anterior thorax, lungs, pleura (ppt 16)
what are the nerve branches that innervate intercostal mm
-parietal pleura sensory branches -collateral branch -lateral cutaneous branch - *lateral thorax and abdomen* -anterior cutaneous branch -*anterior thorax and abdomen*
the intercostal space contains 3 layers of intercostal mm...all mm of respiration: they are
1. superficial: external intercostal mm 2. middle: internal intercostal muscle 3. deepest: innermost intercostal mm, transversus thoracis m, and subcostal m
the trachea is made of about ______ C-shaped cartilaginous (hyaline) rings, keeps the lumen patent
16-20
clinical significance of costodiaphragmatic recess
Pleural effusions here when in standing position. *thoracocentesis*(pleural tap) is often performed here while a patient is in full expiration because of less risk of puncturing the lungs and thereby causing pneumothorax
where do all the lung lymphatics drain into
brachiocephalic vein (thoracic duct drains inro subclavian v)
what are the anatomical, functional, and surgical units of the lung
bronchopulmonary segments
Pulmonary (segmental) arteries follow the tertiary bronchus into the bronchopulmonary segment and continues down the bronchiole tree. What do they carry?
deoxygenated blood to the capillary plexuses within the alveolar wall
[POSTERIOR intercostals] blood supply to lower nine (3-11) intercostal spaces are branches from the
descending (thoracic) aorta
the left lung has a groove for
descending aorta
inferior border of the thoracic wall
diaphragm
what is the right bronchus of right lung also called
eparterial bronchus
the right lung has grooves for
esophagus, SVC, and azygos vein
decreases the diameter of the thoracic cavity
expiration
why is the intercostal neurovascular bundle (VAN) vulnerable to injury?
fractured ribs due to location
depression at middle of mediastinal surface
hilum
what type of pneumothorax has the pleural cavity exposed to the atmosphere through an open wound in the chest wall (often called "blowing wound" or a *sucking pneumothorax*)
open pneumothorax
Pulmonary (segmental) veins located in the connective tissue septum between bronchopulmonary segments. what do they carry?
oxygenated blood from the alveoli to the left side of the heart
_________ pleura is sensitive to pain, temp, touch, pressure
parietal
what are the two parts of the pleura
parietal and visceral
a loose fold of visceral pleura hanging down below the root of lung, continues inferiorly almost to diaphragmatic surface
pulmonary ligament
lateral borders of thoracic wall
ribs and intercostal space
which lung is slightly larger
right
the tracheal muscles are SMOOTH posteriorly and ends at its bifurcation of ________ at the level of sternal angle
right and left main bronchus
accessory mm of inspiration
scalene mm, SCM
what lies in the CT between adjacent bronchopulmonary segments (in the septal margins)
segmental (small pulmonary) veins
the nerve supply for each pulmonary plexus is found at the root of each lung, it recieves branches from
sympathetic trunk and parasympathetic fibers from the *vagus n*
what type of pneumothorax is often referred to as a positive pressure pneumothorax
tension pneumothorax
ribs that attach directly to the sternum via costal cartilages (mobility of thoracic wall) ribs 1 through 7 First rib deep to clavicle, hard to palpate
true ribs
posterior boundary of thoracic wall
vertebral column
which pleura completely covers the outer surfaces of the lungs, extends into depths of interior fissures
visceral pleura
blood supply to lungs
-bronchial aa branching from descending aorta -bronchial veins drain into azygous and hemiazygous vv
principal mm of inspiration
-ext intercostal mm -interchondral part of internal intercostal mm -diaphragm
what are the lymphatics of the thorax?
-parasternal nodes, posterior mediastinal nodes, intercostal nodes, paratracheal nodes, superior phrenic nerves, thoracic duct
what are the apertures (openings/gaps) of the thoracic wall?
-superior thoracic aperture/thoracic inlet -inferior thoracic aperture/thoracic outlet
list external to internal linings of thoracic wall
1. skin 2. superficial and deep fascia, breast 3. muscle 4. sternum, costal cartilages, ribs and intercostal mm 5. endothoracic fascia (thin layer of loose CT separating parietal pleura and fibrous pericardium from thoracic wall) 6. pleura (visceral) and pericardium (coverings of thoracic viscera)
how many bronchopulmonary segments are there per lung
8-10
4 branches off of internal thoracic a
Pericardiacophrenic a. Anterior intercostal a. Collateral branches Perforating and sternal branches
angle made between manubrium and body of sternum (T4 and T5, 2nd costal cartilage)
Sternal angle (angle of Louis)
each bronchopulmonary segment is surrounded by CT and contains:
a segmental (tertiary) bronchus and artery, lymph vessels, and autonomic nn
in mechanics of respiration, what type of breathing includes Internal Intercostal mm (except interchondral part) and abdominal mm depress lower ribs, compress abdominal viscera which forces diaphragm up
active breathing
what is the sternal angle also called
angle of Louis
what is the innervation of the intercostals
anterior (ventral) rami of the first 11 thoracic spinal nn
what branch of nn goes to *anterior thorax and abdomen*
anterior cutaneous branch
the _____ of the lungs project into the base of the neck, roof is the suprapleural membrane
apex
corresponding posterior intercostal vv drain backward into the
azygos v, hemiazygos v, accessory hemiazygous v, l/r superior intercostal v
the ______ of the lungs is a concave surface that sits on diaphragm
base
the parietal pleural is subdivided into
cervical, costal, diaphragmatic, and mediastinal pleuras
lower border of thorax, formed by cartilage (ribs 7-10,end of 11/12)
costal margin
lower area of the pleura cavity (formed by parietal pleura) into which the lung expands on inspiration
costodiaphragmatic recess
the trachea begins at the _________ (body of 6th cervical vertebra) and extends to level of sternal angle (T4)
cricoid cartilage
the right lung has a small cardiac impression, whereas the left lung has a
deep cardiac impression
sensory innervation of back is from
dorsal rami of spinal nn C4-S3
ribs that attach indirectly to sternum via pieces of cartilage along costal margin Ribs 8 through 10
false ribs
no sternal connection Ribs 11 and 12
floating ribs
the subpleural (superficial) plexus lies underneath the visceral pleura and drains into
hilum
increases the diameter of the thoracic cavity (like expanding box)
inspiration
costal innervation
intercostal nn
space between ribs (11 total) Example: 5th intercostal space between 5th and 6th rib
intercostal space
what neurovascular element of the chest wall courses through the intercostal space (hint: VAN)
intercostal vein, intercostal artery, intercostal nerve
[ANTERIOR intercostals] blood supply to first 6 intercostal spaces branch from the
internal thoracic a
anterior intercostal veins drain forward into the _______________ or musculophrenic vv
internal thoracic v
what branch of nn goes to *lateral thorax and abdomen*
lateral cutaneous branch
which bronchus is more narrow, longer and more horizontal. at the hilum it divides into the superior and inferior lobar bronchus
left main bronchus
combined term for the two lingular bronchopulmonary segments of the left upper lobe: inferior lingular segment. superior lingular segment
lingula
each main bronchus, left and right, divides into ______ (secondary) bronchus which divide into segmental (tertiary) bronchus
lobar
the visceral and parietal pleura become continuous with one another at the
lung root
what is the joint between the manubrium and sternum (at sternal angle)
manubriosternal joint
the sternum is made of what 3 parts
manubrium, body, xiphoid process
3 surfaces of lungs
mediastinal, diaphragmatic, costal
[ANTERIOR intercostals] blood supply to lower 5 are from the ________ (one of the terminal branches of the internal thoracic a)
musculophrenic a
terminal branches of internal thoracic a
musculophrenic a, superior epigastric a
which pleura lines the thoracic wall, the thoracic surface of the diaphragm and lateral part of the mediastinum, extends into the root of the neck
parietal pleura
where does VAN lie in the intercostal space?
partially under the cover of the costal groove of the upper rib (between 2 deepest intercostal m layers/ along internal surface of inf border of rib)
mediastinal innervation
phrenic n
diaphragmatic innervation
phrenic n (dome) and lower six intercostal nn (periphery)
the space between two layers of pleura--covered by a thin film of pleural fluid
pleural cavity
what is the result of disease or injury where air enters the pleural cavity from the lungs or through chest wall
pneumothorax
what are the fxns of the thoracic wall?
protection, respiration, site of mm attachment for upper limbs
what ligament is formed where the visceral pleura folds on itself
pulmonary ligament
what drains the deepest region of the lung
pulmonary nodes
in mechanics of respiration, what type of breathing is passive recoil of lungs and rib cage
quiet breathing
what connects the nerves of intercostals (ventral rami of first 11 spinal nn) to a ganglion of the sympathetic trunk
rami communicantes
the parts of ____: Head (articular facets) Neck Tubercle (articular facet for transverse process of vertebrae) Body Angle - where body turns sharply forward Costal groove - on inferior, internal surface
ribs
what are the effects of a positive pressure/tension pneumothorax?
right lung would collapse and heart/left lung would be shifted to the left
which bronchus is wider, shorter and more vertical. At the hilum, it branches into superior, then the middle and inferior lobar bronchus, and is *most likely location for foreign objects*
right main bronchus
_____ of lung: formed from the bronchi, vessels, nerves, and lymphatics entering and exiting the hilum
root
what is the most common type of pneumothorax; usually results from rupture of a bullae (bleb) on lung surface and most often results in a tension pneumothorax
spontaneous pneumothorax
anterior border of thoracic wall
sternum and costal cartilages
what angle: inferior end of sternum, between sternal attachment of seventh costal cartilages
subcostal angle
what innervates intercostal mm thats from 12th thoracic spinal n
subcostal n
what are the 3 lobes of right lung. Separated by the oblique and horizontal fissures
superior (upper), middle, and inferior (lower)
what are the TWO lobes of left lung, divided by the oblique fissure
superior and inferior
[POSTERIOR intercostals] blood supply to first two spaces are from __________, a branch of the costocervical trunk (off of subclavian a)
superior intercostal a
superior border of thoracic wall
suprapleural membrane (dense fasciae layer) at the thoracic inlet
which notch is the superior margin of the manubrium--easily felt between medial ends of clavicle (lower border of T2)
suprasternal (jugular) notch
a diseases bronchopulmonary segment can be removed by
surgery
what lymph nodes are located at tracheal bifurcation
tracheobronchial (carinal) nodes
___________ pleura- autonomic (motor and visceral afferent) supply from pulmonary plexus, sensitive to stretch but not to pain or touch
visceral
in spontaneous pneumothorax, what layer has been compromised?
visceral pleura
joint between xiphoid process and sternum (between T8/T9)
xiphisternal joint