(Netter Basic Science) Frank H. Netter - Atlas of Human Anatomy-Elsevier (2018)

Structures With High* Clinical Significance
4
ANATOMICAL STRUCTURES
Mammary gland
INTEGUMENTARY SYSTEM
CLINICAL IMPORTANCE
Breast cancer is most common malignancy in women; movement of breast with pectoral
muscles indicates invasion of retromammary space
PLATE
NUMBERS
188
Ribs
SKELETAL SYSTEM
Sternal angle (of Louis)
Chest wall (ribs and intercostal
spaces)
Rib fractures may breach pleural space and cause pneumothorax; flail chest occurs when
multiple rib fractures lead to thoracic cage instability
Surface landmark for counting ribs (2nd pair of ribs articulate here) and intercostal
spaces; divides superior from inferior mediastinum
Knowledge of relationships between chest wall and underlying organs is necessary for
thoracotomy
192
192
194, 202, 204
Left ribs (ribs 9, 10, 11) If fractured, may cause injury to underlying spleen 202
Superior thoracic aperture
Compression of neurovascular structures traversing superior thoracic aperture may
produce thoracic outlet syndrome
198
MUSCULAR SYSTEM
Intercostal spaces
Respiratory diaphragm
RESPIRATORY SYSTEM
Lines of pleural reflection
Pleura of lungs
Cervical pleura
Tracheal bifurcation
Apex of lung
NERVOUS SYSTEM
Long thoracic nerve
Intercostal nerve
Posterior root (spinal) ganglion
Phrenic nerve and respiratory
diaphragm
Recurrent laryngeal branch of
vagus nerve (CN X)
Important relationship of intercostal neurovascular bundle to ribs when placing chest
drainage tube to relieve pneumothorax or hemothorax
Widening of esophageal hiatus or congenital defect allows for protrusion of stomach into
thorax (hiatal hernia)
Knowledge of location of lung and pleura with respect to chest wall is necessary for
chest tube thoracostomy
Air or gas (spontaneous or traumatic) can leak into pleural space between visceral and
parietal pleura and compress lung
Extends into neck superior to 1st rib; it may therefore be punctured during neck
procedures, producing pneumothorax
Right main bronchus is shorter, more vertical, and wider; aspirated objects are therefore
often in right lung
Pancoast syndrome (bronchiogenic carcinoma) of apex invades sympathetic trunk,
resulting in Horner’s syndrome (ipsilateral miosis, ptosis, anhidrosis, facial flushing)
May be damaged during chest tube placement or mastectomy, resulting in winged
scapula (denervation of serratus anterior muscle)
Site of local anesthetic nerve block for procedures such as thoracostomy or to alleviate
pain caused by shingles
Can house dormant varicella zoster virus, which, when activated, can result in herpes
zoster (shingles)
Ipsilateral injury to phrenic nerve may cause ipsilateral paralysis of hemidiaphragm
Diaphragmatic irritation may manifest as shoulder pain because of referral to C3-5 spinal
levels
Pathologic findings in aorticopulmonary window may compress this nerve and produce
hoarseness of voice
195, 221
201, 239
202, 203
202, 204
202
208
202, 234
189, 194
196, 197
197
199, 201
199, 216
235, 236
Clinical Tables
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Table 4.1