Module 7: Respiratory Flashcards
(156 cards)
1
Q
- kidney shaped
- ovoid space; indented posteriorly
3 Compartments
1. Rt. Pulmonary Cavity
2. Lt. Pulmonary Cavity
3. Mediastinum
A
THORACIC CAVITY
2
Q
THORACIC CAVITY: Three Compartments
A
- Right pulmonary cavity
- Left pulmonary cavity
- the right and left pulm. cavities contain the lungs and pleurae - Mediastinum
- contains the heart, great vessels, thymus, trachea, esophagus
3
Q
- A serous membrane composed of simple squamous mesothelial cells on a thin connective tissue layer that contains collagen and elastic fibers
- Line the pulmonary cavities and lungs
A
PLEURA
4
Q
2 layers of Pleura:
A
- Visceral layer - Refers to the viscera, the internal organs of the body
- Parietal layer - Latin: parietalis – “belonging to the wall”
* The structures that we will be referring when we are talking of PARIETAL PLEURA, I’m referring to the WALL, not the organ. If VISCERAL PLEURA, I’m referring to the ORGAN and that’s the lungs.
5
Q
The layers of visceral and parietal pleura are continuous forming a __. The lung is outside the pleural sac and is surrounded by it
A
pleural sac
6
Q
- also known as the pulmonary pleura
- provides the lung with a smooth slippery, shiny outer surface
- continuous with the parietal pleura at the hilum of the lung
- closely covers the lungs including the fissures
- adheres firmly to the lungs
- in cadaver dissection it cannot be dissected from the lung surface
A
VISCERAL PLEURA
7
Q
- lines the pulmonary cavities
- may be separated from the surface it covers
- thicker than the visceral pleura
A
PARIETAL PLEURA
8
Q
PARTS OF THE PARIETAL PLEURA
A
- Costal Pleura
- MediastinalPleura
- Diaphragmatic Pleura
- Cervical Pleura
9
Q
- covers the internal surfaces of the thoracic wall
A
COSTAL PLEURA
10
Q
- Costal pleura is separated from the internal surfaces of the thoracic wall by __
- forms a natural cleavage plane for surgical separation of the costal pleura from the thoracic wall
A
endothoracic fascia
11
Q
- covers and forms the lateral boundary of the
mediastinum - continues superiorly into the root of the neck as the cervical pleura
- continuous with the costal pleura anteriorly and posteriorly
- continuous with the diaphragmatic pleura inferiorly
A
MEDIASTINAL PLEURA
12
Q
It is the __ that reflects laterally onto the root of the lung to become continuous with the visceral pleura
A
mediastinal pleura
13
Q
- covers the superior or thoracic surface of the diaphragm except at its costal attachments and where it is fused to the pericardium
- the PHRENICOPLEURAL FASCIA is a thin, elastic layer of the endothoracic fascia
- it connects the diaphragmatic pleura with the muscle fibers of the diaphragm
A
DIAPHRAGMATIC PLEURA
14
Q
- dome-shaped cap that covers the apex of lungs
- superior continuation of the costal and mediastinal pleura
A
CERVICAL PLEURA
15
Q
Cervical Pleura forms a cup like dome called the __ that reaches its summit 2-3 cm.superior to the level of medial third of clavicle at the level of the neck of the 1st rib
A
pleural cupula
16
Q
Cervical Pleura is reinforced by the__ membrane which is a fibrous extension of the endothoracic fascia
A
sibson’s fascia or suprapleural
17
Q
- potential space between the layers of the pleura
- also called pleural space
- contains serous pleural fluid
- lubricates the pleural sufaces.
- It allows the layers of pleura to slide smoothly during respiration.
- normally contains 5-10 ml. of clear fluid.
A
PLEURAL CAVITY
18
Q
Abrupt lines along which the parietal pleura changes direction as it passes from one wall of the pleural cavity to another.
A
LINES OF PLEURAL REFLECTION
19
Q
- where the costal pleura become continuous with the mediastinal pleura anteriorly
- start from the cupulae
- run inferomedially at sternoclavicular joints
- meet at the anterior median line (AML)
- descend at 2-4 costal cartilages
A
STERNAL LINE(Rt./Lt.)
20
Q
- pass inferiorly in the AML to the posterior aspect of the xiphoid process (6th costal cartilage)
A
STERNAL LINE (Rt. Side)
21
Q
- pass inferiorly in the AML at the level of the 4th costal cartilage then passes to the left margin of the sternum
- continues inferiorly at the 6thcostal cartilage creating a shallow notch
A
STERNAL LINE (Lt. Side)
22
Q
- where the costal pleura becomes continuous with the diaphragmatic pleura inferiorly
- passes obliquely at the 8th rib (MCL), 10th rib
(MAL) and at the neck of the 12th ribs
A
COSTAL LINE
23
Q
- where the costal pleura becomes continuous with the mediastinal pleura posteriorly
- parallel the vertebral column running in the paravertebral plane from T1 to T12
A
VERTEBRAL LINE
24
Q
- slit-like spaces between the costal and the diaphragmatic pleurae
- located at the most inferior limits of the parietal pleura
A
COSTODIAPHRAGMATIC RECESS
25
- slit-like spaces between the mediastinal and costal pleurae
- located posterior to the sternum
- left recess is larger
COSTOMEDIASTINAL RECESS
26
Injury to the Cervical Pleura
- Due to the inferior slop of the 1st pair of ribs
- Wounds to the base of the neck
- (+) Pneumothorax
- Vulnerable to injury during infancy and childhood
27
Injury to Other Parts of Pleura
- Pleura descend inferior to the costal margin in 3 regions where an abdominal incision might enter a pleural sac:
a. Right part of infrasternal angle
b. Right costovertebral angle
c. Left costovertebral angle
28
- Inflammation of pleura
- Aka pleurisy
- Pleural surfaces are covered with inflammation exudates causing the surfaces to the rough
- Common causes:
o Tuberculosis
o Pneumonia
o Lung abscess
o Lung infarcts
o Bronchiectasis
- Symptoms:
o Sharp stabbing pain
o (+) Pleural rub
o (+) Pleural adhesion
Pleuritis
29
- arise from either the visceral or parietal pleura
- white tumor nodules due to exposure to asbestos
- symptoms: chest pain; dyspnea; pleural effusion
- (+)pleural rub
- (+)pleural adhesion
- (+)asbestos bodies found in the lungs
- Treatment: chemotherapy; radiation therapy; pneumonectomy
Mesothelioma
30
- condition that increases the production of fluid (inflammation, malignancy, congestive heart disease) or impairs the drainage of fluid (collapsed lung) resulting to abnormal accumulation of fluid presence of serous fluid in the pleural cavity
- clinical signs include: decreased breath sounds and dullness on percussion
PLEURAL EFFUSION
31
- entry of air in pleural cavity from the lungs or through the chest wall
- caused by penetrating wound or fractured ribs
PNEUMOTHORAX
32
- sudden entry of air in pleural cavity due to a ruptured bulla (bleb)
SPONTANEOUS PNEUMOTHORAX
33
- pleural cavity is open to the outside air secondary to stab wounds that pierces the thoracic wall and parietal pleura
OPEN PNEUMOTHORAX
34
- air pressure builds up on the wounded side
| - collapsed lung is on the injured side and the opposite lung is compressed by the deflected mediastinum
TENSION PNEUMOTHORAX
35
- blood in pleural cavity caused by stab or bullet wounds
| - injury to intercostal or internal thoracic vessel
HEMOTHORAX
36
THE SECRET FORMULA
air + serous fluid=hydropneumothorax
air + pus=pyopneumothorax
air + blood=hemopneumothorax
pus –air (without air)= empyema
37
- amount of blood and air determines the extent of pulmonary collapse
- PRIMARY ATELECTASIS is the failure of a lung to inflate at birth
- SECONDARY ATELECTASIS is the collapse of a previously inflated lung
ATELECTASIS
38
- insert a hypodermic needle through an ICS into pleural cavity
- obtain sample of fluid or remove blood or pus
- needle is inserted at the 9th ICS MAL
THORACENTESIS
39
- diagnostic and therapeutic procedure using a thoracoscope
- small incision into the pleural cavity
- biopsies can be taken
THORACOSCOPY
40
- incision at 5th or 6th ICS in MAL
- extracorporeal end of the tube is connected to an underwater drainage system
- removes major amounts of blood, fluid, pus and air; allows reinflation of collapsed lung
CHEST TUBE
41
- conical in shape
- attached to the mediastinum only by its root
- weight of healthy adult lung:
right lung = 620gms.
left lung = 570 gms
LUNGS
42
Healthy Lungs
- light
- soft, spongy, elastic
- fully occupy the pulmonary cavities
43
Cadaveric Lungs
- discolored
- firm/hard to touch
- shrunken
44
Each lung has:
```
o Apex
o Base
o 2 or 3 lobes
o 3 surfaces
o 3 borders
```
45
- blunt superior end
- ascends above the level of the 1st rib into the root of the
neck
- about 1 inch above the clavicle
APEX OF THE LUNGS
46
- extensive necrosis and cavitation of apex and superior lobe of lung
PULMONARY TUBERCULOSIS
47
- concave inferior surface of the lungs
| - rests on the diaphragm
BASE OF THE LUNGS
48
Right vs Left Lung
The right lung is larger and heavier than the left. It is shorter and wider and it has a straight anterior border. Left lung has a lingula.
49
- has 3 lobes divided by the oblique and horizontal fissures
1. superior lobe
2. middle lobe
3. inferior lobe
Right Lung Lobes
50
- has 2 lobes divided by the oblique fissure
1. superior lobe
2. inferior lobe
- indented anterior border which is the cardiac notch
- lingula is a tongue-like process
LEFT LUNG LOBES
51
- most common accessory lobe which appears superior to the hilum
- azygos vein arches over the apex and not over the hilum
- right lung in approx. 1% of people
Azygos Lobe
52
- patchy consolidation of the lungs
| - multilobar, bilateral and basal
BRONCHOPNEUMONIA
53
- fibrinosuppurative consolidation of a large portion of a lobe or entire lobe
LOBAR PNEUMONIA
54
complications include:
- abscess formation
- empyema
- bacteremic dissem.
treatment: antibiotics
BRONCHOPNEUMONIA AND LOBAR PNEUMONIA
55
- line drawn along the 4th costal cartilage to meet the oblique fissure in the midaxillary line
- above the __ is the upper or superior lobe and below it lies the middle lobe of the right lung
- there is no __ on the left lung
HORIZONTAL FISSURE
56
- extends from the level of the spinous process of T2 vertebra posteriorly to the 6th costal cartilage anteriorly
- the upper or superior lobe lies above and anterior to the oblique fissure while the lower lobe lies below and posterior to it
OBLIQUE FISSURE
57
- where the costal and mediastinal surfaces meet anteriorly and overlap the heart
- begins behind the sternoclavicular joint down to the xiphisternal joint
ANTERIOR BORDER OF THE LUNGS
58
- begins behind the sternoclavicular joint but deviates laterally at the level of the 4th costal cartilage then goes
downward to the xiphisternal joint
- the anterior border of the left lung has a deep cardiac notch due to the deviation of the apex of the heart to the left side
- this notch indents the antero-inferior aspect of the superior lobe of the left lung
ANTERIOR BORDER OF THE LUNGS
59
- where the costal and mediastinal surfaces meet posteriorly
- broad and rounded
- lies at the side of the thoracic region of the vertebral column
- extends from the spinousprocess of the 7th cervical vertebra to the 10th thoracic vertebra
POSTERIOR BORDER OF THE LUNGS
60
- circumscribes the diaphragmatic surface of the lung
INFERIOR BORDER OF THE LUNGS
61
3 SURFACES OF THE LUNGS
1. Costal Surface
2. Diaphragmatic Surface
3. Mediastinal Surface
62
- large, smooth, convex
- related to the costal pleura
- posterior part referred to as vertebral part of costal surface
COSTAL SURFACE
63
- concave; deeper concavity on the right lung
- forms the base of the lung
- rests on the dome of the diaphragm
DIAPHRAGMATIC SURFACE
64
- concave because it is molded to the mediastinal structures
- includes the hilum
- (+) lung impressions
MEDIASTINAL SURFACE
65
- wedged-shaped on the mediastinal surface
- doorway through which structures forming the root of the lungs enter or exit the lungs
- the root of the lungs includes the following:
* bronchi
* pulmonary arteries and veins
* pulmonary plexus of nerves
* lymphatic vessels
HILUM
66
ROOT OF LUNGS
1. Main bronchus is in the middle of the posterior boundary
2. Superior and inferior pulmonary veins are anteriormost and inferiormost
3. pulmonary artery is superiormoston the left
4. superior lobar bronchus may be superiormoston the right
67
- area of continuity between visceral and parietal layers
PLEURAL SLEEVE (MESOPNEUMONIUM)
68
- continuity of the visceral and parietal pleura inferior to the root of the lung
- consists of a double layer of pleura separated by a small amount of connective tissue
- loose fold that allows the movement of the pulmonary
vessels and large bronchi during respiration
PULMONARY LIGAMENT
69
- Provide clues to the relationship of the lungs
| - Formed by the structures adjacent to them
LUNG IMPRESSIONS
70
- (+) cigarette smoking
- arise in mucosa of large bronchi
- (+) cough/hemoptysis
- spread to: brain, lungs bones, adrenals
BRONCHOGENIC CARCINOMA
71
- cartilaginous and membranous tube
- 12-14 cm. long 1 inch in diameter in the adult
- 16-20 cartilagenous rings keep the lumen of the trachea open
- extends from the lower border of the cricoid cartilage and
ends at the carina
- bifurcates at the level of the sternal angle into main bronchi of each lung
- posterior free ends of the cartilage are connected by smooth muscle - TRACHEALIS MUSCLE
TRACHEA
72
- contracts during the cough reflex to narrow the tracheal lumen and produce stronger expulsion of air and mucus
- relaxes during swallowing to facilitate the passage of food by allowing the esophagus to bulge into the lumen of the trachea
trachealis muscle
73
- keel-like ridge
- cartilaginous projection of last tracheal ring
- mucous membrane covering the carina is the most sensitive assoc. with cough reflex
- enlargement of tracheo-bronchial lymph node may distort the carina
CARINA
74
TRACHEA: Blood Supply
upper 2/3 supplied by INFERIOR THYROID ARTERIES
| lower 3rd supplied by BRONCHIAL ARTERIES
75
TRACHEA: Nerve Supply
- sensory nerve from the vagi and recurrent laryngeal nerve
| - sympathetic nerves supply the trachealis muscle
76
TRACHEA: Lymph Node
lymph drains into the:
- pretracheal lymph nodes
- paratracheal lymph nodes
- deep cervical nodes
77
COMPRESSION OF TRACHEA due to
- enlarged thyroid gland
| - dilatation of the aortic arch (aneurysm)
78
RIGHT vs LEFT MAIN BRONCHI
1. Right Main Bronchus
- wider
- shorter
- more vertical
2. Left Main Bronchus
- narrower
- longer
- horizontal
79
- lined by pseudostratified tall columnar ciliated epithelial cells
- abundant mucus and serous glands are present with ducts opening into the bronchial lumen
- in the primary bronchi most cartilage rings encircle the lumen
RIGHT AND LEFT MAIN BRONCHI
80
- the right bronchus is about 1 inch long
- before entering the hilum of the lung it gives off the superior lobar bronchus
- on entering the hilum it divides into a middle and inferior lobar bronchus
RIGHT MAIN BRONCHI
81
- the left main bronchus is about 2 inches long
- passes below the arch of the aorta and in front of the
esophagus
- divides into a superior and inferior lobar bronchus
LEFT MAIN BRONCHI
82
- foreign bodies tend to enter and lodge into one of the branches of the right bronchus due to its physical properties
- common in children
- pins, screws, peanuts and parts of chicken bones
FOREIGN BODY ASPIRATION
83
- enables the physician to examine the:
* trachea
* carina
* main bronchi
* lobar bronchi
* beginning of segmental bronchi
- obtain biopsy specimens
- remove inhaled foreign bodies
BRONCHOSCOPY
84
LOBAR BRONCHI (SECONDARY BRONCHI)
THE RIGHT AND LEFT MAIN BRONCHI DIVIDE INTO
| >> LOBAR BRONCHI (3 ON THE RIGHT; 2 ON THE LEFT) EACH OF WHICH SUPPLIES A LOBE OF THE LUNG
85
- lined by columnar ciliated epithelium
- have firm cartilagenous walls
- supplies a pulmonary lobe; 3 on the right and 2 on the left
LOBAR BRONCHI (SECONDARY BRONCHI)
86
SEGMENTAL BRONCHI (TERTIARY BRONCHI)
EACH LOBAR BRONCHUS DIVIDES INTO >> TERTIARY SEGMENTAL BRONCHI
87
- each segmental bronchus passes to a structurally and functionally independent unit of a lung lobe called a bronchopulmonary segment
SEGMENTAL BRONCHI (TERTIARY BRONCHI)
88
CONDUCTING BRONCHIOLE
BEYOND THE SEGMENTAL BRONCHI ARE 20-25 GENERATIONS OF BRANCHING CONDUCTING BRONCHIOLES THAT END AS >> TERMINAL BRONCHIOLES (LESS THAN 1mm IN DIAMETER)
89
- bronchioles lack cartilage in their walls
- lack glands or alveoli
- end as terminal bronchioles (smallest conducting bronchiole)
TERMINAL BRONCHIOLE
90
RESPIRATORY BRONCHIOLE
TERMINAL BRONCHIOLES (LESS THAN 1mm IN DIAMETER) >>RESPIRATORY BRONCHIOLE (DIAMETER=0.5mm)
91
- characterized by scattered thin walled outpocketings (alveoli) that extend from their lumens
- involved in air transportation and gas exchange
- end by branching into 2-11 alveolar ducts
RESPIRATORY BRONCHIOLE
92
ALVEOLAR DUCTS
RESPIRATORY BRONCHIOLE (DIAMETER=0.5mm) >>ALVEOLAR DUCTS (2-11)
93
- elongated airways lined with alveoli leading to the alveolar sacs
- give rise to 5-6 alveolar sacs
ALVEOLAR DUCTS
94
- tubular passages with numerous thin-walled outpouchings
- consists of several alveoli
- each alveolus is surrounded by a rich network of blood capillaries where gaseous exchange takes place
ALVEOLAR SACS
95
- the lobes of the lungs are subdivided into
smaller units called bronchopulmonary segments
- defined as the area of distribution of a bronchus
BRONCHOPULMONARY SEGMENTS
96
knowledge of the bronchopulmonarysegments is essential
for:
- interpretation of diagnostic images
- surgical resection of diseased segments
BRONCHOPULMONARY SEGMENTS
97
BRONCHOPULMONARY SEGMENTS (RIGHT)
1. superior lobe
- apical
- posterior
- Anterior
2. middle lobe
- lateral
- medial
3. inferior lobe
- superior
- medial basal
- anterior basal
- lateral basal
- posterior basal
98
BRONCHOPULMONARY SEGMENTS (LEFT)
1. superior lobe
- apical
- posterior
- anterior
- superior lingular
- inferior lingular
2. inferior lobe
- superior
- medial basal
- anterior basal
- lateral basal
- posterior basal
99
CHARACTERISTICS OF A BRONCHOPULMONARY SEGMENT 1
1. pyramidal-shaped with apices facing the lung root and bases at pleural surface
2. 18-20 in number
- 10 in right lung
- 8-10 in left lung
3. largest subdivisions of a lobe
4. separated by connective tissue septa
5. named according to a segmental bronchi supplying them
100
CHARACTERISTICS OF A BRONCHOPULMONARY SEGMENT 2
6. supplied by segmental bronchus and a tertiary branch of the pulmonary artery
7. drained by intersegmental parts of the pulmonary vein that lie in the connective tissue between
101
CHARACTERISTICS OF A BRONCHOPULMONARY SEGMENT 3
surgically resectable
A. pneumonectomy - whole lung
B. lobectomy - lobe of lung
C.segmentectomy - bronchopulmonary segment
102
- blood clots occluding the large pulmonary arteries usual source-thrombi in deep veins of the leg in the form of blood clot, fat globule or air bubble
- results in a lung sector that is ventilated with air but not perfusedwith blood
- right side of heart is dilated because blood cannot be pushed through the pulmonary circuit (acute corpulmonale)
- symptoms: acute respiratory distress
- risk factors: pulmonary hypertension, heart failure and pulmonary atherosclerosis
- prophylactic therapy: anticoagulation; ambulation; compression stockings
PULMONARY EMBOLISM
103
RIGHT AND LEFT PULMONARY ARTERIES 1
arise from the pulmonary trunk carrying low-oxygen blood to the lungs for oxygenation
>> divides into lobar arteries
104
RIGHT AND LEFT PULMONARY ARTERIES 2
```
lobar arteries divides into >>
Right Lung
-superior lobar
-middle lobar
-inferior lobar
```
Left Lung
- superior lobar
- inferior lobar
105
RIGHT AND LEFT PULMONARY ARTERIES 3
lobar arteries divides into >> tertiary segmental arteries
106
RIGHT AND LEFT PULMONARY VEINS
superior and inferior pulmonary veins >>carry well oxygenated blood from the lungs to the left atrium of the heart
107
- receive blood from the bronchopulmonary segments
- drains blood from the:
visceral pleura
peripheral regions of the lung
distal components of the root of lung
RIGHT AND LEFT PULMONARY VEINS
108
RIGHT AND LEFT BRONCHIAL ARTERIES
single right bronchial artery may arise directly from the aorta or indirectly from the post. intercostal >> two left bronchial arteries arise from the thoracic aorta
109
supply blood to the:
- root of lungs
- supporting tissues of the lungs
- visceral pleura
RIGHT AND LEFT BRONCHIAL ARTERIES
110
drain the proximal part of the roots of the lungs
RIGHT AND LEFT BRONCHIAL VEINS
111
PARASYMPATHETIC FIBERS
- bronchoconstrictor
- vasodilator
- secretory to alveolar glands of bronchial tree
112
SYMPATHETIC FIBERS
- bronchodilators
- vasoconstrictor
- inhibitory to alveolar glands of bronchial tree
113
- drains the lung parenchyma and visceral pleura
| - drain into the bronchopulmonary lymph nodes (hilar lymph nodes)
Subpleural Lymphatic Plexus
114
- drain structures that form the root of the lung
| - drain initially to the pulmonary lymph nodes then to the hilar lymph nodes
Bronchopulmonary Lymphatic Plexus
115
- Double-domed
- Musculo-tendinous partition
- Right dome is higher than the left dome
- Convex superior
- Concave inferior
- Chief muscle of inspiration
DIAPRHAGM
116
- Divided into 3 leaves, resembling a cloverleaf
- Aponeurotic tendon of all muscular fibers of diaphragm
- Lies near the center of the diaphragm
- Caval opening perforates the central tendon
CENTRAL TENDON
117
- Situated peripherally
- Forms a continuous sheet
- Divided into 3 parts based on peripheral attachments:
o Sternal
o Costal
o Lumbar
MUSCULAR PART
118
Two muscular slips that attach to the posterior of xiphoid process
Sternal Part
119
- Wide muscular slips
- Attaches to the internal surfaces of the inferior six costal cartilages and ribs
- Forms right and left domes
Costal Part
120
- Arises from the medial and lateral arcuate ligaments and 3 superior lumbar vertebrae
- Forms the right and left muscular crura
Lumbar Part
121
Musculotendinous bundles that arise from:
o Superior 3 lumbar vertebrae
o Anterior longitudinal ligament
o IV discs
CRURA
122
- Larger and longer
- Arise from the first 3-4 lumbar vertebrae
- Form the right and left sides of the esophageal hiatus
Right Crura
123
- Lies to the left of midline
| - Arise from the first 2-3 lumbar vertebrae
Left Crura
124
LIGAMENTS (Diaphragm)
Two important ligaments
o Lateral arcuate ligament
o Medial arcuate ligament
- Also known as lumbosacral arches
125
- Upper thickened border of psoas fascia
| - Lies between the body of the 2nd Lumbar and tip of the transverse process of 1st limb
Medial Arcuate Ligament
126
- Extends from the tip of the transverse process of the 1st lumbar vertebra to the lower border of the 12th rib
- associated with quadratus lumborum
Lateral Arcuate Ligament
127
(DIAPHRAGMATIC APERTURES)
-Opening in the central tendon
- Transmits the following:
o Inferior vena cava
o Terminal branches of phrenic nerve
o Lymphatic vessels
*This is the most superior part.
CAVAL OPENING
128
```
(DIAPHRAGMATIC APERTURES)
- Located in muscle of right crus
- Transmits the following:
o Esophagus
o Anterior and posterior vagal trunks
o Esophageal branches of left gastric vessels
o Lymphatic vessels
```
ESOPHAGEAL HIATUS
129
```
(DIAPHRAGMATIC APERTURES)
- Opening posterior to diaphragm
- Lies anterior to the body of the 12th thoracic vertebra between the crura
- Transmits the following:
o Aorta
o Thoracic duct
o Azygos vein
o Hemiazygos vein
*This is the most inferior part
```
AORTIC HIATUS
130
- Located between the sterna and costal attachments of the diaphragm
- Transmits the following:
o Superior epigastric vessels
o Lymphatic vessels
STERNOCOSTAL TRIANGLE
131
ACTIONS OF THE DIAPHRAGM
Phrenic nerve stimulation >> Diaphragm contracts >> Diaphragm descends >> Domes are pulled inferiorly >> Abdominal viscera pushed inferiorly >> Increased volume of thoracic cavity >> Decreased intrathoracic pressure >>
Air is taken into the lungs
132
ARTERIES OF THE DIAPHRAGM: SUPERIOR SURFACE OF DIAPHRAGM
1. Pericardiacophrenic artery
2. Musculophrenic artery – from thoracic aorta
3. Superior phrenic artery – from abdominal aorta
133
VEINS OF THE DIAPHRAGM: SUPERIOR SURFACE OF DIAPHRAGM
1. Pericardiacophrenic vein
2. Musculphrenic vein
3. Superior phrenic vein of right side
134
ARTERIES OF THE DIAPHRAGM: INFERIOR SURFACE OF DIAPHRAGM
Inferior phrenic artery
135
Veins Of The Diaphragm: Inferior Surface Of Diaphragm
Right inferior phrenic vein
| Left inferior phrenic vein
136
Nerves of the Diaphragm
Motor Supply
- Right and left phrenic nerves (C3-C5)
Sensory Supply
- Centrally: Phrenic nerves
- Peripherally: Intercostal nerves Subcostal nerves
137
BOCHDALEK HERNIA
- L.T., 43 y/o, female
- Chief complaint: difficulty breathing
- Physical examination:
o Chest/Lungs: symmetrical chest expansion, no retractions, no lagging, decrease breath on left lower lung field, no crackles, no wheezes
Plan: Reduction and repair of diaphragmatic hernia through laparotomy; possible close tube thoracostomy, left; possible thoracotomy, left
Laparotomy; Adhesiolysis; Reduction of Bochdalek hernia; On-lay mesh repair
Diagnosis: Bochdalek Hernia, Left
138
- Postero-lateral defect of the diaphragm
- Occurs on the left
- Life-threatening breathing difficulties
CONGENITAL DIAPHRAGMATIC HERNIA
139
Protrusion of a part of the stomach into the thoracic cavity through the esophageal hiatus
HIATAL NERNIA
140
- Important anatomic division of thorax
- Lies between right and left pleura
- Near median sagittal plane of chest
- Site of localized disorders
- Contents: Thoracic viscera (EXCEPT lungs)
MEDIASTINUM
141
Mediastinum can be divided into 2 subdivisions:
o Superior mediastinum
| o Inferior mediastinum
142
Mediastinum: BORDERS
```
Superior: Thoracic inlet
Inferior: Diaphragm
Anterior: Sternum
Posterior: Vertebral column
Lateral: Parietal pleura
```
143
(Divisions of Mediastinum)
- Above plane that passes through sternal angle and lower border of T4 vertebrae
- Above the imaginary line
- Sternal angle of Louie = T4
SUPERIOR MEDIASTINUM
144
SUPERIOR MEDIASTINUM: Boundaries
Anterior: Manubrium
Posterior: Upper thoracic vertebrae
Lateral: Pleura
145
SUPERIOR MEDIASTINUM: Contents
- Sternohyoid
- Sternothyroid
- Upper part of SVC
- Aortic arch
- Trachea
- Innominate artery and vein
- Esophagus
- Left common carotid artery
- Highest intercostal vein
- Left subclavian artery
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(Divisions of Mediastinum)
- Below plane between sternal angle and lower border of T4 vertebrae
- Area below the imaginary line
- Can be further subdivided into small regions:
o Anterior mediastinum
o Middle mediastinum
o Posterior mediastinum
- The subdivisions are dined by their relationship to pericardial sac
INFERIOR MEDIASTINUM
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- small space
- Boundaries:
anterior : body of sternum
posterior : pericardium
- contains:
fats
sternopericardial lig
thymus [in some]
1. Anterior Mediastinum
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- Space bounded by pleura
- Contains:
heart
ascending aorta
pulmonary artery
phrenic n / vessels
trachea bifurcation
lower part of superior vena cava
2. Middle Mediastinum
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- Irregular triangular space [blue] parallel to vertebral column
- Boundaries:
Anterior: pericardium
Posterior: T4-12 vertebra
Lateral: mediastinal pleura
3. Posterior Mediastinum
150
Posterior Mediastinum contains:
- esophagus
- thoracic aorta
- thoracic duct
- thoracic sympathetic trunk
- azygos / hemiazygos veins
- vagus nerve
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Masses generally arise from structures posterior to the heart. You can use the mnemonic LATTE to remember these structures:
```
o Lymph nodes
o Aorta
o Trachea, bronchi
o Tumor
o Esophagus
```
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- The film is in front and the light is coming from the back to the front
- This is preferred over anteroposterior view because x-ray beams are divergent. So the further the structure of concern is from the film, the larger it is projected
- Heart – does not want to be magnified or projected
therefore PA View is more optimal than AP View
Posteroanterior view
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- Done if the patient is debilitated or has problem standing upright
- The film is in the back and the light is coming from the front to the back
Anteroposterior view
154
- To look at the apical segment of the lung
| - To view the mid lung and anterior base
Lordotic view
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- Oblique view is used view mid lungs and cardiac
| contour
Right anterior oblique view
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- Left lateral decubitus – patient is lying on left side
- Patient should be in the lateral lying position 15 mins before the imaging procedure to let the body fluid be pulled by gravity
- The film is in the back
Decubitus view
