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Thorax

Name
Thoracic Outlet Syndrome [TOS]

Problem
Compression of neurovascular structures in outlet

Cause
Pressure on lower trunk of Brachial Plexus [C8/T1] Cervical Rib cause compression of subclavian artery

Symptoms
Pain, numbness, tingling, weakness and fatigue of upper limb Ischemic muscle pain in upper limb

Treatment

Rib Fracture

Broken Rib [Usually at angle]

Crushing blow and violence

Pain due to movement of rib during respiration, coughing, laughing and sneezing Impaired ventilation Paradoxical respiration Affect oxygenation of blood cause respiratory failure

Flail Chest

Large segment of anterior or lateral part of chest moves freely Wall moves inward during inspiration Wall moves outward during expiration

Multiple Rib Fractures

Paralysis of Half of Diaphragm Diaphragmatic Ruptures Breast Infection [mastitis] Tearing mostly likely in posterolateral side Infection of the tissue of breast

Injury of Phrenic nerve on same side Blunt or penetrating trauma Mostly motor vehicle crash Usually occurs during breast feeding Bacteria from baby goes in through nipple Attachment to suspensory (Cooper) ligament causing shortening Obstruction of subcutaneous lymphatic and lymph accumulation on skin Shortening of lactiferous ducts

Paradoxical movement Lung Compression Pain, swelling, redness, and increase of temperature

Detect through radiology

Carcinoma of Breasts

Adenocarcinomas arising from epithelial cells

1. 2.

1. 2. 3.

Shortening of ligaments cause dimpling Prominent or puffy skin between dimpling pores give is DOrange Sign Inversion of nipple

Need mammography Radial mastectomy

3.

Heart
Name
Cardiac Tamponade

Problem
Inflammation of Pericardium Restricts venous filling and reduce cardiac output Failure to close foramen ovale after birth Failure of septum primum and septum segundum to fuse Mixing of oxygenated and deoxygenated blood Failure to close foramen ovale after birth Failure of septum primum and septum segundum to fuse Mixing of oxygenated and deoxygenated blood

Cause
Accumulation of pericardial fluid due to penetrating injury (stab wound or gun shot)

Symptoms

Treatment

Hypotension Pericardiocentisis Faintly Audible Heart Sounds Insert needle in medial 5th/6th intercostal space 45 degree angle upward and backward to avoid damage to lung Blood shunt from left to right Non-Cyanotic Effect (no sign) May need surgical repair if large

Atrial Septal Defect Type 1

Endocardial cushioning doesnt not extend

Atrial Septal Defect Type 2

Too much apoptosis of Septum primum

Blood shunt from left to right Non-Cyanotic Effect (no sign)

May need surgical repair if large

Ventricular Septal Defect

Foramen in ventricles

Failure to fuse membranous part to muscular part of ventricular septum

Blood Shunt from left to right Right Ventricular Hypertrophy Non-Cyanotic Effect Cause blueness of skin after physical activity Right to Left Shunt of blood Cyanotic

Surgery needed for large defect

Tetralogy of Fallot

Congenital Heart Disease

1. 2. 3. 4.

Pulmonary Stenosis Overriding Aorta Interventricular Septal Defect [VSD] Right Lung Hypertrophy [secondary]

Cardiac Hypertrophy

Enlargement of Left Atrium

Mitral Valve Failure

Compression of esophagus Difficulty swallowing Filling defect in X Ray

Barium Swallow will show something wrong in the esophagus

Angina Pectoralis

Pain due to ischemia of Heart

Lack of blood supply to heart Blockage of large branch of coronary artery

Pain over sternum May spread to arms, root of neck, and lower jaw Lead to myocardial infarction

Lungs
Name
Esophageal Artesia or Tracheoesophageal fistulae Pulmonary Hypoplasia Bronchogenical Carcinoma

Problem
Wrong connection of trachea and esophagus Underdevelopment of Lung Cancer is mucosa of bronchi

Cause

Symptoms

Treatment

Persistent cough and hemoptysis Pancoast tumor [apex] may lead to TOS

Thoracic Outlet Syndrome [TOS]

Compression or neurovascular structures

Bronchogenical Carcinoma Pancoast tumor on apex of lungs

Pain in medial side of forearm Atrophy of intrinsic hand muscles Constriction of pupil [miosis] Drooping eyelid [ptosis] Loss of sweating [hemianhydrosis] Dilation of head and neck veins Facial swelling Cyanosis

Horners Syndrome

Bronchogenic Carcinoma

Superior Vena Cava Syndrome

Compression of Superior Vena Cava

Bronchogenic Carcinoma

Dysphagia Hoarseness of Voice Paralysis of Diaphragm

Inability to Swallow Compression of recurrent laryngeal nerve Compress Phrenic Nerve

Bronchogenic Carcinoma Bronchogenic Carcinoma Bronchogenic Carcinoma

Can not swallow Hoarse Voice No Inspiration

Pneumonia

Inflammation of Lung

Infection [bacteria, virus, fungi] or chemical injury

Open Pneumothorax

Entry of air into pleural cavity

Stab wound of thoracic wall Pierce the parietal pleura Cavity is exposed to air

Pleuritis Inflammation of Pleura Coartation of Aorta Congenital Narrowing of Aorta Inflammation of Coastal Pleura produce local chest pain via intercostal nerve Irritation mediastinal pleura produce pain via phrenic nerve to shoulder C3-C5 dermatomes

Cough, chest pain, fever and difficulty breathing Enlargement of bronchomediastinal lymph nodes Air moves freely through wound Inspiration: Air enters chest wall and mediastinum will shift to other side Expiration: Mediastinum will move back Hear friction of rough surfaces of lungs Level of fluid is good visible on X-Ray Sharp Pain upon respiration

Opaque areas on X-rays Seen as white area

Thoracocentsis Fluid and Air = 7th -9th Intercostal space Air only = 2nd intercostal space Inserted in upper border of rib to avoid neurovascular damage Thoracocentsis Fluid and Air = 7th -9th Intercostal space Air only = 2nd intercostal space Inserted in upper border of rib to avoid neurovascular damage

Patent Ductus Arterious Failure for ductus arterious (connection between aorta and pulmonary trunk) to constrict after birth Causes mixing of oxygenated and deoxygenated blood Foreign body lodging High Prostaglandin Low Oxygen Common in premature babies

Higher Blood pressure in upper limb compared to lower limb Cause collateral circulation between internal thoracic and thoracic aorta X-Ray show notches on inferior border of ribs Cause left to right shunt of blood Non-Cyanotic Pulmonary hypertension Increase oxygen Prostaglandin inhibitors Surgical ligation Surgery may damage left recurrent laryngeal nerve (wraps aortic arch) causing hoarseness

Constriction of Esophagus (common sites of carcinoma)

C6: Pharynx joins upper end T4/T5: Crossing of aortic arch and left bronchus

T10: Passing through diaphragm

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