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Important points of thorax &
clinicals

1. Diaphragmatic Aperture:
Spinal Levels:
Aortic Hiatus...(12 letters)...T12
Esophagus ....(10 letters)....T10
Vena Cava........(8 letters)....T8

2. In thorax all veins r on right side n arteries on left side,on increase blood flow veins
expand enormously while large arteries don't,due to creation of dead space tumors n
fluids r likely to project in right side

3. PREVERTBRAL fascia of deep cervical fascia is attached inferiorly to 4th thoracic

vertebra so infection to this fascia extend only to superior mediastinum,but pretracheal
fascia is also the fascia on neck,blends with arch of aorta,the infection b/w the above 2
fascia can extend in superior as well as posterior mediastinum.

4. Right vagus nerve is crossed by azygous vein left vagus by left phrenic nerve.

5. Reflections in pleura of lungs r to mark the extensions of pleural cavity. 2.no pain
sensations in visceral pleura.

6. Blood supply of lungs is bronchial vessels not pulmonary vessels.

7. Hilum: where the bronchi, blood vessels, and nerves enter and leave the lungs.

8. Root: by which the lung is connected to the heart and the trachea. 5.hilum is not
covered by pleura but root is by parietal pleura.

By Ussama Maqbool (N61 NMC. Multan)

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9. Pulmonary ligament provides dead space into which veins expand on increased venous
return.

10. Extent of root of lung is t5-t7

11. No anastomosis b/w superficial n deep lymphatic vessels but some can open

12. During pulmonary segment removal surgeons work along pulm. vein 10. pulmonary
vein don't accompany arteries/bronchi so each bronchopulmonary segment is not
bronchovascular,

13. Smallest cardiac veins have direct openings in rt.atrium

14. Transverse pericardial sinus separates arteries 4m veins n oblique sinus is due
reflection of pulmonary veins.

15. Left n right coronary artery arise 4m right n left aortic sinus,post sinus is non
coronary sinus.

16. Crista terminalis separates auricle from right atrium,crista terminalis absent in left
atrium

17. Right coronary artery dominates the coronary circulation of heart. 16.damage 2
suprapleural membrane cause pneumothorax.

18. Thorax wall have 3 layers of muscles,

Outer layer: serratus post sup.+serratus post inf+levator
costae+external intercostal
Middle layer: internal intercostal
Inner layer:subcostal+intercostal intimi+transversus thoracis

19. Each half of diaphragm have its own sided phrenic nerve supply,on abdominal side
this nerve divides into ant+post+lat branch.

20. 4th intercostal space is b/w t4 n t5,not b/w t3 n t4.

21. Simple thoracotomy is done along 5th or 6th rib but thoracoabdominal incision is
done along 8th or 9th rib

22. Superficial cardiac plexus lies ant to ligmentum arteriosum n deep plexus lies post to
it,left recurrent laryngeal nerve hook around it.

23. Pericardial drainage is done on 45 degree angle.

24. Angle of lois is 140 degree.

By Ussama Maqbool (N61 NMC. Multan)
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25. Esophagus starts from C6 passes 4m diaphragm at T10 n enters stomach at T11.

26. Venous anastomosis around esophagus is on T8 level

27. On level of t5 esophagus returns to midline n thoracic duct comes to right side of it

28. Pleural aspiration is done by choice of any space but generally its 4th space

29. On both sides of lungs apical segment of lower lobe is supplied by bronchus

30. Material aspirated by supine,comatose,anesthetized patient would tend to go sup.

segment of right lower lobe

31. Cardiac temponade is heart compression

32. Supine position central tendon of diaphragm is on level of T9 n in sitting or standing

upright position its on T9-T10

33. HEMOPTYSIS is 95% due to hemorrhage in bronchial vessels 4.hematogenous

metastasis of bronchogenic carcinoma is towards brain,bones,lungs,suprarenal gland

35. Irritation 2 costal n diaphragmatic part of diaphragmatic pleura results pain in

thoracic
and abdominal wall

36. Irritation 2 mediastinal n central diaphragmatic parts of pleura cause pain to root of
neck
and over shoulder(C3-C5)

37. Thoracentesis is for getting sample of fluid,remove blood/pus n its done in 9th costal
space

38. Insertion of chest tube(tube thoracostomy)is for removal of major amount of

blood,fluid,pus,air n its done in 5th /6th costal space

39. On lung collapse actually pulmonary cavity is not decreasing on inspiration but size
of
lung

40.Chest pain also occur in gallbladder,intestinal,musculoskeletal disorder

41. The most common septal defect is membranous interventicular septal defect

42. The most common stenosis is Aortic stenosis

By Ussama Maqbool (N61 NMC. Multan)

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43. In axilla all lobes of lung can be checked physically

44.Chances of coronary occlusion LAD 50%,RCA 40%,circumflex 20%

45. Great cardiac vein is on ant interventicular groove with LAD,n middle vein is with
post interventricular branch of RCA

46.Anesthetic material is injected around the nerve not in the nerve 14.pleural space
normally contains 5-10ml of pleural fluid

47.Collection of pus without air in plural space is emphysema,and collection of serous

fluid
is pleural effusion

48. Left atrium lies in close relation of esophagus so left sided heart failure can be
checked
by help of esophagus

49.Azygous vein collects all blood from inf vena cava but not from liver

50..which areas of heart gets ischemic if there is sudden occlusion in artery lying in post
interventicular groove?
Ans: Artery will be post interventicular artery branch,so it supplies 1/3 of interventicular
septum,little of post part of left ventricle,little part of left atrium n if we take complete
right coronary artery then additional right atrium ventricle,SA node,AV node will be
affected,n if you take left coronary artery then remaining parts will b ans.

By Ussama Maqbool (N61 NMC. Multan)