Thoracic Wall General Questions
What are the borders of the thoracic inlet?
L rib 1
R rib 1
manubrium
vertebral body of T1
Why is the first sternocostal joint cartilaginous and the rest synovial?
The first is to stabilize and resist movement
the rest need to be able to move during respiration
What is the name for the 12th n/a/v?
subcostal
What is the pathway milk takes through the breast?
Mammary lobes> lactiferous ducts> lactiferous sinuses> exit
When draining blood back to the heart medially which will the mammary blood hit first brachiocephalic or subclavian?
brachiocephalic as the internal thoracic v. drains directly into that v. not the subclavian.
What are the borders of the thoracic outlet?
Xiphisternal joint
L costal cartilage and ribs 7-12
R costal cartilage and ribs 7-12
Vertebral body of T12
If the descending aorta is blocked will any of the posterior intercostals receive blood flow? If so, what is the pathway?
Yes intercostal aa. 1 and 2 will receive blood
Aorta> Brachiocephalic trunk> subclavian> Costocervical trunk> supreme intercostal> 1st and 2nd intercostal aa.
What muscles does the VAN run between? What rib feature does it run parallel to?
internal intercostal and innermost intercostal
runs in the costal groove
What layer of the breast allows it to move on the thoracic wall?
Retro mammary space
Lymphatic fluid originally in the breast is most likely to drain via which group of lymph nodes?
Axillary
A patient is ℅ UE pain and weakness and presenting with hyperabduction of the arm, what can we assume is occurring?
Thoracic outlet syndrome
Compression of the neurovasculature of the thoracic inlet structures
What are the terminal branches of the internal thoracic artery?
Musculophrenic and superior epigastric
How would blood from the L upper lung return posteriorly to the heart?
Posterior intercostal vv> Accessory hemiazygos v> azygos v.> SVC> Heart
If the internal thoracic a. was blocked at its origin would the breast get any collateral blood flow medially? If so, describe the pathway.
Yes
Aorta> Posterior intercostal aa> lateral cutaneous a> lateral mammary aa> anastomose with medial mammary aa
When draining lymph fluid from the R breast which duct will the fluid drain into?
R lymphatic duct
At what vertebral level is the sternal angle found?
T4
What is the anterior blood pathway to the thoracic wall?
Aorta> brachiocephalic trunk> subclavian> internal thoracic a> anterior intercostal aa
Which artery supplies the lats but also contributes to the external thoracic wall?
Thoracodorsal
What are the two origins of lateral mammary arteries?
Lateral thoracic
Posterior intercostal aa
Where in the breast is cancer most likely and least likely to develop? Why?
Superior Left side d/t most lymph nodes
Inferior Right side d/t the least lymph nodes
What type of rib is rib 10 and why?
False d/t attaching indirectly to the sternum via adjacent costal cartilage
How would blood from the L lower lobe of the lung return to the heart?
Posterior intercostal vv> Hemiazygos v.> azygos v.> SVC> heart
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What is the venous drainage pathway for the lateral mammary vv?
Lateral mammary vv> lateral thoracic v.> axillary v.> subclavian v.> brachiocephalic v.> SVC> heart
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