Cardiothoracic 🫁🫀

Question 1

Pulmonary fissures seen radiographically in:

Number of pleural layers in fissure

Answer 1

Rt transverse fissure —> 50%
Inferior accessory fissure —> 8%
Superior accessory fissure —> 5% (letter S from superior with letter S in 5 in Arabic)
Azygos fissure —> 4% (only present in 1% of total population and seen in 4%)
Lt transverse fissure —> 2%

Superior accessory separate the apical segment of the Rt lower from the basal
Inferior accessory separate the Rt medial basal from the other basal

The number of pleural layers:
Major and minor fissures have 2 layer of visceral pleura reflection
The azygos and all the others variant have 4 layers (2visceral and parietal)

Question 2

Pleura reflection:

Answer 2

Visceral pleura:

• anterior: 6th costal cartilage
• midaxillary line: 8th rib
• posterior: T10

Parietal pleura:

• anterior: 7th costal cartilage
• midaxillary line: 10th rib
• posterior: T12

Question 3

Diaphragm openings:

Answer 3

Caval opening: T8 located in Central tendon, contain IVC and Rt phrenic nerve
ESophegial: T10 located in the Rt cruS, contain esophagus and fatal nerve
AoRta: T12 located btw cRuRa, contain aorta with azygos and thoracic duct

Question 4

Cervical rib:

Answer 4

Bands between C7 and the first rib
Found in 1–2% of subjects.
Of these, >50% are bilateral,
x-ray: 10 degree cranial tilt
More common in female الحرمة رقبتها طويلة
Associated with klipple flail deformity (fused vertebrae)