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The neck, Thoracic Inlet and Outlet, the Axilla and Chest Wall, the Ribs, Sternum and Clavicles.
Published in Fred W Wright, Radiology of the Chest and Related Conditions, 2022
The chest wall may be involved with disease processes, arising within it or extending from within the thorax, etc. - see Table 12.3. Conditions involving or originating in the skin, the breasts (including accessory nipples), axillae, etc. also have to be considered, in addition to normal structures and normal variants which may be evident on chest radiographs.
Chest wall deformities
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Robert E. Kelly, Marcelo Martinez-Ferro, Horacio Abramson
Pectus excavatum is the most common chest wall deformity in infants, children, and adolescents. Its incidence is estimated at 1 in 400 live births and has a male to female ratio of 4 : 1. The etiology of pectus excavatum is unknown. It has a genetic predisposition with patients having a family history of chest wall deformities in 35–40% of cases. Excavatum patients may have a family history of a carinate or protrusion deformity. The pectus excavatum depression is created by two components: Sternum and costal cartilages, with different morphology in different patients. The pectus excavatum depression may be symmetric or asymmetric. In the asymmetric deformities, the more acute and severe depression is more commonly on the right side. The rarest configuration of pectus excavatum is a combination of ipsilateral depression and a contralateral carinate protrusion. In some series, 90% of cases are noted within the first year of life, but in others the lesion is noted more commonly after the onset of the pubertal growth spurt. The great majority of carinate deformity is noted after the pubertal growth spurt.
The patient with acute respiratory problems
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
The lungs are situated in the thoracic cavity, with two lobes on the left and three lobes on the right (see Figure 5.2). The mediastinal cavity is found between the two lungs and accommodates the heart, great vessels, trachea, oesophagus nerves and lymph nodes. The apices of the lungs extend just above the inner third of the clavicles, a fact that needs to be considered when a central line is being inserted! The bases of the lungs sit on the diaphragm. The anatomical and mechanical relationships of the lungs and chest wall facilitate effective ventilation. Each lung is surrounded by pleural membranes, with the inner membrane (visceral pleura) attached to the lung surface and the outer membrane (parietal pleura) attached to the chest wall (also diaphragm). In the resting state, there is inward recoil of the lungs (also visceral pleura) and outward movement of the chest wall (also parietal pleura). These two opposing forces on either side of the pleural membranes contribute to a negative pressure (less than atmospheric pressure) in the pleural cavity, which is important in keeping the lungs inflated. We will return to the significance of this later.
Intra and inter observer agreement in the mobility assessment of the upper thoracic costovertebral joints
Published in Physiotherapy Theory and Practice, 2023
Michael Cibulka, Justin Buck, Bria Busta, Erika Neil, Drake Smith, Reece Triller
Limited mobility of the costovertebral joints is a potential source of neck and upper thoracic pain (Fruth, 2006; Mastromarchi and May, 2021) as well as shoulder pain (Strunce, Walker, Boyles, and Young, 2009). Pain that develops unilaterally between the scapula and the spinous processes of the upper thoracic spine can arise from the costovertebral joints (Fruth, 2006; Young, Gill, Wainner, and Flynn, 2008). Because of its location, costovertebral pain is often misdiagnosed as rhomboid muscle strain, or described as trigger point pain (Erosa, Erosa, and Sperber, 2018; Fruth, 2006). Costovertebral pain is also related to anterior chest wall pain (i.e. costochondritis also called Tietze’s syndrome) as well as misdiagnosed as a cardiac event (Arroyo, Jolliet, and Junod, 1992; Aspegren, Hyde, and Miller, 2007; Preutu, 2001; Steinrücken, 1980). Inflammation of the costovertebral joints is more common than previously thought in patients with spinal pain (Chui et al., 2020). Decreased mobility of the costovertebral joint of the first rib is also considered as a cause of thoracic outlet syndrome (Kuwayama, Lund, Brantigan, and Glebova, 2017; Lindgren and Leino, 1988; Smith, 1979; Weinberg et al., 1972). Kuwayama, Lund, Brantigan, and Glebova (2017) recommend that in a physical therapy examination of patients with thoracic outlet symptoms testing the first rib with a spring test for mobility is imperative.
A randomized controlled comparison of three modes of ventilation during cardiopulmonary bypass on oxygenation in pediatric patients with pulmonary hypertension undergoing congenital heart surgeries
Published in Egyptian Journal of Anaesthesia, 2022
Ahmed Ali Gado, Salwa Mohamed Hefnawy, Ashraf M Abdelrahim, Mostafa Abdel Wahab Abdel Aziz Alberry, Mai A. El Fattah Madkour
The lung ultrasound score was obtained by scanning 12-rib interspaces with the probe longitudinally applied perpendicular to the wall. Each hemi-thorax was divided into six areas: two anterior areas, two lateral areas, and two posterior areas. The anterior chest wall (zone 1) was defined from the parasternal to the anterior axillary line. It was divided into upper and lower halves, from the clavicle to the third intercostal space and from the third intercostal space to the diaphragm. The lateral area (zone 2) was delineated from the anterior to the posterior axillary line and was divided into upper and basal halves. The posterior area (zone 3) was considered as the zone beyond the posterior axillary line. The sum of B-lines found on each scanning location (0: no B-lines; 1: multiple B- lines 7 mm apart; 2: multiple B lines 3 mm apart; 3: consolidation) yields a score from 0 to 36 [15,19,20]. Two ultrasound doctors examined all lung ultrasound images. Both doctors were unaware of the clinical data of the patients and to other doctor’s ultrasound diagnoses.
The ultrasound estimation of extravascular lung water in volume controlled versus pressure controlled ventilation after one lung ventilation in Thoracoscopic surgery. A-comparative study
Published in Egyptian Journal of Anaesthesia, 2022
Ahmed Mohamed Ahmed Ibrahim, Hisham Hosny, Ahmed El-Agaty, Mohamed Khaled Hamza
The sum of lung comets produces a score reflecting the extent of lung water accumulation. The (LUS) score was obtained by scanning 12-rib interspaces with the probe longitudinally applied perpendicular to the wall. The dependent lung intraoperative was divided into six areas: two anterior areas, two lateral areas, and two posterior areas. The anterior chest wall (zone 1) was delineated from the parasternal to the anterior axillary line and was divided into upper and lower halves, from the clavicle to the third intercostal space and from the third to the diaphragm. The lateral area (zone 2) was delineated from the anterior to the posterior axillary line and was divided into upper and basal halves. The posterior area (zone 3) was considered as the zone beyond the posterior axillary line. The sum of B-lines on each scanning site.