Thoracic Wall.pdf

TABLE OF CONTENTS 1. Bones and Joints of the Thorax Thoracic Wall 2. Muscles and Functions 3. Blood Vessels and Blood Supply 4. Nerves and Innervations 5. Practice Questions 6. Radiology -...

TABLE OF CONTENTS 1. Bones and Joints of the Thorax Thoracic Wall 2. Muscles and Functions 3. Blood Vessels and Blood Supply 4. Nerves and Innervations 5. Practice Questions 6. Radiology - Thoracic X-Ray 7. Radiology - Thoracic CT 8. Clinical - Carcinoma of the Breast REVIEW OUTLINE 1. Muscles 3. Veins Thoracic Wall External intercostal Internal intercostal Anterior intercostal Internal thoracic Innermost intercostal Superior epigastric Transversus thoracis Musculophrenic Pericardiacophrenic 2. Arteries Superior vena cava Anterior intercostal Internal thoracic 4. Nerves Superior epigastric Phrenic Musculophrenic Pericardiacophrenic Ascending aorta Pulmonary trunk  Thoracic Wall Bootcamp.com Pmmammanmadanmurmann EXTERNAL INTERCOSTAL mmmm INTERNAL INTERCOSTAL INNERMOST INTERCOSTAL INTERCOSTAL MUSCLES RIBS BETWEEN https://upload.wikimedia.org/wikipedia/commons/9/9a/1114_Thorax.jpg  Thoracic Wall Bootcamp.com Pmmammanmadanannumm EXTERNAL INTERCOSTAL mmmm ELEVATES RIBS DURING FORCED INHALATION 1 µ INTERNAL INTERCOSTAL µ DEPRESSES RIBS DURING FORCED EXHALATION INNERMOST INTERCOSTAL DEPRESSES RIBS DURING FORCED EXHALATION INTERCOSTAL MUSCLES RIBS BETWEEN https://upload.wikimedia.org/wikipedia/commons/9/9a/1114_Thorax.jpg  Thoracic Wall Bootcamp.com TRANSVERSUS THORACIS A ORIGIN r g r g INSERTS r s r s https://upload.wikimedia.org/wikipedia/commons/d/db/Gray390.png  Thoracic Wall Bootcamp.com TRANSVERSUS THORACIS as DEPRESSES RIBS DURING FORCED EXHALATION 2 f By 3 A ORIGIN XIPHOIDPROCESS r 9 LATERAL ASPECTOF STERNUM 4 y r s INSERTS RIBS 2 6 p smh r s all 6 i https://upload.wikimedia.org/wikipedia/commons/d/db/Gray390.png  Thoracic Wall Bootcamp.com SYSTEMIC CIRCULATION ASCENDING AORTA SUPPLIES UPPERLIMBS HEAD NECK BRAIN PULMONARY CIRCULATION PULMONARY TRUNK SUPPLIES LUNGS https://upload.wikimedia.org/wikipedia/commons/9/92/2008_Internal_Anatomy_of_the_HeartN.jpg Thoracic Wall Bootcamp.com RecA Lcca SYSTEMIC CIRCULATION THE AORTICARCHALSOBRANCHES TOTHELEFTCOMMONCAROTIDA LSA ELEFTSUBCLAVIANA ASCENDING AORTA THEBRACHIOCEPHALICTRUNK ALSOBRANCHESTO THE q RIGHTCOMMONCAROTIDA AORTIC ARCH i t BRACHIOCEPHALIC TRUNK 2 a SUBCLAVIAN v INTERNAL THORACIC Thoracic Wall Bootcamp.com SUBCLAVIANA e t t I r r t v BRACHIOCEPHALICA I e i r v I t it v r posteriorIntercostALA isi s e sa d ANTERIORINTERCOSTAL A t o kk i ei ee i e I v E rI e E as e z 8o rI e a En rv v w Ea e e tI e i g e t v a v r t onc I e r µuswwpHREN Es naa v H rI e ao ca v w i n SUPERFICIALINFERIOR y EPIGASTRICA  Thoracic Wall Bootcamp.com SUBCLAVIANA I r t Z r1 t Internal THORACICA I 3 1 ANTERIOR tI Intercosima rd 4 ri ri ri S r i r i r1 SUPERIOR EPIGASTRICA 6 a MusculopHRENIca https://upload.wikimedia.org/wikipedia/commons/d/db/Gray390.png  Thoracic Wall Bootcamp.com SUBCLAVIANA t r1 1 Internal THORACICA 1 ii Ti PERICARDIA A coPHRENIC rI ri ri ri r i r i ri r v https://upload.wikimedia.org/wikipedia/commons/7/75/Gray530.png Thoracic Wall Bootcamp.com ANTERIORINTERCOSTAL A it v 16 INTERCOSTALspacesmuscles I it THORACICA INTERNAL PLEURA PARIETAL IF u v ANTERIORINTERCOSTALV I ANTERIORTHORACICWALL it BREASTS v u THORACICv INTERNAL it MUSCULOPHRENICA PERICARDIACOPHRENICA it I PERICARDIUM e INTERCOSTALspaceslmusuestg it THORACICDIAPHRAGM PERICARDIUM it4 UPPERRECTUSABDOMINIS it ANTERIORDIAPHRAGM 1 PERICARDIACOPHRENICH it e Il MUSCULOPHRENICH it1 SUPERIOREPIGASTRICA v ABDOMINAL wall upperrectusABDOMINIS a v SUPERIOREPIGASTRIC V Thoracic Wall Bootcamp.com SUBCLAVIANV i n t I i BRACHIOCEPHALIC T i r I r i u r 1 to ANTERIORINTERCOSTALv 11 I u a yee s i i E I e t rj t s sp rI teez or g t's 8s tI t a sa t eri ri i e r i e I musculopHRENICV t n t I E 11 1 a a n e v e  Thoracic Wall Bootcamp.com SYSTEMIC CIRCULATION SUPERIORVENACAVA SUPERIOR VENACAVA RECIEVESBLOOD FROM UNIONOFRIGHTCLEFT BRACHIOCEPHALIC U DRAINSBLOODINTO RIGHTATRIUM DRAINSBLOODFROM UPPERLIMBS HEAD RIGHTATRIUM NECK BRAIN Ream Braun n.ecv ocepn Leer lieu Braatiocepan a vena superior cava RIGHTatrium https://upload.wikimedia.org/wikipedia/commons/9/92/2008_Internal_Anatomy_of_the_HeartN.jpg  Thoracic Wall Bootcamp.com Innermost Intercostal EXTERNAL INTERCOSTAL INTERNAL INTERCOSTAL https://upload.wikimedia.org/wikipedia/commons/9/9a/1114_Thorax.jpg https://upload.wikimedia.org/wikipedia/commons/d/db/Gray390.png  Thoracic Wall Bootcamp.com NERVESOF THE THORACIC WALL INTERCOSTAL NERVE INTERCOSTAL NERVE MUSCULARINNERVATION PHRENIC NERVE SENSORY E MUSCULAR INNERVATION PHRENICNERVE https://upload.wikimedia.org/wikipedia/commons/9/9a/1114_Thorax.jpg https://upload.wikimedia.org/wikipedia/commons/7/75/Gray530.png  Thoracic Wall Bootcamp.com INTERCOSTAL NERVE INNERMOST Intercostal EXTERNAL INTERCOSTAL INTERNAL INTERCOSTAL https://upload.wikimedia.org/wikipedia/commons/9/9a/1114_Thorax.jpg https://upload.wikimedia.org/wikipedia/commons/d/db/Gray390.png  Thoracic Wall Bootcamp.com PHRENIC NERVE CI ROOTS CZ E3 CS 3 PATHWAY 4 1 ANTERIORTO ANTERIORSCALENE MUSCLE CS 2 POSTERIORTO SUPERIOR VENACAVA 6 3 ANTERIORTO ROOT OFTHELUNG C7 cg TRAVELS WITH THE T1 PERICARDIACOPHRENIC A https://en.wikipedia.org/wiki/Phrenic_nerve#/media/File:Gray806.png  Thoracic Wall Bootcamp.com PHRENIC NERVE l SENSORY FUNCTION cz FIBROUSPERICARDIUM 3 MEDIASTINALPLEURA 4 DIAPHRAGMATIC PERITONEUM MOTOR FUNCTION CG DIAPHRAGM 7 c8 WHAT WOULD HAPPEN IF THE T1 PHRENICNERVEWASLESIONED https://en.wikipedia.org/wiki/Phrenic_nerve#/media/File:Gray806.png  Thoracic Wall Bootcamp.com ARE THESE MUSCLES ASSOCIATED WITH www.mmumm INHALATION OR EXPIRATION today k EXTERNAL INTERCOSTAL EXPIRATION 1 INTERNAL INTERCOSTAL INNERMOST INTERCOSTAL INHALATION g teddy tagged https://upload.wikimedia.org/wikipedia/commons/9/9a/1114_Thorax.jpg Thoracic Wall Bootcamp.com WHERE IS BLOOD FOUND BEFORE IT ENTERS THE ASCENDING AORTA RIGHT ATRIUM LEFT ATRIUM RIGHT VENTRICLE LEFT VENTRICLE  Thoracic Wall Bootcamp.com WHAT NERVEROOTS DOES THE c PHRENIC NERVE ARISE FROM 4 C7 C8 Tl https://en.wikipedia.org/wiki/Phrenic_nerve#/media/File:Gray806.png REVIEW OUTLINE 1. Muscles 3. Veins Thoracic Wall External intercostal Internal intercostal Anterior intercostal Internal thoracic Innermost intercostal Superior epigastric Transversus thoracis Musculophrenic Pericardiacophrenic Review Questions 2. Arteries Anterior intercostal Superior vena cava § What are the functions of the Internal thoracic 4. Nerves Superior epigastric Phrenic muscles listed? Musculophrenic § What areas are supplied by Pericardiacophrenic the arteries? Ascending aorta Pulmonary trunk § What are the sensory and motor functions of the phrenic nerve?  iii É É r i SUPERIOR INFERIOR ANTERIOR POSTERIOR I 8 8 REVIEW OUTLINE 1. Carcinoma of the Breast Carcinoma of 2. Lymphatic Drainage of the Breast the Breast 3. Mastectomy  Carcinoma of the Breast Bootcamp.com Malignant tumors (adenocarcinomas) arising from epithelial cells of lactiferous ducts in mammary gland lobules Tumor enlarges & attaches to the suspensory ligament shortening it  Lymphatic Drainage of the Breast Bootcamp.com Parasternal Anterior axillary (pectoral) Posterior axillary (subscapular) Lateral axillary (humeral) 75% 25%  Mastectomy Bootcamp.com Removal of the breast, pectoral muscles, fat, fascia & lymph nodes in the axilla & pectoral region Winged scapula Knowledge Check Bootcamp.com Which lymph nodes are primarily responsible for lymphatic drainage of the breast? a. Parasternal b. Anterior axillary (pectoral) c. Posterior axillary d. Lateral axillary (humeral) A 43-year-old woman with a history of breast cancer undergoes a double mastectomy and after surgery, she presents with a winged scapula. Why did this happen? Knowledge Check Bootcamp.com Which lymph nodes are primarily responsible for lymphatic drainage of the breast? a. Parasternal b. Anterior axillary (pectoral) c. Posterior axillary d. Lateral axillary (humeral) A 43-year-old woman with a history of breast cancer undergoes a double mastectomy and after surgery, she presents with a winged scapula. Why did this happen? Injury to the long thoracic nerve causing paralysis of serratus anterior  References Bootcamp.com Slide 2 Breast Anatomy: Andrewmeyerson, CC BY-SA 3.0, via Wikimedia Commons Breast Appearance Cancer: Raphseck, CC BY-SA 4.0, via Wikimedia Commons Mammogram: BruceBlaus. When using this image in external sources it can be cited as:Blausen.com staff (2014). "Medical gallery of Blausen Medical 2014". WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436., CC BY 3.0, via Wikimedia Commons Slide 3 Don Bliss (Illustrator), Public domain, via Wikimedia Commons Slide 4 Woman Mastectomy: Unknown Illustrator, Public domain, via Wikimedia Commons Long Thoracic N.: Internet Archive Book Images, No restrictions, via Wikimedia Commons Winged Scapula: Dwaipayanc at the English-language Wikipedia, CC BY-SA 3.0, via Wikimedia Commons REVIEW OUTLINE 1. Carcinoma of the Breast Carcinoma of 2. Lymphatic Drainage of the Breast the Breast 3. Mastectomy