Thoracic Duct & Lung Cancer Metastasis

• Auscultation of the tricuspid valve is best heard on the level of the fifth intercostal space, right sternal border.
• Cancer of the right lung may metastasize to the right hilar lymph nodes, which are the same as the bronchiopulmonary nodes. The metastasis then spreads to superior/inferior tracheobronchial nodes, pre+para tracheal nodes, and finally the right bronchomediastinal lymph trunk, leading to the thoracic duct.
• The thoracic duct originates at the level of T12 – L1 posterior to the aorta
• The thoracic duct lies along the left margin of the oesophagus in the superior mediastinum. It crosses from the right to the left side at the fourth thoracic vertebra level.
• The thoracic duct may enter the left subclavian vein in the venous angle and starts in the abdominal cavity as a dilation called the cisterna chyli.
• Irritation of the phrenic nerves is a source of hiccups and they provide motor and sensory innervation to the diaphragm and sensory innervation to the pericardium.
• Three bronchopulmonary segments locate in the superior lobe of the right lung
• Mitral valve is best heard on the left side in the midclavicular line in the 5th intercostal space
• Pulmonary valve is located on the level of second left intercostal space.
• The conus arteriosus (infundibulum) matches the right ventricle
• The Crista terminalis matches the right atrium
• The right main bronchus is more likely for a foreign object to fall into, because it is wider, shorter, and more vertical than the left main bronchus.
• A hypodermic needle through an intercostal space should be inserted superior to the rib and at the level of the 7th - 9th intercostal space to avoid the intercostal nerves and vessels.
• Splanchnic nerves are mainly preganglionic sympathetic fibers and only pelvic nerves are parasympathetic.
• The ductus arteriosus connects the left pulmonary artery and the arch of the aorta and its closure begins soon after birth.
• Injury to the thoracodorsal nerve (C6-C8) during surgery on scapular lymph nodes would affect the latissimus dorsi muscle.
• The sympathetic trunk lies on each side of the vertebral column and in thorax gives 12 paravertebral ganglia.
• Autonomic system originates from the Vagus nerve.
• The pericardium is the only one that is innervated by branches from the phrenic nerve.
• The ductus venosus diverts over one half of the blood around the liver into the inferior vena cava and in fetal period, is charged with oxygen and nutrient in the placenta
• The diaphragm assists the anterior abdominal muscles during defecation and parturition.
• Papillary muscles contract to close the atrioventricular (A-V) valve during ventricular systole, and during its contraction, prevents eversion of the valve cusps when the volume of the ventricle decreases.
• At the level of T10 the oesophagus pass through the diaphragm via the esophageal hiatus
• During fetal circulation, conductivity occurs between the aorta and the pulmonary trunk.
• Peau d'orange characteristics are a symptom of breast cancer caused by blockage of cutaneous lymphatic vessels
• The anterior part of the right pleural cavity descends vertically downwards in the midline to the level of the fifth costal cartilage during percussion.
• Parietal pleura is innervated by somatic nerves
• An aneurysm in the arch of the aorta could affect the left subclavian artery or the left recurrent laryngeal nerve
• The thoracic part of the oesophagus receives splanchnic outflow from T5 contribution to the greater splanchnic nerve.
• The accessory hemiazygos vein receives bronchial veins from the oesophageal vein
• With significant occlusion in the beginning of the right coronary artery, and minimal collateral circulation, the right (acute) marginal artery and the sinuatrial nodal artery will have reduced blood flow.
• The structure that carries part of the right bundle branch of the AV bundle is the Moderator band (septomarginal trabecula)
• Stenosis in the initial part of the left coronary artery may lead to myocardial infarction
• The middle portion of the oesophagus is supplied by the oesophageal branches of the thoracic aorta

Other Points

• The vagus nerve is responsible for innervations of bronchial smooth muscle.
• The right main bronchus is wider, shorter and runs more vertically than the left main bronchus.
• The pulmonary ligament hangs inferiorly from the pleural sleeve around the lung root.
• The pectoralis major is supplied by the pectoral nerves.
• The ascending aorta begins at the semilunar valves
• The pectoralis minor muscle is a surgical landmark for axilla structures.
• the sternal angle is formed at the junction of the manubrium with the body of the sternum
• The atrioventricular bundle (His bundle) divides into right and left bundle branches.
• The oesophagus, Hemiazygos vein, and thoracic duct are located at the posterior mediastinum.
• The superior mediastinum contains the thymus.
• The usual branches of the aortic arch including the brachiocephalic trunk, left common carotid artery, and the left subclavian artery
• ligamentum arteriosum passes from the root of the left pulmonary artery to the inferior surface of the aortic arch
• The foramen ovale is most likely due to incomplete closure for a patient with a clinically significant atrial septal defect
• The chordae tendineae are presented at the: the left ventricle
• the phrenic nerve course posterior to the hilum (root) of each lung
• In fetal circulation, mixing of oxygenated and non-oxygenated blood occurs in the right atrium.
• The right coronary artery supplies blood to the sino- atrial node
• the right third posterior intercostal artery gives off the right bronchial artery
• The pulmonary trunk lies within the pericardial sac
• the right atrium receives the coronary sinus and has the sinu-atrial node in its wall. the crista terminalis separating the smooth and rough parts
• The lateral arcuate ligament extends from transverse process of L1 vertebra to the 12th rib
• the first rib's neck is related to the sympathatic trunk
• the azygos vein receives the superior intercostal vein and is formed by the union of right subcostal and right ascending lumbar vein
• The trachea contains incomplete rings of hyaline cartilage and bifurcates at the level of the sternal angle
• The ductus arteriosus shunts blood from the pulmonary trunk to the aorta before birth
• The anterior primary ramus of the twelfth thoracic nerve is the subcostal nerve
• The vertebral, and internal thoracic veins drains into the right brachiocephalic vein

Other Notes

• The aortic opening of the diaphragm transmits the azygos vein, thoracic aorta, and thoracic duct.
• The thoracic duct starts as a swelling called cisterna chyli located in the pelvis
• The correct order of bronchial tree is; lobar bronchus, segemntal bronchus, terminal bronchiolus, respiratory bronchiolus, bronchioli, alveolar duct and alveolar sac
• The atrioventricular bundle of his divides into left and right branches
• Accessory inspiratory muscles do not include the diaphragm
• septal papillary muscle, chordae tendineae, and trabeculae carnea components of the right ventricle
• the heart apex lies in the v intercostal space and more to the left
• The thoracic cardiac nerve, great splanchnic nerve, and lesser splanchnic nerve, are branches of the thoracic part of sympathetic trunk
• The tracheal carina is found at the site of tracheal bifurcation
• The thymus forms the thymic triangle on x ray graphs, which is relatively bigger in infancy
• Esophageal hiatus transmits the anterior vagal trunk
• If the right coronary artery in the initial part is infarcted, the right atrium is at the risk of hypoxia/necrosis
• The sternocostal triangle contains the superior epigastric artery and vein
• Validation of theorems concerning the congenital heart defect may lead to the development of the Lutembacher syndrome if the defect is not properly corrected
• For a boy with asthma corresponding with bronchoconstriction and bronchial muscle contractions smooth, the relaxation and bronchial relaxation can be obtained after blocking Fibrae symphaticae nervi T1-T4
• Plexus pulmonalis maintains fibrae parasymphateticae preganglionares from vagus nerve
• the Bronchus lobaris superior sinister runs under the left prostatosis
• Impaired innovation in mediastinal pleura and pericardium
• Nodus atrioventricularis; the right marginal branch runs during the right coronary artery infarction

More Notes

• Some symptoms off Tetralogy of Fallot is moving the aorta to the right, and narrowing of the aorta
• Mammary glands is composed of glandular and adipose part, and has lactiferous duct, which smooth musculature is constructed by oxytocin
• Scm muscle, and scalene are muscles of forced Inspiration
• The angle of the sternum indicates the second intercostal space
• The axillary lymph nodes or armpit lymph nodes (20 to 49 in number) drain lymph vessels from the lateral quadrants of the breast.