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Clinical Correlates
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- 1Where do most fractures occur in a rib?immediatley anterior to the costal angle (weakest part of the rib)
- 2Supernumerary ribs: Cervical Ribsthoracic outlet syndrome : compresses neurovascular structures exiting superior thoracic aperture
Confusion of the vertebral levels in diagnostic images - 3Lumbar Ribs:articulates with the lumbar transverse processes
can be misdiagnosed as a fracture of the L1 transverse process on a radiograph - 4Flail Chestunstable injury of the thoracic wall,
multiple ribs fractured
paradoxical motion
inspiration the damaged portion moves inward (due to negative pressure) - 5Congenital thoracic wall deformities Pectus Excavatumconcave depression
causes: intrauterine pressure on the chest wall during development
Complication: compression of heart/lungs - 6Pectus Carinatum:protrusion of the sternum and costal cartilages
causes: connective tissue disorder
complicatons: scoliosis and congenital heart disease - 7Sternal fracture:causes injurires to superior mediastinal structures, heart/vessels, and lungs
- 8Xiphoid process fracture:poor CPR procedure
contact sport
dislocation of the Xiphisternal joint
injury compresses the diaphragm - because the xiphisternal joint forms the anterior attachment of diaphragm and inferior parts of heart
broken pieces can puncture the heart or liver - 9Rib Dislocation: "slipping rib"displacement of sternocostal joint or between the interchondral joints
displaced rib can cause injuries to the underlying structures (neuro, diaphragm, liver) - 10Rib Separation:dislocation of costochondral joint
separated rib may be displaced superiorly and often overrides the rib above - 11Severe dyspnea (shortness of breath)acessory muscles are used
- 12For Intercostal nerve block: the recommended site of injection:proximal to the midaxillary line before the origin of lateral cutaneous branches
between the internal and innermost intercostal mm - 13Herpes zoster infectionreactivation of chicken pox viruses which reside dormant in the dorsal root ganglion.
sharp pain follows a strip of dermatome supplied by the involved nerve
skin eruption - 14Pleural sites prone to injuries : Cervical pleura (cupula)lung apex project through the superior thoracic aperture
the 1st ribs slopes inferiorly exposing the pleura - 15Pleural sites prone to injuries: Cervical pleura right infrasternal angle right/left costovertebral anglecervical: lung apex via superior thoracic aperture, 1st rib slopes inferiorly exposing pleura
right infrasternal angle: pleura descends below costal margins
right/left costovertebral angle:
no costal cartilage inferomedial to 12th rib (pleura exposed) and vulnerable to damage through surgeries (kidney) - 16Pleuritis:inflammation of pleura, sharp chest pain with deep breath (irratation of parietal pleura - innervated by intercostal nerves)
pleura rubs against each other
detectable during auscultation as rough, grating sound similar to sound rolling hair between fingers - 17Pleurodensis:Obliterating (closing) the pleural space
treat pleural effusion or pneumothorax - 18Pneumothoraxentry of air into pleural cavity
trauma: thoracic wall opening (stab or bullet)
Bronchopulmonary fistula: a communication between the lung and pleural cavity
hydrothorax: fluid
hemo: blood
hemopneumo: air and blood
pyothorax: pus
chylothorax: lymph - 19Thoracentesis (pleural tap)insert needle to obtain samples of fluid
needle inserted midway within the intercostal spaces to avoid damaging the nerves
midclavicular: 6 to 8 ribs, 7th intercostal space
midaxillary : 8 to 10 ribs, 9th intercostal space
paravertebral line: 10 to 12 ribs, 10th intercostal space
make sure the needle is angled upward to avoid injuring the diaphragmatic pleura and the diaphragm - 20Chest tube/Chest drain:to remove excess fluid, blood, pus, or air
ideal sites 5th or 6th intercostal space along the midaxillary line (below will damage diaphragm) "safe triangle"
fluid removal: tube directed inferiorly towards the costodiaphragmatic recess
air removal: tube directed superiorly towards the cervical pleura - 21Intercostal nerve block:anesthetic drug must infiltrate the space between the internal and innermost intercostal muscles to reach the intercostal nerves
- 22Thoracentesis or chest tube:infiltrate all layers (superifical to deep - skin, superifical fascia, 3 intercostal muscles, endothoracic fascia, and parietal pleura --> all layers innervated by the intercostal nerves)
- 23Extrapleural intrathoracic surgical accessendothoracic fascia (glue between the parietal pleura and thoracic wall) forms an important natural cleavage plane for surgical separation of parietal pleura from thoracic wall
- 24Auscultation:listening to lungs sounds by a stethoscope.
to assess air flow through tracheobronchial systems - 25Percussion:tapping the thorax wall with fingers to listen to lung sounds
detects air filled spaces
fluid filled --> dull sound
solid --> flat sound
ex: tapping alevoli of lung = resonant sound
if there is infection --> dull sound - 26Lung Ausculation areas: (anterior chest)apex of the lung: superior to middle third of clavicle
superior lobe: 2nd intercostal space
Middle lobe: 4th intercostal space
inferior lobe: 6th or 7th intercostal space/ posterior (triangle of auscultation) - 27open pneumothoraxpleural cavity open to outside
lung collapses
mediastinal/tracheal shift towards the AFFECTED side - 28Tension pnemothoraxvalve-like opening
mediastinal/tracheal shift towards the UNAFFECTED side
widening of intercostal spaces
diaphragm displaced inferiorly (affected side) - 29Aspiration of Foreign bodiesright main bronchus (straight, wider, short compared to left)
- 30Aspirated fluid or Vomitus (Aspirated Pneumonia)when seated upright --> right posterior basal segment
when lying supine --> right superior segment - 31Pancoast Tumor (lung cancer - apex of lung)Compresses sym trunk --> Horner's syndrome : miosis, ptosis, anhidrosis
Compresses brachial plexus:
Klumpke's (C8-T1)
Compression of subclavian a/v
PPP (pulseness, pallor, pain) - 32Carinal tumorsbifercates to give right/left main brochus
changes to carina
normal carina: lies in a sagittal plane and has a sharp/smooth edge - 33Pulmonary Embolism (PE)obstruction of pulmonary artery by a blood clot
most of the dislodged emboli are from the deep veins of the lower limbs
Associated conditions:
acute respiratory distress - blockage of pulmonary artery
acute cor pulmonale: dilated right heart ventricle
pulmonary infarct
symptoms: dyspnea, sharp chest pain, blood-tinged foamy sputum - 34Mitral Valve Insufficiency:Mitral valve leaflets disorder.
• Blood regurgitates into the left atrium.
• Dilated left atrium likely to compress
esophagus = dysphagia. - 35Pericarditis:inflammation of pericardium
causes chest pain
pericardial friction rub -sounds like a rustle of silk - 36Pericardial Effusion:passage of fluid from pericardial capillaries into the pericardial cavity
- 37Pericardial effusion complications:Cardiac Tamponade (heart compression)
due to extensive pericardial effusion
heart can't fully expand --> limits amount of blood heart receives --> reduces cardiac output
Symptoms- "Beck's Triad"
Hypotension (less stroke volume)
jugular-venous distention
muffled heart sounds
Treatment: Withdrawl of fluid known as Pericardiocentesis
sites: left 5th or 6th intercostal space near the sternum infrasternal angle - 38Coronary arteries variation:dominance depends on the origin of the posterior interventricular artery (70% of the population the posterior comes off the RCA)
15% of the population comes off of LCA - 39coronary artery diseasescoronary atherosclerosis --> myocardial infarction (MI)
reduced blood flow to myocardial tissue
-lipid deposits in the intima (lining) of coronary arteries
slow progression
MI: usually in LAD, RCA, Circumflex (infarcted/necrotic) - 40Coronary Artery RecanalizationCoronary Angioplasty
catheter with a ballon tip allows flattening of plaques to increased blood flow
and so we add a intravascular stent (placed after dilation of vessel to main dilation) - 41Coronary Artery Bypass Graft (CABG)reroute blood flow due to arterial stenosis/arterial atresia
Arterial: internal thoracic, radial, gastroepiploic, inferior epigastric
Venous: great saphenous, small saphenous (flip around to avoid valve) - 42Enlarged right superior tracheobronchial nodes and hilar nodescan compress the easily collapsible arch of the azygous (also can be compressed by tracheal or rt. lung tumors
- 43Retroesophagael right subclavian arterythe right subclavian artery crosses posterior to the esophagus
compresses esophagus leading to dysphagia - 44Double arch of the aorta (DAA) Vascular ring anomaly)forms a ring around esophagus and trachea
symptoms:
stridor (high pitched wheezing sound)
dysphagia (difficulty swallowing) - 45Injury to right recurrent laryngeal nervesaortic arch aneurysm
esophageal tumors
tracheal tumors
mediastinal tumors
unilateral: voice hoarseness
bilateral: aphonia (loss of voice) - 46Phrenic nerve: Painpain from structures served by the phrenic nerve are referred to the somatic region subserved by C3-C5 spinal nerves
(shoulder and neck area)
may elicit hiccup reflexes - 47Parabrochial diverticulum ("true traction diverticula")protrusion of all the layers, not typically the weak spots
causes: tumors
"pulling force from outside" - 48Epiphrenic diverticulum : "False pulsion diverticula"herination of the mucosa and submucosa through the weak spots in the muscular coat.
causes: neuromuscular dysfunction
"pushing force from inside" - 49laceration of thoracic ductvulnerable to injuries during investigate or surgical procedures (because it's thin and dull whitish)
lymph can escape and enter the pleural cavity to produce chylothorax - 50Supra-Azygous SVC obstructiondistended arm and neck veins
dilated tortuous veins on the upper chest and back (SVCS) - 51Infra-Azygos SVC obstructiondilation of collateral vessels on the anterior and posterior abd walls
- 52Rupture of the male urethraThe most common site for rupture of the urethra is at the bulb of the penis
for instance via a straddle injury
• Rupture of the spongy urethra (and corpus spongiosum) results in the flow
of blood/urine into the superficial perineal space
• The attachment of the perinea fascia determines the resultant pathway of
blood/urine
this will push Scarpe's fascia away from underlying abd wall and cause swelling in the anterior abd wall due to space and not the thighs because it is continuous with fascia lata - 53Psoas signis a medical sign that indicates irritation to the iliopsoas group of hip flexors in the abdomen, for instance by an inflamed appendix
person is asked to lie on unaffected side and extend the thigh on the affected side against the resistance of the examiner's hands.
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- Fichas sobre Clinical Correlates , creado por Gina Fatahi el 07/03/2015.
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- Gina Fatahi
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