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Lung Anatomy (Muscle of ventral thoracic wall (Pectoralis minor (Just deep…

- - - - can detect radiographically as one side will not descend during inspiration, but will instead move up due to increase pressure from abdominal viscera when the other side push down
- - - - Pass between R brachiocephelic vein and brachiocephelic trunk, descends and runs lateral along trachea, pass posterior to root of right lung to reach posterior side of esophagus.
      - Also gives right to right recurrent branch that dives under R subclavian artery and ascends to larynx
    - - Posterior to left brachiocephalic vein and between L common carotid and L subclavian arteries, crosses over arch of aorta as it descends and gives L recurrent laryngeal branch that dives under arch and ascent to larynx.
        Continues down, posterior to root of left lung, anterior surface of esophagus
  - - - Lateral to left vagus, follow left brachiocephalic vein, continues to descen through left side of pericardium anterior to root of left lung, reach diaphragm near apex of heart
    - - Lateral to right vagus, follows R brachiocephalic vein and then SVC, continues down right side of heart anterior to root of R lung and to the diaphragm
- - - - Carcinomas appear as a large, jagged density, and skin is thickened over the tumor, with a depressed nipple
      - Normal mammogran will appear white
      - Ulteasonography useful for looking a formation palpated but not observed on a mammogram (in patients with dense breast tissue)
        
        non invasive means of distinguishing fluid filled cysts or abscesses from solid mass
        
        Also used to guide a surfical needle or enable fluid aspiration
      - MRI to confirm
    - - Retracted signs: skin dimpling (large, size or bigger of fingertips), edema of skin (orange skin), nipple retraction and deviation, abnormal contours
    - - inferior crease cut (deep skin fold) and can be hidden
      - Cuts on breast itself are normally directed radially or circumferentially
      - Simple mastectomy: removed down to retromammary space, saving nipple and areola with immediate reconstruction
      - Radical masectomy: more extensive, remove muscle, fat, fascia and as many lymph nodes as possible
      - Currently: only tumor and surrounding tissues removed (lumpectomy or quadrantectomy) followed by radiation
  - - - Runs alongside sternum, eventually splitting into superior epigastric artery and musculophrenic arteries
- - - - Costodiaphragmatic (Near lateral limits, where rib cage meets diaphragm)
      - Costomediastinal recesses (Near midline, where lung tissue is closest to mediastinum)
- - - - 3 lobes (superior, middle, inferior) and 2 fissures (horizontal (aka minor) and oblique (aka major)
    - - 2 lobes (Superior and inferior) and 1 fissure (oblique)
      - Has little lungula (tongue) that represents a small lobular extension that covers over apex of heart
        Cardiac notch is superior to the lingula, where the heart is contained
      - access to lungs for surgery normal through 5th intercostal space, where major lung fissures can be found
  - - - Bronchial arteries
        
        2L (directly from thoracic aorta) and one R (commonly from right 3 posterior intercostal artery, sometimes aorta)
        
        provides to upper esophagus, then posterior aspects of main bronchi, supplying all the way to distal parts, and then anastomose with branches of pulmonary arteries
      - Bronchial veins
        
        drain part of blood supplied to lungs by bronchial arteries, primarily for more proximal parts of lungs
        
        remainder drained by pulmonary veins
        
        Also receive from esophageal veins
        
        right to azygous vein, left to accessory hemi-azygous vein
      - Bronchial lymphatic veins
        
        Didnt study, just know they exist, and the right lymphatic duct
- - - - Midline marker for superior limit of liver, central tendon for diaphragm and inferior border of heart
  - - - 2nd is at level of sternal angle, which 7th is at level of xiphisternal joint
      - Largest distance between 2nd and 3rd, and distance between costal notches decrease down
    - - Head
        
        wedge shaped with two facets (separated by crest of head)
        one facet for articulating with same numbered VB and one for the vertebrae superior to it (inferior and superior facet)
        
        Interacts with superior and inferior costal facets on the VB
      - Neck
        
        Connects head to tubercle
      - Tubercle
        
        Smooth articular part articulates with corresponding TP, and a rough non-articular part that provides attachment for costotransverse ligament
      - Body
        
        Thin, flat and curved (most markedly at costal angle)
        
        Concave inner inferior surface: costal groove
        Provides protection for intercostal nerve and vessels
    - - 1st
        
        Broadest, shortest, most sharply curved
        
        Single facet on head for articulated with T1
        
        2 transversly directed grooves on superior surface for subclavian vessels
        
        Grooves separated by scalene tubercle and ridge, to which anterior scalene muscle is attached
      - 2nd
        
        Thinner, less curved and substantially longer than 1st
        
        2 facets for articulating with T1 and T2
        
        Main feature: rough area on upper surface, the tuberosity for serratus anterior, from which part of the muscle originates
      - 10-12th
        
        Single facet that articulates with one VB
        
        11 and 12 are short and have no neck or tubercle
    - - Joints of heads
        
        attach with superior costal facet of corresponding VB and with inferior costal facet of superior VB, and also articulates with IV disc
        
        Crest of head attaches to IV disc by intra-articular ligament of head of rib within the joint
        
        Divide enclosed space into two synovial cavities
        
        Fibrous layer of joint strongest anteriorly, where it forms a radiate ligament of head of rib that fans out from anterior margin of head of rib to sides of the two VBs/
        
        So close that only slight gliding movements occur, but small movemnets at joints may produce relatively large movement at distal end
      - Costotransverse joints
        
        costotransverse ligament pass from neck of rib to TP and a lateral costotransverse ligament passing from tubercle of rib to tip of TP
        
        strengthens AP aspects of joints respectively
        
        separated by the costovertebral joint
        
        Superior costotransverse ligament joins crest of neck of rib to the TP superior to it
        
        aperture between this and VB allows spinal nerve and posterior intercostal artery to pass through
        
        Strong Anterior
        
        limit movements to slight gliding
        
        Weak Posterior
        
        Superior 6 ribs articulate around convex TP -> rotation (pump handle motion, rotatiing around the VB, shifts sternum superior anteriorly)
        
        7th to 10th have flatter articular surface of tubercles and TP:
        Only glides (slight rotation with movement up and down facet and sternum notch
- - - - thoracic aorta -> internal intercostal a. (posterior) which connects to the anterior internal intercostal a. from internal thoracic a.
      - Azygous from intercostal veins on the right, hemiazygous from the left, and drains into SVC