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Unit 1 Thoracic Wall and Lungs and Pleurae
Unit 1 Thoracic Wall and Lungs and Pleurae
33
Anatomy
Graduate
09/11/2011

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Term
External Intercostal Membrane
Definition
The external intercostal muscles turn into the external intercostal membrane as they approach the sternum
Term
External Intercostal Muscles
Definition
Located superficial and lateral to internal intercostal muscles
originate in lower border of rib, insert into upper border of rib below
innervated by ventral rami of thoracic spinal nerves (intercostal nerve)
Term
Internal Intercostal Muscles
Definition
innervated by ventral rami of thoracic spinal nerves (intercostal nerve)
originate in lower border of rib, insert into upper border of rib below
Forced inspiration involves contraction of the intercostal muscles to elevate the ribs
Are relaxed during expiration
Term
Transversus Thoracis Muscles
Definition
originates from the lower third of the posterior surface of the body of the sternum, from posterior surface of xiphoid process and from the sternal ends of the costal cartilages of the lower 3 or 4 true ribs
innervated by ventral rami of thoracic spinal nerves (intercostal nerve)
separates thoracic cage from parietal pleura
Deep to the internal thoracic artery, connects to body of sternum
Term
Internal Thoracic Artery
Definition
originates from the subclavian artery
branches into the superior epigastric artery (medial) and the musculophrenic artery (lateral) at approximately the 6th intercostal space
also has branches to the anterior intercostal arteries
Term
Anterior Intercostal Arteries
Definition
branch of internal thoracic arteries, supply blood to the upper 5 or 6 intercostal spaces
supply intercostal muscles, pectoral muscles
anastomose with posterior intercostal arteries which branch from the thoracic (descending) aorta
Will become dilated and tortuous if there is an aortic coarctation due to the anastomoses to provide a collateral blood supply
Term
Internal Thoracic Vein
Definition
Bilaterally, it arises from the superior epigastric vein, runs with the internal thoracic artery and drains into the brachiocephalic vein
Term
Musculophrenic Artery
Definition
Supplies the diaphragm
Perforates the diaphragm at the 8th or 9th costal cartilage
branches off internal thoracic artery (lateral branch)
Term
Superior Epigastric Artery
Definition
branches off internal thoracic artery (medial branch)
anastomoses with inferior epigastric artery
Will become dilated and tortuous if there is an aortic coarctation due to the anastomoses to provide a collateral blood supply
Term
Intercostal Nerve
Definition
Innervate the intercostal muscles
Are the ventral rami of Spinal nerves from T1 through T11
somatic sensory, somatic motor, postganglionic sympathetic
Each nerve connects with the adjoining ganglion of the sympathetic trunk via a white and gray ramus communicans
Supply the intercostals, transversus thoracis. At the front of the thorax some of these branches cross the costal cartilages from one intercostal space to another.
Term
Superior Lobar Bronchus
Definition
secondary bronchi
consists of smooth muscle surrounded by hyaline cartilage
Parasympathetic fibers of Vagus nerve bronchoconstrict
Afferent fibers of Vagus nerve distributed to mucosa initiate cough reflex
Afferent fibers of Vagus nerve distributed to muscles respond to stretch
Sympathetic fibers monitor parasympathetic control and bronchodilate, as well as vasoconstrict pulmonary vessels
Visceral afferent fibers from the bronchi accompany the sympathetics. Pain is referred over the anterior chest wall (dermatomes T1 – T5)
Term
Middle Lobar Bronchus (right lung)
Definition
secondary bronchi
consists of smooth muscle surrounded by hyaline cartilage
Parasympathetic fibers of Vagus nerve bronchoconstrict
Afferent fibers of Vagus nerve distributed to mucosa initiate cough reflex
Afferent fibers of Vagus nerve distributed to muscles respond to stretch
Sympathetic fibers monitor parasympathetic control and bronchodilate, as well as vasoconstrict pulmonary vessels
Visceral afferent fibers from the bronchi accompany the sympathetics. Pain is referred over the anterior chest wall (dermatomes T1 – T5)
Term
Inferior Lobar Bronchus
Definition
secondary bronchi
consists of smooth muscle surrounded by hyaline cartilage
Parasympathetic fibers of Vagus nerve bronchoconstrict
Afferent fibers of Vagus nerve distributed to mucosa initiate cough reflex
Afferent fibers of Vagus nerve distributed to muscles respond to stretch
Sympathetic fibers monitor parasympathetic control and bronchodilate, as well as vasoconstrict pulmonary vessels
Visceral afferent fibers from the bronchi accompany the sympathetics. Pain is referred over the anterior chest wall (dermatomes T1 – T5)
Term
Pulmonary Arteries
Definition
Receive afferent fibers from the vagus nerve (pressoreceptors)
Arise from the right atrium
Carry deoxygenated blood
The right pulmonary artery runs horizontally toward the hilus of the right lung under the arch of the aorta behind the ascending aorta and SVC and anterior to the right bronchus.
The left pulmonary artery is connected to the arch of the aorta by the ligamentum arteriosum, the adult remains of the ductus arteriosus shunt.
An pulmonary embolus can occlude these arteries (saddle embolus) and quickly result in right sided heart failure (cor pulmonale)
Term
Pulmonary Veins
Definition
Leave the lungs as five pulmonary veins, one from each lobe of the lungs. However, the right upper and
middle veins usually join so that only four veins enter the left atrium.
Receive afferent fibers from the vagus nerve (chemoreceptors)
Carry blood into the left atrium
Are intersegmental in drainage (do not accompany the bronchi or the segmental artery within the
parenchyma of the lungs).
Carry oxygenated blood from the respiratory part (alveoli) of the lung (Gas exchange occurs
between the walls of alveoli and pulmonary capillaries)
Term
Lymph Nodes
Definition
The lymph vessels run along the bronchiole and bronchi toward the hilus, where they drain to the pulmonary (intrapulmonary) and then bronchopulmonary nodes, which in turn drain to the tracheobronchial nodes, the tracheal (paratracheal) nodes, bronchomediastinal nodes and
trunks, and eventually to the thoracic duct
Filters the interstitial fluid to remove metastatic cells, dirt debris, cell debris
The lymph system removes interstitial fluid
An increase in the size of bronchopulmonary nodes can cause a deviation of the carina of the trachea from the midline, Enlargement of the bronchoplumonary or tracheobronchial nodes localized on the left side may compress the left recurrent laryngeal nerve, causing hoarseness or a “weak” voice
Term
Costal Surface
Definition
Surface of lung located anterior, lateral, and posteriorly
Term
Mediastinal Surface
Definition
The hilum is located at the center of the mediastinal surface from approximately T5-T7 which contains the structures that comprise the root of the lung.
Impressions are made on this surface by adjacent vasculature and esophagus
Term
Diaphragmatic Surface
Definition
Located at the base of the lungs, the inferior border is at the margin of the diaphragmatic surface
Term
Anterior Border of Lung
Definition
Projects into costaldiaphragmatic recess
Costal and mediastinal surfaces meet
overlaps the front of the pericardium. The anterior border of the right lung is almost vertical, and projects into the costomediastinal sinus; that of the left presents, below, an angular notch, the cardiac notch, in which the pericardium is exposed. Opposite this notch the anterior margin of the left lung is situated some little distance lateral to the line of reflection of the corresponding part of the pleura.
Term
Cardiac Notch (left lung)
Definition
Located superior to the lingula between 4th-6th costal cartilage on the anterior border of the left lung in the superior lobe.
The cardiac notch exposes the pericardium and enables access to the heart for pericardiocentisis to relieve cardiac tamponade.
Term
Inferior Border
Definition
The inferior border of the lung goes all the way around the margins of the diaphragmatic surface area
separates the base from the costal surface and extends into the phrenicocostal sinus; medially where it divides the base from the mediastinal surface
Term
Posterior Border
Definition
Mediastinal meets costal surface posteriorly
received into the deep concavity on either side of the vertebral column. much longer than the anterior border, and projects, below, into the phrenicocostal sinus.
Term
Apex
Definition
located at the most superior part of the lung above the clavicle, makes access to the subclavian arteries difficult as they run in a sulcus on the apex.
Pancoast's or superior pulmonary sulcus tumor: is a malignant neoplasm of the lung apex and causes Pancoast's syndrome , which comprises (1) lower trunk brachial plexopathy (which causes severe pain radiating toward the shoulder and along the medial aspect of the arm and atrophy of the muscles of the forearm and hand) and (2) lesions of cervical sympathetic chain ganglia with Horner's syndrome (ptosis, enophthalmos, miosis, anhidrosis, and vasodilation).
Term
Base
Definition
The anatomical base is the entire inferior portion of the lung that comes in contact with the diaphragm. Clinicians consider the most inferior part of the inferior lobe to be the base of the lung, 2 costal spaces below anatomical base.
Term
Upper Lobe
Definition
The upper lobe of the left lung contains the lingula which is inferior to the cardiac notch. The upper lobe is separated from the remainder of the lung by the oblique fissure.
Term
Middle Lobe (right lung)
Definition
The smallest lobe in the right lung
Located anterior and inferior to the superior lung on the right lung
The horizontal fissure separates the middle lobe from the superior lobe in the right lung
The oblique fissure separates the middle lobe from the inferior lobe
Term
Lower Lobe
Definition
The left lower lobe, the larger of the two in the left lung, is situated below and behind the oblique fissure, and comprises almost the whole of the base, a large portion of the costal surface, and the greater part of the posterior border.
The right lower lobe is situated below and behind the oblique fissure, and comprises almost the whole of the base, a large portion of the costal surface, and the greater part of the posterior border.
Term
Oblique Fissure
Definition
Separates the inferior lobe of each lung from the remainder of the lung.
In the right lung it separates the inferior lobe from the superior and middle lobes
In the left lung it separates the inferior lobe from the superior lobe.
Starts posteriorly from T2-T4 to the 6th costal cartilage anteriorly.
Term
Horizontal fissure (right lung)
Definition
Begins in the oblique fissure, Located at T6 - T7 or 4th costal cartilage, separates the middle from the superior lobe of the right lung
Term
Secondary Bronchus
Definition
consist of smooth muscle surrounded by hyaline cartilage
conducting portion of airway, does not participate in gas exchange
Arise from primary bronchi, each serves as the airway to a specific lobe of the lung
There are 3 in the right lung (Upper, Middle, and Lower Lobar bronchus)
There are 2 in the left lung (Upper and Lower Lobar bronchus)
Lung buds develop at the distal end of the laryngotracheal diverticulum and divide into two bronchial
buds, which branch into the primary, secondary, and tertiary bronchi
Term
Tertiary Bronchus
Definition
consists of smooth muscle surrounded by hyaline cartilage
conducting portion of airway, does not participate in gas exchange
Arise from secondary bronchus
supply bronchopulmonary segments, disease processes often become localized and confined to these segments, compromised segment may be removed
Leads to respiratory units and alveoli, emphysema can result in the loss of elastin around the terminal bronchi which results in the inability to completely exhale.
Lung buds develop at the distal end of the laryngotracheal diverticulum and divide into two bronchial
buds, which branch into the primary, secondary, and tertiary bronchi
Term
Pulmonary Plexus
Definition
Preganglionic parasympathetic, effect part of vagus, bronchoconstrictors, INITIATE glandular secretory activity
Postganglionic sympathetic, bronchodilators
Visceral afferent fibers of both types from vagus nerve
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