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HMS Anatomy > Thorax Anatomy > Flashcards

Thorax Anatomy Flashcards

1
Q

Regions of the Anterior Thorax

A
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2
Q

The Five Trunk Lines

A

Midsternal line (anterior median) is a vertical line through the midline of the sternum.

Midclavicular lines run through the midpoint of the clavicles parallel to the midsternal line.

Midaxillary line is a vertical line that runs inferiorly from the deepest part of the axilla.

Midvertebral line (posterior median) is a vertical line through the vertebral column.

Scapular lines are parallel to the midvertebral line and cross the inferior angle of the scapula.

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3
Q

Anterior Thorax Vasculature

A
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4
Q

Lateral Thorax Vaculature

A
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5
Q

Posterior Thorax Vasculature

A
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6
Q

The major lymph nodes of the upper trunk are the. . .

A

axillary lymph nodes

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7
Q

The skin above the manubriosternal joint is supplied by sensory fibers from

A

the lower cervical plexus (C3, C4 and C5)

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8
Q

Below the manubriosternal joint and to the upper epigastric region is innervated by

A

the intercostal nerves (anterior primary rami of the T1-T12)

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9
Q

There is considerable ___ between neighboring dermatomes.

A

There is considerable overlap between neighboring dermatomes.

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10
Q

Auscultating the Aortic Valve

A

right 2nd intercostal space, just lateral to the sternum.

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11
Q

Auscultating the Pulmonary Valve

A

left 2nd intercostal space, just lateral to the sternum.

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12
Q

Auscultating the Tricuspid Valve

A

left 5th intercostal space, just lateral to the sternum.

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13
Q

Auscultating the Mitral Valve

A

left 5th intercostal space, midclavicular line.

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14
Q

The costal cartilages of ribs ____ articulate with the sternum via sternocostal joints, while the costal cartilages of ribs ____ articulate with one another at interchondral joints to form the costal margin.

A

The costal cartilages of ribs 1-7 articulate with the sternum via sternocostal joints, while the costal cartilages of ribs 8-10 articulate with one another at interchondral joints to form the costal margin.

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15
Q

symphesis (plural sympheses)

A

immovable joint

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16
Q

“False ribs”

A

Ribs 8-10, which are conjoined by cartilage to one another but are not conjoined directly to the sternal body.

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17
Q

“Floating ribs”

A

Ribs 11-12, which have no joints with other ribs or the sternal body and are mostly posterior.

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18
Q

Sections of thoracic wall muscle

A

Outer layer: External intercostal muscles

Middle layer: Internal intercostal muscles

Inner layer: Innermost intercostal muscles (and transversus thoracis, subcostal muscles)

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19
Q

Accessory Respiratory Muscles

A

Not shown is the abdominal wall muscle, also an accessory respiratory muscle.

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20
Q

Intercostal neurovasculation

A

Blood supply and nerve innervation resides in each intercostal segment just inferior to the superior rib of the intercostal space. They run in the following order:

Vein

Artery

Nerve

(VAN)

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21
Q

Intercostal Nerves

A

Intercostal nerves run below each rib and they are distributed to the thoracic wall, intercostal muscles, parietal pleura, periosteum of the ribs, abdominal wall and the peritoneum.

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22
Q

Intercostal arteries

A

posterior intercostal arteries (main intercostal arterial supply) are branches of the thoracic aorta; anterior intercostal arteries arise from the internal thoracic artery and anastomose with the respective posterior intercostal artery. Intercostal arteries run below each rib and supply the intercostal muscles - with additional branches from the subclavian and axillary arteries - the pectoralis muscles, the breast and the skin.

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23
Q

Intercostal veins

A

Intercostal veins accompany the intercostal arteries. They drain into the azygos system and internal thoracic veins.

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24
Q

Intercostal lymphatics

A

The lymph vessels of the intercostal spaces follow the intercostal vessels.

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25
Q

Internal Thoracic Artery

A

The internal thoracic artery arises from the subclavian artery; it is a paired artery, each runs on the side of the sternum. It supplies the anterior chest wall and the breasts.

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26
Q

Subdermal view of the anterior thoracic wall

A
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27
Q

Internal view of the anterior thoracic wall

A
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28
Q

A patient has fluid in the pleural space (underneath the thoracic cage). You are considering inserting a needle to drain the fluid. Where would you insert the needle?

A

Just above the rib that forms the lower boundary of the intercostal space

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29
Q

Points of attachment of the diaphragm

A

The false ribs (7, 8, 9, 10), the floating ribs (11, 12), the 12th thoracic and upper lumbar vertebra, ligaments to the upper thoracic wall (as high as the axillary T4), and the xiphoid process.

Palpable points of attachment are shown.

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30
Q

The costodiaphragmatic recess

A

The inferior and posterior area of the thorax which extends to the T12-L2 area of the spine. This area experiences the greatest vertical movement of the diaphragm as it contracts and relaxes during respiration.

Abnormal fluid accumulation of the thorax tends to collect here.

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31
Q

Diaphragm Tendons

A

The right crus is fixed to the upper L3, the left crus to the upper L2, and the central tendon is a trifoliate in which diaphragm muscles converge radially.

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32
Q

The superior aspect of the tendon is ___ with the inferior aspect of the ___.

A

The superior aspect of the tendon is continuous with the inferior aspect of the fibrous pericardium.

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33
Q

Major openings of the diaphragm

A
  1. Aortic opening, level of T12
  2. Esophageal opening (also vagus nerve), level of T10
  3. Inferior Vene Cava (also right phrenic nerve), level of T8

Smaller openings also exist, mostly for nerve fibers.

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34
Q

Superior diaphragm vasculation

A
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35
Q

Inferior diaphragm vasculation

A
36
Q

Diaphragm innervation

A

Only innervated from the abdominal surface.

37
Q

In tranquil inhalation,

A

only the diaphragm’s domes descend as the muscle contracts

38
Q

Mediastinal box

A

Made by drawing the midclavicular lines, then drawing two axial planes: one at the level of the xiphoid process, the other at the beginning of the midclavicular lines.

Any injury in the mediastinal box is assumed to have punctured the heart until proven otherwise.

39
Q

Mediastinal regions

A
40
Q

Major structures of the superior mediastinum

A
  1. L and R brachiocephalic veins
  2. Aortic arch
  3. Pulmonary Trunk
  4. Trachea and R/L Main Stem Bronchi
  5. Esophagus
  6. Azygos vein
41
Q

Ligamentum arteriosum

A
42
Q

Why is the right lung more likely to be filled with fluid than the left?

A

Because the angle between the right bronchus and trachea is more accute than that between the left bronchus and trachea due to the postion of the heart inferior to the left bronchus

43
Q

Location of the thoracic duct

A
44
Q

Superior mediastinum radiograph

A
45
Q

The anterior mediastinum is mostly occupied by the ____ during childhood

A

The anterior mediastinum is mostly occupied by the thymus during childhood

46
Q

Major structures of the posterior mediastinum

A

“Four birds resting on a tree”, where the “tree” is the descending thoracic aorta. The branches are the intercostal arteries, right/left bronchial arteries.

The four birds are:

The vagus nerve (“vagoose”)

The esophagus (“esophagoose”)

The Azygos vein (“azygoose”)

The thoracic duct (“thoracic duck”)

47
Q

Posterior mediastinum diagram

A
48
Q

Trachea

A

The trachea is a hollow cylinder in the middle of the respiratory tract; it connects the larynx with the lungs. The trachea descends in the midline of the thoracic cavity between the level of the C6 vertebra and T4-T5 vertebrae.

It is comprised of about 20 C-shaped hyaline cartilages that provide structural rigidity to the trachea. The trachea bifurcates in the superior mediastinum into the right and left main bronchi. The right main bronchus is shorter, wider and more vertical than the left main bronchus.

49
Q

Trachea neurovasculation

A
50
Q

Shape of the lungs

A

The lungs have roughly half cone shape, each lung consists of a base, apex, three surfaces (costal, diaphragmatic, mediastinal), and three borders (anterior, inferior, posterior). The base of each lung is semilunar and has a concave diaphragmatic surface.

51
Q

Pleura

A

Formed from mesodermal tissue and stays with the embryonic endodermal lung through its development.

The parietal layer is fixed via a loose connective tissue (endothoracic fascia) to the inner thoracic wall, lower cervical vertebra, costovertebral area, mediastinum, and diaphragm. The visceral layer is attached to the lungs; it is continuous with the parietal pleura.

52
Q

Subdivisions of parietal pleura

A
53
Q

Relative height of the pleura and lung

A

During quiet respiration the inferior borders of the lungs are two ribs higher than the borders of the pleural cavity. The borders of the pleural cavity are:

Anterior: 8th rib at the level of the midclavicular line.

Lateral: 10th rib at the level of the midaxillary line.

Posterior: 12th rib at the level of the scapular line.

54
Q

Lung apeces may be auscultated best ____.

A

Lung apeces may be auscultated best just superior and posterior to the clavicles.

55
Q

The visceral and parietal pleura meet at. . .

A

The mediastinal root or hilum.

56
Q

How to detect fluid accumulation in the costodiaphragmatic recess

A

With permission, palpate and percuss the area just right and left of the T12-L2 region of the dorsal side. Then, auscultate.

Fluid accumulation may be detected by a more ‘distant’ sound to respiration on one side (the side containing fluid) as opposed to the other.

57
Q

Hilum

A

The region of the lung, where the lung roots (neurovascular and airway structures) enter and leave the lung. The lung roots are the structures that run through the hilum; they are covered by pleura. Inferiorly, the pleura that covers the lung root extends as a narrow folds that is called the pulmonary ligament.

58
Q

Lung Lobes

A
59
Q

Bronchopulmonary segments

A

There are 10 such segments in the right lung, and 8 – 9 in the left lung. The segments are separated from each other by connective tissue. The bronchopulmonary segments are functional units as they have their own air and blood supply. There are no superficial anatomical markings that outline the bronchopulmonary segments.

60
Q

Fissure of the left lung

A

There is one fissure in the left lung, the oblique fissure, which arises from the 10 o’clock position and ends at the 5 o’clock position. It divides the left lung into superior and inferior lobes.

61
Q

Lobes of the left lung

A

The inferior lobe is larger than the superior lobe. It contains most of the left lung base, a large part of the posterior border, and the lower posterior part of the medial and lateral surfaces.

The superior lobe includes the apex, most of the costal and medial surfaces, the entire anterior border and the cardiac notch as well as the lingula, which is a tongue-like projection of the left lung below the cardiac notch.

62
Q

Hilum of the left lung

A

The left hilum is inferior to the aortic arch and anterior to the thoracic aorta. It contains the: pulmonary artery, left main bronchus and pulmonary veins, lymph nodes and the bronchial arteries.

63
Q

Right lung lobes

A
64
Q

Fissures of the right lung

A

On the medial surface of the right lung, the oblique fissure can be seen at the 7 o’clock position of the hilum of the right lung. It forms a junction with the horizontal fissure in the 4th intercostal space at the mid-axillary line. The horizontal fissure is much shorter than the oblique fissure.

65
Q

Hilum of the right lung

A

The right main bronchus sits posterior to the right pulmonary artery and relatively higher to it compared to the left main bronchus. The upper pulmonary vein is anterior and inferior to the pulmonary artery and anterior and superior to the lower pulmonary vein.

66
Q

Lung Dual Blood Supply

A

1) the pulmonary vascular system -> pulmonary artery, pulmonary vein
2) the bronchial (systemic) vascular system -> bronchial arteries, bronchial veins, azygos and hemiazygos veins

67
Q

Lung Lymphatics

A
68
Q

Innervation of the lung

A

The sympathetic preganglionic fibers originate from the lateral horn of the T2-T4 segments of the spinal cord relay in the upper thoracic ganglia. The postganglionic fibers are part of the pulmonary plexuses. They innervate the bronchial tree and the pulmonary vessels. Activation of the sympathetic fibers results in bronchodilation, vasoconstriction and inhibition of glandular secretion.

The vagal afferent fibers transmit information for the coughing reflex, stretch reception, blood pressure and chemoreception.

The vagal efferent fibers innervate the smooth muscle in the airways and pulmonary vessels and regulate the secretion of the bronchial glands. Activation of the parasympathetic fibers results in bronchoconstriction, vasodilation and glandular secretion stimulation.

69
Q

During deep inhalation the left lung tissue (just above the cardiac notch) expands into which space?

A

The left lung tissue (superior lobe) above the cardiac notch expands into the costomediastinal recess during deep inhalation. The costodiaphragmatic recess is a space at the inferior border of the lung. The inferior lobe of the lung enters into this space during deep inhalation. Neither the anterior nor the posterior mediastinum contains lung tissue.

70
Q

The posterior surface of the right lung is almost entirely. . .

A

the inferior lobe.

71
Q

During a bronchoscopic examination the instrument that was inserted into the airway accidentally punctured the posterior wall of the right main bronchus. The rapid flow of blood indicates that the instrument has torn the wall of the blood vessel that lies immediately behind the right main bronchus. Which blood vessel was most likely punctured?

A

The azygos vein

72
Q

Lingula

A

The lingula is a projection of the left lung (part of the superior lobe), which is located right below the cardiac notch. During deep inhalation the lingula partially fills the costomediastinal recess.

73
Q

Heart Diagram

A
74
Q

Location of the phrenic neurovascular bundles

A

In the white ovals, running between the parietal mediastinal pleura and parietal pericardium.

75
Q

pericardial reflections

A

Curvatures of the serous pericardium (at around the great vessels), that is formed by the parietal pericardium (attached to the fibrous pericardium) as it changes direction (reflects) and continues as visceral pericardium and covers the heart.

76
Q

Oblique and Transverse Sinuses

A

Important for cardiac surgery.

77
Q

Neurovasculation of the pericardium

A

Blood supply comes from the internal thoracic arteries and blood is drained through the internal thoracic veins.

Innervation: the fibrous pericardium and the parietal layer of the serous pericardium are supplied by the phrenic nerve and the visceral layer of the pericardium is supplied by fibers from the sympathetic trunk.

78
Q

Heart atria

A
79
Q

Heart valves cross section

A
80
Q

Heart arteries

A
81
Q

Heart veins

A
82
Q

Heart Innervation

A
83
Q

A 72-year old patient presents with elevated systolic blood pressure in the right ventricle. Which valve’s opening is most likely narrowed?

A

Pulmonary Valve

84
Q

The intercostal nerve innervates. . .

A

The intercostal nerve is the anterior primary ramus of the thoracic vertebra. It innervates the whole facsiocutaneous flap, muscle, endothoracic fascia, and parietal pleura.

85
Q

“C3,4,5 keep the diaphragm alive”

A

Anterior primary rami phrenic nerves that innervate the diaphragm.

86
Q

Pneumothorax

A

Air in the pleura compressing the lung

87
Q

Parietal pleura is innervated by ____, visceral pleura is innervated by ____.

A

Parietal pleura is innervated by intercostal somatic nerve fibers, visceral pleura is innervated by visceral sensory fibers.

Thus, you can localize pain very finely on the parietal pleura, but not on the visceral pleura.

HMS Anatomy (15 decks)

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