Download Personal Anatomy Notes – The Thoracic Cage

Costodiaphragmatic Recess:
 While standing, this is where fluid builds up (pleural effusion)
 Thoracocentesis: removing fluid from the costodiaphragmatic space due to
pleural effusion
o What are the layers of the Pleura? Pleura: Parietal (around organ)
and Visceral (outer layer) layers around the lungs. Potential space in
between (pleural cavity).
o Where should the needle be inserted? Insert needle between ribs 810 (ICS 9) at the mid-axillary line. Needle should be directed directly
superior to the inferior rib. This will minimize the change of
damaging the Neuromuscular Bundle in the ICS.
o What is the order of the Neuromuscular Bundle? Vein, Artery, Nerve.
This means the nerve is the most vulnerable during this procedure.
They other two are more protected by the costal groove.
 Pneumothorax: Presence of air in pleural space. Insert wide needle into 2nd
ICS.
 What type of membrane is the Pleura (and the Pericardium)? Serous
Membrane.
Lungs:
 Right Lung
o 3 Lobes
o Two Fissures: Oblique and Horizontal (AKA: Transverse)
 Left Lung
o 2 Lobes
o One Fissue: Horizontal (AKA Transverse)
What is the area of the thoracic cavity where the lungs are safe but you can access
the heart? Infrasternal Angle. 5th costal cartilage on left side
What is the function of the Bronchial Arteries? They are for nourishment. They are
branches of the Aorta. They can take over if Pulmonary Arteries become blocked.
What is the function of the Pulmonary Arteries? They are for gas exchange.
Which lung has the cardiac notch?
 The lung, which is why it is smaller and only has two lobes
Tracheobroncial Tree Branches:
 Left Main Bronchus – Longer, narrower, more oblique
o Superior Lobe
 Apico-posterior
 Anterior
 Superior/Inferior Lingula
o Inferior Lobe

 Superior Basal
 Anterior Basal
 Medial Basal
 Lateral Basal
 Posterior Basal
Right Main Bronchus – Shorter, wider, straighter
o Superior Lobe
 Apical
 Posterior
 Anterior
o Middle Lobe
 Lateral
 Medial
o Inferior Lobe
 Superior (Apical) Basal
 Anterior Basal
 Medial Basal
 Lateral Basal
 Posterior Basal
If a foreign body is accidentally traveling down your trachea, which side of the
carina will it mostly likely go down?
 The right side – shorter, wider, straighter
If it continues further down, and the patient was standing/sitting when it happened,
where would it most likely end up?
 RASSP. Sitting/Standing = Posterior Basal
If it continues further down, and the patient was lying down (recumbent) when it
happened, where would it most likely end up?
 RASSP. Recumbent = Apical/Superior Basal (This is also for Mendelson’s
Syndrome!!!)
What structure isolates one Bronchopulmonary Segment from another? Why is this
significant? Each pulmonary structure is contained by Pulmonary Veins. This is
significant because if you are removing one of the segments, the Pulmonary Veins
are the borders in which you stop removing tissue.
At what lobe do you have the Cardiac Notch? Left Superior Lobe
Lymphatic Drainage of the Lungs: (same concept as the heart)
 Right Lymphatic Duct drains 25% of body.
 Left Thoracic Duct drains 75% of body.
o ** Thoracic Duct is the DUCK between TWO GOOSES. (The thoracic
duct is located between the Esophagus and the Azygous Vein)

Tracheobroncial nodes filter the fluid.
o Bronchopulmonary Nodes drain fluid from Broncopulmonary
Segments.
o What lymphatic trunk does all of this drain into? The
Bronchomediastinal Trunk.
Respiratory Auscultation:
If I wanted to auscultate the inferior lobes of BOTH the left and the right lungs,
where would I go?
 Posteriorly (the back of the patient)
If I wanted to auscultate the Superior, Middle, and Inferior lobes of the Right Lung,
where would I go?
 Laterally (the side of the patient)
Transverse Thoracic Plane:
If a patient comes in with a stab wound to the Manubriosternal Joint (Angle of
Louis), what structures could possibly be damaged?
R: Rib 2
A: Aorta
T: Trachea
P: Pulmonary Trunk
L: Ligamentum Anteriosum (connects Aortic Arch to Pulmonary
Trunk)
A: Azygous Vein
N: Nerves (Left Recurrent Laryngeal)
T: Thoracic Duct
A: Arches
Aortic Arch and Azygous Arch
B: Bifurcations
Trachea (carina)
Pulmonary Trunk
C: Changes Direction
Esophagus
Aorta
Thoracic Duct
Sympathetic Chain:


Where is it located? Posterior Mediastinum
What kind of ganglion is found towards the top of the Sympathetic Chain?
Stellate Ganglion
Breasts:
 What is the name of the lymph nodes that drain the majority of the breast?
Axillary Lymph Nodes
 What is the name of the group of Axillary Lymph Nodes that drain the
majority of the breast? Pectoral Region
 Where does the majority of the lymph drain from in the breast? Lateral 75%
of breast
 What are Rotter’s Nodes? Also called interpectoral because they are between
the Pectoral Major and Pectoral Minor muscles. They are clinically relevant
in relationship to metastasis with breast cancer.
 What dermatome is correlated with the breast? T4.
 What lymph nodes drain the medial aspect of the breast? 25% medially to
Parasternal Nodes
 What nerves can possibly be injured during mastectomy? Long Thoracic
Nerve and Thoracodorsal Nerve
 What does severing the Long Thoracic Nerve lead to? Winged Scapula – The
innervation of the Serratus Anterior Muscle is severed, so nothing can hold
the scapula onto the back. The Rhomboids pull the scapula the opposite way.
 What ligament causes the Orange Peel Appearance? Ligament of Cooper
 What is another sign of breast cancer? Inversion of the nipple.
 What is the million-dollar space? The Retro-Mammary Space
Innervation of the Lungs:
 What does the Sympathetic Nervous System do? It is a Bronchodilator
 What does the Parasympathetic Nervous System do? It is a
Bronchoconstrictor
Trauma on the Thoracic Wall:
 CC 1-3 on right side: Superior Vena Cava
 CC 2-3 on left side: Ascending Aorta
 Cardiac Notch: Will only affect the heart
 Shattering Medial Clavicle: Apex of lung
Boerhaave’s Syndrome: A rupture of the esophageal wall, where the gastric contents
flow up the esophagus. Presents with severe chest pain and vomiting.
Diaphragm:




Which structures pierce the diaphragm at:
o T8: Inferior Vena Cava, Phrenic Nerve,
o T10: Vagus Nerve, Esophagus
o T12: Azygous, Aorta, Thoracic Duct
I Phrenically 8, 10 Vial Eggs, At Around Twelve (12)
What is the innervation of the Diaphragm? Phrenic Nerve, C-3-4-5
What is the diaphragm the principle muscle for? Inspiration
Hernias:
 Acquired:
o Sliding Hernia: The lower esophageal sphincter slides into the
thoracic cavity, allowing the contents of the stomach to come up into
the esophagus leading to acid reflux. Worst one of the two.
o Rolling Hernia (Paraesophageal): The hernia occurs and protrudes
but the sphincter stays in place so that no gastric contents can flow
into the esophagus.
 Congenital Hernias
o Morgagni Hernia: Anterior herniation
o Bochdalek Hernia: Posteriolateral, (compresses the lung) Worst of the
two.
Thoracic Outlet Syndrome
 Syndrome occurring when there is compression at the Thoracic Inlet
(opening at the top of the thoracic cage). Results from excess pressure
placed on a neuromuscular bundle. It affects the nerves that innervate the
upper limb (weakness of hand muscles, numbness, pain, tingling. for
example).
Horner’s Syndrome
 Occurs when the Sympathetic Trunk is damaged (stellate ganglion) It is
characterized by:
o P: Ptosis – Weak, droopy eyelids
o A: Anhydrosis – Decreased sweating
o M: Miosis – Constricted pupil
o PAM is HORNy
o What can it be caused by? Pancoast Tumor – Tumor of the pulmonary
Apex. Can compress veins, arteries, nerves, etc. in the area. Can
compress sympathetic ganglia.
Why should an apical tumor of the right lung produce hoarseness of the voice? It is
compressing the Left Recurrent Laryngeal