Duke Anatomy Tables - thoracic wall

Topographical Anatomy of the Thorax

Structure/Space

Description/Boundaries

Significance

mediastinum, anterior (N231,TG4-35,TG4-36,TG4-37)

between sternum and pericardial sac; extends from thoracic inlet to diaphragm

contains sternopericardial ligaments & lymph nodes (Latin, medius = middle + stare = stand, thus that area which stands in the middle of the thorax)

mediastinum, middle (N231,TG4-35,TG4-36,TG4-37)

bounded by pericaridal sac

contains heart, pericardial cavity, great vessels, and phrenic nerves (Latin, medius = middle + stare = stand, thus that area which stands in the middle of the thorax)

mediastinum, posterior (N231,TG4-35,TG4-36,TG4-37)

between pericaridal sac and vertebral bodies

contains esophagus, descending thoracic aorta, azygos system, thoracic duct, and lymph nodes (Latin, medius = middle + stare = stand, thus that area which stands in the middle of the thorax)

mediastinum, superior (N231,TG4-35,TG4-36,TG4-37)

bounded by thoracic inlet above and plane through sternal angle below

contains great vessels, trachea, esophagus, phrenic and vagus nerves (Latin, medius = middle + stare = stand, thus that area which stands in the middle of the thorax)

midaxillary line (TG4-01C)

an imaginary vertical line passing through the middle of the axilla

used as a surface landmark for descriptive purposes

midclavicular line (TG4-01B)

an imaginary vertical line passing through the midshaft of the clavicle

used as a surface landmark for descriptive purposes

nipple (TG4-01)

located superficial to the 4th intercostal space in the male and prepuberal female

location of the left nipple may be used to help locate the apex of heart, which is approximately 8 cm from the midline in the left 5th intercostal space; a surface landmark used to place the stethoscope for auscultation of the bicuspid valve

sternal angle (TG4-01A)

a protrusion on the anterior thoracic wall at the junction of the manubrium and body of the sternum (manubriosternal symphysis)

sternal angle is the location of the attachment of the costal cartilage of the 2nd rib to the sternum; an imaginary horizontal plane through the sternal angle passes through the T4/T5 intervertebral disc and marks the inferior boundary of the superior mediastinum

suprasternal notch

the notch located at the superior border of the manubrium of the sternum, between the sternal ends of the clavicles

also known as: jugular notch

thoracic inlet

the opening at the superior end of the rib cage through which cervical structures enter the thorax; bounded by the T1 vertebral body, both of the 1st ribs and their costal cartilages, and the manubrium of the sternum

thoracic inlet marks the boundary between the neck and the superior mediastinum; also known as: superior thoracic aperture

thoracic outlet

the opening at the inferior end of the rib cage through which thoracic structures exit the thorax; it is bounded by the T12 vertebral body, both 12th ribs, the costal cartilages of ribs 7-12, and the xiphisternal joint

thoracic outlet is closed by the respiratory diaphragm which is attached at its boundary; also known as: inferior thoracic aperture

costal margin (TG4-01A)

the inferior margin of the lowest costal cartilages and ribs

serves as part of the origin of the respiratory diaphragm

Osteology of the Thorax

Bone

Structure

Description

Notes

rib(N186,TG4-04,TG4-05)

the bone forming the lateral thoracic wall

12 pairs; several types are described: typical or "true" ribs, "false" ribs, "floating" ribs; all three types of ribs have many features in common: head, neck, tubercle, angle, body, costal groove

head (N186,TG4-04,TG4-05)

posteromedial end of the rib

it articulates with demifacets of two adjacent vertebral bodies

neck (N186,TG4-04,TG4-05)

the constricted region lateral to the head of the rib

the neck of the rib is located between the head and the tubercle

tubercle (N186,TG4-04,TG4-05)

a projection located posteroinferior and lateral to the neck of the rib

it articulates with the transverse process of a vertebra

body (N186,TG4-04,TG4-05)

the shaft of the rib

the body is the longest part of a typical rib

angle (N186,TG4-04,TG4-05)

the marked angulation of the body located just lateral to the tubercle

the angle of the rib is its most posterior part

costal groove (N186,TG4-04,TG4-05)

the groove on the inner surface of the inferior border of the body of the rib

it accommodates the intercostal neurovascular bundle; the costal groove provides a protective function for the intercostal neurovascular bundle,

ribs 1-7(TG4-04A, TG4-04B))

"true" ribs - those which attach directly to the sternum

true ribs actually attach to the sternum by means of a costal cartilage and a true synovial joint

rib 1

the most cephalic rib

it is the broadest, shortest and widest of the ribs; the scalene tubercle marks its superior surface and is an elevation between grooves for the subclavian vein & artery; the scalene tubercle is the attachment site of the scalenus anterior m.

rib 2

the rib attached to the 1st and 2nd thoracic vertebrae

it articulates via a costal cartilage with the sternum at the level of the sternal angle; its superior surface is roughened by the attachments of the scalene mm.

rib 8-10

"false" ribs

they articulate via costal cartilages with the costal cartilage of rib 7

rib 11-12

"floating" ribs

the anterior ends of these ribs do not articulate with the sternum or the costal cartilage of the rib above; their costal cartilages are short and end in the muscle of the posterolateral abdominal wall

sternum (TG4-04A)

the broad flat bone forming the anterior thoracic wall

it is formed by three parts: manubrium, body, xiphoid process

manubrium (TG4-04A, Practical)

the superior part of the sternum

Latin, manubrium = handle, as in the handle of a sword

jugular (suprasternal) notch (TG4-04A)

a notch on the superior border of the manubrium

it is located between the clavicular notches which articulate with the sternal ends of the clavicles (Latin, jugular = throat)

clavicular notch

a notch on the superolateral border of the manubrium

it articulates with the sternal end of the clavicle

sternal angle (TG4-04A)

the junction of the manubrium and body of the sternum

it is an anterior projection located at the level of the costal cartilage of rib 2; an important landmark for internal thoracic anatomy

body (TG4-04A, Practical)

the middle part of the sternum

it articulates with the manubrium superiorly and the xiphoid process inferiorly; laterally it articulates with the costal cartilages of ribs 2-7

xiphoid process (TG4-04A)

the inferior part of the sternum

it is variable in size, shape & ossification; it articulates with the body of the sternum superiorly (Greek, xiphos = sword + eidos = appearance, the tip of the sternum is pointed like the tip of a sword)

Muscles of the Thoracic Wall

Muscle

Origin

Insertion

Action

Innervation

Artery

Notes

Image

external intercostal(N188,N189,TG4-08)

lower border of a rib within an intercostal space

upper border of the rib below, coursing, downward and medially

keeps the intercostal space from blowing out or sucking in during respiration

intercostal nerves (T1-T11)

intercostal a.

11 in number; they extend from the tubercle of the rib to the costochondral junction; continuous with the external intercostal membrane anteriorly (Latin, costa = rib)

internal intercostal(N188,N254,TG4-09,TG4-10)

upper border of a rib

lower border of rib above, coursing up and medially

keeps the intercostal space from blowing out or sucking in during respiration

intercostal nerves (T1-T11)

intercostal a.

11 in number; they extend from the margin of the sternum to the angle of the rib; continuous posteriorly with the internal intercostal membrane (Latin, costa = rib)

innermost intercostal (N189,254,TG4-09,TG4-10, Practical)

upper borders of a rib

fibers course up and medially to insert on the inferior margin of the rib above

keeps the intercostal space from blowing out or sucking in during respiration

intercostal nerves (T1-T11)

intercostal a.

innermost intercostal mm. have the same fiber direction as the internal intercostal mm., the only difference being that they lie deep to the intercostal neurovascular bundle (Latin, costa = rib)

subcostalis (TG4-10)

angle of ribs

angle of a rib 2-3 ribs above origin

compresses the intercostal spaces

intercostal nerves

intercostal a.

subcostalis, transversus thoracis & innermost intercostal mm. make up the deepest intercostal muscle layer (Latin, costa = rib)

transversus thoracis (N189,TG4-09, Practical)

posterior surface of the sternum

inner surfaces of costal cartilages 2-6

compresses the thorax for forced expiration

intercostal nerves 2-6

internal thoracic a.

transversus thoracis, subcostalis & innermost intercostal mm. make up the innermost intercostal muscle layer

Joints and Ligaments of the Anterior Thorax

sternoclavicular joint (TG2-42C)

the joint what connects the clavicle with the sternum

a synovial joint; its joint capsule is subdivided by a fibrous articular disc; it is strengthened by the sternoclavicular, interclavicular and costoclavicular ligaments; the sternoclavicular joint has the range of movement, but not the form, of a ball and socket joint

sternoclavicular ligament (TG2-42A)

a ligament that reinforces the capsule of the sternoclavicular joint

the sternoclavicular ligament has two parts: anterior and posterior; it is a very strong ligament; the combined effect of this ligament, the costoclavicular ligament and the interclavicular ligament is to produce a very strong sternoclavicular joint that seldom dislocates

sternocostal joints (TG2-42A)

the articulations that connect the costal cartilages with the sternum

a synchondrosis (rib 1) or synovial joints (ribs 2-10); sternocostal synovial joints involving ribs 2-7 contain thin joint capsules; interchondral joints involving ribs 8-10 have simple gliding synovial articulations; radiate sternocostal ligaments reinforce the sternocostal articulations

xiphisternal joint (TG4-01A)

the articulation that connects the xiphoid process with the body of the sternum

a synchondrosis; the cartilage within this joint usually becomes ossified in old age; the xiphisternal joint marks the inferior extent of the thoracic cavity

Arteries

Artery

Source

Branches

Supply to

Notes

epigastric, superior (N191,TG4-08,TG4-09, Practical)

internal thoracic a. (N191,TG4-08,TG4-09)

no named branches

upper rectus abdominis m., upper abdominal wall

superior epigastric a. is the direct continuation of the internal thoracic a.; it anastomoses with the inferior epigastric a. within the rectus abdominis m.

intercostal, anterior (N191,TG4-08,TG4-09)

internal thoracic a. (upper 6 intercostal spaces), musculophrenic a. (7-10th intercostal spaces)

unnamed muscular branches

intercostal muscles anteriorly; skin overlying the intercostal muscles

there are two anterior intercostal aa. per side per intercostal space, one coursing above and one coursing below each rib

intercostal, posterior (N192,TG4-10,TG4-39, Practical1, Practical2)

highest intercostal (upper 2 intercostal spaces), descending thoracic aorta (3rd-11th intercostal spaces)

posterior br., spinal br., anterior br., collateral br., lateral cutaneous br.

intercostal muscles, spinal cord and vertebral column, deep back muscles, skin and superficial fascia overlying the intercostal spaces

posterior intercostal aa. supply the lateral and posterior portions of the intercostal space; anterior intercostal aa. supply the anterior portions of the intercostal spaces

internal thoracic (N191,TG4-08,TG4-09, Practical)

subclavian a. (1st part)

pericardiacophrenic a., perforating brs., anterior intercostal aa., mediastinal brs., thymic brs., musculophrenic a., superior epigastric a.

mediastinum, anterior thoracic wall, anterior abdominal wall, respiratory diaphragm

internal thoracic a. is also known as: internal mammary a.

musculophrenic N191,TG4-08,TG4-09, Practical1, Practical2)

internal thoracic a.

anterior intercostal aa.

anterior diaphragm, anterior aspects of intercostal spaces 7-10 or 11

musculophrenic a. supplies muscles that develop in the septum transversum (Greek, phreno = diaphragm)

pericardiacophrenic (N194,N212,TG4-18)

internal thoracic a.

pericardial br., sternal br., mediastinal br.

pericardial sac, pleura, diaphragm

pericardiacophrenic a. accompanies the phrenic n.

aorta, ascending (N212,TG4-37,TG4-39, Practical)

left ventricle of heart

left & right coronary aa., continues as aortic arch

heart, entire body

(Greek, aorta = to lift)

aortic arch (N212,TG4-37,TG4-39, Practical1, Practical2, Practical3)

the continuation of the ascending aorta

brachiocephalic trunk, left common carotid a., left subclavian a.

the entire body except the heart

aortic arch continues as the descending thoracic aorta; the ligamentum arteriosum connects to the inferior surface of the aortic arch and marks the location of the fetal ductus arteriosus(Greek, aorta = to lift)

pulmonary trunk (N212,TG4-19,TG4-29, Practical)

right ventricle

right pulmonary a., left pulmonary aa.

lungs

the pulmonary trunk carries deoxygenated blood from the heart to the right and left pulmonary aa.; each pulmonary a. carries deoxygenated blood to the hilum of one lung; bronchial aa. supply oxygenated blood to the tissues of the lung as far distally in the bronchial tree as the respiratory bronchioles

Veins

Vein

Tributaries

Drains Into

Region Drained

Notes

vena cava, inferior (N206,N261,TG4-20,TG4-37)

union of paired common iliacs; lumbar vs. 4-1, rt. ovarian/testicular, renal vs., rt. suprarenal, rt. inferior phrenic, hepatic vs.

rt. atrium

body below diaphragm

vena cava, superior (N212,TG4-35,TG4-40)

union of paired brachiocephalics; azygos arch

rt. atrium

body above diaphragm except for pulmonary vs. & heart

intercostal, posterior (N191,TG4-08,TG4-09)

spinal trib., posterior trib., collateral trib., lateral cutaneous trib.

1st: brachiocephalic; 2nd-4th: superior intercostal; right 5th-11th: azygos; left 5th-7th or 8th: accessory hemiazygos; left 9th-11th: hemiazygos

intercostal space & muscles & adjacent ribs, spinal cord segment & vertebra

intercostal, superior (N231,TG4-36,TG4-40, Practical1, Practical2, Practical3)

2nd-4th posterior intercostal

right: arch of azygos; left: left brachiocephalic

intercostal spaces 2-4

pulmonary

left atrium

lungs

usually two pulmonary vs. per side, sup. & inf., empty into left atrium (N206,TG4-29)

Lymphatics

Structure

Location

Afferents from

Efferents to

Regions drained

Notes

parasternal nodes (N181,TG2-11)

lateral border of sternum, along the course of the internal thoracic vessels

anterior phrenic nodes, lymphatic vessels from the anterior thoracic wall

larger lymphatic vessels in the root of the neck

medial side of the mammary gland; medial part of the anterior chest wall and muscles

parasternal nodes constitute an important drainage pattern in cases of cancer of the mammary gland; one or two parasternal nodes may be found in the anterior end of intercostal spaces 1-6; also known as: sternal nodes

Nerves

Nerve

Source

Branches

Motor

Sensory

Notes

intercostal n.(N189,N254,TG4-09,TG4-10, Practical)

ventral primary rami of spinal nerves T1-T11

lateral & anterior cutaneous brs.

intercostal muscles; abdominal wall muscles (via T7-T11); muscles of the forearm and hand (via T1)

skin of the chest and abdomen anterolaterally; skin of the medial side of the upper limb (via T1-T2)

intercostal n.travels below the posterior intercostal a. in the costal groove (Latin, costa = rib)

phrenic n. (N194,N212 TG4-09,TG4-18, Practical1, Practical2)

ventral primary rami of spinal nerves C3-C5 (cervical plexus)

no named branches

skeletal muscle of the respiratory diaphragm

diaphragmatic pleura; some fibers contributed to the pericardium and to the adjacent mediastinal and costal pleurae

phrenic n. crosses the anterior surface of the anterior scalene m. (Greek, phren = diaphragm, from which we derive our word "frenzy," for the diaphragm was considered to be the seat of emotions)

subcostal n.

ventral primary ramus of T12

lateral cutaneous br., anterior cutaneous br.

muscles of the abdominal wall

skin of the anterolateral abdominal wall

the subcostal n. is equivalent to a posterior intercostal n. found at higher thoracic levels (Latin, costa = rib)

vagus n. (N206,N212,TG4-19,TG4-36, Practical)

medulla: dorsal motor nucleus (GVE preganglionic parasympathetic); inferior ganglion (GVA); nucleus ambiguus (SVE); superior ganglion (GSA); inferior ganglion(SVA)

auricular br., pharyngeal br., superior laryngeal, superior and inferior cervical cardiac brs., recurrent laryngeal n., thoracic cardiac brs., brs. to the pulmonary plexus, brs. to the esophageal plexus, anterior and posterior vagal trunks

SVE: intrinsic muscles of the larynx, pharynx (except stylopharyngeus), and palate (except tensor veli palatini); GVE: smooth muscle of the respiratory tree & gut (proximal to the left colic flexure), heart; secretomotor: mucous glands of the larynx, respiratory tree, pharynx and gut; secretomotor to digestive glands

GSA: skin of the external auditory meatus; GVA: viscera of head, neck, thorax & abdomen proximal to the left colic flexure; SVA: taste from the epiglottis

also known as: CN X, 10th cranial nerve; the vagus n. passes through the jugular foramen to exit the posterior cranial fossa; (Latin, vagus = wanderer so called because of its extensive distribution to the body cavities)

recurrent laryngeal n. (TG4-36,TG4-45)

vagus n. (X)

esophageal brs., tracheal brs., cardiac brs., pharyngeal brs., inferior laryngeal n.

upper esophagus, lower pharynx, laryngeal mm. (except cricopharyngeus); smooth muscle of the trachea; secretomotor to mucosal glands in the upper esophagus, lower pharynx, larynx below the vocal fold, trachea; cardiac muscle of the heart (slows heart rate, decreases force of contraction)

upper esophagus, lower pharynx, larynx below the vocal folds, GVA from heart

right recurrent laryngeal n. loops posteriorly around the right subclavian a.; left recurrent laryngeal n. loops posteriorly around the aortic arch and ligamentum arteriosum; the inferior laryngeal br. supplies all intrinsic muscles of the larynx EXCEPT the cricothyroid m.

Viscera/Fascia of the Chest

Organ/Part of Organ

Location/Description

Notes

pleura (N241)

serous membrane lining the pleural cavity

there are two types of pleura: visceral pleura covers the lungs, parietal pleura lines the inner surfaces of the walls of pleural cavity; parietal pleura is sensitive to pain but visceral pleura is not sensitive to pain (Greek, pleura = rib, side)

cupula (N211,N196,TG4-13, TG4-15)

serous membrane lining the pleural cavity which extends above the level of the 1st rib into the root of the neck

cupular pleura is continuous inferiorly with the costal and mediastinal parietal pleurae; it is reinforced by a specialization of scalene fascia (called Sibson's fascia or suprapleural membrane); also known as: cervical parietal pleura or cervical dome of pleura

pleura, cervical parietal (TG4-13, TG4-15)

serous membrane lining the pleural cavity which extends above the level of the 1st rib into the root of the neck

cervical parietal pleura is continuous inferiorly with the costal and mediastinal parietal pleurae; it is reinforced by a specialization of scalene fascia (called Sibson's fascia or suprapleural membrane); also known as: cupula or cervical dome of pleura (Latin, paries = wall (of a cavity))

pleura, costal parietal (TG4-18, TG4-19)

serous membrane lining the pleural cavity on the inner surfaces of the ribs, costal cartilages, and intercostal mm.

costal parietal pleura is continuous anteriorly with the mediastinal parietal pleura at the costomediastinal reflection; it is continuous posteriorly with the mediastinal parietal pleural at the vertebral bodies; it is continuous inferiorly with the diaphragmatic parietal pleura at the costodiaphragmatic reflection; it is continuous superiorly with the cervical parietal pleura at the level of the 1st rib (Latin, paries = wall (of a cavity))

pleura, diaphragmatic parietal (TG4-11B, TG4-12B, TG4-18, TG4-19)

serous membrane lining the pleural cavity on the superior surface of the diaphragm

diaphragmatic parietal pleura is continuous superiorly with the costal parietal pleura at the costodiaphragmatic reflection; it is continuous superiorly with the mediastinal pleura at the inferomedial borders of the pleural cavities (Latin, paries = wall (of a cavity))

pleura, mediastinal parietal (TG4-11B, TG4-12B, TG4-18, TG4-19)

serous membrane lining the pleural cavity on the lateral surface of the mediastinum

mediastinal parietal pleura is continuous anteriorly with the costal parietal pleura at the costomediastinal reflection; it is continuous inferiorly with the diaphragmatic pleura at the inferomedial borders of the pleural cavities; it is continuous posteriorly with the costal parietal pleura lateral to the vertebral bodies; it is continuous superiorly with the cervical pleura at the level of the 1st rib (Latin, paries = wall (of a cavity))

pleura, visceral (TG4-29)

serous membrane lining the surfaces of the lungs

visceral pleura extends into the oblique and horizontal fissures of the lungs; it does not have pain fibers (Latin, viscus = internal organ)

pulmonary ligament (N199,N230,N231,TG4-31,TG4-35,TG4-36, Practical)

fold of pleura located below the root of the lung

pulmonary ligament is where the visceral pleura and the mediastinal parietal pleura are continuous with each other

costodiaphragmatic recess (N230,N231,TG4-13A,TG4-13B,TG4-15, TG4-16,TG4-17, Practical)

a potential space between the apposing surfaces of the costal and diaphragmatic parietal pleura

this space extends to the 8th rib in the midclavicular line, 10th rib in the midaxillary line, and 12th rib at the medial scapular/paravertebral line.

costomediastinal recess (N230,N206,TG4-13A,TG4-15)

a potential space between the apposing surfaces of the costal and mediastinal parietal pleura

this space is more pronounced on the left because of the location of the heart

endothoracic fascia (TG4-08)

connective tissue between inner aspect of chest wall & costal parietal pleura

equivalent to transversalis fascia layer of the abdomen

pericardial sinus, oblique (TG4-20)

an area of the pericardial cavity located behind the left atrium of heart

serous pericardium reflects onto the inferior vena cava and pulmonary vv. to define this space

pericardial sinus, transverse (TG4-20)

an area of the pericardial cavity located behind the aorta and pulmonary trunk and anterior to the superior vena cava

transverse pericardial sinus was a simple structure when the heart tube began to form during development; it separates the outflow vessels from the inflow vessels of the heart

pericardium, fibrous (N211, Practical)

a fibrous sac that attaches to the central tendon of the diaphragm and fuses with the adventitia of the great vessels superiorly

fibrous pericardium contains the pericardial cavity and heart; it is lined on its inner surface by the parietal layer of serous pericardium; it defines the outermost boundary of the middle mediastinum

pericardium, parietal serous (N212,N241,TG4-18,TG4-19)

serous membrane lining the pericardial cavity; it is located on the inner surface of the fibrous pericardium

parietal serous pericardium reflects onto the heart at the origins of the great vessels to become continuous with the visceral serous pericardium

pericardium, visceral serous (N212,N241,TG4-18,TG4-19)

serous membrane covering the surface of the heart

visceral serous pericardium reflects onto the inner surface of the fibrous pericardium at the origins of the great vessels to become continuous with the parietal serous pericardium; also known as: epicardium

hilum of lung

medial surface of the lung

the point at which the structures forming the root - the main bronchus, pulmonary vessels, bronchial vessels, lymphatic vessels, and nerves - enter and leave the lung

coronary sulcus (N212)

groove separating atria from ventricles

coronary sinus, circumflex a., & right coronary a. lie in coronary sulcus, (Latin, coronary = something that is "crown-like", i.e., goes around in a loop)

apex (N212,TG4-19, Practical)

tip of left ventricle

located 3" left of midline at level of 5th intercostal space

base (N212,TG4-19,TG4-22)

superior aspect of heart

where aorta, pulmonary trunk & superior vena cava enter the heart

atrium, right (TG4-25A, TG4-25C, Practical)

forms the right margin of the heart

receives blood from the superior vena cava, inferior vena cava & coronary sinus

atrium, left (TG4-26A, TG4-26B, Practical)

located on the posterior aspect of the heart

receives blood from the pulmonary vv.

auricle TG4-25C, Practical1, Practical2)

projects anteriorly from the atrium

one on each atrium, they lie beside aorta & pulmonary trunk (Latin, auricula = little ear, the auricle of the atrium is shaped like a little ear)

interventricular sulcus, anterior (TG4-25C)

groove between ventricles on anterior surface of heart

anterior interventricular a. & great cardiac v. lie within sulcus (Latin/Greek, holkos (sulcus)= furrow)

interventricular sulcus, posterior

groove between ventricles on diaphragmatic surface of heart

posterior interventricular a. & middle cardiac v. lie within sulcus (Latin/Greek, holkos (sulcus)= furrow)

ligamentum arteriosum (TG4-19,TG4-29, Practical1, Practical2)

remnant of ductus arteriosus; connects left pulmonary a. near origin with undersurface of aortic arch

left recurrent laryngeal n. passes beneath it

right (acute) margin (N212,TG4-15

inferior margin formed by right ventricle

called acute due to the sharp angle formed between the anterior and diaphragmatic surfaces of the right ventricle

left (obtuse) margin (N212,TG4-15)

left, upper margin formed by left ventricle

called obtuse due to the broad curving angle formed by the anterior and diaphragmatic surfaces of the left ventricle

trachea (N206,N211,TG4-33,TG4-37)

main airway that lies anterior to the esophagus

trachea extends from vertebral level C6 to the level of the T4/5 intervertebral disc; superiorly it is connected to the cricoid cartilage via the cricotracheal ligament; it bifurcates into two primary bronchi (Greek, trachys = rough)

Clinical Terms

Term

Definition

collateral circulation

compensatory circulation carried on through secondary channels after obstruction of the principal vessel supplying the part; collateral circulation is common around moveable joints

shingles (herpes zoster)

disease in adults caused by Varicella zoster virus (Herpetoviridae), that in children causes chicken pox; arises by reactivation (usually associated with a decline in cell-mediated immunity) of latent virus that persists in spinal or cranial sensory nerve ganglia

thoracotomy

a surgical procedure in which an incision is made opening the chest cavity

sternotomy

midline incision through the sternum

funnel chest

a developmental anomaly in which the lower sternum is posteriorly dislocated and concavely deformed, resulting in a funnel-shaped thorax; also known as pectus excavatum

pigeon chest

prominence of the breast bone (sternum); also known as pectus carinatum

empyema

the accumulation of pus in a cavity of the body, when used without a descriptive qualifier; it refers to thoracic empyema (Greek, empyema = suppuration)

thoracocentesis

a medical procedure that involves the removal of fluid from the chest cavity using a hollow-bore needle; performed for therapeutic reasons when drawing off large volumes of fluid and for diagnostic reasons (to analyze the fluid) (Greek, -centesis = puncture)

pneumothorax

a collapse of the lung due to an abrupt change in the intrapleural pressure within the chest cavity; may be due to lung or chest penetration (trauma); may also occur spontaneously (rupture of the lung - typically in tall, young males); symptoms include shortness of breath and severe, one-sided (affected side) chest pain on inhalation; signs include decreased breath sounds and hyperresonance on the affected side. A tension pneumothorax is one which allows air to enter the pleural space (from a hole in the chest wall or the lung) but not escape leading to a valve effect pushing the mediastinal structures to the opposite side - the additional signs and symptoms signaling this medical emergency are shock from decreased venous return to the heart (IVC is kinked due to mediastinum being pushed to one side) and tracheal deviation away from the affected side.

hemothorax

blood in the pleural space

pleurisy

inflammation of the pleura with exudation into its cavity and upon its surface; may occur as either an acute or a chronic process; in acute pleurisy the pleura becomes reddened, then covered with an exudate of lymph, fibrin, and cellular elements (the dry stage); the disease may progress to the second stage, in which a copious exudation of serum occurs (stage of liquid effusion); the inflamed surface of the pleura tends to become connected by adhesions, which are usually permanent; symptoms are a stitch in the side, a chill, followed by fever and a dry cough; as effusion occurs there is an onset of dyspnea and a diminution of pain; the patient lies on the affected side (Greek, pleura = a rib or the side)

crepitus

a crackling sound in the lungs or a grating feeling (Latin, crepo = to rattle)

tension pneumothorax

a condition in which the ruptured tissue forms a valve that permits air to enter the chest cavity upon inspiration, but does not allow air to escape during expiration and therefore greatly increases the pressure inside the cavity such that the vessels and trachea are displaced to the opposite side (Greek, pneuma = air + thorax = chest)

tachypnea

abnormally rapid respiration rate; normal resting adult respiration rate is 12-20 breaths per minute (Greek, tachy = quick + pnea/pnoie = breathing)

dyspnea

difficulty or distress in breathing (Greek, pnea/pnoie = breathing)

parasthesia

an abnormal spontaneous sensation such as burning, pricking, and numbness

pleural effusion

excess fluid in the pleural space. This can be either a transudate or an exudate (Greek, pleura = a rib or the side)

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