Clinical aspect of thorax

 

Thorax

Surface anatomy & markings

1 sternal angle (T4/5) 2 xiphoid process (T9) 3 suprasternal notch (T2/3)

1 superior angle of scapula (T2) 2 spine of scapula 3 inferior angle of scapula

Precordium from apex-5th interspace medial to midclavicular line to right upper border 2nd interpace to right of sternum to 2nd interspace to left of sternum to 6th chondrosternal junction to the left of sternum

 

 

Pleura reaches 12th rib at lateral border of erector spinae10th rib at midaxillary line and 8th rib at midclavicular line. The lung reaches 10th rib at lateral border of erector spinae, 8th rib at midaxillary line.

 

 

Flail chest

Causes

  • Crushing injuries especially which is extensive and causes indentation.

  • Direct violence

  • Involves many ribs which break at the anterior and posterior angles.

  • The fracture unit remains a different unit from others and there is paradoxical breathing.

  • Extensive flaccid instability of chest wall

Diagnosis

  • History: War or RTA with direct violence.Condition is painful and may involve stability of chest. Paradoxical breathing occurs with difficulty in breathing. It always has indentation of chest wall.

  • General examination: Crepitus and localized tenderness.

X-ray:

Treatment

  • Artificial respiration

  • Tracheostomy cures the condition.

  • Analgesics for pain.

  • Intercostal nerve block may be used for persistent pain.

  • Surgical intervention to elevate the depressed chest wall

Stove-in-chest

Causes and features

  • Crushing injuries especially which is extensive and causes indentation.

  • Direct violence

  • Involves many ribs which break at the anterior and posterior angles.

  • The fracture unit may remain a different unit from others and there is paradoxical breathing.

  • It is found in three places usually- anterior (involving sternum) and lateral (subscapular).

Diagnosis

  • History: War or RTA with direct violence.Condition is painful and may involve stability of chest. Paradoxical breathing occurs with difficulty in breathing. It always has indentation of chest wall.

  • General examination: Crepitus and localized tenderness.

  • X-ray:

Treatment

  • Artificial respiration

  • Tracheostomy

  • Analgesics for pain.

  • Intercostal nerve block may be used for persistent pain.

  • Surgical intervention to elevate the depressed chest wall

  • Recurrence requires fixation of ribs with wires

 

Thoracotomy:

To enter the pleural cavity to remove any foreign object or to operate on the lungs or its root, incision has to be made in the middle of the intercostal space, usually below or at 8th interspace. The incision is made in the middle in order to avoid the vessels and nerves, which run along the margins of the ribs. Also, it is placed in the 8th space to avoid the lung and enter the costodiaphragmatic recess.

 

 

Surgical approach to the heart

This is via the anterior mediastinum. Incision is made on the skin covering the sternum and the sternum is divided into two halves with a longitudinal incision, to expose the anterior mediastinum in order to gain access to the pericardial sac.

 

 

Cervical rib syndrome:
This is a costal element of 7th cervical vertebra. it could be an epiphysis on its transverse process.  It then is provided with a head, neck and tubercle, with or without shaft. It ends anteriorly on sternum or first costal rib or cartilage. Its superior relations are the brachial plexus and subclavian plexus, which may suffer pressure with neural and vascular symptoms.

 

 

 

Imaging anatomy
Surgical anatomy
Anesthetic anatomy
Endoscopic anatomy
 

 

 


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Clinical anatomy

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Electronic School of Medicine
Creator: Oluwole Ogunranti