Transcript Surface anatomy: Anterior Chest Wall

Surface anatomy:
Anterior Chest Wall
By Zara Kwan
Objectives
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Anterior Thoracic Wall Planes
Surface markings
Breast
Lungs and Pleura
Planes
Midsternal/Anterior
median line
Midclavicular lines
(pass just medial to the nipples)
Suprasternal plane
Sternal Angle plane
Xiphisternal plane
Planes
• Axilla: armpit
and surrounding
area
• Anterior axillary
line is on the
border of
Pectoralis Major
muscle
Surface markings and levels
Clavical
Jugular
Notch- T2
Manubrium of
Sternum- Ribs
1-2, T3-T4
Sternal
Angle/Transverse
thoracic plane- rib
2 T4/T5
Sternum bodyT5-T9
Nipple- (males)
Intercostal
space 4
Xiphisternal
plane- T9
Breast- ribs
2-6
Infrasternal Angle- where the costal margins
converge
Feature/Line
Rib(s)
Jugular notch/suprasternal
plane
Thoracic Vertebral
level
T2
Manubrium
Rib 1 ,(2)
T3-T4
Sternal Angle/Transverse
thoracic plane
Rib 2
T4-T5
Nipple
ICS 4
Breast
Ribs 2-6
Sternum Body
Ribs 2-6,
(false ribs
7-10)
Xiphisternal Plane
Intercostal space
T5-T9
T9
The breast
• Ribs 2-6
• Sternum to midaxillary line
• Areola is the pigmented area
around the nipple
• Pregnancy and hormonal
changes darken it.
Lymphatic drainage
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Apical axillary
Central axillary
Lateral axillary
Pectoral axillary
Parasternal
Supra and Infra
clavicular
• 75% drain axillary nodes
• Other 25% is Abdominal
or Parasternal.
Clinical Importance: Breast
examination needs to be done on
my both breasts and to the axilla
where cancer can spread.
What’s the connection?
Peau d’orange
• Due to oedema/ fluid
infiltration into the
breast around
dimpled areas due to
inflammation.
Lungs and pleura
Lung  Visceral pleura Pleural cavity Parietal pleura Thoracic wall
Recesses
• Costodiaphragmatic/
costophrenic recess
• Costomediastinal
recess
• Two layers of parietal
pleura are unopposed.
• No lung tissue
occupies this space
except deep
inhalation.
Clinical Importance: Fluid
accumilates in these areas that may
require aspirating.
Pleural effusion
Parietal pleura and Lung surface markings
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Rib 2 reflections close to the sternal angle
Parallel down to rib 4
Rib/ costal cartilage 6 indent on the left parietal pleura due to heart
Rib 8 where it meets the midclavicular line
Rib 10 where it meets the midaxillary line
Rib 12 where it meets the scapular line (back)
General advice about learning
anatomy
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Read up
Learn keywords
Make notes
Look at the prosections!
Don’t worry too much about the weekly
assessment.
Any questions?
Email: [email protected]