Clinical Correlations 3.1

Exam 3 Lecture 1

Clinical importance of midclavicular line

The 2nd intercostal space on the midclavicular line serves as a site for needle decompression in emergencies

Clinical importance of midaxillary line

- Posterolateral thoracentesis at 8th-10th intercostal space on midaxillary line; drains pleural fluid

- placement of chest tube placement at 4th-5th intercostal space

Clinical importance of midscapular line

site for ultra-sound guided thoracentesis to drain posterior accumulation of pleural fluid in supine patients

Where is a needle inserted in relation to the ribs during an thoracentesis and why?

The needle is inserted above the superior border of the rib to avoid hitting the intercostal neurovascular bundle which is located on the inferior border of the ribs

Clinical importance of inframammary folds

used as reference point in reconstructive surgery to maintain natural contour and symmetry

Clinical importance of Tail of Spence

frequent site of breast cancer due to its rich glandular density and lymphatic drainage pathway; often included in imaging for this reason

Clinical importance of Lactiferous duct

most breast carcinomas originate in the epithelial lining of the lactiferous ducts

Clinical importance of suspensory ligaments

visible dimpling or puckering of the skin can serve as an early sign of breast tumor on or within the suspensory ligaments

Clinical importance of MRI in breast

used to detect invasive breast cancer in women with dense breasts or inconclusive mammography

Clinical importance of Internal thoracic artery

commonly used in coronary artery bypass grafting procedures but this can reduce blood supply to the medial breast and potentially compromise healing in reconstructive surgery

Clinical importance of venous drainage in breast

the valve less venous connections may allow breast cancer to metastasize to the spine and brain via the Batson plexus; this bypasses the lungs

Clinical importance of axillary lymph nodes

serves as a site of sentinel lymph node biopsy in order to minimize surgical morbidity while accurately staging breast cancer

Clinical importance of upper outer quadrant of breast

the high density of glandular lobules and lymphatic channels provide an increased risk of tumor development and metastatic spread to axillary lymph nodes

Clinical importance of cervical rib

presence of cervical rib could lead to thoracic outlet syndrome due to compression on brachial plexus and/or subclavian A and V

Clinical importance of right crus

a weak or lax right crus may contribute to hiatal hernia (stomach herniates through esophageal hiatus)

Clinical importance of pleura innervation

• parietal pleura is somatically innervated which causes sharp and localized pain

• visceral pleura pain does not present for example in early lung cancer

Clinical importance of pulmonary diseases

they impair alveolar gas exchange by altering surface area or thickening the alveolar membrane which can contribute to hypoxemia