Clinical Anatomy: Thorax Pt. 1 & some pt 2

Suprasternal notch

hollow U-shaped depression just above the sternum, in between the clavicles

sternal angle (angle of Louis)

angle between the manubrium and the sternal body; lies opposite of the IV of 4th and 5th thoracic vertebrae; 2nd costal cartilage of 2nd rib

xiphisternal joint

joint between diploid and body of sternum

subcostal angle

inferior end of sternum, between sternal attachments from 7th costal cartilage

the sternal attachments of 7th costal cartilage

the subcostal angle is between...

costal margin

lower boundary of the thorax

clavicle

collar bone

Ribs

The bones in the chest that protect the heart and lungs.

diaphragm

Large, flat muscle at the bottom of the chest cavity that helps with breathing

xiphisternal joint

the central tendon of the diaphragm lies directly behind the...

4th

nipples are located in the ____ intercostal space

Apex beat of the heart

lower portion of the left ventricle; 5th ICS/MCL

5th ICS

the apex beat of the heart is found in...

lower border of the pectoralis major muscle

the anterior axillary fold is made up of...

tendon of the latissimus dorsi muscle as it passes around the lower border of the teres major muscle

the posterior axillary fold is made up of...

spinous processes

Project backwards from each vertebra; also serve as attachment sites for skeletal muscles

Vertebra prominens

spinous process of C7

Ligamentum Nuchae

an elastic ligament that connects the vertebrae of the neck to the skull

C1-C6

ligamentum niche runs from the spinous processes of...

Superior angle of the scapula

part of scapula that is opposite of spinous process of 2nd thoracic vertebrae

2nd

the superior angle of the scapula goes across from the ___ thoracic vertebra

Spine of the scapula

sharp ridge located on posterior side of the scapula; root lies on T3 level

3rd

the spine of the scapula goes across from the ___ thoracic vertebra

inferior angle of scapula

bottom point of scapula (T7)

7th

the inferior angle of the scapula goes across from the ___ thoracic vertebra

Midsternal line

a vertical line down the middle of the sternum

Midclavicular line

imaginary vertical line that runs vertically downward from the midpoint of the clavicle

Anterior axillary line

imaginary line that runs vertically downward from the anterior axillary fold

Posterior axillary line

imaginary line that runs vertically downward from the posterior axillary fold

midaxillary line

An imaginary vertical line that starts at the middle of the axilla (armpit) and extends down the side of the chest.

Scapular line

imaginary line that runs vertically downward on the posterior wall of the thorax, passing through the inferior angle of the scapula while the arms at at the side.

Trachea

a large membranous tube reinforced by rings of cartilage, extending from the larynx to the bronchial tubes and conveying air to and from the lungs; the windpipe.

lower border of the cricoid cartilage

the trachea begins from the...

Apex of the lung

tip or uppermost portion of the lung.; projects into the neck

Anterior border of the right lung

Behind the sternoclavicular joint and runs downward almost reaching the midline behind the sternal angle, it then continues downward until it reaches the xiphisternal joint

Anterior border of the left lung

similar to its counterpart, but at the level of the 4th costal cartilage, it deviates laterally and extends for a variable distance beyond the lateral margin of the sternum to form the cardiac notch

Cardiac notch

a concave space on the left lung in which the heart lies

6th, 8th, and 10th ribs

the lower border of the lung extends into the...

Posterior border of the lung

where costal and mediastinal surfaces meet posteriorly

oblique fissure

separates superior and inferior lobes of the R/L lungs

Horizontal fissure

separates the superior and middle lobes of the right lung

so the heart can fit into the the cardiac notch

why does the right lung have 3 lobes while the left only has 2?

lateral border of sternum to midaxillary line

the female breasts extend from...

2nd, 6th

the female breasts span from the ___ to ____ ribs

axillary tail of spence

superior lateral corner of breast tissue, projects up and laterally into axilla

deep pectoral fascia overlying the pectoralis major

2/3 of the breast rests on the...

fascia covering serratus anterior

1/3 of the breast rests on the...

Retromammary space

potential space between breast tissue and pectoralis major; allows for movement of breast on pectoral fascia

allows for movement of breast on pectoral fascia

function of retromamary space

suspensory ligaments of breast

attach breast to underlying muscle

Breast lobules

gland in the breast that makes milk; have 15-20

Lactiferous ducts

drains each boule, opens independently of nipple

Lactiferous sinus

under areola; dilated reservoir for milk during lactation

Let down reflex

the reflex that forces milk to the front of the breast when the infant begins to nurse; infant compresses areola and the lactiferous sinus and a droplet of milk will come out; encourages infant to continue to suckle on breast; actual reflex occurs when milk is secreted into the baby's mouth

Montgomery glands/tubercles

"small bumps" located around areola that secrete an oily substance during pregnancy and lactation; a lubricant

Mammary glands

accessory glands of the skin that are capable of secreting milk

yes; in the male and immature female, the breast are similar in structure

are mammary glands present in both sexes?

areola

dark-pigmented area surrounding the breast nipple

connective tissues

ducts are embedded in...

capsule or sheath

mammary glands are modified sweat glands, meaning they have no...

fat lobules

most of the breast is composed of...

new glandular tissue will form

breasts will enlarge during pregnancy because...

Alveoli

milk-secreting grape like clusters

FSH/LH increase; secondary to gonadotropin hormones

breasts enlarge slightly during menstrual cycles due to...

Colostrum

premium fluid that is secreted from the breast during the last trimester of pregnancy and at the beginning of nursing; rich in protein, growth factors, and helps the infant's intestines

large and pendulous

in multiparous women, the breast often become...

the decrease in fat and atrophy of glandular tissue

why do breasts become small/wrinkled in elderly women?

4

the breasts are divided into ___ quadrants; they are used to document masses or physical findings on examination

location, size, consistency, mobility, and delimitation of the mass

if one finds a mass on a breast exam, one must note the...

upper outer quadrant

breast masses are mostly found in the...

internal thoracic (mammary) artery, lateral thoracic artery, thoracoacromial arteries, posterior intercostal arteries

arterial supply of the breast

axillary vein

main venous drainage of the breast

internal thoracic vein, posterior intercostal veins

other routes of venous drainage for the breast

they drain into the azygos and hemiazygos system of veins alongside the bodies of the vertebrae -- this can be a route in which cancer cells can spread from the breast to the vertebrae and from there to the skull and brain

why are the posterior intercostal veins important clinically?

axillary lymph nodes, pectoral (anterior) does, parasternal nodes, phrenic nodes

lymphatic drainage of the breast

axillary lymph nodes, initially to the anterior nodes

most lymph from the breast drains to the...

parasternal nodes

the remaining lymph goes to the ______ after the axillary nodes

supraclavicular/infraclavicular, subclavian lymphatic trunk

lymph from the axillary nodes goes to the ______ and _______ nodes and then into ________.

bronchomediastinal

lymph form the parasternal nodes travels to the _______ trunk

abdominal nodes (phrenic)

lymph form the lower breast quadrants pass deep to the...

4th-6th intercostal nerves

the nerves of the breast derive from anterior and lateral cutaneous branches of the...

Breast cancer

the most common cancer in women and the 2nd leading cause of cancer death (after lung) in women in the US; 1 in 8 American women affected; 2/3 of cases occur in postmenopausal women

adenocarcinoma

most common cell type for breast cancer

skin retraction/skin dimpling, nipple retraction, mass, palpable nodes

clinical signs of breast cancer

dimpling of skin over carcinoma is caused by involvement and retraction of Cooper's ligaments

what causes dimpling of the skin in breast cancer?

cancer involvement of mammary ducts may cause duct shortening and retraction of inversion of the nipple

what causes nipple retraction in breast cancer?

axillary nodes

what nodes are the most common site of breast cancer metastasis?

Peau d'orange

orange peel appearance of breast due to interference with lymphatic drainage of the breast by cancer; skin is puffy and has prominent pores that give it an orange peel appearance

subareolar breast cancer

nipple inversion can occur from...

stereotactic biopsy

needle biopsy using a computer-guided imaging system to locate suspicious tissue and remove samples for study

lumpectomy

excision of a small primary breast tumor and some of the normal tissue that surrounds it

sentinel lymph node biopsy

injection of blue dye and/or radioactive isotope used to identify the sentinel lymph nodes

Simple mastectomy

removal of an entire breast but with the underlying muscle and axillary lymph nodes left intact; breast removed down to retromammary space

radial mastectomy

the surgical removal of an entire breast and many of the surrounding tissues such as pectoral muscles, fat, fascia, lymph nodes, in axillary and pectoral region

Supernumerary breasts

extra breasts that may appear anywhere along a line extending from the axilla to the groin (Milk line)

Milk line

the location of the embryonic mammary ridge from which the breast develops

Polymastia

presence of more than two breasts

Polythelia

extra nipples

Gynecomastia

enlargement of one or both breasts in men

puberty, aging, drug-related (antihypertensives, estrogen), medical conditions (cirrhosis of liver, testicualr tumors, pituitary adenoma)

what can cause gynecomastia?