Main
- Ribs
- Ribcage protects the heart and lungs, expands and contracts to allow for respiration
- 12 pairs
- 7 true ribs
- Articulate directly with sternum
- 5 false ribs
- 8-10 articulate with costal cartilage of ribs above
- 11 and 12 are floating ribs
- 7 true ribs
- Vessels
- Inferior posterior part of rib, in the costal groove
- In between internal and innermost intercostal muscles
- From superior to inferior
- Intercostal vein
- Intercostal artery - arise from superior intercostal artery, internal thoracic, and musculophrenic arteries
- Posterior intercostal arteries off of aorta
- intercostal nerve - anterior divisions T1-T11 Thoracic nerves
- Supply thoracic wall, pleura and peritoneum
- To avoid damaging these vessels, procedures that involve piercing the ribcage are done near the superior border of the rib
- Inferior posterior part of rib, in the costal groove
- Mediastinum
- Area of the thorax bounded by the sternum, thoracic vertebrae, superior and inferior thoracic apertures, and pleural cavities
- Superior mediastinum
- Contents
- Anterior mediastinum
- Middle mediastinum
- Posterior mediastinum
- Contents
- Thoracic part of descending aorta
- Azygos vein
- Hemiazygos and accessory hemiazygos
- Vagus nerve
- Splanchnic nerves
- Sympathetic chain
- Esophagus
- Thoracic duct
- Contents
- Superior mediastinum
- Clinical
- Anterior
- Substernal thyroid goiters, lymphoma, thymoma, teratoma
- Middle
- Lymphadenopathy
- Posterior
- Neurogenic tumors
- From nerve sheath (mostly benign)
- From elsewhere (mostly malignant)
- Neurogenic tumors
- Mediastinitis
- Pneumomediastinum
- Air in the mediastinum
- Can lead to pneumothorax, pneumoperitoneum, pneumopericardium
- Air in the mediastinum
- Anterior
- Area of the thorax bounded by the sternum, thoracic vertebrae, superior and inferior thoracic apertures, and pleural cavities
- Lungs
- Right lung
- 3 lobes
- Superior lobe
- Horizontal fissure
- Middle lobe
- Oblique fissure
- Inferior lobe
- Can not hear inferior lobe from anterior chest
- Superior lobe
- Root and Hilum
- Contents
- Bronchus
- Pulmonary artery (deoxygenated blood)
- Pulmonary vein (oxygenated blood)
- Bronchial artery
- Pulmonary plexus of nerves and lymph vessels
- Pulmonary arteries anterior to bronchii
- Contents
- 3 lobes
- Left lung
- 2 Lobes
- Superior lobe
- Oblique fissure
- Inferior lobe
- Superior lobe
- Root and Hilum
- Contents
- Bronchus
- Pulmonary artery (deoxygenated blood)
- Pulmonary vein (oxygenated blood)
- Bronchial artery
- Pulmonary plexus of nerves and lymph vessels
- Pulmonary arteries superior to bronchus
- Contents
- 2 Lobes
- Pleural cavities
- Visceral
- Covers the lungs
- Innervated by pulmonary plexus (vagus)
- Autonomic innervation
- Only sensory to stretch
- Innervated by pulmonary plexus (vagus)
- Covers the lungs
- Parietal
- covers internal surface of thoracic cavity
- Innervated by phrenic and intercostal nerves
- Sensitive to pressure pain and temperature
- Innervated by phrenic and intercostal nerves
- covers internal surface of thoracic cavity
- Plueral recesses
- Costodiaphragmatic
- Between costal pleurae and diaphragmatic pleura
- Costomediastinal
- Between costal pleurae and mediastinal pleurae, behind sternum
- Locations where fluid can collect
- Costodiaphragmatic
- Visceral
- Clinical
- Pulmoary embolism – obstruction of pulmonary artery by substance that has traveled from elsewhere in the body
- Thrombus – majority of cases, often arises in a distant vein
- Fat – following bone fracture of ortho surgery
- Air –following cannulation in the neck
- Pneumothorax – collapsed lung
- air leaks into pleural cavity
- Treatment
- Chest tube insertion between ~4th rib
- Diaphragm rises to 5th rib
- Done laterally to avoid dissecting through pectoralis major
- Chest tube insertion between ~4th rib
- Pleural effusion
- Fluid buildup between lungs and pleura
- Causes
- Heart failure
- Pulmonary embolism
- Cirrhosis
- Post open heart surgery
- Treatment
- Thoracentesis
- 9th rib or below around the midscapular line
- Thoracentesis
- Causes
- Fluid buildup between lungs and pleura
- Pulmoary embolism – obstruction of pulmonary artery by substance that has traveled from elsewhere in the body
- Right lung
- Heart
- Located in the middle mediastinum
- Surrounded by pericardium
- Surface anatomy
- Sternocostal border – Right ventricle
- Posterior border – left atrium
- Diaphragmatic border – left and right ventricles
- Coronary sulcus
- represents wall dividing atria from ventricles
- Interventricular sulci
- Internal anatomy
- Atria
- Right atrium
- Receives deoxygenated blood from SVC and IVC
- Pumps deoxygenated blood to right ventricle
- Through tricuspid valve
- 3 cusps attached to chordae tendineae which attach to papillary muscles
- SA node – located lateral to the sinus venarum
- Primarily Parasympathetic innervation
- Responsible for initiation of the cardiac cycle
- AV node- located in Koch’s triangle
- Primarily Sympathetic innervation
- Fossa Ovalis – remnant of fossa ovale
- Left atrium
- Receives oxygenated blood from pulmonary veins
- Pumps oxygenated blood to left ventricle
- Through mitral valve
- 3 cusps attached to chordae tendineae which attach to papillary muscles
- Right atrium
- Ventricles
- Right ventricle
- Receives deoxygenated blood from right atrium
- Through tricuspid valve
- 3 cusps attached to chordae tendineae which attach to papillary muscles
- Pumps blood into pulmonary trunk through semilunar (pulmonary) valve
- Anterior, right, and left semilunar cusps
- Left ventricle
- Right ventricle
- Atria
- Innervation
- Parasympathetic fibers from vagus nerve
- Sympathetic from T1-T5 off of sympathetic trunk
- Clinical
- Pericarditis
- Inflammation of the pericardium
- Most likely due to viral infection
- Pericardial effusion – collection of fluid in the pericardial sac
- Can lead to cardiac tamponade
- Pressure on the heart due to fluid buildup
- Pericardiocentesis
- Procedure to drain fluid from pericardial sac
- Insert needle through left 5th or 6th intercostal space near sternum
- Subxiphoid approach
- Procedure to drain fluid from pericardial sac
- Precordial exam
- Aortic region – 2nd and 3rd intercostal spaces at right sternal border
- Pulmonic region – 2nd and 3rd intercostal spaces at left sternal border
- Tricuspid region - 3-6th intercostal spaces in midclavicular line
- Mitral region - Near apex of the heart between 5th and 6th intercostal spaces in mid clavicular line
- Patent Foramen Ovale
- Failure of fusion between atrial septum primum and secundum
- Tetralogy of Fallot
- 4 signs
- Large ventricular septal defect (VSD)
- Pulmonary stenosis
- Right ventricular hypertrophy
- Overriding aorta
- 4 signs
- Pericarditis
- Aorta/arch
- Receives oxygenated blood from the left ventricle.
- 3 main branches
- Runs inferiorly and posteriorly to become the descending aorta
- Clinical
- Aortic Coarctation
- Stenosis occuring at the arch of the aorta
- Pre-ductal
- Narrowing occurs before the ductus arteriosus
- Congenital
- Can be life threatening
- Post- ductal
- Narrowing occurs after the ductus arteriosus
- Symptoms
- High BP in upper extremities
- Low BP in lower extremities
- Pre-ductal
- Stenosis occuring at the arch of the aorta
- Transposition of the great vessels
- Aorta and pulmonary arteries are switched (Congenital)
- Blood goes to lungs, picks up oxygen, goes back to heart, then back to lungs..
- Symptoms
- Cyanosis
- Clubbed fingers or toes
- Shortness of breath
- Treatment
- Arterial switch procedure (surgery)
- Patent ductus arteriosus
- Congenital defect
- Failure of ductus arteriosus to close, mixing oxygenated and deoxygenated blood
- Symptoms
- shortness of breath
- poor eating
- heart murmur*
- Congenital defect
- Aortic Coarctation
- Trachea
- branch of the pharynx that leads to the lungs, covered by the epiglottis when swallowing
- Carina
- branching point of the trachea into (primary) bronchii
- Right bronchus
- Larger diameter and shorter than left bronchus
- Foreign objects tend to get lodged in this side
- Esophagus
- Branch of pharynx that leads to the stomach
- lined with smooth muscle
- Innervation
- Vagus nerve (parasympathetic)
- T5-T10 (Parasympathetic) - Stomach splanchnic nerve
- Clinical
- Tracheoesophageal atresia w/ without fistula
- Atresia of the esophagus
- Different types depending on fistula/fistula site
- Determined by symptoms
- Air in stomach, spitting up food - atresia with fistula
- Determined by symptoms
- Tracheoesophageal atresia w/ without fistula