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n

Sternu.u.-

~ T.;::o·rax ~

-

~

-~

o Differences in sex ---=::!====~sm~:J!:\tr:mroiSlerin the female '-'

.
.

ONE MARROW BIOPSY o [.,Manubnum Has jugular notch

. ONE MARROW BIOPSY o [.,Manubnum Has jugular notch -­ ~Rib C~-'L---' 1 and half of

~Rib

C~-'L---'

1 and half of 2 articulates here

---­

c::;: ;iQ~ ArtiC~ la~ wit~ Q~.9LtilC19~t:L ­

~~c

1~

TI 0 leveloc:::r Ossifies slowly from the center out ­

-./"1

0

Sternal angle [angle of Louis) between monubrium and body

V ~

.

2 nd

rib articulates here:::;,

0$ At T4/T5 intervertebral level

J A~.vI ~TtI- V

v.

;~

~

V

',

<"

7k,~

I

L.1-t,

'l1V\

Boun~_rx.'QeJ.w~en _SU.Re.r.iQLQD1.ilJ!eri0!.lD~di22.!i_I}"um

0

J

e

LeTfT~®-tlt

_ o L'ill.9 US

Aortic Arch begin_s -­

TrOCl:!ea Azygous _ arch , i ur~ciTe~"-

Azyg'6us"e'nrer~SVC -­

Th§CaclCdUcT crosses frQml to R side of body :::;

Head that arliculates w ith vertebral bodies .­ Body

r-

Tuberclesmjculgt.ElS't{jJbJr9r:!J':'.E?!i~_p.LQ_<;;,ess9f

ribse~ tforrib 11 and 12 ,'

,

.--­

T!1Ie

ribs

'N ' )

L v ,'C ,

,~

./~bS(12i~

0

Structure

o True 1-7./'-'

o False 8-10

~IOOlitl~2

( ~Iinic ols.-.--/ ~ERARY -7 usua~ical or :::::>

Thoracic outlet syndrome:

ribs

compression.2!

-:==:­

r1~.9.y.g1i.cular

struc .,~Ig_~ _mthor.QGic-outiet -7 causes

pain, numbness, lingling, weakness,

Body Xiphoid Process
Body
Xiphoid
Process
pain, numbness, lingling, weakness, Body Xiphoid Process ribs ~ segment of thoracic wall moves freely due

ribs

~

segment of thoracic wall moves freely due to numerous rib fractures#t 4- Fracture'

~~-7

~!atigue

1f

Rib I

can injure brachial glexus or subclavian vessels

Most commonly by-dl;ecibioy/"of'crushli-ig"inJurY"

Often fracture at the angle

o External intercoslals

~ <

~ Dow~ from lower edge of rib to upper edge of next rib going antenor "Hands in front pockets direction" Internal intercostals

~ Opposite of externals

/'/

0

,,//

&>0

~,

~~

":

­
­

--

"Hand in back pockets"

o Innermost Down and forward

 

"Hand in front pockets"

o

Clinical :

/

~horacocentesis Insert needle properly to avoid neurovascular bundle between internal and innermost (VAN) within costal groove of ribs

Insert n

e.eEi

o.!.!lb

Usuall

~ al9 ln

to ovoid puncturing the lung. liv~

 

.-.--

Blood supply: arteries '

lung. liv~   .-.-- Blood supply: arteries ' , ~.o< vv.-t sa404002 WWW . fotosearch .

, ~.o< vv.-t

sa404002 WWW.fotosearch.cJm >-vl'

rYrb

~

  .-.-- Blood supply: arteries ' , ~.o< vv.-t sa404002 WWW . fotosearch . cJm >-vl'

~(cv~~

o

Anterior thoracic wall • -:=;4FaeroollboroCic orteN From subclavian

--=-=­

orteN From subclavian - - = - = ­ /" Behind costal cartilages feeds IC 1-6

/"

Behind costal cartilages feeds IC 1-6 ---~,- \ ,,---~-- ~ t Superior epigastric and musculophrenic
Behind costal cartilages feeds IC 1-6
---~,- \
,,---~--
~
t
Superior epigastric and musculophrenic branches
Pericardlophrenic goes to pleura, pericardium, diaphragm
o
\
o Anterior perforalin
branches ~ pectoralis major and subcutaneous
, \ !
o
nor Intercostal orlene
up
ery anastomoses with posterior intercostal and lower
joins collateral branch
Supplies intercostal musfles. serratus OD.llll.OL pecto[9.!
~.
~~cles
o Superior epigastric: descends on deep surface of rectus abdominus
-'"':
Anosiomoses with inferior epigastric
Su
plies anterior cibdominOTwali. peritoneum. diaphragm
o
Musculo
hrenic IC 7-9
-
-- --
.,
I
FoUQ.~ costa "gr,ch
Anasiomoses with deep
circumflex iliac artery (from
extEi r;:;o!inac artery)
Supplies pericardium.
diaphragm. abdominal wall
muscles
o Posterior
Subclavian to costoceNical trunk ICS 1-2
/
Descending thore'crrOortGlC3- T1
­
• Veins -.-------]
o
(
AnterioU
~
~hreniC to interQ8LlliPlacic to br2~ri!:;t9.ePh.ol~to
~posteriorR: IC I_II azygous to SVS •.,./'
L
I :8accesmfYnemlOZygous to subclavian to SVS
,,­
.
L
9-11 hemiazygous to azygous to SVC a~
.~
~=:i
o
Stern
or
odes lie along internal thorocic artery V
Medial breast. ICS, diaphragm supra-umbilical all drain
---
"~
.\
Drains at jun.ction of internal ju~~.'9rand subclavi?n
,
o
AniNiof' wiew
Intercostal space drains to head 6rn5S
flgur-.1.41. A.lygot ~tlf'lnoIY1tirrs and r.h.oncic durt. RSy' nghf
"
ICS and pleura into cisterna
chyli or thoracic duct
LYI br.l.chi.o«ph~lcvnn; lav, l('r1 b",)'hiOCt'p~hC'W"lrt.
o
Phrenic nodes drain diaphragm surface
Lymph from pericardium. diaphragm, liver
\
Into sternal and posterior mediastinal nodes
o
Breast
./
Nipple to lobules to subareolar lymph plexus
75% to axillary nodes,/
25% to parasternal nodes !---'"
axilla",
nodes
I~.
, ,­
o
Body
--- I
The entire body except for the r:i.9J;l.U;.b.~ight arm
and right side of the head drains into the thoracic
duct
axUIa",
nod
'/
.
--- -
----­
J~
i
'- ;
.
The iight upper half of the body drains into the right
Pectoralis
minor
• ~dim!jA:::> j - ---
lymphatis.9.~ct
f
I~
\
Subscapular vein ----'
~
.,
o
Superior
Between 1" rib and sternal angle
Contents: S\iC--:-brachiocephalic veins. aortic arch, thoracic duct. trachea.
esophagus. vagus n, phrenic neNe, left recurrent laryngeal
o
Anterior
Between pericardiuD1.ocO s.1erDurn
Remnants of~ymus, lymph. fa!, (:1-:)
o
Middle
Between
Contains
he
Rand L pleural cavities
ni ~ §.r:'::.~!l2.QLQ.'-.9reat vessels, azygQus arch. main bronchi
9.!LQ.bLe
o
Poslerior
lwN)
Behind pericardium ~
p-
1
Esophagus, thoracic aorta, azygou?, hemiazygous, thoracic duct. vagus ner:'~, sympQtOE:).tic trunk --. ~- _•.

Esophagus, thoracic aorta, azygou?, hemiazygous, thoracic duct. vagus ner:'~, sympQtOE:).tic

trunk

--. ~-

_•. -' -

-- -

---

.--

.~--- -

EMBRYO

trunk --. ~- _•. -' - -- - --- .-- .~--- - EMBRYO o Loyers V-­

o Loyers V-­

• Endodel'TTi tracheal epitheliu~

• t

\/iiceral;;;;!silllerrYl) trach~als'ri{o2th musc~,con~ctivetissu~cartilage nngs

o~ Laryn~otracheal groove olvertJculOm)"7tracheoesophageal se tum separates foregut into

'y Ventral laryngotracheal tube: larynx, trac eo,

', lungs

, "'-)

Dorsal laryngotracheal tube: o~harynx an~ophaw.s

o Penods.of development

ar (7-16 weeks)

~seudog~

'-=';;"~'tnaOaermal tubules present

o Each terminals in 15-25 t

Respiration not possible, preemiI?,2a~n~,rs::-:-u-::rv';"l;'v"";"-

• 'j(>~ • ~analicular (16-24 weeks) •

'j(>~

~analicular (16-24 weeks)

• Terminal bronchioles branch into respiratory bronchioles

Respiratory bronchioles If born after week 20.

Iveolar ducts

.LJ

. ossibly can survi
.
ossibly can survi

t

~ Terminal sac (24-birth)

Alveolar ducts branch into terminal sacs Terminal sacs dilate and expand into surrounding mesoderm Type I and type II pneumocytes differentiate

Born between

week 25-28 can survive

From The Reql1iste8~Pedia1ric Radio~

with intensive core Alveolar (32 weeks - 8 yearsf Terminal sacs partitioned into adult alveoli After birth, lungs increase in size because

of increase in number of respiratory bronchioles

R u)

V'"

in number of respiratory bronchioles R u) V'" Pulmonary agenesis -7 no lung or lobe or
in number of respiratory bronchioles R u) V'" Pulmonary agenesis -7 no lung or lobe or
in number of respiratory bronchioles R u) V'" Pulmonary agenesis -7 no lung or lobe or

Pulmonary agenesis -7 no lung or lobe or bronchi

Respiratory distress syndrome

• Deficiency or absence of surfactant

• Made'5'[fype lJ~neumocQU'#;

TracheoesophogWtlistlli Aberrant connection between trachea

and esophagus Improver division of foregut by ­

tracheoesophageal septum

Can be associated with esophageal atresia and polyhydramrfios

symptoms

--­

'~

o

o

o

Baby will gag and turn cyanoticv­ after swallowing milk ~- - Abdominal distension after

crying

Reflux of gastriC contents into

lungs -7 pneumonitis \ -"""

­

Diagnosis 0/\ Can't pass catheler into stomach

o Air in stomach on x-ray

fA !lAd

dif401 fi vJo

m a c h o n x - r a y fA !lAd dif401 fi vJo

NoEA bill "H" MIlito

a y fA !lAd dif401 fi vJo NoEA bill "H" MIlito fA ond 2 fjSl~IQ' ~A

fA ond

2 fjSl~IQ'

~A !il!d'

no- l\milo

2 fjSl~IQ' ~A !il!d' n o - l \ m i l o o n e
2 fjSl~IQ' ~A !il!d' n o - l \ m i l o o n e

one a

~P·tl--- o

,

I

Lines thoracic wall In~atedby intercostal nerves and phrenic nerv~sitivet:~

o

Visceral

o

Pleural

r

Invests lungs

dtl>!#OSlflve to pa~

Q ,potentio space between parietal and visceral pleura

s

Costodiaphragmatic recess -7 fluid accumulates when standing

o Allows lungs to expand during inspiration

Costomediastinal recess ~.

/

/

/

 

Mid-clavicular

Mid-axillary

/

Mid-scapular J

Where lung ends

6

8

10

Where pleura ends

8

10

12

o CliniC~~

• Pleurisy

inflammation of pleura

• Hear friction rub _

/\

~pneum<¥thorax-7 accumulation o~ pleural cavity

• <J Leads to ~.nQcollapse

·

j

TensiOn pneum=Olhora x -7 increase in pressure dis~~

~de

F

t~

site

I t Pleural efft7siOn -7 abnormal accumulation of excess fluid in pleural space

Structure

o

Trachea

Storts at cricoids cartilage and goes to

 

T4/T5 ­

16-20 C shaped hyaline cartilage rings

 

'ltarina -7 downward and backward

projection

of last -tracheal cartilage

Atlevelof slernoi angle

 

Ridge separating Rand L bronchi

 

\

Compress trQ(;:h~ortic

o

)

Bronchi

arch aneurysm ~ ­

'

­

Ri~Tnchus :shorter, wider more vertical

• -, fAore aspirations here

~nder arCh of azygous

P

Left

lobar/secondary bronchi .-Eparterial into right superior lobe and the rest are hyparterial

,

3

~feriorto arch of aorta, anterior to esophagus and thoracic aorta 2 lobar/secondary bronchi

to esophagus and thoracic aorta 2 lobar/secondary bronchi Larger and heaver, shorter and _ wider than

Larger and heaver, shorter and _ wider than left Ob,lique fissure

_

r'"'

o

Heas;! 2L5 th ri b

o FOllows line of 6 th rib horizontal fissure

~

'-

~

~ ~
~
~

Hilum of trachea

[J Superior Lobes

Middle Lobe

1mJ 1f'Lb n ertor , 0

es

Cardiac

notch

~~obar

o from oblique fissure in mid a xillary bronchi into lQ terminal bronchi (3

line to 6 th rib lev~ lobes, 10 subdivision s)

 

Oblique fissure

'

Lingual -7 tongue shaped portion of upper lobe

• Lingual -7 tongue shaped portion of upper lobe Clinical 2 lobar Impres~ bronchi into 8-10

Clinical

2 lobar

Impres~

bronchi into 8-10 terminal bronchi (2 lobes, 8- 10 subdivisions)

v'"

_

lung

 

/"R' ~ Cardiac notch, aortic arch, descen~ingaorta, left subclavign

o

\

Y.

SVC, arc~ofa

 

ous vein, esophagus V-

o

Identify which lun

y R

"

• RIGHT lung , pu monary artery is ANTERIOR to everything else in hilum

LEFT lung. pulmonary artery is SUPERIOR to everything else in hilum

LS:

pulmonary artery is SUPERIOR to everything else in hilum LS: ~LUnglymph o ~A . PuJrr.l'lfiory arUry

~LUnglymph

o

~A .
~A
.

PuJrr.l'lfiory

arUry

~pleural plexus to interlobular nodes to pulmonary/intrapulmonary and bronchopulmonary nodes to inferior carinal and superior tracheobronchial nodes to tracheal nodes to bronchomediaslinal nodes to thoracic duct ON RIGHT: to bronchomediastinal nodes to right

:.:>

-

lymphatic duct to subclavian lymphatic trunk

~

o~

Cancer in c:wicallobe presses on~pat~

causing

Horner's Syndrome

ftOsrs----­

.

£ ;:,

---

Miosis

 

anhydrosis

. £ ;:, --- • Miosis   anhydrosis Blood suppi ulmonary trunk_ Upward {rom conus arterio~

Blood suppi ulmonary trunk_ Upward {rom conus arterio~

Deoxygenated btood V"

SUPERIOR and POSTERIOR to ascending aorta Left

Arches over left primary bronchus

Connected to aortic arch by ligamentum

arteriosus

o

\

Right

Pulmonary vei ns

Horizontal under arch

.2.Q.ulmonary veins leave lungs

L

-

Righ t upper and middle jo~

On~nter Jeft atrium

 

OXYGENATED VEINS"

 

o

\

Bronchial arteries

V

 

From thoracic eorte

 
 

ne arle

to right lung

oeftlun

V

Go 0 n n-respiratory tissues

o

Bronchial veins Into azygous on right Accessory hemiazygous or superior intercostal on leH

Innervation

5

o c:rulmonary P~-7 sympathetic Idilate bronchi) and parasympathetic Iconstrict bronchi and - . ---- ~~ene~O~

o c:rulmonary P~-7 sympathetic Idilate bronchi) and parasympathetic Iconstrict bronchi and

-

.

----

~~ene~O~

~-

~

• C3-C5 ~ Anterior to root of lung and vagus goes posterior to root

• Innervates fibrous pericardium - and mediastinal and diaphragmatic pleura

­

- -

-- -- -,

­

.

Lesions -7 may produce complete or partial paralysis - ---- of a ~gJIlH;jjgJ2br.Qgm

-

~

PericardiuI!l.

 

J

Heart=:>

::::;.;P

0

middle mediastinum

o

 

• Transverse Subdivision of p!?}i.sardial sac Posterior to asceQQing aorta and pulmona!YJLy.nk Anterior to SVC Supeii5riOi:A and pulmonary veins Surgeons use to make ligature to stop blood flow

 

• Oblique

"

'

--­

 

.

• Subdivision ~[ ic.9r.d~ c ~~ rt

 

o

Clinical

­

 

Cardiac tamponade

• Acute heart compression as fluid accumulate sin pericardium Compresses venous return, reduces cardiac OJ.lJput Pericardiocentesis -7 surgical puncture of pericardia I cavity

aort:t ;lnd

pulmonary trunk
pulmonary trunk

• Insert needle into cavity through ~S lef~~ternum@

~-- -

-

.--

/

t-e-. ~

./

'$

External surface,

o

~uICUS terminals J J

 

J

• RA

~inus venosus with atrium Crista termlnolis on the internal heart surface

 

o

Coronary sulcus Division between atria and ventricles

 

-

.=

o

Cardiovascular silhouette -7 cardiac shadow Posterior-inferior chest radiographs Right border -7 SVC, RAe 1'lC

 

'--

• Left border -7 aoriic arch , pulmonarx trunk, left auricle, LV

. - .

~

Aortic arch aneurysm presents as dysphagia, dyspnea, and horse voice if recurrent laryngeal -- ­

is compressed Aortic dissection con occur in Marfan's syn,grome -7 tear between Iinfr1g of aorta

~ Blood goes oetwe~E§J9.y§rs.

valve (closed)
valve
(closed)

Internal anatomy

ofao~

--­

.r

o

RA

 

/n~svenarum -7 posterior Opening of venae cavae Crista termTrlOlif separCiTes from muscle-"-'- '

• / Auricle -7 muscotor pouch on supe(ior

anteriorpqrl

"

­

Covers first part of right

/

coronary artery

• /peclinate muscle

• Venae cordis minimae -7 small cardiac

/

veins emply into RA Fossa ovalis -7 used to be foramen ovale J

o

RV

Trabeculae carneae cordis / Anastomosing muscular ridges of myocardium

£J~~~

.~lIarymuscles -7 cone shaped muscle enveloped by endocardium From anterior and posterior ventricular walls and septum attached to chordae tendinae

• Contract to tighten chordae, preventing tricuspid valve from opening

• /Chordae tendinae from

,conus arterlosu

In!

n'

opillory muscle to more than one cusp of tricuspid u

0 erator bon
0 erator bon

• Smooth wo led por

• tSeptmarglnal trabecu ar

Trabeculoe corneoe bon orms bridge between IV septum and base of

papillary muscle

• Prevents over-distention of ventricle

2eptum

Most posterior port of the heart (ffJ {,

~

o

LV

~

~

Apex goes downward, forward, and to the left Aortic vestibule 2 papillary muscle with chordae tendinoe and trabeculae carneae cordis Thicker

HJila;~~ds
HJila;~~ds

Mnemonic for remember locations APT M (apartment M) 2245 (intercostal spaces 2, 2. 4, 5)

mitLOLclosesv

First sound (S1) -7 t(i~~~pid ond

o

S2

-7

A V and PV

o

S3 -7 filling of ventricle

 

Normal In kids and athletes Pathological In adults over 50

o

S4 -7 otrial contraction

/

Always pathological

/ conduct~ of heart

O~,

• Upper end of cristo terminalis

/

Pacemaker

Has Sinus node artery

/

-----­
-----­

-=

~pply

o~_

_

=:>

~ Interotriol septum, superior and medial to coronary sinus opening -"A V nodal artery from right coronary artery (MOST OF

o

--

un

ETIME)

Down interventricular septum

The Electrical System of the Heart

Bachmann's Bundle

AntS(tor _ Inlemodal Tract
AntS(tor _
Inlemodal
Tract

AtI;owntricular

(AV)

Node

Righi Bundle

Branch

Conduction

Pathways

~ .-£QLQnqry arlerj'Ol£

~

:::::>

o

- Right~onary

f?cer "(tt SA node artery between RA and root of

 

MQfuif!QL~ Inienoi'border toward apex Supplies inferior margin of RV Pgal eripr II( artery

-=-­

Supplies IV septum and LV and AV

-

node --- WAV nodol artery \.

 

Opposite origin of posterior IV artery Supplies AV node

o

eft corona

nterior IV artery

 

Cardiac veins

~Right and left ventric les ~

• IVseptumv

• Apex Circumfled In coronary su lc u).-""

LA and LV

v

• Left marginol artery ""

Lef\ main

corollary artery ;.,~ :; ----Lett circum(-1cx branch Len llllterior descending branch
corollary artery
;.,~
:;
----Lett
circum(-1cx
branch
Len llllterior
descending
branch

AOIia ----~-

Right --- .::: ~:a l:

corollary

artery

Righi

marginal --T~~t~~~ bmnch

7

Cfow.Vh

VC\W~

~oronary~

• Largest vein --­ In coronary sulcus Opens in RA between Ive and AV

vein --­ In coronary sulcus Opens in RA between Ive and AV o \ o \

o \

o

\

o

\

o

o\.

o

o-rcroltltIm@inofheartwithmarginal

arte1lo--­

Oblique vein of LA Descends and empties into coronary sinus Anterior cardiac vein V Anterior RV Crosses coronary groove Into RA

~ma\lest cardiac veins v Wall of heart and go into chambers

cardiac veins v Wall of heart and go into chambers o ~----~ Heart Embryoto earttube~ ,

o

~----~

Heart Embryoto

earttube~

, -- - --o.f­ '-S:I!r*-'----- Ro--'--- -r-'- '- --':3
,
--
-
--o.f­
'-S:I!r*-'-----
Ro--'---
-r-'- '-
--':3

-- Aortic arch

Superior vena cava -

Pulmonary trunk

Left atrium

Coronary sinus

Great cardiac veir

Le11 ventricle

Right atrium ------ ---l'--,-~

Middle cardiac vein --

Small cardiac vein

Rigf1t ventricle ----'

(b) Coronary veins

Late.19LPJ91§.mas

splits into somatic layer and selanchnic layer

aderm

(cephalic area of embryo)

Form~cordlal cavitY,

     

,,",oull STructure

/"ffiJnr-.

Aorta

'<:::

Pulmonary trunk

 
 

~Bulbus cordis

Smooth part of RV (conus arteriosus) Smoolh pari of LV [aortic vestibule)

Primitive ventricle

Trabeculated pari of both Rand L V

­

Primitive atrium

Trabeculated pori of Rand L afrium

_Sinus venosus

Smooth pari of RA (Sinus venarum)

-

Co ro na ry jig us Oblique vein of LA

,,·t

 

0

Blood flow In heart tube Sinus venosum '"1"" Primitive atrium /

r1>

d- 1rl1

£,Vi- I

,

Ventricle
Ventricle

Bulbus Carois (COOll

stnus V~I)OSU5

Dny23

o

Left ventricle

;l.­

• Right ventricle~~

• Bulbus cordis

~~riOSUS-

~OoP ing

.

./

eonvergenceCI::fi~rioventricu~naland

conoventricular cClllClt Wedges to neslle conoventricular canal between

.r

tricus ° o=copulmonary septum

nd formation of

epositlon

ave atrioventricular canal to straddle

ri
ri

Trunca

Rid es

nd left ventricles

u monary septum

ar ridges invaded by neural crest cells row and twist around each other in spiral fashion

cells row and twist around each other in spiral fashion ~ I 01 • ° nl

~

I

01

° nl
°
nl

Per istent truncus art

. 0

o

row and twist around each other in spiral fashion ~ I 01 • ° nl Per
row and twist around each other in spiral fashion ~ I 01 • ° nl Per

--.r

--

~

.-

,

o

u;t vesseiS')

o ~onspiral AP septum development

R~!~~~

~itif

o

Aorta arises from RV and pulmonary artery frQm LV

o

Ind5mpatible'Wffh life unlesS"fFiereT'fanother shunt -7 VSD

'"

.

unlesS"fFiereT'fanother shunt -7 VSD '" . Corrected transposition of great ve monary trunk are

Corrected transposition of great ve

monary trunk are transposed

")

transposition of great ve monary trunk are transposed ") o RV andDL o.c.e inverted o f

o

RV andDL

o.c.e

inverted

of Fallot---/

o

Pulmonary stenosis '-~'

q7 li?-o-.J e> 0

.

,

'J

0

Right ventricular hypertrophy \/

Overriding aorta

,/

o

VSD

"'/

o

R7 L shunt

o_~~~

C::=~p~ from roof of primitive atria towards AV

~;.;;Io"-n,,,-s_~

~en Rri~etween cushions and septum primum sec~ -7 hole in the middle of the septum

~en

Normal heart

Tetralogy of Fallol

middle of the septum ~en Normal heart Tetralogy of Fallol primum • ~~I-m-se-c-u-n-Cil:Im:from just to the

primum

~~I-m-se-c-u-n-Cil:Im:from just to

the right of the septum primum From AV cushions and roof of atria and grow toward each other but don't meet

J,.-<' ~ova~pening

between septum secundum

porti

J~irth -7 ssures presses ~ tum primum into septum secundum to close off foramen

~~~.;

~~~'4

into septum secundum to close off foramen ~~~.; ~~~'4 Septum secundum Ostium secundu tn Septum p
into septum secundum to close off foramen ~~~.; ~~~'4 Septum secundum Ostium secundu tn Septum p

Septum secundum

Ostium secundu tn Septum p rimum

V cushions

'.

Defect in foramen secundum

Common atria -7 cor trilocular biventricuJare = complete failure of septum primum or secundum to form Probe patency of foramen ovale -7 incomplete anatomic fusion of septum primum with secundum

Premature closure of foramen ovale -7 durin

renatallife

o Hypertrophy of right sideof t;E;Ort a nd un

er

evelopment

=-~_--"'ilf::lio"'->.Qlood clot con pass Into systemic circulation through ASD

~

o tricular septu

::r=~i"iTi~r! o:":r'icushionand

ventral AV cushion approach each other

and ventral AV cushion approach each other I ure of fusion o large hole in the

I ure of fusion

o large hole in the center of the heart -7 tricuspid and bicuspid valve are one common valve

\ o t of blood Ive regurgilatio o ramen primum defect cushions don't fuse with
\
o
t of blood
Ive regurgilatio
o
ramen primum defect
cushions don't fuse with septum primum
_
.---~~~~!
'n·or
I ral valv~e
ricuspid atres
ypoRla~ic right hear!.
-
~
o
Not enough AV cushion tisSUG
(\
o
No communication betwee
of tricuspid valve
R
an'<t9 exist ~
--~<:~ J~)
tl~~".y
~
.
-
•r:
,:.
,.
~
~.:"
-""

.

~

~

o

~SiS

Can a-truncus Venlricula r septum
Can a-truncus
Venlricula r
septum

35 days

~ ~ o ~SiS Can a-truncus Venlricula r septum 35 days o 28 days Can a-truncus

o

28 days

Can a-truncus

V cushions

openings

entrici
entrici

J.,I

----""'e~~branous VSD L pressure <==- R -7 ~
----""'e~~branous VSD
L
pressure
<==-
R -7
~

Int~

, :.:.:"

,--­

Bad fusion of righl bulbar ridge, lefl bulbar ridge, and AV cushion

-7 R shun I and pulmonary

resislance 10 be higher Ihan syslemic -7 reverse shunl l\~

L s:~l,. \f

~~x

Single or mulliple perforations in musculor IV septum

hyperlension Can evenlually increase pulmonary

and cause pulmonary

12fii!'

.~ Common ventricle

0

No meeiing of membranous and muscular septum

o

 

Arch

Derivative

 
 

1

Part of maxillarv artery

 
 

Part of stapedial artery

 

----

 

3

\

.i

Rand L cO~!l1moq carotid

 

.

,

­

Rand L internal carotids

 

4 \

 

RighI: j$igjlt subclavian and

7

,--"",,'/

brachioc~ --

 
 

LefCL>';:~" --:- .

-:7

 

L

n

.J:

/­

-

 

Rand L pulmonary arteries

 

(

 
'­
'rc
'rc

01 ,

get o:r(genated blood from placenta

-

~oramen ovale

0

oxygenated blood from placenta from RA to LA to bypass lungs

~ ductus arteriosus

o

becomes ligamentum arteriosum after birth

o

blood from pulmonary

bypass lung~

lrunk into aorla -7 -

 

.

o

if it 'persist s, shunts oxygenated b loQ dJrom

si~,~ pulmo-~ aiY,fr0iik -- -- "'--­

fkductuGt:e~~:~

 

0

bilical vein to Ive to bypass liver

, \

0

ecomes ligamenlucn ~enOS.J,im

~ umb ilical arteries lake back deo'xygentiletfl)lood to placenla

• umbilical veins corry oxygenate.d blood to fetus

right vein ~uring embryonic period

L-"'frllt:-(I-t~ J.ljt.lt'l&>,\ f-i1,

,

,~

~~ 'I

rets.1 Circulation

~uring embryonic period L-"'frllt:-(I-t~ J.ljt.lt'l&>,\ f-i1, , ,~ ~~ 'I rets.1 Circulation

• 'te, i vell i ) IigeJl: ,9~h::11¥1 tSFS§ hengJis veins in embryo

vifelline veins -? refurn blood

fo yolk sac

V

o righf -? hepafic veins and sinusoids, ducfus venosus ,

hepatic porlaL SMV, IMV, splenic veins, part of IVC

o leff -? hepatiC veins , sinusoids, ducfus venosus J62ib.gersists In adult and are functiona®

umb~veJns

o

blood form placenta

o

right vein obliferates

o

leff vein -? ligamenfum teres hepati<f

[J

cardinal veins

"\

:/

to placenta

.'

. ~

o ~nJcals _---='

subcardina SVC , common Ilac , reno, gonadal
subcardina
SVC
, common Ilac
, reno, gonadal

f

Y

0

supracardinal -? IVC, intercostals, azygous, hemiazygous

Y 0 supracardinal -? IVC, intercostals, azygous, hemiazygous -·l'n· i.t.il't. S~cll'tr;"'rt\
-·l'n· i.t.il't. S~cll'tr;"'rt\ '. JliWli",
-·l'n·
i.t.il't.
S~cll'tr;"'rt\
'. JliWli",

f.'!"Wf

.- . L>.~ oj Olll>i<T

.

V-

~O"" Abnormal origin of right subclavian artery -? right aortic arch 4 and dorsal aorta abnormally regress

Right subclavian lies left inferior to left subclavian artery

~-=-_-'-'-'::::'>'><:<'>".I.lL!~trachea or esophagus

t Ductus arteriosus oesn't obliterate ~ L -? R shunt Machine-like whir on auscultation •
t Ductus arteriosus oesn't obliterate
~ L -? R shunt
Machine-like whir on auscultation
• /
pos~uctalcoarcfation
G
Aorta is abnormally constricted

Strong pulse in upper limbs but no femoral pulses Istal to origin of left subclavian artery and inferior to ductus arteriosus

o Turner's syndrome

S e rib notching on x-ray from intercostal blood vessels dilate to compensate and

~. ~end blood inferior ~reductal -? congenital Embryology of the Diaphragm

o 4 parts

51f~ lMV-f

(,,.~ L~

~eptum transversum -? thick mass of mesoderm between heart and liver

Central tendon of diaphragm 0($ Pleuroperitoneal membrane Somatic mesoderm

o

Septum Iransversum
Septum
Iransversum

o

b) 0

Develop from dorsal and dorsolateral body wall

U7M-'~

~r~.~

(!)(Dorsal mesentery of esophagus -? myoblasts to form crura

Gi

wall -? muscle of periphery

diaph,agmatic hemia

_~- B;;:;Ody
_~-
B;;:;Ody

bdominal contents herniaIe into pleural cavity

o

eur0s,eOI membrane failure C sit : left osterolateral side

o

-

o

Compr

slung buds-? pulmonary hypoplasia

Newborn born with flat abdomen, breathlessness,

0

dyspnea, bowel sounds over left chest cyanosis

~sophageal ~ hWa

\~

bowel sounds over left chest cyanosis ~sophageal ~ hWa \~ Stomach through esophageal hiatus ~sophagastric sphincter

Stomach through esophageal hiatus ~sophagastric sphincter become incompetent -? reflux ~igns :vomiting (often projectile) when infant lies on its back aHer feeding What vessel passes through where

Inferior VEL Phrenic nerve

lies on its back aHer feeding What vessel passes through where Inferior VEL Phrenic nerve -r

-r

4-

V r

- f'I,~\.

lies on its back aHer feeding What vessel passes through where Inferior VEL Phrenic nerve -r

Aorta ~ T12

Azygous

Thoracic duct

Mnemonic

/

• I Bte 10 eggs at 12 (noon)

_, .

: --- -- --~,if

-- ---- --j -;- il 1

_Location of Thorax ?

Thorax is between the lower end of the Neck and the upper most part of the Abdomen- - - j - ; - i l 1 _ Location of Thorax ?  

 

I

.

!

I

i

I

I

i

I

,

i

I

- ------.---------.---! I i I I i I , i I ---------.---.----- ------------- - I I I

---------.---.-----

------------- -

I I

I

---.-------------------- --l I

Function of Thorax

• To House and Protect the Heart and Lung

:

i

• Accommodates volume changes during respiration by Mobility of thoracic cage

• This is accomplished by the ribs and

intercostal muscles

.--

-

-

. - -- - --

--. --.--- - - .----- --

J

I I

is1

Layers of the Thorax

i J~ €~i~erfiCi~asCiaand its Contents

!

Muscle and Fascia on the chest wall

~ Breast in the females

• Bony cage of Thorax and

• Intercostal space &its contents:

~

intercostal

muscles, Vein, Artery and Nerve (VAN)

--

. - - - .--. --- -.-~-

-

- -

-,, - - - ---- - ~------ - -

-

--- -- - - -- -----. -

- . - .---- . ---- - -.--- -- --- - -. - --

Female Breast &Thoracic Wall

Suspensory ligaments lV ~ Lactiferous sinus Pectoralis minor m. 4th intercostal space
Suspensory
ligaments
lV
~
Lactiferous
sinus
Pectoralis minor m.
4th intercostal
space

-- -

.

--

-

-------­

J i

"

- -------- - _ --- - - -,

I

:.J

-.

"

-

-

.

;, ,,' : Quadtarits'.-'of Breast

-~

-

-

",

-

T

o

'

.

v

"

I

I

!

12 .o'clock

·· . ,Lower
··
.
,Lower

Inner

T Right breastJ

Tumor of Breast in Quadrants & Underlying Muscles - Pectoral & Serratus

.,,,,--- ----.,,--------

--- -' ------ -- ---- ---,,---_·_,,-- -------,---- ,,----1

Breast - Lymphatic Drainage

CeNfco.

axillary canal

.

Sut)¢/avian

lymphatic

trunk

-

~

Fh9h1,

(01 Ie t)

venous

'\ angle Suprac~vlClJfar na<Jes Apical nDde-s
'\
angle
Suprac~vlClJfar
na<Jes
Apical nDde-s

Pectoral (anl0rior)

J'\o(!e-s

I

I

-,,"""-' -

-"---- ,- ---

---- -

-------------- - ,,-

------ -- ---- ,,-- ------,----,

Muscles of the Chest (Ant)

Il

Muscles of the Chest (Ant) Il Coracoid process Pecloralis major m. Clavicular head SIClnocoslal head ~",*-f---'=-

Coracoid process

Pecloralis major m.

Clavicular head

SIClnocoslal head

~",*-f---'=- Cut ends of

pectoralis major m.

Pectoralis minor m.

----'

External

intercostal muscles

'+serratus anterior m.

Serratus

anterior m.

Intercostal membrane Ant. Ext. Intercosal M. between costal cartilage

I Pectoral Region: Blood supply

Subclavian a. Lateral 1I1Oracic a.
Subclavian a.
Lateral 1I1Oracic a.

L

--

--

1

!

"I I

I

I

!

Surface Anatomy of Thorax

i \

-

--

Jugular notch

Clavicle Acromion L~ ~r-----' { (' ~ '\ ~.---. , - ' I~ . Vi
Clavicle
Acromion
L~ ~r-----'
{
(' ~
'\
~.---. ,
-
'
I~
.
Vi 1/ V")'',"
/1
Seventh costal cartilage
r

---

-

-

Costal marnin

- .----------.- -- --.~

I

I

I

Boundaries of the Thorax

e

Posteriorly: Vertebral column T1 - T12

o

Anteriorly: the sternum

Joining from posterior (vertebral spine) to the sternu m anteriorly are the ribs

-- -~ --

--

-

-

--

-

-

-

.-

~

I

I

!

I

,

•. , " . Biopsies of the Sternum , ' ­   Sternal'"BiQPsies    

•.

,

"

. Biopsies of the Sternum

,

'

­

 

Sternal'"BiQPsies

   

The stern nlbodyis. often useq _Fo r~oJftlmarrow~tte~dle'

 

bloW ,because~·Qfit5 bre:adth -a,nd,-subc,utane9uS

positio ,~; The . nr: , edJe pierc~5 the thin cortlcbo~e and

 

1

e~(ers:he viJ,sculartrabecular€onW.pone.Stemai

2

blOPSY'l$commol1lyused to obtrunspeClmenso{bone

 

tn arro\v fa r transp la nttl t.i 0 n 'and fo rdet ,ecti on .of

 

metastatic ranee ti

 
 

I

,,_

_

"

.

_o_

_

_

,,

_

_

_

_

_

_

_

_

_

_

_

_

,,

"

_

_

_

_

_

_

_

_

_

,,

_

I

-\

Classification of RIBS

-

• True ribs: 1

7

False ribs: 8 - 10

., Floating ribs:

11 - 12

- ,,-

,-

- --- -

---­

I

I

I

of RIBS - • True ribs: 1 7 • False ribs: 8 - 10 ., Floating

--

Lateral View of the Thorax

Thoracic Inlet Manubrium Bodyo[ stornum Xiphoid pro~s5 Dlaphragrn~'---I Thoracic Outlet
Thoracic Inlet
Manubrium
Bodyo[
stornum
Xiphoid
pro~s5
Dlaphragrn~'---I
Thoracic Outlet

-

-

-

----

-

-

_-- ------ --

Thoracic Outlet - - - ---- - - _-- ------ -- Anterior View of Sternum and

Anterior View of Sternum and its costal notches

-----

-- -

------ -

. Thoracic Outlet Syndrome ­

. , 'Wh~n : ~fi nfcr~[lS r~fer.[Q '·tH ,~.s.u pe'r;pt::di :oracica.Rer~

~urt(~ ~.tfre·;t69~Fic :~ouH~t,j~ :;t.hey : ate>emphasi~ng;

.···the:i.meOr,tan.t:QetVe$and-arterie.5:·i:hat·R~s:through·

!

I

I

\

I

I

I

i

.tha$:ageh:ureititoth€ 'owerneck'~nd upp eiHmho . 'Hencey,arious ·typesof. thoradc :oud{i syndromes

exT 5t~ <SU ch ·.as ~het:(Jsto-cltrfli'i1!!!!!!I/ulrdme-:p~lJQ.r

andc,Q!anessofthe ·skif'lof the upper Ii'm.b and:dl­

minished.~~u

ofche su bdavian <irref):betMtcert :' dte CJav,de and·tQ'~

19 d1>t' par-deu} ct lIy whf n . theangleb~t\veen ' chi!

neck and the shoulder 15 in(:r~,ase(L .

.

- -----.-.-----~

;

i

-- - -- -- - -- ---- - -1

-

Intercosatal Muscles

I

I

I

Q

-~~~~~ColiatGraJ _ br.anches CDs~al groove
-~~~~~ColiatGraJ _
br.anches
CDs~al groove

Later~l view

NOTE: The site of the (VAN) in the intercostal space

elevates

I

i . Kl/t~

-~Int!1roosta~veln.

_&7I~~~~:~artery. and nerve ('f\)

Inlem-a' Intercostal

-

\2/ depresses -CC.~I{.,r1f"7 )

epresses

,

1:

l

r.;.

I

I

I

I

I

I i

~'i=1-lnliermo$tintercostal 0- I\d~"P,tJ

3

- -- --- - ----- -- ---- -- - - ------ --

---- ----- ---- - --- ---- -. --- -- - - -- -- - - - - ---- --- --- ------ ------ - - ---, !

Structures in Intercostal Space

- -- . -- -

-

-- --

Innermost i ntercostal m. Intercostal: External intercostal m reflected ' ft'---IJU:>lCIl groove
Innermost i ntercostal m.
Intercostal:
External
intercostal m
reflected
' ft'---IJU:>lCIl groove
intercostal m.

Rib~-_-I.:

rr.o---Vein ---~'t.l

Artery~.--f

\ \

~-- Nerve --

Innermost Intemal intercostal intercostal m.------'~ m.

~

B !~-

External. intercostal m. Collateral vessels

(cut edge)

A. Anterior View

B. Coronal section at mid axillary line

-- - --- - -

-

- -

- -- - -- - -- - --

_- -- -

- -- -- -

- -- - - - --

-- ­

--

- _

_-- _

I

i

I

1

SOlTletimes it: is necessary t:o ins-erc a h)-'poderrnic n.eedle ~hrough an i .nrercosraI spac~into the

SOlTletimes it: is necessary t:o ins-erc a h)-'poderrnic n.eedle

~hrough an i .nrercosraI spac~into the pleural cavity-the

p~t:ential spac~ bet.wecn

t:he.

parietil.i

pleura

lin·ing

t'h:e:pulrnO~ary :Ca!l~

jEyar'dt:he;

vi!jc.e:raJ pleura ' covering '

th~dt.iE}g-:-t;b 6l,::t~~in aS3 rri.ple.: ofpJ€!-l~I fluid . 01' to re~

mov.eb.lpodorp,tjs Tq:av~id d arn.<ige 1:0 thein~e

costa

is inserted super-lor co t:.b~

nelv~·andvesSels the . needle

rib • . highcr}ough i:b~i:vold ·the coll .a t eralbranches

I

. PariElla I pleura , ~- - . Pleural cavity ;r:-,----- FluiClln .pleura!'cavity
. PariElla I pleura
, ~-
-
. Pleural cavity
;r:-,----- FluiClln
.pleura!'cavity

-

-

.

-,

-

,

Anatomical Relationship·&Thoro'cocentesis

Abdorninal cavity
Abdorninal cavity

with brga'ns :

Skin and subcu1aneous tissue

Intercostal muscles

Aspiration of fluid (effusion) from pleural cavity

muscles Aspiration of fluid (effusion) from pleural cavity Rib 8 with intercostal nerve and vessels Needle
muscles Aspiration of fluid (effusion) from pleural cavity Rib 8 with intercostal nerve and vessels Needle

Rib 8 with intercostal

nerve and vessels

Needle in Mid axillary line

Aspiration of fluid (effusion) from pleural cavity Rib 8 with intercostal nerve and vessels Needle in

Surface Marking of Thoracic Wall

1 ".

. id procetss .maphtarn
. id procetss
.maphtarn

.

-,

'"

'

~. Clinical"Correlation

Anterior Thorack Wall

1

2

,.

The anterior and lateral approaches are the two most common

surgical agDroaches to the contents of the thorax. In the,ante­

rior approach, the steroLLm is split vertically in the midline. This

approach doesnot'crossmajor vessels and allows good access to the heart. The incision throughtne ~~E~~~is c!osedwi:th stainless steel wires. In the lateral approach, £!lJD.~rsQgarB

space is incised to provide access to the lungs or to structu res

>1

1<£

:

""'"-'

:':".,

posterior to the heart

1<£ : ""'"-' :':"., posterior to the heart - ------- ------- --- -- -- ------ ,

- -------

-------

--- --

--

------

, -~

-

1

- --

Intercostal Nerve

! I

i

I

i

I

I

I

HI1tpe5zostcr (sh;i1gf~)~aviraI'disease ofspJnal ganglia­

is a demlatomallyJjs~bllreds,~;nles;on:Thehetpes viM in:

vades a spinal ganglionandistran~ported'fllongthe axon

to the skin, wherelc pr,oduces an ilJ(eccioll ~hatcau5esa

sharp bumingpa\n'inthe;~e.fma'rorrie.supptiedbythein"

volvec,i nerve. Afew days ia~,ei'jche ~!<InofdH~;dcimawmc

~ccome5red ;;Ind vesicular etirpti~nsapp,eiir"

"

~ccome5 red ;;Ind vesicular etirpti~nsapp,eiir " " -- -- -- -------------­ i I I I I

--

-- -- -------------­

i

I

I

I

I

Local,anesthesia of an inrercoscal space is produced by,

ir.je~tingalocal anesthetic agentarou~ndd)e}nterc6sral

n!rves.,This , procedure, aii 'jlltsrcostafneYVe bto(k, in­ i volves infiltration of theallesthcoc,aroundtlle inrer­

c()seal. nelVe and itscollate'ral br<i.~Cl1cs'(Fig. 61 (5).

Because anypari:iC1,Jlar are , a , of skiri ~suiillyrec~i v.es 1ri­

nervation fri:l'm [\YQ ,adjacent neJ:Ves, cOnSi,derablc over­

I~ppingofcontiguous LIE~rma,tomes ol=i:urs. Thi!i'cfor

e

, I

complete loss ofsensacionusuaUy:does rioc"o<:~r, \In­ liss . tWO or more in~ertost~1 nerves in aifji.lc~nt in~er-

costa! spaces arc,ancsthetizeCl. '

.

.

'

.

liss . tWO or more in~ertost~1 nerves in aifji.lc~nt in~er- costa! spaces arc ,ancsthetizeCl. ' .

Cross Section of Mediastinum

Cross Section of Mediastinum Parietal and Visceral Pleura ~ V i s c e r a

Parietal and Visceral Pleura

~
~

Visceral;"­

Pleural Cavity

Pleura ~ V i s c e r a l ; " ­ Pleural Cavity ~~1~tiJJt.~~.~~A'"

~~1~tiJJt.~~.~~A'"

a l ; " ­ Pleural Cavity ~~1~tiJJt.~~.~~A'" /J_ Parietal Pleura M E o I A

/J_

Parietal

Pleura

M E o I A s T I NUM
M
E
o
I
A
s
T
I
NUM

WI

Visceral

Pleura

Schematic Diagram: Cross Section of Thoracic Cavity

Recess & Reflection of Pleural Cavity

Thoracic Cavity Recess & Reflection of Pleural Cavity , Costomedistinal recess ~l~~

, Costomedistinal recess

~l~~

CPSiOd~~n~r~9m,~ti~:r~'c~~~;

Parietal Pleura and Subdivisions

,.::,-,:,~!,\." Parietal :~·~~-g.Z~'f".r,)1 Visceral ~r
,.::,-,:,~!,\."
Parietal
:~·~~-g.Z~'f".r,)1
Visceral
~r

Costo diaphragmatic race~s

Collection in Pleural Cavity and Lung Collapse

race~s Collection in Pleural Cavity and Lung Collapse Pleural Cavity and Clinical Application , ~.".

Pleural Cavity and Clinical Application

, ~.".

Pleural Cavity and Clinical Application , ~.". Haematoma Pneumothorax Pleural effusion ! The potential

Haematoma

Pneumothorax

Pleural effusion

!

The potential space becomes real space

';' ,

Relationship of Mediastinum & Pleura & Lungs

Mediastinum

J;/r

'11."1 Line of re!!eclion between
'11."1
Line of re!!eclion between

dlaphragmalic ami COSlal pleura

Lungs Surfaces and Location

lungs are not in the mediastinum

Lungs have 3 surfaces

• Costal

III Mediastinal

• Diaphramatic

Lung Fissures: Clinical Significance

Apex

Horizontal fissure (Rt) corresponds to laterally and anterior to 4th costal cartilage ~b Lett Lung
Horizontal fissure (Rt) corresponds to
laterally and anterior
to 4th costal cartilage
~b
Lett Lung
Right Lung

Posterior

border

Oblique fissure corresponds to 5 th rib mid axillary & anteriorly to~starCa'i1:ilage

Anterior View of Thorax

Wf.\\t Oblique fissure Infcrior lobe
Wf.\\t
Oblique
fissure
Infcrior
lobe

Aorlicarcn

4th rib laterally

4th costal cartilage~1\i

anteriorly

Mediastinal Surface of Lungs

Cardiac Impression IE',. ;,.'
Cardiac Impression
IE',. ;,.'

Groove lor superior vona caya~

impression

1'1/7

Pleural Reflection

c::=t OutihiCl' 01 lung . ') " : '
c::=t OutihiCl' 01 lung
. ') " :
'

=:> lIno~'of rOllactlon of parietal pleura J;

Thorococentesis Lung and

Pleural

Reflection Relationship

Skin and sub~utaneoustissue Intercostal muscles Aspiratlonof fluId (effusion) frompleural . AbdQ-n\fnalciJvi~"
Skin and sub~utaneoustissue
Intercostal muscles
Aspiratlonof fluId (effusion)
frompleural
.
AbdQ-n\fnalciJvi~" " .
.·0irh;Qrg~rit· .'

Lung Level and Pleural Reflection and Corresponding Rib

 

Location

Pleural

Lung

Midclavicular

8 th rib

6 th rib

 

line

Midaxillary

10 th rib

8 th rib

 

Line

   

I

Midscapular

12th rib

10 th rib

 

Line

'-----

--

-

1~

Bronchogram

  Line '----- -- - -­ 1~ Bronchogram P06tttrollintcrfor view CllWlcla Archae aorte. Loll mt11n

P06tttrollintcrfor view

CllWlcla

Archae

aorte.

Loll mt11n

b,onr.:h us

~icop05t060(

bconc:hoG

tete $\lpa-riOI

lobar bloncl'ltlt)

lert intorior

lobnr t>Ionch119

GaGbubblo

In fvndu~

0( Gtomacll

Bronchoscopy

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Bronchogenic carcinoma

II

fJ

~L " .:,':' Bronchogenic carcinoma II fJ KnCiWledge of Lymphatic Drainage of lung . Parietal

KnCiWledge of Lymphatic Drainage of lung .

Parietal Pleura: Pain

Inj~ry.t~~le~.~~

D ~' TI,evjScey.alp;ei,.ra~;~;;,1$ei.iitiv~ to paf,-r ' becausei c:s in n er­

·.:~~;~~f~~~;~~1~~~~f~0~:~;:fc~e~~~:~~r::~.p~;

;. '

.nl:h:~th~ b"0t:·chi~' .yess~l.s'·::T:hc y!sccr:a !: pl :eu.-:a . re~e Ives

,;;d;!t;~itti~~~~~;t~~~~~d~:t:tr~~1:t:b~;:~::~:':~8

i,i c:JqY~u.PPJj ~~ :··· p. ~ ~J?,~p,: .& :~s :\ i?§1:b.e: ' S:9r,p~dG- : I nee rcost'al

f:lliil'tliitft!~!t& n

. ' d fii!'.~hr;if.i'ma p c",.¥'s:Qf~'7he ·'Pa:r"H~tai'.p I e~m reS .Ltlt:!' • n a

; ~, .
;
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.

Lung: Lymphatic Drainage

6/t

Qf~'7he ·'Pa:r"H~tai'.p I e~m reS .Ltlt:!' • n a ; ~, . Lung: Lymphatic Drainage 6/t

Sup. Iymp. Plexus (under visco pleura) -

1:' Lung Parenchyma

'2. Visceral pleura

'

_

~"""'''''~ ''~ '~ r "" ,.,;,-, '

il>e tCi""dlTO "<'-'hrlona ,' ,

." " " "0.,.,,,

'!il;'},"' -'-ih~ " de s '[(hil ' r,) :

",,,!;~g\.pgo" 7 ;"'-" i·,lY~~L""

PIt .

, '" . ' ry

L

Deep Lymp. Plexus

(submucosa of bronchi

and peribronchial

­

Connective tissue)

n c h i and peribronchial ­ Connective tissue) , Root of th'e lung , mainly

, Root of th'e lung

,

mainly

­

Connective tissue) , Root of th'e lung , mainly ­ LYInPh~tic6raina;ge of Lung , ' Xray

LYInPh~tic6raina;geof Lung , '

Xray Chest: Cardiac shadow description (cardiac shilouette

Right

brach1<r

.

Rl~hlj

CX!phal!c

vein

bord~r<1 Superior

vena cava

Inferior ,"

'J$r'i!.i: cava 3

Clavicles '

"

~f:'

.,

;

~

Arch of

aor1a

"

,

;.( .

1,

~

.~.

,'j

"

,

""

Pulmonary

trunk

lef~

aunclo

4

Loft

ventricle

5

', " ';~. , Exjta;.

Diaphragm~

i~ricardral

left

bordol

/

~r

Xray of Chest (AntPost View)

~ i~ricardral left bordol / ~r Xray of Chest (AntPost View) Clavicle Coracoid p'ocess Ar c

Clavicle

Coracoid

p'ocess

Ar c h o~ ilona

Pulmonary

.r'ery

lell

lefl

bordoI

aur icle

"

f < 4 ::)ii

.r -;,",:"

.

,', ' 7

'

"

ol \1 ll!'rlll~11 -; ' : , 3 : :.: '

'Ienlricl e)

,; , ,',

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Apex 01l'cOot

Inf~fior L"<1rder

01

lI

o ~n

" , '2 .

~ .

~

location of the Heart

" The Heart is located in the middle part of the inferior mediastinum

o The Heart is covered with two layers of pericardium

.,

Superiorly in the middre part of the inferior mediastinum are the roots of

great vessel arising or ending in the

heart

Heart Surfaces

c Srernocostal (anterior) surface - formccimainlv

by rhe right ventricle.

e Diaphragmatic

(inferior)

surface

-

formed

Ill<lillir by rhekft v~ntrjcleand a small part of the

rig'hr ventricle.

,,,,,,d

o Pulmollary (left) surf.'1ce - fOJ'fIled mainlv by the I,err: \'cntl'ic1e. The pulmonary surl1we of the he,lrt is

ill contact with the cilrdiilc impression of the left

lung'.

,

~-e: II

Heart: Surfaces

of the left lung'. , ~-e: II Heart: Surfaces 3 1· ----A 2 1. Sternocostal (Anterior):

3

----A
----A

2

1. Sternocostal (Anterior): Rt. Ventricle 2. Diaphragmatic (inferior): Lt Ventricle & small part of the Rt. Ventricle 3 Pulmonary Ll Surface Lt. Ventricle

AnteriorThqta~t ;'. ., .
AnteriorThqta~t ;'.
., .

The antedor.

.ang ~i:ate;~I;!~RP:rq?l,<r!)~s;.a.re::;fffl~tWi:t hiOst ;cprnxnpn

su rgic?I

a pprQa ~h~ sitQ }t6$ ~~QriJ~6.t$:>cifthg ·1@q .r;~~!~ i,O ;;~IJippte­

rlorapproa dh; 'ib.~~st~rj;j,tIrii::f$::s~lrt&,~r1ri~lIy\ iOlb¢ · o1\dWrfe,;':This .

approa(h .:dde~ :·~~, ;·,9r.q~s; rnaf()li;:¥.~$s~ ,s ~:a.q# :~all()yiJfi :g .g~q i~~ <r~ss ·

1 to thehe.ar.t ··the :;i.n Gi?r0h :tl1r0t:1~g.h :>t,ye : st~r mllliTS':~ld~~W,:~Wth

stainless steeh;~il:~s;J~Ah~-iate(dbappr0atli, . aiJ :' lhtercosici t· 2.

space . is Jnci$eq .:!q~,p.r¢X i~I~ .~ .§~~ .~td .:ti~e ;)t1dg spri(f~tr4·~tJ.res

I /~,

. posteriqr toth:e;h·eatt~,:

'

.

.

.

Surface Anatomy of the Heart

2 nd :I .j • ~
2 nd
:I
.j
~

Costal Cartilage

yd Costal Cartilage

Ri~aordi!r'::RdAt;iun:I:'

F,1-.'

, -1 "tr' ,

"1

~

'"

'J,,-<

it'Border: Lt;Ve~tricle,~

5 th Intercostal Space

6 'il

Costal Cartilage

Apex of Heart (Part of Lt. Ventricle)

Mid. clavicular Line

Heart, Pericardium & Vessels

~ The pericardium

heart

is a sac that encloses the

" The peldcarditllm is pierced by the great vessels to enter or leave the heart. These vesse~s indude:

Aorta Pulmonary trunk

Sup. vena cava

Inf. vena cava

4 pulmonary veins

/

r&L/q

'#-11

Auscultation Areas

4 pulmonary veins / r&L/q '#-11 Auscultation Areas 1 = Mitral area (5 Lies) 2 =

1 = Mitral area (5 Lies)

2 =Tricuspid area (4L1GS)

3 =Secondary pulmonic

area (3L1CS)

4