Breast cancer is a common disease, particularly in postmenopausal women ( ). Each year, in the United Kingdom, there are approximately 40,000 new cases diagnosed and 14,000 deaths. Male breast cancers constitute up to 1% of all mammary malignancies and may include tissue beyond the areolar boundary. Breast cancers arise within the epithelia of lobules or ducts. As they increase in size and become invasive, they…
Major Blood Vessels The major blood vessels of the thorax include the pulmonary trunk, the thoracic aorta and its branches, and the superior and inferior venae cavae and their tributaries ( Fig. 58.1 ). Arteries Pulmonary trunk The pulmonary trunk conveys deoxygenated blood from the right ventricle to the lungs (see Figure 57.4, Figure 57.5, Figure 57.6, Figure 57.8, Figure 57.9, Figure 57.10 ). About 5…
Pericardium The pericardium contains the heart and the juxtacardiac parts of its great vessels ( Fig. 57.1 ). It consists of two parts, the fibrous and the serous pericardia, arranged in three layers with a normal combined thickness of 1–2 mm, as seen on cross-sectional imaging ( Figs 57.2 – 57.3 ) . The fibrous pericardium is a closed sac made of tough connective tissue, completely…
The mediastinum is the visceral compartment between the two lungs and includes the mediastinal part of the parietal pleura. It is commonly defined as the region between the two pleural sacs, bounded laterally by the mediastinal parietal pleura, anteriorly by the sternum and posteriorly by the thoracic vertebral column, and extending vertically from the superior thoracic aperture (thoracic inlet) to the respiratory diaphragm (see Fig. 52.1…
The respiratory diaphragm is a domed musculofibrous sheet, approximately 2–4 mm thick that separates the thoracic and abdominopelvic cavities ( Fig. 55.1 ). The superior surface of the respiratory diaphragm is mainly convex and forms the floor of the thoracic cavity. It is covered by a layer of phrenicopleural fascia, a continuation of the endothoracic fascia, covered in turn by a layer of diaphragmatic parietal pleura,…
The lungs are the essential organs of respiration and are responsible for the exchange of oxygen and carbon dioxide in the blood. The functional anatomy of the thorax and respiratory diaphragm facilitates this complex process. Acting together, the muscles of respiration and the diaphragm increase the intrathoracic volume, creating a negative pressure within the pleural space that causes air influx and lung expansion ( Ch. 55…
The chest wall surrounds the thoracic cavity. It is formed by: an osseocartilaginous frame consisting normally of 12 pairs of ribs, which articulate with the 12 thoracic vertebrae posteriorly and (except for the last two or three pairs of ribs) with the sternum anteriorly, via their costal cartilages; intrinsic muscles and muscles that connect the chest wall with the upper limb and the vertebral column; overlying…
The thorax is the upper part of the trunk. It consists of an external musculoskeletal cage, the thoracic wall and an internal cavity that contains the heart, lungs, oesophagus, trachea and main bronchi, thymus, vagus and phrenic nerves, sympathetic trunks and ganglia, thoracic duct, lymph nodes, and major systemic and pulmonary vasculature ( Fig. 52.1 ). Superiorly, the thoracic cavity communicates with the neck and the…
This commentary addresses glenohumeral instability (GHI), although the analysis of stability and its perturbation, and the system of classification described, is applicable to all articulations in which the experience of symptomatic abnormal motion (the clinical syndrome of instability) is reported by a patient. Stability: definition Stability of any articulation (defined as asymptomatic normal mechanical behaviour at rest and in motion) depends on the retention of structural…
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Skin and Soft Tissues Skin Dorsal skin versus palmar skin The dorsal skin is thin, mobile and frequently hirsute over the proximal phalanges and the ulnar aspect of the dorsum of the hand. The skin of the palm and the palmar surface of the digits is thick and hairless, with a well-defined stratum lucidum and a higher density of nerve endings and eccrine sweat glands, but…
Skin and Soft Tissues Skin Cutaneous vascular supply The skin of the elbow and forearm receives its blood supply from muscle perforators, fasciocutaneous networks and direct cutaneous vessels. The skin of the anterolateral cubital fossa is supplied by muscle perforators arising from the radial collateral and radial recurrent arteries. The skin of the medial cubital fossa receives branches from an anastomosis between the inferior ulnar collateral…
The upper limb is differentiated to achieve the complex patterns of stereotactic, non-stereotactic and gestural movements (each with a distinct neurological basis) that enable hand function. The combined movements of the shoulder and elbow bring objects in the hand into the visual field, while the great range of the shoulder and pectoral girdle enable a wide reach. Oculospinal afferents appear to be the most important modulators…
The upper limb is, in mechanical terms, a series of powered, articulated segments which enable the hand to be positioned accurately in space so that it can sense and manipulate its surrounding environment. It is attached to the bony thorax at the sternoclavicular joint, and to the chest wall by a series of powerful flat muscles which stabilize the scapula, allowing it to act as a…
The gross anatomy of the structures that lie within the vertebral canal and their extensions through the intervertebral foramina, the spinal nerve or radicular (‘root’) canals, is described in this chapter. The internal organization of the spinal cord is described in Chapter 27 . The spinal cord and its blood vessels and nerve roots lie within a meningeal sheath, the theca, which occupies the central zone…
Most clinical disorders of the back present as low back pain with or without associated lower limb pain, weakness or numbness, and so, historically, most attention has been paid to the anatomy of the lower (lumbosacral) back. In this Section, the term ‘back’ will include the whole of the posterior aspect of the trunk and of the neck. The whole of this region has great clinical…
The outer surface of the eye is composed of parts of two spheres with different radii. The anterior segment, part of the smaller sphere, is formed by the transparent cornea and accounts for approximately 7% of the ocular surface. The posterior segment of the eyeball is part of the larger sphere formed externally by the opaque sclera ( Fig. 45.1 ). Open full size image Fig.…
Bony Orbit The bony orbits are skeletal cavities located on either side of the root of the nose that serve as sockets for the eyes and associated tissues. The walls of each orbit protect the eye from injury, provide points of attachment for six extraocular muscles that allow the accurate positioning of the visual axis, and determine the spatial relationship between the two eyes, which is…
The inner ear contains the organ of hearing and the organs of balance. All are located within the labyrinth, a series of interlinked cavities in the petrous temporal bone containing interconnected membranous sacs and ducts. All spaces within the labyrinth are filled with fluid. The different sacs contain sensory epithelia consisting of supporting cells and mechanosensory cells, the hair cells that underlie acoustico-lateralis sensory systems in…