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64 terms

HSF Anatomy - Thorax

Anatomy Exam 2
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Manubrium Sterni
upper section of the sternum
Manubriosternal joint/ sternal angle of louis
• secondary fibrocartilagenous joint
• articulates iwth 2nd costal cartilage
• count ribs from sternal angle
Body of the sternum
main part of the sternum from costal cartilage of 2nd rib to 7th costal cartilage
xihisternum
tip of the sternum - starts out cartilaginous and ossifies by middle age
true ribs
first 7 ribs, articulate directly with sternum in front and vertebrae behind
false ribs
last 5 ribs, 8-10 articulattew with sternum thru 7th costal cartilage
floating ribs
11, 12, dont articulate with sternum at all.
xiphisternal joint
with 7th costal cartilage
Head of the rib
has two articular facets - upper (articulates with T vertebra above and IV disk above) - lower - articulates with corresponding vertebra
neck of rib
narrowing below the head
Tubercle of rib
articulates with trasnverse process of corresponding vertebra
Angle of rib
where the rib takes a sharp turn anteriorly
Costal Groove
inferior border of the rib towards the viscera. houses Vein Artery Nerve VAN
typical ribs
3-9 look alike
atpycical ribs
1,2
scalene tubercle
on first rib attaches to scalenus anterior, on second rib also attaches to scalenus anterior
groove for subclavian artery and lower trunk of brachial plexus
posterior to scalene tubercle
groove for subclavian vein
anterior to scalene tubercle
Thoracic outlet syndrome
caused by cervical rib or spasm of scalenus anterior muscle pressing on brachial plexus. results in ischemia and nerve pressure atrophy of muscles in upper limb
Cephalic vein
runs in deltopectoral groove, drains into axillary vein
Anterior cuteneous nerves and vessels
branches of upper 6 intercostal nerves, pierce pectoralis major muscles, supply skin of anterior chest wall; lower 5 (7-11) intercostal and subcostal T12) supply skinof anterior abdominal wall
Lateral cutaneous nerves and vessels
branches of intercostal nerves
External Intercostal Muscle
run dowards and forwards like hands in pockets; replaced anteriorly by external intercostal membrane
Internal intercostal muscel
fibers run at 90º angle from external muscle fibers. replaced by internal intercostal membrane posteriorly - medial to angle of the rib
Innermost Intercostal muscle
has 3 parts:
• transversus thoracis (sternocostalis) in front behind sternum
• innermost intercostal membrane/muscle in middle
• subcostalis - posteriorly
neruovascular intercostal bundle - posterior intercostal vein, posterior intercostal artery and intercostal nerve
lie between internal and innermost intercostal muscles
sternocostalis/transversus thoracis muscle
takes origin from posterior surface of lower half of body of sternum and attaches to 2nd to 6th costal cartilages
Internal thoracic artery / Internal Mammary artery
branch of first part of subclavian artery
branches into:
• anterior intercostal arteries in upper 6 interostal spaces
• pericardioacophrenic artery
• perforating branches to mammary gland
• terminates into superior epigastric and musculophrenic arteries
• anterior intercostal arteries in lower (7-9) intercostal spaces branch from musculophrenic artery
subcostalis muscle
from inner surface of rib near angle and jumps up 1-2 ribs to upper border of rib below
posterior intercostal arteries
branch from descending thoracic aorta in 3rd - 11th IC spaces.
• branch from superior intercostal artery (branch of costocervical trunk of subclavian artery) in upper 2 intercostal spaces
anastamose with anterior intercostal arterires from the internal thoracic artery/musculophrenic artery
Ventral ramus intercostal nerve
from rami communicantes after the sympathetic ganglionic chain. gives rise to laterla and anterior cutaneous branches
1-6th intercostal nerves
give motor muscular branches to intercostal muscles in corresponding spaces
anteior cutaneous and lateral cutaneous branches along chest wall
7-11th intercostal and subcostal T12 nerves
give motor muscular branches to intercostal muscels in corresponindg spaces and muscels of anterior abdominal wall
give anterior and lateral cutenous branches to skin of abdomen
Herpes Zoster
shingles, viral infection of dorsal root ganglion. red painful blisters along course of intercostal nerve
Visceral Pleura
covers lung and fuses with lung tissue
• supplied by autonomic nerves and insensitive to pain
• pulmonary vessels and bronchial vessles supply it and lymphatisc drain into bronchopulmonary lymph nodes
Parietal pleura
four parts:
• costal (IC nerves)
• diaphragmatic (peripheral part by IC nerves)(medial part by phrenic nerve)
• mediastinal (phrenic nerve)
• cervical / cupola (intercostal nerves)
cupola
cervical pleura, covers apex of lung and ocvered by suprapleural memrbane, apex of lung is 1 inch above medial 1/3rd of clavicle
Pneumothorax
abnormal presence of air in the pleural cavity resulting in the collapse of the lung, abnormal presence of air in the pleural cavity resulting in the collapse of the lung
Costomediastinal recess of pleura
left recess larger because of cardiac notch on left lung
costodiaphragmatic recess of pleura
allow expansion oflungs in deep respiration; 8th rib MCL, 10th rib MAL, 12th rib at neck of rib
lower border of lung
MCL 6th rib, 8th rib at MAL, 10th rib at neck of rib
pleurisy
inflammation of pleura, sound like a rub
pleural effusion
fluid in pleura - hydrothorax if water, hemothorax if blood, pneumothorax if air
Pleural Tap, Thoracocentesis
in 8th or 9th intercostal space at MAL higher at area of maximum dullness with a lot of fluid and chest tube inserted: needle passes skin, superficial fascia, external intercostal muscle, internal intercostal muscle, innermost intercostal membrane/muscle, endothoracic fascia, parietal pleura
Phrenic Nerve
ventral rami of C3-5
• motor to diaphragm (c3,4,5 keeps the diaphragm alive)
• sensory pleura mediastinal and central part of diaphragmatic pleura, pericardium and peritoneum
• pericardiacophrenic vessels
Root of lung
Pulmonary veins (superior inferior)
pulmonary artery
primary prinicple bronchus
bronchial arteries (branches of throacic aorta)
anterior & posterior pulmonary plexus
lymph nodes
anchored to mediastinum
right lung
3 lobes, upper middle lower
left lung
2 lobes upper lower
oblique fissure
divides upper and lower lobes in left lung, divides upper and middle from lower lobe in right lung
horizontal fissure
divides upper and middle lobes of right lung
apex of lung
top of lung
lingula
extension of left lung corresponds to midle lobe of right lung
Hilum of lung
Midline region where the bronchi, blood vessels, and nerves enter and exit the lungs.
top to bottom:
pulmonary artery
superior and inferior pulmonary veins
principal bronchus
eparterial bronchus
right superior lobar bronchus on right lung to superior lobe
pulmonary ligament
point of reflection from visceral to parietal pleura of lung below the hilum
ligamentum arteriosum
hooked by left recurrent laryngeal nerve from vagus nerve, connects aortic arch to pulmonary artery?
azygous vein
impresson on right lung
left lung impressions
• groove for 1st rib
• groove for left subclavialn artery
• trachea and esophagus
• groove for arh of descending thoracic aorta
impression for lower end of esophagus
• cardiac notch
• cardiac impression
right lung impressions
impressions for right brachiocephalic vein and SVC
• groove for trachea and esophagus
• groove for arch of azygos vein
• groove for esophagus
• groove for IVC
• cardiac impression
bronchopulmonary segments
independent respiratory units of lung supplied by tertiery bronchus, and own pulmonary artery
10 on right and 10 on left
right has 3 in upper, 2 in middle and 5 in lower lobe
left has 5 in upper lobe (including 2 in lingula) and 5 in lower lobe
trachea
leads to bronchi
right principal bronchus
broader and shorter 2.5cm in dorect continuation of trachea, things can get trapped here.
left principal bronchus
primary bronchus longer 5 cm narrower and at an angle
carina
division between right and left principal bronchi