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Musculoskeletal System > Imaging And Clinical Anatomy Of The Thorax > Flashcards

Imaging And Clinical Anatomy Of The Thorax Flashcards

1
Q

Describe the innervation of the thoracic wall

A

Posterior rami
Ventral rami- anterior and lateral cutaneous

Pain from the thoracic wall structures including the pleura is felt on the skin

The pain is mediated by somatic sensory nerves and as a result is felt at the corresponding area

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2
Q

What conditions cause thoracic wall pain?

A

Inflammation of the costochondrial joints, costvertebral points

Pleurisy

  • pain from the parietal pleura is felt at a different location depending on the area affected
    • Central diaphragmatic and mediastinal; C3,4,5(phrenic nerve)
    • Costal; the corresponding rib level

Skin lesions such as herpes zoster

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3
Q

Explain the herpes zoster-shingles

A

After infection with varicella zoster virus (chicken pox) the virus remains dormant in Sensory ganglia

  • Dorsal root ganglia of spinal nerves
  • Trigeminal ganglion
  • Geniculate ganglion of facial nerve
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4
Q

When is herpes zoster reactivated?

A

It may be reactivated during times of severe stress or use of steroids

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5
Q

What are the effects of herpes zoster?

A

Causes eruption of vesicles similar to chicken pox on the skin along the dermatome of the affected nerve

  • Usually unilaterally
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6
Q

What are the milk line(ridges)?

A

Two vertical thickenings of the ectoderm from the axilla to the inguinal region (embryology)

-In humans only two areas start differentiation into mammary tissue, the remainder of the milk lines involutes

  • Nipples and breasts may develop anywhere along these lines in both males and females
    • Remnants May resemble a mole

Such additional breast can be functional and subject to breast disease

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7
Q

What is polymastia?

A

Ectopic mammary gland; fully functional

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8
Q

What is polythelia?

A

Extra nipples more common in males

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9
Q

What are the main parts of the mammary gland?

A

Axillary tail (of Spence)

Retromammary space

T4 cutaneous nerve

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10
Q

What is the axillary tail of Spence of the mammary gland?

A
  • Breast tissue that extend into the axilla

- Subject to tumor development even if the rest of the breast is clear

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11
Q

What is the function of the T4 cutaneous nerve if the mammary gland?

A

T4 cutaneous nerve

Supply to the nipple corresponds to the T4 dermatome

Even in pendulous breasts

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12
Q

What is the function of the retromammary space in the mammary gland?

A

Space between the breast and the pec muscles

Allows free movement of the breast

Breast is firmly attached to the pectoral fascia by the suspensory ligaments

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13
Q

What are the clinical quadrants of the breast?

A

Upper lateral: UL

UM: upper medial

LL: Lower lateral

LM: lower medial

This is important as it relates to lymph drainage and therefore cancer metastases

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14
Q

Explain breast self examination

A
  • Self examination of the breast is important for early detection of irregularities.
  • Some women have naturally lumpy breasts which may change depending on the phase of the menstrual cycle
  • It is important to compare the two sides as normal lumps will have a similar pattern on both sides
  • Any changes or new lumps should be reported to the physician and investigated
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15
Q

What is Pau d’ orange/orange peel ?

A

The Sunkist oranges typically have this pitted appearance and hence the description “peau d’ orange”

This is due to blockage of the lymphatic channels leading to lymohodema in the skin, akin to water retention

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16
Q

What happens when peau d’ orange becomes advanced?

A

The cancerous ligaments invade suspensory ligaments and the nipple retracts as a result

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17
Q

What is a nanmmography used for?

A

Specific for veiwing the breast

Also uses x-rays

18
Q

What are some examples of non-malignant opaque lumps seen in mammogram?

A

Some examples of non-malignant lumps
-Fibroadenomas

  • Fibroadenosis
  • Breast cysts
19
Q

What is the significance of the mammogram showing opaque lumps ?

A

Does not necessarily indicate cancer

-Confirm with biopsy

  • Lymph node biopsy essential for determining the stage of cancer
    • Sentinental node always biopsied

Benign lumps generally cause pain

20
Q

What is the blood supply of the breast?

A

The breast is supplied by a variety of vessels
-internal thoracic sends small segmental branches

  • lateral thoracic artery
  • pectoral artery
21
Q

What is the innervation of the breast?

A

Innervation to the skin corresponds to the dermatomes

-The nipple is supplied by the T4 nerve

22
Q

What is the first node that lymph drains from any of the quadrants?

A

Sentinel node

23
Q

Where does lymph drain into first from the breast?

A

Lymph will drain first to the nearest group of nodes (typically anterior)

Continue to move from node to node until ultimately into the apical nodes

Eventually into Bronchomediastinal and Subclavian trunk

Joins the veinous system by left or right main duct

24
Q

What is the function of axillary nodes ?

A

Receives 75% lymph from breast

25
Q

What is the function of para sternal nodes for the breast?

A

Receives only 25%

Some may cross to contralateral

26
Q

What is radical mastectomy?

A

Surgical removal of the entire breast

It includes removal of the axillary tail and associated lymph nodes
-The number and extent of lymph node removal is determined by the stage (axillary clearance)

27
Q

What damages often occur in a radical mastectomy?

A

Three nerves are commonly damaged

  • long thoracic
  • thoracodorsal
  • intercostobrachial

Damage occurs during lymph node removal
-May also occur due to scarring

Causes muscle weakness, pain and restricts movement

28
Q

What is lymohedema?

A

Can be a consequence of mastectomy or radiation therapy

  • Removal of/damage to axillary lymph nodes leads to decreased lymphatic drainage of the upper limb
  • accumulation of intestinal fluid
29
Q

How does inspiration affect x-ray?

A

On full inspiration 9- 10 ribs should be visible

Posterior ribs are used for counting

The anterior ribs are faint because of the costal cartilages

30
Q

Differentiate the between the anterior and posterior aspects of ribs

A

Anterior:
-Visible but are more difficult to see

-Oriented downward (obliquely)

  • Attach to the sternum or each other with cartilage that is usually not visible on x-rays
    • May clarify later in life and will then be visible

Posterior:

  • Immediately more appearent on frontal chest radiographs
    • Usually the ones that are counted
  • Oriented more or less horizontally
  • Each pair if. Posterior ribs attaches to a thoracic vertebral body
31
Q

Explain the siting of lateral Thoracic X-ray

A

Spine appears to be darker caudally

  • More air in the lower lung lobes and the thoracic wall is thinner
  • The sternum should be seen edge on
  • Posteriorly you should see two sets of ribs
  • The right ribs are large due to magnification and usually projected posterior to the left ribs if the patient was examined in a true lateral position
32
Q

Explain rib fractures

A

Ribs May fracture at a single point or multiple points

-The weakest area of the rib during compression forces is the angle

Single point rib fractures typically do not need fixation as they are more stable

  • Causes Can be as strange as a sudden bout of serious coughing
  • The only symptom of uncomplicated fractures is chest pain or none and due to lack of associated trauma are often incidental finds
33
Q

What other injuries May rib fractures be associated with?

A
  • sternal injuries are uncommon even with direct trauma

- Trauma from posterior may involve injuries to the vertebrae instead of or in addition to ribs

34
Q

How is a rib fracture indicated on the x-ray?

A

A visible darker area indicates that the two parts are no longer continuous at that point

35
Q

Explain the clinical relevance if multiple point fractures

A

Associated with trauma; specifically vehicular accidents and pathology

-When pressure is applied from anterior, ribs may fracture in more than one place

  • These fractures cause instability to the chest wall and may be associated with trauma to the pleura and/or blood vessels
    • pneumothorax (air in the pleural cavity)
    • hemothirax (blood in the pleural cavity)
36
Q

What is flail chest?

A

From a motor vehicle accident

Multipoint fracture of consecutive ribs

Segment becomes loose from the rest of the chest wall

Patient presents with shallow labored breathing

The fractured segment(s) move in the opposite direction from the remainder of the chest when the patient breathes

37
Q

Explain pleurisy/pleuritis

A

Inflammation of the pleura

  • The inflamed pleural layers rub against each other every time the lungs expand
  • Causing sharp pain during respiration
  • Pain is localized to the area affected because it is supplied by somatic nerves

May radiate to the shoulder due to the phrenic nerve innervation to the central diaphragmatic pleura

On auscultation pleural friction rub (scratching) sounds are evident as long as the patient breathes

38
Q

What is the neurovascular bundle ?

A

Travels in costal groove on inferior aspect of rib

All incisions/tubes placed above rib to avoid VAN:
Thoracocentesis- “pleural tap” to sample fluid from pleural space
Thoracostomy- chest tube inserted to drain fluid or air from pleural cavity

39
Q

Summarize thoracocentesis

A

Needle inserted into the pleural cavity to obtain a sample of fluid

9th ICS—> mid axillary line during expiration, directed slightly upwards

Collateral branches are of no clinical consequences, so needle is always superior to the rib

40
Q

What are the surface landmarks of the pleura at the mid-clavicular line(exhaled)?

A

Inferior border of lung- rib 6

Inferior edge of parietal pleura - rib. 8

41
Q

What are the surface landmarks of the pleura at the mid-axillary line(exhaled)

A

Inferior border of lung- rib 8

Inferior edge of parietal pleura- rib 10

42
Q

What are the surface landmarks of the pleura at the paravertebral(exhaled)?

A

Inferior border of lung- TV10

Inferior edge of parietal pleura- TV12

Musculoskeletal System (41 decks)

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