How do the external intercostal muscles run?
Obliquely anteriorly and inferiorly in the intercostal spaces
How do the internal intercostal muscles run?
Obliquely posteriorly and inferiorly in the intercostal spaces deep to, and at right angles, to the external intercostals
What are the disease processes involving the pleural lining?
Pleuritis Pleural adhesion Pneumothorax Hemothorax Pleural exudates/effusion Empeyma (pyothorax) Chylothorax
What is the complication with hemo or pneumothorax?
Compression of the parenchyma tissues of the lung resulting in respiratory distress
What are the lower borders of the costal pleura?
8th rib - MCL
10th rib - MAL
12th rib - neck
How can you safely access the pericaridal sac?
At the left parasternal area, between costal cartilages 4 and 6
Can be entered without piercing the pleural space and lungs
Where are the three places the pleura extends below the costal margins
Right xiphisternal angerl
Right and left costovertebral angles
Anteriorly, what is the upper border of the lung?
Apex rises about 2-4cm above the inner (medial) third of the clavicle
The slow of the lower borders of the lung run….?
2 ribs above the plerual reflection
Lower border crosses the 6th rib at the MCL and T10 in MSL
Where do you find the oblique fissure?
Begins on the anterior chest at the level of the 6th rib MCL and extends laterally upward
Crosses the 5th rib in the MAL
Crosses the 4th rib and 4th interspace
Ends at the spinous process of T4
Where do you find the horizontal fissure?
Extends form the fourth rib at the sternal border
Follows the contour of the costal cartilage of the 4th rib
Crosses the foruth interspace and ends at the oblique fissue, after crossing the 5th rib in the MAL
Where does the trachea bifurcate?
Anteriorly - level of the sternal angle
Posteriorly - T4 spinous process
Where is the right hemidiaphragm located?
At the level of the 5th rib anteriorly
Describe the vena caval hiatus
Inferior vena cava and branches of the right phrenic nerve
Describe the esophageal hiatus
Esophagus, anterior and posterior vagus nerve, esophageal branches of the left gastric vessels
Describe the aortic hiatus
Azygos vein, thoracic duct, lymph vessels
NOT the aorta - it runs posterior the the median arcuate ligament and anterior to the 12th rib
Describe the steronocostal hiatuses?
Superior epigastric vessels
What are the structures that pass through the diaphragm without a specific hiatus?
Thoracic splanhnic nerves
Branches of the phrenic nerves
That thoracic landmark is at level: T2?
That thoracic landmark is at level: T3?
Base of scapular spine
Top of aortic arch
That thoracic landmark is at level: T4?
Sternal angle (manubriosternal junction)
Second costal cartilage
Upper end of the ascending aorta
Beginning of descending aorta
Arch of azygos vein and its entrance into the superior VC
Fusion of right and left mediastinal pleura in anterior midline
That thoracic landmark is at level: T7?
Inferior angle of scapula
That thoracic landmark is at level: T8/9 disc?
Vena caval hiatus
That thoracic landmark is at level: T9?
That thoracic landmark is at level: T10?
That thoracic landmark is at level: T12?