IMPORTANT LANDMARKS RELATIONSHIPS FOR THE THORAX Anatomical

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IMPORTANT LANDMARKS RELATIONSHIPS FOR THE THORAX Anatomical Powered By Docstoc
					IMPORTANT LANDMARKS / RELATIONSHIPS FOR THE THORAX


    Anatomical landmarks
    jugular notch – T2
    sternal angle – disc between T4-T5
    xiphisternal junction – T9
    nipple (male) – 4th intercostal space
    arch of the aorta – starts at T4, ascends to T2, descends to T4
    tracheal bifurcation – T4
    apex of the heart – 5th intercostal space


    Heart surfaces:
    right surface – right atrium
    left surface – left ventricle
    anterior surface – right ventricle and right auricle
    posterior surface – left atrium
    inferior surface – ventricles and the IVC entering the right atrium


    Auscultatory areas:
    pulmonary semilunar valve – 2nd intercostal space, just to the left of the sternum
    aortic semilunar valve – 2nd intercostal space, just to the right of the sternum
    tricuspid valve – 4th intercostal space, just to the left of the sternum
    bicuspid valve – 5th intercostal space, near the left midclavicular line (apex)


    Heart borders:
    right – from the 3rd right costal cartilage to the 6th right costal cartilage
    left – from the 2nd left costal cartilage to the 5th ICS at the midclavicular line
    superior – from the 3rd right costal cartilage to the 2nd left costal cartilage
    inferior – from the 6th right costal cartilage to the 5th ICS at the midclavicular line
ANSWERS TO EXERCISES – LAB 1

LEARNING EXERCISE




REVIEW EXERCISE

The intercostal vessels and nerves travel between the internal and innermost layers of
intercostal muscles.

The 4th intercostal artery is a branch of the internal thoracic artery anteriorly, and a branch of
the aorta posteriorly.

Intercostal nerves are the VPR of the T1-T11 spinal nerves.

The jugular notch is located at the T2 vertebral level.

Which rib articulates with the transverse process of the 3rd thoracic vertebrae? 3rd
ANSWERS TO EXERCISES – LAB 2

LEARNING EXERCISE
A - right atrium      D - left atrium
a - right auricle     d - left auricle
B - right ventricle   arrows - coronary sulcus
C - left ventricle    arrowheads - interventricular sulcus



ANSWERS TO EXERCISES – LAB 3

LEARNING EXERCISE                            Borders of the mediastinum
                                             Lateral – pleural cavities
                                             Anterior – sternum
                                             Posterior – thoracic vertebral column
                                             Superior – thoracic inlet
                                             Inferior – diaphragm

                                             The borders of the anterior mediastinum are the
                                             sternum anteriorly, the pericardial sac posteriorly,
                                             and the diaphragm inferiorly.

                                             The primary structure located in the middle
                                             mediastinum is the heart, surrounded by the
                                             pericardial sac.


The borders of the posterior mediastinum are the pericardial sac anteriorly, the thoracic
vertebrae posteriorly, and the diaphragm inferiorly.


REVIEW EXERCISES

trachea - bifurcates at T4
phrenic nerve - nerve that crosses the aortic arch anterior to the vagus nerve
SVC - formed by the union of the brachiocephalic veins
aorta           \ the two vessels that are associated with the
pulmonary trunk / ligamentum arteriosum
esophagus - is found directly posterior to the trachea
vagus nerve - nerve that supplies parasympathetic fibers to the cardiac plexus
ANSWERS TO EXERCISES – LAB 4

LEARNING EXERCISE

The superior border of the posterior mediastinum is an imaginary line between the sternal
angle and the disc between the T4 and T5 vertebrae.
The inferior border is the diaphragm.
The anterior border is the pericardial sac.
The posterior border is the thoracic vertebrae.
The lateral borders are the pleural cavities.


REVIEW EXERCISE

Superior mediastinum
thymus
esophagus                                         Middle mediastinum
arch of the aorta                                 pericardium
superior vena cava                                roots of great vessels
vagus nerves                                      heart
trachea
brachiocephalic veins                             Posterior mediastinum
phrenic nerves                                    esophagus
pulmonary arteries                                thoracic splanchnic nerves
thoracic duct                                     azygos system of veins
sympathetic trunks                                descending aorta
                                                  thoracic duct
Anterior mediastinum                              sympathetic trunks
thymus                                            esophageal nerve plexus from vagus
fat cushioning the heart
ANSWERS TO EXERCISES – LAB 5

LEARNING EXERCISE

1. SA node                              4. AV bundle
2. Atria contract                       5. R and L bundle branches
3. AV node                              6. Purkinje fibers


REVIEW EXERCISES

septal papillary muscle                       right ventricle
ostium of the coronary sinus                  right atrium
fossa ovalis                                  right and left atria
conus arteriosus                              right ventricle
pectinate muscles                             right atrium, right and left auricles
crista terminalis                             right atrium
chordae tendineae of the mitral valve         left ventricle
moderator band                                right ventricle
ostia of the pulmonary veins                  left atrium
trabeculae carneae                            right and left ventricles


A areola                      E lactiferous sinus
B areolar glands              F suspensory ligament
C nipple                      G glandular lobules
D lactiferous duct            H fat lobules

A tumor in the upper lateral quadrant of the breast would most likely drain to the axillary lymph
nodes.

A tumor in the upper medial quadrant of the breast would most likely drain to theparas ternal
lymph nodes.



X blood flows from the R atrium to the R ventricle through the bicuspid valve
X papillary muscles contract to close the aortic valve
3 the R ventricle contracts and the tricuspid valve closes
10 blood that is collected in the aortic sinuses flows into the coronary arteries
4 deoxygenated blood flows from the R ventricle to the lungs through the pulmonary valve
9 blood collects in the aortic sinuses and closes the aortic valve
X blood flows from the L atrium to the L ventricle through the tricuspid valve
X oxygenated blood flows from the R ventricle to the lungs through the pulmonary valve
6 blood flows from the L atrium to the L ventricle through the bicuspid valve
7 the L ventricle contracts and blood flows through the aortic semilunar valve
1   blood enters the R atrium through the vena cavae
X   deoxygenated blood flows through the pulmonary veins into the L atrium
X    the coronary arteries fill with blood as blood ascends up the aortic arch
8   the chordae tendineae prevent the bicuspid valve cusps from prolapsing into the L atrium
2   blood flows from the R atrium to the R ventricle through the tricuspid valve
X    the papillary muscles contract to open the bicuspid valve
5   oxygenated blood flows through the pulmonary veins into the L atrium
X    the L ventricle contracts and blood flows through the pulmonary semilunar valve




                                             Parasympathetic innervation of the heart




Sympathetic innervation of the
bronchial tree and pulmonary
vessels



                                             Effects: decreases heart rate, constricts
                                             coronary vessels

                                                Parasympathetic innervation of the
                                               bronchial tree and pulmonary vessels




Effects: dilates bronchial tree,
constricts pulmonary vessels,
inhibits bronchial gland secretion



                                              Effects: constricts bronchial tree, dilates
                                              pulmonary vessels, increases secretion of
                                              bronchial glands
LIST OF STRUCTURES FROM THE DISSECTION

  accessory hemiazygos vein           left common carotid artery
  anterior interventricular artery    left coronary artery
  aortic arch                         left recurrent laryngeal nerve
  aortic valve                        left subclavian artery
  apex of the heart                   left vagus nerve
  azygos vein                         ligamentum arteriosum
  body of the sternum                 lingula
  brachiocephalic trunk               lobes of the lungs
  brachiocephalic veins               manubrium
  bronchi                             marginal artery
  cardiac impressions                 mediastinum
  carina                              moderator band
  chordae tendineae                   oblique fissure
  circumflex artery                   papillary muscles
  conus arteriosus                    parietal pleura and its subdivisions
  coronary sinus                      parietal serous pericardium
  coronary sulcus                     pectinate muscles
  costal cartilage                    phrenic nerve
  costodiaphragmatic recess           posterior intercostal artery
  crista terminalis                   posterior intercostal vein
  descending aorta                    posterior interventricular artery
  esophageal plexus                   primary bronchi
  esophagus                           pulmonary arteries
  external intercostal muscle         pulmonary cavities
  fibrous pericardium                 pulmonary trunk
  fossa ovalis                        pulmonary valve
  greater splanchnic nerve            pulmonary veins
  groove for the esophagus            rib impressions on lungs
  grooves for aortic arch and aorta   ribs 1-7
  hemiazygos vein                     right atrioventricular valve
  hilar lymph nodes                   right auricle
  hilum                               right coronary artery
  horizontal fissure                  right vagus nerve
  inferior vena cava                  superior vena cava
  innermost intercostal muscle        surfaces of the heart
  interatrial septum                  surfaces of the lungs
  intercostal spaces                  sympathetic trunk
  intercostal vessels and nerve       thoracic duct
  internal intercostal muscle         trabeculae carneae
  internal thoracic vessels           trachea
  interventricular groove             transversus thoracis
  interventricular septum             vagal trunks
  left atrioventricular valve         visceral pleura
  left auricle                        visceral serous pericardium