Thoracic Walls and Breast Anatomy PDF

Thoracic Walls and Breast Professor Jason Ivanusic Room E724 7th Floor, East Wing, Medical Building Email: [email protected] Phone: 83447254  WARNING This material has been provided to you pursuant to section 49 of the Copyright Act 1968 (...

Thoracic Walls and Breast Professor Jason Ivanusic Room E724 7th Floor, East Wing, Medical Building Email: [email protected] Phone: 83447254  WARNING This material has been provided to you pursuant to section 49 of the Copyright Act 1968 (the Act) for the purposes of research or study. The contents of the material may be subject to copyright protection under the Act. Further dealings by you with this material may be a copyright infringement. To determine whether such a communication would be an infringement, it is necessary to have regard to the criteria set out in Part 3, Division 3 of the Act.  Intercostal space Rib/Thoracic cage Thoracic wall (muscle, nerves and vessels) Protects Mechanical basis of breathing Includes thoracic cage and covering Intercostal muscles Subcutaneous fat Superficial fascia Deep Fascia Skin Pectoralis Major sweat glands, fat, blood (superficial muscles) and lymphatic vessels, nerves, the mammary Netter, F.H. Interactive Atlas of Human Anatomy. 3rd ed. gland. New Jersey, Icon Learning Systems, 2003, ISBN: 1-929007- 15-9, Plate #179  Intercostal space Thoracic cage (muscle, nerves and vessels) Rib/Thoracic cage Intercostal muscles Subcutaneous fat Superficial fascia Deep Fascia Skin Pectoralis Major sweat glands, fat, blood (superficial muscles) and lymphatic vessels, nerves, the mammary Netter, F.H. Interactive Atlas of Human Anatomy. 3rd ed. gland. New Jersey, Icon Learning Systems, 2003, ISBN: 1-929007- 15-9, Plate #179  Costal cartilage Rib Ribs Attaches ribs to sternum anteriorly Contributes to mobility of thoracic Ribs 1-7 (True ribs) cage Attach directly to sternum via costal cartilage Intercostal spaces Ribs 11 and 12 (Floating ribs) Have no anterior attachment Ribs 8-10 (False ribs) Attach to costal cartilage of rib above Author’s own  Typical ribs (3-9) Atypical ribs (1, 2, 10-12) Curved and flat Different markings Superior facet Head Inferior facet Neck Articular facet Angle Tubercle Grooves for subclavian vessels Costal groove Scalene tubercle Shaft Superior view of rib 1 Posterior view Inferior view Author’s own  Sternum Clavicular notch Jugular notch Manubrium Sternal angle Manubriosternal (of Louis) joint and attachment of 2nd Attachment for costal cartilage costal cartilages Body Xiphoid process Author’s own  Transverse Superior articular facet process Thoracic vertebra Body Spinous process Spinous process Inferior articular Lamina facet Transverse Intervertebral process foramen Intervertebral Pedicle disc Vertebral Body Thoracic vertebrae permit canal Author’s own mainly rotation  Articulations for ribs Superior demifacet Costal facet (head of its own rib) Rib 3 Inferior demifacet Costal facet Costotransverse joint Rib Tubercle Head Costovertebral joint Author’s own  Intercostal space Intercostal (muscle, nerves and vessels) Rib/Thoracic cage space Intercostal muscles Subcutaneous fat Superficial fascia Deep Fascia Skin Pectoralis Major sweat glands, fat, blood (superficial muscles) and lymphatic vessels, nerves, the mammary Netter, F.H. Interactive Atlas of Human Anatomy. 3rd ed. gland. New Jersey, Icon Learning Systems, 2003, ISBN: 1-929007- 15-9, Plate #179  Intercostal muscles Internal intercostal External muscles intercostal muscles (postero- inferior) (antero- inferior) Depress Elevate External intercostal membrane Eizenberg N, Briggs C, Barker P, Grkovic I. An@tomedia: Thorax module. Melbourne An@tomedia Publishing, 2001, ISBN: 0646 407 317  Innermost intercostal muscle (postero- inferior) Deficient posteriorly Eizenberg N, Briggs C, Barker P, Grkovic I. An@tomedia: Thorax module. Melbourne An@tomedia Publishing, 2001, ISBN: 0646 407 317  Innermost intercostal muscle Intercostal space Internal intercostal muscle Intercostal vein External intercostal muscle Intercostal artery Intercostal nerve Costal groove of rib Author’s own Intercostal nerves Moore K L. Clinically Oriented Anatomy. 2nd ed. Williams and Wilkins; 1985. ISBN 0683061321. Ch.1 Page 65  Rami Intercostal communicantes nerve Innermost Sympathetic intercostal ganglion muscle deficient posteriorly T4 teets T1O Sympathetic trunk Netter, F.H. Interactive Atlas of Human Anatomy. 3rd ed. New Jersey, Icon Learning Systems, 2003, ISBN: 1- Netter, F.H. Interactive Atlas of Human Anatomy. 3rd ed. 929007-15-9, Plate New Jersey, Icon Learning Systems, 2003, ISBN: 1-929007- #150 15-9, Plate #179 Intercostal vessels Moore K L. Clinically Oriented Anatomy. 2nd ed. Williams and Wilkins; 1985. ISBN 0683061321. Ch.1 Page 65  Posterior intercostal Descending aorta artery Internal thoracic vessels Anterior intercostal artery Internal thoracic Transversus artery thoracis Netter, F.H. Interactive Atlas of Human Anatomy. 3rd ed. Netter, F.H. Interactive Atlas of Human Anatomy. 3rd ed. New New Jersey, Icon Learning Systems, 2003, ISBN: 1-929007- Jersey, Icon Learning Systems, 2003, ISBN: 1-929007-15-9, 15-9, Plate #179 Plate #176  Intercostal space Superficial (muscle, nerves and vessels) Rib/Thoracic cage muscles Intercostal muscles Subcutaneous fat Superficial fascia Deep Fascia Skin Pectoralis Major sweat glands, fat, blood (superficial muscles) and lymphatic vessels, nerves, the mammary Netter, F.H. Interactive Atlas of Human Anatomy. 3rd ed. gland. New Jersey, Icon Learning Systems, 2003, ISBN: 1-929007- 15-9, Plate #179  Subclavius Clavicle Coracoid anchors clavicle Process Pectoralis Major (clavicular head) Pectoralis Humerus Minor (medial) Elevates ribs/ Pectoralis stabilizes Major scapula (sternal head) Adducts arm Author’s own  Serratus Anterior Protracts scapula Medial border of anterior surface of scapula Lateral aspect of ribs 1-8 Author’s own Serratus Posterior Vertebra to posterior ribs Spinous processes of C7-T3 Angle of ribs 2-5 Spinous Elevates ribs processes of T11-L2 Angle of ribs 9-12 Depresses ribs Netter, F.H. Interactive Atlas of Human Anatomy. 3rd ed. New Jersey, Icon Learning Systems, 2003, ISBN: 1-929007- 15-9, Plate #177A  Intercostal space Coverings (muscle, nerves and vessels) Rib/Thoracic cage of thoracic cage Intercostal muscles Subcutaneous fat Superficial fascia Deep Fascia The mammary gland (breast). Skin Pectoralis Major sweat glands, fat, blood (superficial muscles) and lymphatic vessels, nerves. Netter, F.H. Interactive Atlas of Human Anatomy. 3rd ed. New Jersey, Icon Learning Systems, 2003, ISBN: 1-929007- 15-9, Plate #179 Breast  Mammary gland Sits on fascia superficial to Pectoralis major Retromammary space 15-20 lobules Each lobule contains alveoli, the milk secreting portion of the lobule Drained by lactiferous duct which opens independently on the nipple Lactiferous sinus is dilated portion of duct Fat between lobules Glands enlarge during pregnancy and grow during puberty Attached to skin and fascia by Moore and Dalley. ‘Clinically Oriented Anatomy’, 4th Edition, suspensory ligaments Lippincott, William and Wilkins, 1999, ISBN: 0683061410.  Pectoralis Major (2/3) R2 Axillary tail R3 R4 Serratus R5 Anterior R6 (1/3) Lateral border of Sternum Mid-axillary line Author’s Own, Adapted from Moore and Dalley. ‘Clinically Oriented Anatomy’, 4th Edition, Lippincott, William and Wilkins, 1999, ISBN: 0683061410.  Author’s Own, Adapted from Moore and Dalley. ‘Clinically Oriented Anatomy’, 4th Edition, Lippincott, William and Wilkins, 1999, ISBN: 0683061410. Nipple 4th intercostal space in mid-clavicular line (nulliporous women) Opening of lactiferous ducts Areola Smooth muscle Pigmented area around nipple No fat, hair or sweat glands Sebaceous glands for lubrication Dense (connective tissue Low density (fatty) Fatty and breast glands) Dense breast Older women Younger women Pectoralis Major Fat Nipple Suspensory Ligaments Mammograms Eizenberg N, Briggs C, Barker P, Grkovic I. An@tomedia: Thorax module. Melbourne An@tomedia Publishing, 2001, ISBN: 064407317  Blood supply to breast Subclavian artery Internal thoracic artery Axillary artery Lateral thoracic artery Lateral mammary branches Lateral mammary branches of posterior intercostal arteries Author’s Own, Adapted from Moore and Dalley. ‘Clinically Medial mammary Oriented Anatomy’, 4th Edition, Lippincott, William and Wilkins, 1999, ISBN: 0683061410. branches  Venous drainage of breast Internal Jugular vein Subclavian vein Axillary vein Lateral Thoracic vein Internal Thoracic vein Lateral Mammary vein Author’s Own, Adapted from Moore and Dalley. ‘Clinically Medial Mammary vein Oriented Anatomy’, 4th Edition, Lippincott, William and Wilkins, 1999, ISBN: 0683061410. Lymphatics of Subclavian trunk Right Lymphatic duct Breast Parasternal Nodes Axillary Nodes To other (75% of lymph breast from breast) Subareolar plexus To abdomen Author’s Own, Adapted from Moore and Dalley. ‘Clinically Oriented Anatomy’, 4th Edition, Lippincott, William and Wilkins, 1999, ISBN: 0683061410. Author’s own Breast Cancer Usually derived from glandular epithelium in lobules Can appear as jagged mass on mammogram (can be difficult to identify in women with dense breast mammogram) Cancer cells can damage suspensory ligaments. As a result, the skin becomes thick or dimpled, or the nipple inverted, because of shortening of the suspensory ligament Cancer cells that enter a lymphatic vessel usually pass through a number of lymph nodes before entering the venous system Lodge in nodes to form nests (metastases) and can be palpated, particularly in the axilla, to give an indication of the presence of a cancer Not a gaurantee, as cancer could spread to other nodes instead Moore and Dalley. ‘Clinically Oriented Anatomy’, 4th Edition, Lippincott, William and Wilkins, 1999, ISBN: 0683061410. What about us blokes? No glandular development (usually!) Only some small duct development Little fat Can still get breast cancer