Abnormalities of the Thoracic Cage

Abnormalities of the Thoracic Cage

• Increase in chronic intra-abdominal pressure can cause ascites and upper abdominal swelling
• Dislocation of ribs, also known as slipping rib syndrome, can occur due to displacement of costal cartilage from the sternum, dislocation of a sternocostal joint, or displacement of the interchondral joints
• This condition usually occurs unilaterally and involves ribs 8, 9, and 10, causing severe pain, particularly during deep inspiratory movements
• It can also produce a lump-like deformity at the displacement site and injure underlying structures such as the diaphragm and/or liver

Rib Separation

• Rib separation refers to the dislocation of a costochondral junction between the rib and its costal cartilage
• It can occur due to a blow to the ribs, a fall, or landing hard on feet
• In separations of the 3rd - 10th ribs, tearing of the perichondrium and periosteum usually occurs
• The rib may move superiorly, overriding the rib above

Thoracotomy

• Thoracotomy is the surgical creation of an opening through the thoracic wall to enter a pleural cavity
• A lateral approach is most satisfactory for entry into the thoracic cage
• It allows surgeons to access major organs such as the heart, lungs, esophagus, thoracic aorta, and the front (anterior part) of the spine

Mid-Sternotomy

• Mid-sternotomy is a surgical procedure that involves dividing the sternum in the median plane
• It is often performed for coronary artery bypass grafting
• The halves of the sternum are joined together (e.g., with wire sutures) after surgery

Sternal Puncture

• Sternal puncture is a procedure that involves inserting a thick needle into the upper part of the manubrium sterni to obtain a bone marrow sample
• It is preferred over other sites because the manubrium is subcutaneous and readily accessible
• The procedure is not advisable in children due to the risk of injury to the arch of the aorta and its branches

Pectus Carinatum and Pectus Excavatum

• Pectus carinatum is an abnormal shape of the thoracic cage in which the chest is compressed from side to side, and the sternum projects forward and downward like a boat’s keel
• Pectus excavatum is an abnormal shape of the thoracic cage in which the chest is compressed anteroposteriorly, and the sternum is pushed backward by the overgrowth of the ribs
• Pectus excavatum may compress the heart and is common in Marfan syndrome

Sternal Fracture

• Sternal fracture is a common injury that occurs in automobile accidents
• It can occur when the driver’s chest is hit against the steering wheel, fracturing the sternum at the sternal angle
• The backward displacement of fractured fragments may damage the aorta, heart, or liver and cause severe bleeding, which may be fatal

Thoracic Outlet Syndrome

• Thoracic outlet syndrome results from compression of the subclavian artery and/or lower trunk of the brachial plexus
• It can be caused by a congenitally hypertrophied scalenus anterior muscle or a cervical rib
• Symptoms include pallor and coldness of skin of the upper limb, diminished radial pulse, numbness, tingling, and pain along the medial side of the forearm and hand, and wasting of small muscles of the hand

This quiz covers various disorders affecting the thoracic cage, including slipping rib syndrome, ascites, and upper abdominal swelling. Topics include symptoms, causes, and effects of these conditions.