Transcript Surface anatomy, lung surface markings, pleural reflections

Surface anatomy, lungs
and pleura
Cat Seymour
Objectives

Identify important surface landmarks on the anterior
thoracic wall and use the sternal angle (of Louis) to
accurately number the ribs on a living subject

Explain lymphatic drainage of the breast and its
importance in the spread of cancer

Describe the surface markings of the lungs and pleural
reflections
Objectives

Identify important surface landmarks on the anterior
thoracic wall and use the sternal angle (of Louis) to
accurately number the ribs on a living subject

Explain lymphatic drainage of the breast and its
importance in the spread of cancer

Describe the surface markings of the lungs and pleural
reflections
Surface anatomy
3 anterior planes:

Anterior Median line

2 Midclavicular lines
3 anterolateral planes:

Anterior Axillary line

Midaxillary line

Posterior Axillary line
Surface anatomy

Clavicle

Jugular notch

Manubrium

Angle of Louis

Xiphisternum

Costal margin

Anterior axillary fold
Objectives

Identify important surface landmarks on the anterior
thoracic wall and use the sternal angle (of Louis) to
accurately number the ribs on a living subject

Explain lymphatic drainage of the breast and its
importance in the spread of cancer

Describe the surface markings of the lungs and pleural
reflections
The breast
Most prominent surface
feature
 Intermammary cleft
 Nipple- midclavicular line
(10th ics in men)
 Areola
 Sternum to midaxillary line
horizontally
 2nd to 6th ribs vertically


Present in both sexes

Mammary glands developed in
women

Modified sweat glands

Rest on pectoral fascia (2/3rd)

Retromammary space

Axillary tail

Suspensory ligaments

15-20 glandular lobules

Drained by lactiferous duct
Vasculature of the breast

Medial mammary branches of anterior
intercostal branches of the internal
thoracic artery

Lateral thoracic

Thoraco-acromial arteries

Posterior intercostal arteries, from the
thoracic aorta
Lymphatics of the breast



Spread of cancer
Subareolar lymphatic plexus (from
the nipple, areola, etc.)
 75% to axillary lymph nodes
(pectoral, humeral, subscapular,
central and apical)
 Parasternal lymph nodes
 Abdominal lymph nodes
Lymph from axillary nodes drains to
infraclavicular and supraclavicular
nodes, then to the subclavian
lymphatic trunk
Objectives

Identify important surface landmarks on the anterior
thoracic wall and use the sternal angle (of Louis) to
accurately number the ribs on a living subject

Explain lymphatic drainage of the breast and its
importance in the spread of cancer

Describe the surface markings of the lungs and pleural
reflections
Pleura
Each lung is enclosed in a pleural sac (2
layers):

Visceral pleura- adheres to lungs, cannot
be dissected

Parietal pleura- adheres to thoracic wall,
mediastinum and diaphragm
Between the pleural layers is pleural cavity,
filled with serous pleural fluid
(to visualise pleura, think of pushing your fist
into an underinflated balloon)
Parietal has nervous innervation, visceral does
not
Parts of parietal pleura

Costal part- covers the internal surface of
thoracic wall and is separated from wall by
endothoracic fascia

Mediastinal part- lateral aspects of mediastinum

Diaphragmatic part- superior surface of
diaphragm

Cervical pleura- extends superior to thoracic
inlet into the root of the neck
Pleural reflections

Abrupt lines where pleura changes direction

From 1 wall to another

Sternal line


Costal line


costal pleura becomes continuous with mediastinal pleura ANTERIORLY
costal pleura becomes continuous with the diaphragmatic pleura INFERIORLY
Vertebral line

costal pleura becomes continuous with the mediastinal pleura POSTERIORLY
Lungs vs pleura

Apices of lungs and cervical pleura pass
through superior thoracic aperture

Lungs lie adjacent to parietal pleura
between 2nd and 4th cc

Left pleural reflection moves laterally and
inferiorly- cardiac notch 6th cc

The right pleura travels parallel to lung
down to 6th cc

Both pleural reflections pass laterally to
midclavicular line at 8th cc

Midaxillary line 10th cc

Scapular line at 12th rib

Pleura extends 2 ribs below lungs
2, 4, 6, 8, 10, 12
Recesses of the pleural cavity

Lungs do not completely occupy pleural
cavity during expiration

Costomediastinal recess- left is larger

Costodiaphragmatic recess

Lungs expand into recesses during
inspiration
Thanks for listening!
Any questions, email me: [email protected]
References:
Moore and Agur- Essential Clinical Anatomy
Gray’s Anatomy
Google images