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Surface anatomy, lungs and pleura Cat Seymour Objectives Identify important surface landmarks on the anterior thoracic wall and use the sternal angle (of Louis) to accurately number the ribs on a living subject Explain lymphatic drainage of the breast and its importance in the spread of cancer Describe the surface markings of the lungs and pleural reflections Objectives Identify important surface landmarks on the anterior thoracic wall and use the sternal angle (of Louis) to accurately number the ribs on a living subject Explain lymphatic drainage of the breast and its importance in the spread of cancer Describe the surface markings of the lungs and pleural reflections Surface anatomy 3 anterior planes: Anterior Median line 2 Midclavicular lines 3 anterolateral planes: Anterior Axillary line Midaxillary line Posterior Axillary line Surface anatomy Clavicle Jugular notch Manubrium Angle of Louis Xiphisternum Costal margin Anterior axillary fold Objectives Identify important surface landmarks on the anterior thoracic wall and use the sternal angle (of Louis) to accurately number the ribs on a living subject Explain lymphatic drainage of the breast and its importance in the spread of cancer Describe the surface markings of the lungs and pleural reflections The breast Most prominent surface feature Intermammary cleft Nipple- midclavicular line (10th ics in men) Areola Sternum to midaxillary line horizontally 2nd to 6th ribs vertically Present in both sexes Mammary glands developed in women Modified sweat glands Rest on pectoral fascia (2/3rd) Retromammary space Axillary tail Suspensory ligaments 15-20 glandular lobules Drained by lactiferous duct Vasculature of the breast Medial mammary branches of anterior intercostal branches of the internal thoracic artery Lateral thoracic Thoraco-acromial arteries Posterior intercostal arteries, from the thoracic aorta Lymphatics of the breast Spread of cancer Subareolar lymphatic plexus (from the nipple, areola, etc.) 75% to axillary lymph nodes (pectoral, humeral, subscapular, central and apical) Parasternal lymph nodes Abdominal lymph nodes Lymph from axillary nodes drains to infraclavicular and supraclavicular nodes, then to the subclavian lymphatic trunk Objectives Identify important surface landmarks on the anterior thoracic wall and use the sternal angle (of Louis) to accurately number the ribs on a living subject Explain lymphatic drainage of the breast and its importance in the spread of cancer Describe the surface markings of the lungs and pleural reflections Pleura Each lung is enclosed in a pleural sac (2 layers): Visceral pleura- adheres to lungs, cannot be dissected Parietal pleura- adheres to thoracic wall, mediastinum and diaphragm Between the pleural layers is pleural cavity, filled with serous pleural fluid (to visualise pleura, think of pushing your fist into an underinflated balloon) Parietal has nervous innervation, visceral does not Parts of parietal pleura Costal part- covers the internal surface of thoracic wall and is separated from wall by endothoracic fascia Mediastinal part- lateral aspects of mediastinum Diaphragmatic part- superior surface of diaphragm Cervical pleura- extends superior to thoracic inlet into the root of the neck Pleural reflections Abrupt lines where pleura changes direction From 1 wall to another Sternal line Costal line costal pleura becomes continuous with mediastinal pleura ANTERIORLY costal pleura becomes continuous with the diaphragmatic pleura INFERIORLY Vertebral line costal pleura becomes continuous with the mediastinal pleura POSTERIORLY Lungs vs pleura Apices of lungs and cervical pleura pass through superior thoracic aperture Lungs lie adjacent to parietal pleura between 2nd and 4th cc Left pleural reflection moves laterally and inferiorly- cardiac notch 6th cc The right pleura travels parallel to lung down to 6th cc Both pleural reflections pass laterally to midclavicular line at 8th cc Midaxillary line 10th cc Scapular line at 12th rib Pleura extends 2 ribs below lungs 2, 4, 6, 8, 10, 12 Recesses of the pleural cavity Lungs do not completely occupy pleural cavity during expiration Costomediastinal recess- left is larger Costodiaphragmatic recess Lungs expand into recesses during inspiration Thanks for listening! Any questions, email me: [email protected] References: Moore and Agur- Essential Clinical Anatomy Gray’s Anatomy Google images