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Thorax Anatomy

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 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.
Percussion of the chest wall as a method to demonstrate cardiac and liver dullness, lung fields and gas in stomach. (See also Skeletal and soft tissue framework of the thorax

Sternum, manubrium, xiphisternum; sternal angle
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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