of Thorax
| Question | Answer |
|---|---|
| superior thoracic aperture | top opening for structure to enter/leave neck/thorax |
| inferior thoracic aperture | opening at bottom of thoracic cavity (closed by diaphragm) |
| thoracic outlet syndrome (TOS) | nerves and blood vessels become compressed between the first rib |
| symptoms of TOS | shoulder and neck pain, numbness in fingers |
| causes of TOS (5) | trauma eg car accident, repetitive stress injuries eg sports, congenital conditions eg extra rib in neck, poor posture, and pregnancy |
| horizontal planes of thorax (3) | suprasternal plane (T2 posteriorly), plane of sternal angle (T4/5 posteriorly), xiphisternal plane (T9 posteriorly) |
| vertical lines of thorax (3) | lines go superior to inferior and left to right including: midaxillary line, midsternal line, midclavicular line |
| how many intercostal muscles are there | 3- external, internal and innermost |
| where are the intercostal muscles (3) | external are lateral, internal are medial and innermost are on the other side of ribs |
| pleura | serous membrane in thoracic cavity |
| visceral pleura | covers lungs |
| parietal pleura | lines pulmonary cavity |
| why is a needle inserted into the intercostal space of the thorax | to drain fluid, sample fluid (pleural fluid, blood or pus), and the anaesthetise an intercostal nerve |
| where is the needle injected | close to the upper border of the lower rib in intercostal space 9 in midaxillary line) |
| chest tube name | thoracostomy tube |
| triangle of safety for chest tube insertion formed of (3) | lateral border of pectoralis major anteriorly, lateral border of latissimus dorsi posteriorly, and inferior horizontal line from nipple (5th intercostal space) |
| typical ribs | 3-9 |
| atypical ribs | 1 & 2 and 10,11,12 |
| features of typical rib | demifacet, head, neck, tubercle, rounded superior border, costal groove, sharp inferior border, shaft |
| features in 1st rib | facet on head, tubercle, scalene tubercle, subclavian artery + vein groove |
| pigeon chest/ pectus carinatum | birth defect causing sternum and ribs to protrude abnormally |
| pectus excavatum | sternum sunken into chest, where severe cases interfere with heart/lung function |
| how many thoracic vertebrae are there | 12 |
| typical thoracic vertebrae | 2-8 |
| atypical thoracic vertebrae | 1st and 9-12 |
| how many facets per thoracic vertebrae | 6 (2 transverse processes and 4 demifacets on the body) |
| demi facets per thoracic vertebrae on body | 4 |
| thoracic disc herniation | intervertebral discs (which absorb shock) protrude out and compress nearby spinal nerves causing pain |
| where is the mammary gland | base extends from ribs 2-6 from lateral margin of sternum to midaxillary line. An axillary tail runs superiorly and laterally towards axilla (armpit) |
| mammary gland | modified sebaceous gland with 15-20 lobes sending lactiferous ducts to nipple. |
| importance of lymphatic drainage in mammary gland | reduce frequency of breast cancer that can spread to other parts of body by lymph and blood vessels |
| pectoralis major attachment of 2 heads | clavicular head from medial half of clavicle and sternocostal from sternum and upper 6 costal cartilages |
| pectoralis major actions and where | adductor and medial rotator (at shoulder joint), flexor (clavicular head when arm extended), and extensor (sternocostal head when arm flexed) , and accessory muscle of inspiration |
| pectoralis major nerve supply | medial and lateral pectoral nerves (C5-8, T1) |
| pectoralis minor attachments | coracoid process of scapula at ribs 3-5 near cartilage |
| pectoralis minor actions | depressor of scapula, protractor of scapula, accessory muscle of respiration |
| pectoralis minor nerve supply | medial pectoral nerve (mainly C8, T1) |
| breast cancer symptoms | palpable breast mass (hard, immobile lesion found in upper outer quadrants), and skin changes (peau d'orange and larger dimpling- leading to retraction of the nipple) |
| mediastinum | central part of thoracic cavity found between pleural cavities |
| mediastinum boundaries (4) | anteriorly (sternum), posteriorly (thoracic vertebral column), superiorly (superior thoracic aperture and root of neck), and inferiorly (diaphragm) |
| subdivisions of mediastinum | superior (above plane ending at superior thoracic aperture) and inferior ((below plane ending at diaphragm) |
| T4 level clinical significance | at the level of the sternal angle and second costal cartilage identifying the bifurcation (division) of trachea into bronchi, bifurcation of pulmonary trunk, and beginning + ending of aorta arch |
| inferior mediastinum divisions | anterior, middle, posterior |
| anterior mediastinum of inferior mediastinum | posterior to body of sternum and anterior to pericardium |
| middle mediastinum of IM | bounded by pericardium |
| posterior mediastinum of IM | posterior to pericardium and anterior to vertebrae |
| mediastinal syndrome | life threatening group of disorders characterised by infiltration, entrapment of compression mediastinal structures |
| mediastinal syndrome cause | malignant/ non malignant conditions |
| mediastinal syndrome cause in children | non Hodgkin's lymphoma (NHL) or T cell acute lymphoblastic leukaemia (T cell ALL) |
| front line therapy for mediastinal syndrome in children | systemic steroids |
| mediastinal syndrome symptoms (9) | swelling of veins (fatal), mediastinal widening on xray, chest pain, fever and chills, coughing up blood (haemoptysis), hoarseness, night sweats, SOB |
| hemoptysis | coughing up blood |
| 3 parts of sternum | manubrium, sternal angle (angle of Louis), xiphoid process |
| top of sternum | manubrium |
| middle of sternum | body |
| bottom of sternum | xiphoid process |
| what is the top of the manubrium | jugular notch |
| space between ribs | intercostal space |
| costal margin | cartilage of the 7-10th ribs |
| subcostal angle | angle formed by the left and right costal margins |
| what is the inferior thoracic aperture closed by | diaphragm |
| what structures does a needle penetrate when being inserted into intercostal space | skin, superficial fascia, serratus anterior, intercostal muscles, and parietal pleura |
| where is the neurovascular bundle found | between internal and innermost intercostal muscle |
| what can be used to help visualise where a chest tube is interted | ultrasound |
| demifacet | half a facet |
| facet | notch where vertebrae can articulate |
| cervical rib | extra rib that grows from the transverse process of the 7th cervical vertebrae attaching to first rib, which can compress nerves/ blood vessels leading to TOS |
| pigeon chest/ pectus carinatum cause | overgrowth cartilage between ribs and sternum |
| risk factor of pigeon chest/ pectus carinatum | runs in families, more common in males than females |
| treatment of pigeon chest/ pectus carinatum | chest brace or surgery |
| impact of pigeon chest/ pectus carinatum | no health risks but can impact self image and social life |
| how many facets are there on the transverse processes of thoracic vertebrae | 2 |
| facets on transverse processes articulate with what | rib tubercle |
| what do mammary glands compose of | glands and adipose tissue |
| what separates mammary gland lobes | fibrous septa (suspensory ligaments) |
| what separates the mammary gland from deeper pectoral muscle | retromammary space |
| 2 heads of the pectoralis major | clavicular and sternocostal |
| where does the clavicular head of the pectoralis major attach | medial half of clavicle |
| where does the sternocostal head of the pectoralis major attach | sternum and upper 6 costal cartilages |
| where do all fibres of the pectoralis major converge | intertubercular (bicipital) groove of humerus |
| cause of breast cancer appearance | contraction and degeneration of cooper's ligaments and lactiferous ducts |
| how is the mediastinum subdivided | horizontal plane extending from sternal angle anteriorly to lower border of T4 posteriorly |
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kablooey
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