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thorax anatomy Flashcards

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1
Q

Thorax inlets and outlet borders:

A
  • Superior thoracic aperture: 1st thoracic vertebra, 1st ribs + costal cartilages, superior border of manubrium.
  • Outlet: Between clavicle and first rib.
  • Inferior thoracic aperture: 12th thoracic vertebra, lower 4 costal cartilages (7-10), ribs 11-12, xiphisternal joint.
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2
Q

what are the 3 facets, where do each articulate with

Facets on thoracic vertebrae (and articulations):

A
  • Body of each vertebrae: superior and inferior facets
    -> superior facet articulates with the head of the rib of the same number
    -> inferior facet articulates with the head of the rib below (one number higher)
  • Transverse process of the vertebrae: costal facet
    -> articulates with the tubercle of the rib of the same number
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3
Q

Atypical thoracic vertebrae:

A

T11-12 have no costal facets on their transverse processes.

typical thoracic vertebrae
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4
Q

rib number what? special characteristics of each atypical rib?

Atypical and typical ribs:

A
  • Atypical: 1, 2, 10, 11, 12
    (can remember as all with numbers 0, 1 and 2 in it)
    -> ribs 1, 10, 11 and 12:
    only has 1 facet, located on head
    => articulate ONLY w/ 1 thoracic vertebrae (same number)
    -> ribs 11 and 12:
    no neck or tubercle,
    do not have anterior attachment to sternum and instead ends freely in abdominal muscles
    (floating ribs)
  • Typical: 3-9
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5
Q

Accessory muscles of ventilation:

identify from picture
A
  • Pectoralis major
  • Serratus anterior
  • Pectoralis minor
  • Subclavius

“PSPS”

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6
Q

Three types of intercostal muscles (and functions + directions):

A

External intercostal, internal intercostal and innermost intercostal.
* EICM: Runs downwards and forwards (i.e. towards steernum),
Elevates ribs
* IICM, INICM: Runs downwards and backwards (i.e. away from ribs),
Depress ribs

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7
Q

Branches of an intercostal nerve:

A

Anterior cutaneous, lateral cutaneous, muscular, collateral.<br></br><br></br><u>CLAM</u>

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15
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16
Q

Arterial supply of thoracic cage:

A

Anterior intercostal artery and posterior intercostal artery supplies the cage.<br></br><br></br>AIA arises from <u>internal thoracic</u> artery or <u>musculophrenic</u> artery (terminal branch of ITA). ITA arises from the subclavian artery.<br></br><br></br>First two PIA arises from <u>costocervical trunk</u> of subclavian artery, whilst the other nine directly come from the <u>thoracic aorta</u>. 

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17
Q

Venous drainage of thoracic cage:

A

Anterior intercostal veins drain into the internal thoracic/mammary vein.<br></br><br></br><br></br>Posterior intercostal veins:<br></br><br></br>Uppermost intercostal veins drain directly into the brachiocephalic veins. <br></br><br></br>Left 2-4 posterior intercostal veins come together and form the left superior intercostal vein, which empties into the left brachiocephalic vein.<br></br><br></br>Right 2-4 posterior intercostal veins come together and form the right superior intercostal vein, which empties into the azygos vein. <br></br><br></br>The rest of the posterior intercostal veins eventually drain into the azygos vein.<br></br><br></br><img></img>

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18
Q

Diaphragm innervation:

A

Left and right phrenic nerves, ventral rami of C3-5. 

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19
Q

Where do muscular fibres of diaphragm arise from:

A

Xiphoid process, lower ribs and upper lumbar vertebrae.

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20
Q

Structures passing through opening of diaphragm:

A

T8: Inferior vena cava. <br></br>T10: Oesophagus, vagus nerve.<br></br>T12: Aorta, thoracic duct, azygos vein. <br></br><br></br>VENA CAVA is 8 letters.<br></br>OESOPHAGUS & VAGUS NERVE is 10 letters.<br></br><br></br><img></img>

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21
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23
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25
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30
Reflection of parietal pleura:
Starts 2cm above clavicle, and combines at the sternal angle, from 2nd-4th costal cartilage. 

Left side: Diverges 1cm away at 6th costal cartilage, then meets midclavicular line at 8th costal cartilage, then midaxillary line at 10th costal cartilage, and then paravertebral line at 12th costal cartilage.

Right side: Remains behind sternum until 6th costal cartilage, before following the same path as left side. 
31
Limit of lungs:
Upper limits follow the parietal pleura.

Lower limits lie two ribs above the parietal pleura. So they meet at midclavicular line at 6th rib, midaxillary at 8th rib, and paravertebral at 10th rib.
32
Pleura innervation:
Parietal pleura innervated by somatic plexuses, which are branches of intercostal and phrenic nerves. 

Visceral pleura innervated by visceral plexuses, which are autonomic nerves (insensitive to pain).
33
Positions of root of lungs:
Generally, pulmonary vein is inferior, whilst pulmonary artery is superior. The bronchus sits posteriorly to the vessels. 

Anterior to posterior is: VAB

The inferior pulmonary ligament is a fused triangular-shaped sheet of... | Download Scientific Diagram
34
Why do foreign bodies mainly get stuck in right bronchus?
The right bronchus is wider, shorter and angles more vertically than left.
35
What are bronchopulmonary segments and how many are there?
A bronchopulmonary segment is a region on the lung that has its own neurovascular supply. 

10 on each lung.
36
Trachea relations (what structures lie around it):
Anterior: Sternum, left brachiocephalic vein, brachiocephalic trunk (artery), left common carotid artery, arch of aorta. 

Posterior: Oesophagus, left recurrent laryngeal nerve.

Left: Arch of aorta, left common carotid artery, left subclavian artery, left vagus and left phrenic nerves.

Right: Azygos vein, right vagus nerve.

Take note some structures are not shown here:
37
Position of nerves relative to root of lungs:
Phrenic nerves run in front of root of lungs, whilst vagus nerves run behind root of lungs. 
38
Root of lungs structures:
Within each root and located in the hilum are:
  • Pulmonary artery
  • Two pulmonary veins
  • Main bronchus
  • Bronchial vessels
  • Nerves
  • Lymphatics

PBPBNL: Two PBs, New Lengths 
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What structures sit on upper border of rib, clinical significance?
Collateral branch of intercostal nerve. 

When inserting needle into thoracic cavity, must avoid the upper border of ribs.
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Neurovascular bundles in rib area run between [...] muscles.
Neurovascular bundles in rib area run between internal intercostal muscles and innermost intercostal muscles.


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The middle lobe of the right lung corresponds to which ribs?
Ribs 4-6
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What branches off internal thoracic artery and where does it divide?
The ITA divides at the 6th rib into the musculophrenic artery and superior epigastric artery. 
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Trachea relation to vertebrae:
Begins at C6 and ends around T4-5 (at sternal angle), where it branches to bronchi.
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Horizontal and oblique fissure surface anatomy:
Horizontal fissure: Horizontal line from where 4th costal cartilage articulates with sternum. 

Oblique fissure: Follows 6th rib.
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Mediastinum is split into:
Superior and inferior: Anterior, middle and posterior. 
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Superior mediastinum relation to bones:
Superiorly by 1st rib and inferiorly by T4.
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Pericardium layers:
Outermost layer is fibrous pericardium which is tough and inelastic.

Serous pericardium is made up of parietal and visceral pericardium. Parietal sticks to fibrous pericardium, and visceral pericardium lies on the heart. 
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What are the borders of heart are formed by?
Superior border: Great vessels (SVC, Aorta, Pulmonary trunk).
 
Right border: Formed by right atrium.
 
Inferior border: Mainly right ventricle and a bit of left ventricle.
 
Left border: Left ventricle and part of left atrium.

Posterior border: Left atrium. 
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Heart sounds:
First sound is the mitral valve closing, second sound is the aortic valve closing. 
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Function of chordae tendinae:
They tense up when the atrioventricular (mitral/tricuspid) valves are closed, holding the cusps in place, preventing the cusps from inverting and causing backflow of blood into atria. 
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Coronary dominance:
The artery that supplies the Posterior Descending Artery (PDA) or posterior interventricular artery determines the coronary dominance.
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Posterior descending artery can be supplied by the [...] and/or the [...]. 
Posterior descending artery can be supplied by the left circumflex artery and/or the right coronary artery. 

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All cardiac veins drain into the coronary sinus, except the [...], which drain into the [...] directly. 
All cardiac veins drain into the coronary sinus, except the anterior cardiac veins, which drain into the right atrium directly. 
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The [...] vein (a tributary to [...] vein) travels with the anterior interventricular artery/ left anterior descending artery.

The [...] vein travels with the left circumflex artery. 

The [...] vein travels with the posterior descending/ posterior interventricular artery.

The [...] vein travels with the marginal branch of the right coronary artery.
The anterior interventricular vein (a tributary to great cardiac vein) travels with the anterior interventricular artery/ left anterior descending artery.

The great cardiac vein travels with the left circumflex artery. 

The middle cardiac vein travels with the posterior descending/ posterior interventricular artery.

The small cardiac vein travels with the marginal branch of the right coronary artery.

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The anterior interventricular vein (a tributary to great cardiac vein) travels with the [...] artery.

The great cardiac vein travels with the [...] artery. 

The middle cardiac vein travels with the [...] artery.

The small cardiac vein travels with the [...].
The anterior interventricular vein (a tributary to great cardiac vein) travels with the anterior interventricular artery/ left anterior descending artery.

The great cardiac vein travels with the left circumflex artery. 

The middle cardiac vein travels with the posterior descending/ posterior interventricular artery.

The small cardiac vein travels with the marginal branch of the right coronary artery.

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The superior vena cava is formed by union of [...].
The superior vena cava is formed by union of left and right brachiocephalic veins.

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The brachiocephalic vein is formed by the union of [...] (same for both sides).
The brachiocephalic vein is formed by the union of subclavian and internal jugular vein (same for both sides).
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Both recurrent laryngeal nerves are branches of the [...] (on the respective sides). 

The left recurrent laryngeal nerve hooks around the [...]. Therefore, it enters the mediastinum. 

The right recurrent laryngeal nerve hooks around the [...]. Therefore, it does not enter the mediastinum. 
Both recurrent laryngeal nerves are branches of the vagus nerve (on the respective sides). 

The left recurrent laryngeal nerve hooks around the arch of aorta. Therefore, it enters the mediastinum. 

The right recurrent laryngeal nerve hooks around the right subclavian artery. Therefore, it does not enter the mediastinum. 
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In coronary circulation, which veins drain into the coronary sinus?
  1. Posterior cardiac vein.
  2. Small cardiac vein.
  3. Middle cardiac vein.
  4. Great cardiac vein.

P90 SMG
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The septomarginal trabecula/moderator band functions by [...]. It is found only in the [...]. 
The septomarginal trabecula/moderator band functions by conducting cardiac impulses from right bundle of fibres to the papillary muscles. It is found only in the right ventricle. 
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Contents of superior mediastinum:
Arteries: Aortic arch.

Veins: Superior vena cava, brachiocephalic veins.

Nerves: Vagus, phrenic, left recurrent laryngeal nerves.

Others: Thoracic duct.

Organs: Thymus, trachea, oesophagus. 
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Contents of anterior mediastinum:
May contain part of thymus in infants and children. As thymus shrinks with age, the thymus recedes and no longer occupies anterior mediastinum in adults. 
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Contents of middle mediastinum:
Arteries: Ascending aorta, pulmonary arteries.

Veins: SVC, right and left pulmonary veins.

Nerves: Right and left phrenic nerves, cardiac plexuses.

Others: Lymph nodes.

Organs: Heart with pericardium.
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Contents of posterior mediastinum:
Arteries: Thoracic aorta.

Veins: Azygos vein.

Nerves: Sympathetic chain and trunk.

Others: Thoracic duct.

Organs: Oesophagus.
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The oesophagus is continuous from the [organ] at [...].

It pierces the diaphragm at [...], joining with the stomach. 
The oesophagus is continuous from the pharynx at C6.

It pierces the diaphragm at T10, joining with the stomach. 
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The arch of aorta begins to the [L/R] of the [...] ([vertebral level]), curves upward and back down, moving towards the [...], ending anterior to the [...] vertebra.
The arch of aorta begins to the left of the sternal angle (T4), curves upward and back down, moving towards the midline, ending anterior to the T4 vertebra.
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Branches of ascending aorta:
Left and right coronary arteries.
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Branches of aortic arch:
Brachiocephalic trunk, left common carotid, left subclavian arteries.
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Branches of descending aorta:
Posterior intercostal, oesophageal, subcostal (below 12th rib), bronchial, pericardial, mediastinal arteries.

POSB PM
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Thoracic duct drains all lymph from the body except those coming from the [...].
Thoracic duct drains all lymph from the body except those coming from the right side of chest, right upper limb, and right side of head and neck.


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The thoracic duct drains into the venous angle near the union of the [...]. 
The thoracic duct drains into the venous angle near the union of the left internal jugular vein and left subclavian vein. 
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Thoracic duct course:
Originates from the cisterna chyli in the abdomen, ascends through aortic opening at T12.

In posterior mediastinum, thoracic duct lies between the azygos vein and thoracic aorta. 

At the level of the sternal angle (T4/5), the duct crosses to the left and lies posterior to the oesophagus, ascending into the superior mediastinum and draining into the venous angle. 

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Constrictions of the oesophagus:
  1. C6: At the junction between the pharynx and the oesophagus. 
  2. Sternal angle (T4): Where the arch of aorta crosses to the left of the oesophagus. It is constricted by the aortic arch and the left main bronchus.
  3. T10: Oesophageal hiatus when oesophagus pierces the diaphragm.


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Auscultation
Auscultation
Remarks
Right upper sternal border (to the right and slightly below the sternal angle)
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Auscultation
Auscultation
Remarks
Left upper sternal border (to the left and slightly below the sternal angle)
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Auscultation
Auscultation
Remarks
4th left intercostal space; right at the lower border of sternum
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Auscultation
Auscultation
Remarks
5th left intercostal space at mid-clavicular line
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The left anterior descending artery supplies the [...] and [...], [quantity] of the [...], and [...]. 
The left anterior descending artery supplies the left and right ventricles, 2/3 of the interventricular septum, and AV bundle. 
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The left circumflex artery supplies the [...] and [...]. 
The left circumflex artery supplies the left atrium and left ventricle. 
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The right coronary artery supplies the [...] and [...]. 
The right coronary artery supplies the right atrium and right ventricle. 
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The right marginal branch of the right coronary artery supplies the [...]. 
The right marginal branch of the right coronary artery supplies the right ventricle. 
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The posterior descending artery supplies the [...] of the [...], and [...] portions of the [part of heart].
The posterior descending artery supplies the posterior 1/3 of the interventricular septum, and adjacent portions of the ventricles.
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What is an end artery?
An artery that is the only supply of oxygenated blood to a part of a tissue.
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Visceral heart pain:
In a heart block, the cardiac plexus afferent fibres transmits signals to the spinal cord, which is in close proximity to somatic afferent fibres supplying the T1-T4/5 dermatomes. 

Therefore, the T1-T4/5 regions (upper left arm) will feel pain if there is something occluded in the heart.
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The cardiac plexus consists of a superficial part, [...]. It also consists of a deep part, [...]. 
The cardiac plexus consists of a superficial part, inferior to the aortic arch and between it and the pulmonary trunk. It also consists of a deep part, between the aortic arch and the tracheal bifurcation. 


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The posterior mediastinal lymph nodes receive lymph from:
Posterior intercostal spaces, posterior aspect of pericardium, posterior surface of diaphragm, and oesophagus.
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Nerve supply to pericardium (name of nerves and functions):
Phrenic nerves (sensory), sympathetic nerves (vasomotor), vagus nerve (function uncertain).
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Parietal pleura referred pain:
Costal and peripheral parts of the pleura are referred along intercostal nerves to thorax and abdominal wall.

Mediastinal and central parts of the pleura are referred along phrenic nerves to C3-5 (root of neck and top part of shoulder). 
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What is the triangle of safety? Borders and significance:
Lateral edge of pectoralis major, lateral edge of latissimus dorsi, 5th intercostal space (generally nipple level). 

It is where an incision is made to insert a chest tube. Remember, incision is made above upper border to prevent damage to collateral branches.


British Thoracic Society's triangle of safety detailing anatomic... | Download Scientific Diagram
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Does visceral pleura line the horizontal and oblique fissures of the lung?
Yes
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Simple description of blood flow to kidneys:
  • Aorta
  • Renal arteries 
  • Segmental arteries (5 per kidney; poor anastomosis).
  • Interlobar arteries
  • Arcuate arteries
  • Cortical radiate arteries
  • Afferent arterioles, glomerulus, efferent arterioles, peritubular capillaries/vasa recta.
  • Cortical radiate veins
  • Arcuate veins
  • Interlobar veins (no segmental veins)
  • Renal vein
  • IVC


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The phrenic nerve supplies the mediastinal and central [...], the [...] pericardium, the [...] layer of [...] pericardium, and the [...].
The phrenic nerve supplies the mediastinal and central parietal pleura, the fibrous pericardium, the parietal layer of serous pericardium, and the diaphragm.

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Which part of the heart forms the surfaces of the heart? (Different from borders)
  • Anterior (or sternocostal) – Right ventricle.
  • Posterior (or base) – Left atrium.
  • Inferior (or diaphragmatic) – Left and right ventricles.
  • Right – Right atrium.
  • Left – Left ventricle.
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Thoracic sympathetic ganglia
Thoracic sympathetic ganglia
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Thoracic sympathetic ganglia
Thoracic sympathetic ganglia
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The azygos vein drains into the SVC at [vertebral level].
The azygos vein drains into the SVC at T4.
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Arrangement of neurovascular structures on 1st rib:
Scalene tubercle separates two grooves for subclavian artery and vein.

Subclavian vein is anterior to subclavian artery.

Scalenus anterior muscle attaches to scalene tubercle, separating the subclavian artery and vein. 

Recall that brachial plexus is sandwiched between scalenus anterior and scalenus medius. Therefore, the brachial plexus lies with the subclavian artery. 


Non-Traumatic First Rib Fracture in University Wrestler
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Lower ribs are more involved in [...] movement, increasing transverse diameter.

Upper ribs are more involved in [...] movement, increasing antero-posterior diameter.
Lower ribs are more involved in bucket handle movement, increasing transverse diameter.

Upper ribs are more involved in pump handle movement, increasing antero-posterior diameter.

Getting A Handle On Our Ribs — Hands On Therapeutics
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[...] ribs are more involved in bucket handle movement, increasing [...] diameter.

[...] ribs are more involved in pump handle movement, increasing [...] diameter.
Lower ribs are more involved in bucket handle movement, increasing transverse diameter.

Upper ribs are more involved in pump handle movement, increasing antero-posterior diameter.

Getting A Handle On Our Ribs — Hands On Therapeutics

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