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General Surgery
Thoracic Wall and Pleurae
Built from Skandalakis' Surgical Anatomy: The Embryologic and Anatomic Basis of Modern Surgery
What’s inside
13 sections · 197 slides
Overview
- Scope of this topic
- Anatomic and Surgical History of Thoracic Wall and Pleurae
- Anatomic and Surgical History of Thoracic Wall and Pleurae (continued)
- Anatomic and Surgical History of Thoracic Wall and Pleurae (continued)
- Anatomic and Surgical History of Thoracic Wall and Pleurae (continued)
- Anatomic and Surgical History of Thoracic Wall and Pleurae (continued)
- Anatomic and Surgical History of Thoracic Wall and Pleurae (continued)
- Anatomic and Surgical History of Thoracic Wall and Pleurae (continued)
- Anatomic and Surgical History of Thoracic Wall and Pleurae (continued)
- Anatomic and Surgical History of Thoracic Wall and Pleurae (continued)
- Anatomic and Surgical History of Thoracic Wall and Pleurae (continued)
- Anatomic and Surgical History of Thoracic Wall and Pleurae (continued)
- Anatomic and Surgical History of Thoracic Wall and Pleurae (continued)
- Anatomic and Surgical History of Thoracic Wall and Pleurae (continued)
- Anatomic and Surgical History of Thoracic Wall and Pleurae (continued)
Development of the thoracic wall and pleurae
- Development of the ribs
- Development of the sternum
- Development of the ribs and of the sternum
- Sternal bar fusion as a stepwise process
- Origin of the intercostal musculature
- Differentiation of the thoracic myotome into epimere and hypomere
- The three muscle layers of the thoracic wall
- Development of the pleurae and pleural cavity
- Growth of the lung buds into the pleural canals
Congenital anomalies of the thoracic wall
- Congenital anomalies of the sternum
- Varieties of chest wall deformity in cross section
- Bifid sternum: timing of repair
- Absence of sternal elements with separation of the manubrium
- Failure of sternal fusion
- Complete absence of the sternum with associated ventral defects
- Congenital anomalies of the ribs
- Associated anomalies and hepatic pulmonary fusion
Surface anatomy of the thoracic wall
- Anterior and anterolateral surface anatomy
- Posterior and posterolateral surface anatomy
- The triangle of auscultation
- Superficial muscles of the back and the triangle of auscultation
Skeleton of the thoracic wall
- Parts of the sternum
- Articulations of the manubrium
- The sternum, ventral and dorsal views
- The sternal angle
- Vertebral and visceral relations of the sternum
- Body and xiphoid process
- Thorax, ventral aspect
- Thorax, dorsal aspect
- Two schemes for classifying the ribs
- True ribs and false ribs
- Variations in rib number and form
- Parts of a typical rib
- Head of the rib and the vertebrocostal joints
- Tubercle and the costotransverse joint
- Shaft, angle and the pattern of rib fracture
- Surface features of a typical rib
- Costal groove and the neurovascular bundle
- Curvature of the shaft and the neonatal rib cage
- The first rib
- Grooves and attachments on the first rib
- The second, tenth, eleventh and twelfth ribs
- General features and topographic anatomy of the first and second ribs
Superior and inferior thoracic apertures
- Boundaries of the superior thoracic aperture
- Subdivisions and contents of the superior aperture
- Sympathetic chain and vertebral artery at the first rib
- Relations of neural and vascular structures in the apical region of the right hemithorax
- Costocervical trunk and the highest intercostal artery
- The scalene muscles
- Relations of the subclavian artery and brachial plexus to the scalene muscles and first rib
- Relations of the subclavian artery and brachial plexus
- Relations of the neurovascular elements with the anterior scalene in place
- Subclavian artery and brachial plexus after removal of the anterior scalene
- Cervical rib
- Scalenus minimus and fibrous bands
- Scalenus minimus muscle separating the inferior trunk of the brachial plexus
- The subclavian vein at the thoracic inlet
- Thoracic outlet syndrome
- Ranney's proposed terminology
- Surgical approaches for neurovascular decompression
- Inferior thoracic aperture
Muscles of the thoracic wall
- Extrinsic muscles of the thoracic wall
- Pectoralis major: attachments
- Innervation of pectoralis major
- Actions of pectoralis major
- Musculature of the anterior body wall, superficial and deep
- Pectoralis minor and subclavius
- Serratus anterior
- Long thoracic nerve and scapular winging
- Trapezius
- Latissimus dorsi
- Serratus posterior superior and inferior
- Levatores costarum
- The intercostal spaces
- External intercostal muscle
- Internal intercostal muscle
- Transversus thoracis muscle
- Innermost intercostal muscle and the neurovascular plane
- Subcostalis muscle
- Layers of the intercostal space from outside in
- Lymphatic relations of the posterior thoracic region and the subcostalis muscles
Arterial supply of the thoracic wall
- The three arterial sources
- Course of the internal thoracic artery
- Relations of the internal thoracic artery to the pleura
- Morphometry of the internal thoracic arteries
- Right and Left Internal Thoracic Arteries: Mean Lengths and Average Diameters at the Origin, Costal Cartilage Levels, and Termination
- Branches and variations of the internal thoracic artery
- Perforating branches and the xiphoid branch
- Internal thoracic and intercostal vessels seen from within the thoracic wall
- The internal thoracic artery as a coronary bypass conduit
- Anterior intercostal arteries
- Site of needle entry near the sternum
- Relations of intercostal neural and vascular structures at the sternum
- Sternal vascularisation after sternotomy
- Musculophrenic and superior epigastric arteries
- Costocervical trunk and highest intercostal artery
- Posterior intercostal arteries
- Origins and courses of the intercostal arteries
- Dorsal and spinal branches of the posterior intercostal artery
- Spinal cord supply and the artery of Adamkiewicz
- Visceral and parietal branches of an intercostal artery
- Collateral and cutaneous branches in the intercostal space
- Relations of intercostal vessels and their branches at the posterior ends of the spaces
- Subcostal arteries
- Supreme thoracic artery from the axillary artery
- Collateral arterial circulation in aortic coarctation
- Collateral arterial channels in aortic coarctation
- Sequence of collateral flow in coarctation
Venous drainage of the thoracic wall
- Terminology of highest, superior and supreme veins
- Internal thoracic veins
- Posterior intercostal veins on the left
- The left superior intercostal vein and the aortic nipple
- Posterior intercostal veins on the right
- The azygos vein
- Hemiazygos and accessory hemiazygos veins
- Variability of the azygos system
- A frequent course of the intrathoracic azygos, hemiazygos and accessory hemiazygos veins
- Main connections of the azygos, caval and vertebral systems of veins
- Main veins of the thorax
- Collateral venous circulation of the thorax
Lymphatics of the thoracic wall
- Parietal and visceral nodal groups
- Parasternal (internal thoracic) nodes
- Thoracic Lymphatics: Internal Mammary Nodes
- Thoracic Lymphatics: Internal Mammary Nodes (continued)
- Intercostal nodes and thoracic drainage routes
- Anterior thoracic wall: relations of vascular and lymphatic structures from behind
- Retromanubrial nodes
- Side of drainage of thoracic lymph
- The thoracic nodal map
- American Thoracic Society Lymph Node Map of Thoracic Cavity
- American Thoracic Society Lymph Node Map of Thoracic Cavity (continued)
- American Thoracic Society Lymph Node Map of Thoracic Cavity (continued)
- Choosing a route for lymph node biopsy
- Lymph Node Biopsy Routes
Innervation of the thoracic wall
- The thoracic spinal nerves
- Branches of the thoracic spinal nerve
- Dorsal and ventral primary rami
- Cutaneous branches of the intercostal nerves
- Rami communicantes and the thoracolumbar outflow
- Anatomy of the intercostal space: intercostal nerves and vessels
The pleurae
- Strippability of the parietal pleura
- Adhesion of the pleura and the indication for decortication
- The pulmonary ligament
- The pleurae and the pleural cavity
- Vascular supply of the pleurae
- Lymphatic drainage of the parietal pleura
- Deeper lymphatic routes and the visceral pleura
- Rib levels of the liver, lungs and pleura
- Approximate Rib Levels of Liver, Lungs, and Pleura
- Innervation of the pleurae
- Histology of the pleurae
Ventilatory mechanics and thoracic wall surgery
- Development of thoracic shape and paediatric breathing
- Mechanics of inspiration
- Mechanics of expiration
- Accessory muscles of respiration
- Thoracic wall trauma
- Chest wall resection and reconstruction
- Procedures with anatomic complications
- Thoracocentesis
- Tube thoracostomy and thoracoscopy
- Video-assisted thoracoscopic surgery
- Decortication for trapped lung and chronic empyema
- Malignant pleural effusion and pleuroperitoneal shunt
- Complications of median sternotomy
- Key points to carry from this topic
- Further key points
- Sources cited in this topic
- Sources cited in this topic (continued)
- Skandalakis' Surgical Anatomy: The Embryologic and Anatomic Basis of Modern Surgery
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