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