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Breast
Thorax Anatomy
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8.1.1 Thoracic Cage [Morph]
Structure of the thoracic cage in relation to the movements of respiration,
protection of thoracic contents, and clinical examination of the heart, lungs
and chest wall
8.1.1.1 Living anatomy of the thorax
| Surface markings on the chest of the apex beat and
borders of the heart, the diaphragm, the apex of the lung, the apical
segment of the lower lobe of the lung. Significance of displacement of
apex beat. |
Surface markings of individual heart valves; surface
points where individual valve sounds are best heard.
Surface markings of oblique and transverse fissures. |
| Relative expansion of the upper and lower chest in antero-posterior
and lateral dimensions; descent of diaphragm on inspiration. |
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| Percussion of the chest wall as a method to demonstrate
cardiac and liver dullness, lung fields and gas in stomach. (See also
8.2.2.2.) |
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8.1.1.2 Skeletal and soft tissue framework of the
thorax
| Sternum, manubrium, xiphisternum; sternal angle |
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| Ribs (head, neck, shaft, tubercle) and costal cartilages.
Special features of first & floating ribs. Movements and articulations
of vertebro-sternal and vertebro-costal ribs. |
Rib fractures; effects of flail segments of chest wall |
| Diaphragm, external and internal intercostal muscles —
actions, nerve supply and attachments; costo-phrenic angle; suprapleural
membrane. Structures passing through the diaphragm. |
Innermost intercostal muscles |
| Development of the diaphragm. (See 13.4.7) |
Diaphragmatic herniae |
| Nerves and vessels of intercostal spaces: intercostal
nerves — segmental levels at sternal angle, xiphisternum; posterior
intercostal arteries, internal thoracic artery; venous drainage to azygos
vein system; lymphatic drainage of chest wall including breast;
neurovascular plane. |
Hemiazygos veins; superior and supreme intercostal veins.
Arterial anastomoses of chest wall (collateral circulation in
coarctation of aorta) |
| Position of lung apices. |
Pancoast’s tumour; Horner’s syndrome |
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