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Give the overview of the thorax
- The thorax consists of a wall, and a cavity which contains;
- - Two pleural cavities
- - The lungs
- - The mediastinum: housing the main organs the trachea, esophagus, bronchus, heart and aorta
- Not all thoracic contents are protected; the apex of the lung is above the 1st rib
Describe the surface anatomy of the thorax
- Sternal angle
- Xiphoid process
- Infrasternal (subcostal) angle
- Ant. Median line
- Midclavicular line
- Costal margin/arch
- Jugular/supreasternal notch
Name the contents of the intercoastal wall
- Intercostal muscles: external, internal and innermost
- Pleura: Parietal, cavity, and visceral
- Endothoracic fascia
- Intercoastal; vein, arteries and nerves
- Collateral; vein, arteries and nerves
Describe the vasculature/innervation in the thoracic wall
- Contains intercostal vessels and nerve.
- - Posterior & anterior intercostal arteries
- - Posterior & anterior intercostal veins
- - Intercostal nerve (only 1 each side)
Name the tissue layers via three approaches to the thoracic cavity
- Intercostal space, Periosteal bed and Median sternum
Label the following:
- Suspensory ligaments:
- Adipose tissue in superficial fascia
- Mammary lobes containing alveoli: located in the superficial fascia
- - consists of 15-20 lobules, which drain via the Lactiferous sinus and duct
- - Enlarge during pregnancy
- Secondary tubule
- Mammilary duct
- Lactiferous sinus and duct
- Clinically, the breast is subdivided into 4 quadrants and has an axillary tail
Describe the blood supply, nerve supply and lymphatic drainage of the breast
- Blood supply:
- - Internal thoracic a/v
- - Lateral thoracic a/v
- - Thoracoacrominial a/v
- - Posterior intercostal a/v (in the 2nd to 4th intercostal spaces)
- Nerve supply: Anterior and lateral cutaneous branches of the 4th-6th intercostal nerves
- Lymphatic drainage: Axillary lymph nodes (>75%)
- - Parasternal lymph nodes (both sides)
- - Inferior phrenic lymph nodes
When inserting an intercostal needle or chest drain, why is it important to stay just above a rib border?
The needle should be inserted just above the upper margin of the rib to avoid injury to the intercostal neurovascular bundle, the main part of which runs in the costal groove along the inferior margin of the rib.
When giving local anaestesia to intercostal nerves, why is the posterior region of an intercostal space selected?
- The posterior region of an intercostal space is selected because the intercostal nerve is mainly anaesthetised anteriorly from the point of injection.
- By injecting local anaesthetic nearer the origin of the nerve, this maximises the area of anaesthesia produced
Name two structures that could be damaged by inserting a needle into the subclavian vein?
- The structures most at risk of injury are the;
- - apex of the lung (causing a pneumothorax) and the
- - subclavian artery (causing haemorrhage)