SURFACE ANATOMY OF ANTERIOR THORACIC WALL LUNG SURFACE
- Slides: 26
SURFACE ANATOMY OF ANTERIOR THORACIC WALL, LUNG SURFACE MARKING, PLEURAL REFLECTIONS BY AMANDA TATAR
OBJECTIVES • Explain lymphatic drainage of the breast and its importance in the spread of cancer • Describe the surface markings of the lungs and pleural reflections • Identify important surface landmarks on the anterior thoracic wall • Use the sternal angle (of Louis) to accurately number the ribs on a living subject
ANATOMY OF THE BREAST • Both sexes • Mammary glands • Suspensory ligaments: attach glands to dermis • 15 -20 lobules → parenchyma of mammary glands • 1 lobule → lactiferous duct → nipple • Lactiferous sinuses – dilated area
SURFACE ANATOMY OF THE BREAST Midaxillary line • Ribs 2 → 6 • Lateral border of sternum to midaxillary line • Axillary process • 2/3 over pectoralis major • 1/3 over serratus anterior • Nipple over 4 ics = MEN Axillary proces s Clinical relevance: pathological breast quadrants
SURFACE ANATOMY OF BREAST Axillary tail Intermammary cleft. Body of sternum Anterior axillary fold Areola Nipple Supernumerary nipple Xiphoid process
VASCULATURE OF BREAST • Arterial supply: • Medial mammary branches of anterior intercostals from internal thoracic arteries • Lateral thoracic from axillary arteries • Thoraco-acromial from axillary arteries • Posterior intercostals from thoracic aorta
ARTERIAL SUPPLY CONTINUED RSC Tho. Acr Lat. Tho AIC Med Mam A In Th L C C BC AXILLA RY R C C ARCH PIC HEA RT LSC
LYMPHATIC DRAINAGE OF BREAST • Lymphatics – drainage • All from breast → sub-areolar plexus then: • • • Axillary: 75 % Parasternal Abdominal
LYMPH CONTINUED • Axillary Nodes: • Pectoral • Humeral • Subscapular • Central • Apical • Axillary nodes → supra/infra clavicular → subclavian trunk • Parasternal → bronchomediastinal
IMPORTANCE OF LYMPH • Breast carcinoma → metastasis • ↑ communication of lymph • Metastasis can be extensive
LUNG PLEURAE • Visceral – adherent to lungs • Parietal – lines pulmonary cavities • Between = pleural space = serous fluid: • • Reduces friction – respiration Surface tension - cohesion
LUNGS IN PROSECTION Sternu m Right lung VISCERAL PLEURA Left lung External intercostal muscles Rib s Costal margin
THORACIC CAVITY IN PROSECTION Sternum VISCERAL PLEURA ON RIGHT LUNG PARIETAL PLEURA (costal) Costal margin
PARIETAL PLEURA PARTS • Costal: • • • Mediastinal: • • Lateral mediastinum Diaphragmatic: • • Internal thoracic wall surfaces Endothoracic fascia separates Diaphragm Cervical: • • Thorough superior thoracic aperture 2 -3 cm above clavivles
PLEURAL REFLECTIONS – PARIETAL PLEURA • Sternal - Anteriorly • • Sharp Costal → mediastinal • Costal - Inferiorly • • Sharp Costal → diaphragmatic • Vertebral - Posteriorly • • Rounder Costal → mediastinal
PARIETAL AND VISCERAL PLEURAL MARKINGS VISCERAL: • • • 2 cc → 4 cc → 6 cc inferiorly (R) 4 cc → 6 cc curved (L) 6 cc → 8 cc midaxillary 10 rib posteriorly PARIETAL: • • • 2 cc → 4 cc → 6 cc inferiorly (R) 4 cc → 6 cc curved (L) 6 cc → 8 cc midclavicular 8 cc → 10 rib midaxillary 12 rib posteriorly
RECESSES • Pleural cavities not full in expiration → recesses • Costodiaphragmatic • Costomediastinal
SURFACE ANATOMY – ANTERIOR PLANES Jugular notch Sternal angle • Median (midsternal) • Midclavicular - two MEDIAN LINE MIDCLAVICULAR LINES
SURFACE ANATOMY – ANTEROLATERAL PLANES Axillary fossa • Anterior axillary – along ant. fold (pectoralis major) • Midaxillary – axillary apex ↓ • Posterior axillary – along post. fold (latissimus dorsi, teres major) Anterior axillary Midaxillary Posterior axillary
IMPORTANT FEATURES TO IDENTIFY
IMPORTANT LEVELS • Jugular notch = T 2 • Sternal angle • • T 4/T 5 2 cc Bifurcation of bronchi Counting ribs from here • Xiphoid process = T 9
COUNTING THE RIBS *
CORRESPONDENCE! T 2 T 4/T 5 T 9
CLINICAL RELEVANCE – _? _ THORAX! • Accumulation of ‘stuff’ into pleural cavity • Something is broken or torn open • Pneumothorax – air • Hydrothorax – fluid (from effusion) • Hemothorax – blood • Chylothorax - lymph
QUIZ Q. Most of the lymphatic drainage of the breast goes to the other breast? False – most drains to the axillary nodes Q. The parietal pleura crosses the midaxillary line at 8 cc? False – crosses the midclavicular line at 8 cc, midaxillary at 10 cc. Visceral pleura crosses the midaxillary line at 8 cc Q. Sternal angle is at the level of T 3/T 4? False – T 4/T 5 A B
THANK YOU! • mzyart@nottingham. ac. uk Please email me any questions or come ask me at the end! • In this powerpoint I used: • • Moore and Agur Teach me anatomy Acland Anatomy Videos Google images Point of interest: Pleural effusion – fluid on the lungs
- Posterior intercostal arteries
- Segmental bronchus
- Aortic impression lung
- Artery supply of pleura
- Lung layers
- Rectus sheath
- Pelvic counterstrain points
- Rib
- Thoracic cage anterior view
- Thoracic cage anterior view
- Arterial supply of thorax
- Fascia of thoracic wall
- Subcostales
- Internal thoracic vein
- Chest wall anatomy
- Thoracic wall boundaries
- Bones of thorax
- Function of internal intercostal muscles
- Lung anatomy
- Lung lobe
- Alveoli diagram
- Hernia meaning in english
- Thin
- Lateral wall of axilla
- Content of hesselbach triangle
- Anterior vs posterior abdominal wall
- Posterior abdominal wall nerves