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56 Cards in this Set
- Front
- Back
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Naming of intercostal spaces: How are they named? What is the subcostal space? What is the subcostal nerve?
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*Spaces and neurovascular structures are named according to the rib forming the SUPERIOR border of the space; so there are 11 intercostal spaces and 11 intercostal nerves
* SUBCOSTAL SPACE is below the 12th rib *ventral ramus of spinal nerve T12 is the SUBCOSTAL NERVE |
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True ribs
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AKA vertebrocostal ribs
1st - 7th ribs; attach DIRECTLY to the sternum through their own costal cartilages |
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False ribs
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AKA vertebrochondral ribs
8th - 10th ribs; have cartilages that are joined to the cartilage of the rib just superior; therefore have only INDIRECT connection to the sternum |
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Floating ribs
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AKA free ribs
11th-12th and sometimes 10th ribs; have rudimentary cartilages that do not attach to sternum at all end in abdominal musculature |
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Manubrium
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superior part of the sternum
lies at level of T3 and T4 vertebrae superior border is the JUGULAR NOTCH (SUPRASTERNAL NOTCH) lateral to jugular notch are the paired CLAVICULAR NOTCHES below clavicular notches, 1st rib articulates |
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Sternal angle (of Louis)
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at level of IV disc between T4 and T5
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Body of sternum
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at level of T5-T9
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Xiphoid process
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at T10 level
Midline marker for superior level of liver, central tendon of diaphragm, inferior border of heart. |
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Superior thoracic aperture
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AKA thoracic inlet
Posterior boundary is T1 vertebra Lateral boundary = 1st pair of ribs/their costal cartilages Anterior boundary = superior border of manubrium Passing through to thorax: trachea, esophagus, vessels, nerves |
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Inferior thoracic aperture
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AKA thoracic outlet
Diaphragm closes off thorax, separates it and abdomen here. Structures passing through must go either: 1. through the diaphragm -e.g., IVC and esophagus 2. posterior to diaphragm -e.g., aorta |
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Inferior thoracic aperture: boundaries
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-Posteriorly = T12 vertebra
-Posterolaterally = ribs 11 and 12 -Anterolaterally = costal margin -Anteriorly = xiphisternal joint |
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Joints of thoracic wall
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1. intervertebral joints
2. costovertebral joints a. joints of the heads of ribs b. costotransverse joints 3. Sternocostal joints 4. Sternoclavicular joints 5. Costochondral joints 6. Interchondral joints 7. Manubriosternal joints* 8. Xiphisternal joints* *7. and 8. may be fused in older people. |
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Thoracic outlet syndrome
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Actually refers to the superior thoracic aperture (the thoracic inlet). Here "outlet" emphasizes the fact that nerves and vessels pass through to lower neck and upper neck. Various types of syndromes exist that may affect these components.
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Costoclavicular syndrome
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A thoracic outlet syndrome. Compression of nerves/vessels passing to upper limb between the clavicle and 1st rib, leading to numbness, pallor of upper limb and diminished radial pulse. More noticeable when the angle between the neck and shoulder is increased.
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Changes in thoracic dimensions during NORMAL INSPIRATION
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-Thoracic volume INCREASES with INSPIRATION
-VERTICAL DIMENSION: increases when diaphragm contracts, compressing abdominal viscera -ANTEROPOSTERIOR DIMENSION: increases when intercostal muscles contract; PUMP-HANDLE movement of ribs and sternum -TRANSVERSE DIMENSION: increases slightly when intercostal muscles contract, raising the middle, lateralmost parts of ribs, especially lower ones; BUCKET-HANDLE MOVEMENT |
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Changes in thoracic dimensions during PASSIVE EXHALATION
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-VERTICAL DIMENSION: decreases when diaphragm relaxes, returns to neutral position, relieving compression of abdominal viscera
-ANTEROPOSTERIOR DIMENSION: diminishes when intercostal muscles relax (PUMP-HANDLE MOVEMENT) -TRANSVERSE DIMENSION: diminishes as intercostal muscles relax (BUCKET-HANDLE MOVEMENT) |
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Accessory muscles of breathing
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PECTORALIS MAJOR, PECTORALIS MINOR, inferior part of ANTERIOR SERRATUS: expand thoracic cavity for deep, forceful inspiration
SCALENE muscles: elevate and fix ribs 1 and 2 during forced inspiration, allowing lower ribs to be more effectively elevated |
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Lateral cutaneous branches
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Arise from about the midaxillary line; branches of intercostal nerves that supply thoracic dermatomes
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Anterior cutaneous branches
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Anterior continuation of intercostal nerves; they pass between the costal cartilages and enter the subcutaneous tissue.
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Typical intercostal nerves
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3rd - 6th intercostal nerves.
Run between the innermost intercostal muscles and the internal intercostal muscles, along the costal groove, along with and inferior to the intercostal artery and intercostal vein. |
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Atypical intercostal nerves
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1st and 2nd: Pass on the internal surfaces of the 1st and 2nd ribs instead of along the inferior margins of the costal grooves.
7th - 11th: After giving rise to the lateral cutaneous branches, continue to supply the abdominal skin and muscles. |
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Arterial supply of intercostal spaces
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With exception of 10th and 11th intercostal spaces, each is supplied by 3 arteries:
1. one large POSTERIOR INTERCOSTAL ARTERY 2. two small ANTERIOR INTERCOSTAL ARTERIES |
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Arterial supply to the thoracic wall
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1. Thoracic aorta
a. posterior intercostal aa. b. subcostal aa. 2. Subclavian artery a. internal thoracic aa. b. supreme intercostal aa. 3. Axillary artery a. superior thoracic aa. b. lateral thoracic aa. |
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Intercostal grooves
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Depression along the posteroinferior surface of the ribs along which run (from superior to inferior)
1. intercostal vein* 2. intercostal artery* 3. intercostal nerve* *mnemonic: VAN (vein, artery, nerve--superior to posterior) |
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Veins of thoracic wall
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Accompany intercostal aa. and nn.
*There are 11 INTERCOSTAL vv. and 1 SUBCOSTAL v. on each side. Posterior intercostal vv. anastomose with anterior intercostal vv. (tributaries of internal thoracic vv.) and usually end in the AZYGOS/HEMIAZYGOS VENOUS SYSTEM |
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Endothoracic fascia: what is it?
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Thin fibroareolar layer b/t internal aspect of thoracic cage and the lining of the parietal pleura.
Blends with periosteum of ribs/sternum and perichondrium of costal cartilages. |
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Endothoracic fascia: what does it invest?
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Internal intercostals, innermost intercostals, and subcostal and transverse muscles.
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Endothoracic fascia: clinical significance?
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Forms cleavage plane so surgeon can separate parietal pleura from thoracic wall to access intrathoracic structures.
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Parts of the parietal pleura
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1. COSTAL -- separated from wall by endothoracic fascia
2. MEDIASTINAL 3. DIAPHRAGMATIC 4. CERVICAL -- extends 2-3 cm above the medial 1/3 of the clavicle; reinforced by the suprapleural membrane |
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Suprapleural membrane
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AKA Sibson fascia
Fibrous extension of the endothoracic fascia spanning the 1st rib and C7 vertebra. Reinforces the cervical pleura. |
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Lines of pleural reflection
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1. STERNAL: sharp; anterior line where costal and mediastinal pleura become continuous
2. COSTAL: sharp; inferior line where costal and diaphragmatic pleura become continuous 3. VERTEBRAL: rounder; posterior area where costal and mediastinal become continuous. |
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Potential pleural spaces
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1. pleural cavity
2. costodiaphragmatic recess 3. costomediastinal recess |
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Pleural cavity
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Potential space between parietal and visceral pleura. Normally only contains a small amount of serous fluid.
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Costodiaphragmatic recess
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"Gutter" around the outer edge of the pleural cavity where the diaphragmatic pleura and the costal pleura meet.
Formed by the upward convexity of the diaphragm--the lungs do not fully occupy the space (although occupy more when expanded for inspiration). |
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Costomediastinal recess
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Smaller potential spaces located posterior to the sternum where costal pleura contacts mediastinal pleura.
Left is potentially bigger than right due to cardiac notch. (Left is good spot for thoracentesis b/c easily accessible). |
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Hilum of the lung
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Area on the medial surface of the lung at where the structures forming the root enter and leave.
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Root of the lung
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Main bronchus, pulmonary vessels, bronchial vessels, lymphatic vessels; enter and leave the lung at the hilum, passing through the pleural sleeve.
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Pleural sleeve
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AKA mesopneumonium.
Area of continuity between the visceral pleura and the parietal pleura; encloses the root of the lung. |
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3 surfaces of the lung
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1. costal
2. mediastinal 3. diaphragmatic |
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3 borders of the lung
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1. ANTERIOR: where costal and mediastinal surfaces meet anteriorly and overlap the heart; CARDIAC NOTCH indents this on left
2. INFERIOR: circumscribes diaphragmatic surface, separates it from costal surface 3. POSTERIOR BORDER: where costal and mediastinal borders meet posteriorly; smooth and rounded |
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Bifurcation of the trachea
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Occurs at the level of the sternal angle
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Right main bronchus
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wider, shorter, more vertical; passes directly to the hilum of the lung
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Left main bronchus
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passes inferolaterally; inferior to arch of aorta; anterior to esophagus and thoracic aorta
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Lobar bronchi
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AKA secondary bronchi
divide from main bronchi (primary bronchi) 3 on right; 2 on left; one to each lobe |
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Segmental bronchi
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AKA tertiary bronchi
Divide from lobar bronchi Supply the bronchopulmonary segments |
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Bronchopulmonary segments
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pyramidal, with apex toward root and base at pleural surface
named according to segmental bronchus that supplies it supplied by tertiary branch of pulmonary artery drained by intersegmental parts of pulmonary veins divide to 20-25 generations of branches ending in TERMINAL BRONCHIOLES Surgically resectable units |
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Terminal bronchioles
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divisions of bronchopulmonary segments
give rise to several generations of RESPIRATORY BRONCHIOLES |
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Respiratory bronchioles
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Divisions of terminal bronchioles
Each one branches to 2-11 ALVEOLAR DUCTS, each of which gives rise to 5-6 ALVEOLAR SACS |
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Pulmonary alveolus
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Structural unit of gas exchange in the lung
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Arterial blood supply to lungs
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*IS POORLY OXYGENATED BLOOD
One PULMONARY ARTERY toward root of each lung-->branches to superior lobe before entering HILUM-->descends POSTEROLATERAL to MAIN BRONCHUS-->branch into LOBAR aa.-->branch into SEGMENTAL aa. |
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Venous return from lungs
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*OXYGEN-RICH BLOOD
PULMONARY CAPILLARIES--> unite into larger and larger veins-->INTRASEGMENTAL VEINS-->INTERSEGMENTAL VEINS in the SEPTA-->one main vein drains each bronchopulmonary segment, usually on anterior surface of the corresponding bronchus-->two PULMONARY VEINS from each lung drain into the left atrium |
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Venous return from the VISCERAL PLEURA
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Veins drain into the pulmonary veins
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Venous return from the PARIETAL PLEURA
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Veins drain join the systemic veins in adjacent parts of the thoracic wall
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Bronchial arteries
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Supply blood to structures making up the root of the lungs, the supporting tissues of the lung, and the visceral pleura
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Origin of LEFT bronchial arteries
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thoracic aorta
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Origin of RIGHT bronchial arteries
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Varies; may be
1. a SUPERIOR POSTERIOR INTERCOSTAL ARTERY 2. a common trunk from the THORACIC AORTA with the RIGHT 3RD POSTERIOR INTERCOSTAL ARTERY 3. a LEFT SUPERIOR BRONCHIAL ARTERY |
