1. Regarding the imaging modalities of the chest:
a) HRCT uses 1-2mm slice thickness & a high resolution computer algorith to show fine detail of the lung parenchyma, pleura and tracheobronchial tree. It is not used to delineate mases in the lung.
b) Spiral CT ensures that no portion of the chest is missed due to variable inspiratory effort.
c) Currently MRI is a poor technique for showing lung detail. It allows visualisation of the chest wall, heart, mediastinal and hilar structures.
d) Bronchoscopy is invasive technique, largely been superseded by HRCT.
e) CTPA is performed to diagnose majory pulmonary emboli using a cannula placed in any peripheral vein & is relatively non-invasive compared to conventional pulmonary angiography.
2. Regarding the development of the lung:
a) The tracheobronchial groove appears on the ventral aspect of the caudal end of the pharynx
b) The primary bronchial buds develop from the tracheobronchial diverticulum; The bronchial buds differentiate into bronchi in each lung
c) During embryonic life that alveoli is lined by cuboidal epithelium that lines the rest of the respiratory tract. When respiration commences at birth the transfer to the flattened pavement epithelium of the alveoli is accomplished.
d) Tracheo-oesophageal fistula (TOF) indicates the close developmental relationship between the foregut & the respiratory passages. It is usually associated with an atresia of the oesophagus & the fistula situated below the atretic segment
e) Uni-lateral pulmonary hypoplasia is usually due to congenital diaphragmatic hernia
3. Regarding the blood supply to the chest wall:
a) There are usually 9 pairs of posterior ateries from the postero-lateral margin of the thoracic aorta, distributed to the lower 9 intercostal spaces. The first and second spaces are supplied by the superior intercostal artery, branches of the costocervical trunk from the subclavian artery.
b) The internal thoracic artery arises from the subclavian artery & supplies the upper 6 intercostal spaces.
c) The neurovascular bundle passes around the chest wall in the subcostal groove deep to the internal intercostal muscle.
d) The intercostal spaces are drained by 2 anterior veins & a single posterior intercostal vein.
e) Posterior intercostal veins drain into the brachiocephalic vein & azygos system. The anterior veins drain into the musculo-phrenic & internal thoracic veins.
4. Regarding the azygos venous system:
a) The azygos vein at the level of the 4th thoracic vertebra arches over the root of the right lung to end in the superior vena cava (SVC)
b) In 1% of the population, the azygos vein traverses the lung before entering the SVC resulting in the azygos fissure. The azygos ‘lobe’ is not a true segment.
c) The thoracic duct & aorta are to the left of the azygos vein
d) The 2nd, 3rd and 4th intercostal spaces on the right, drain via the right superior intercostal vein into the azygos vein; Hemiazygos, accessory hemiazygos, oesophageal, mediastinal, pericardial & right bronchial veins drain into the azygos system
e) In congenital absence of the IVC the azygos vein enlarges; In the azygos continuation of the IVC, the azygos is a large structure, but otherwise the anatomy is unaltered. This may be confused with a mediastinal mass.
5. Regarding the hemiazygos & accessory hemiazygos venous systems:
a) The hemiazygos vein at the level of the 8th thoracic vertebra crosses the vertebral column behind the aorta, oesophagus & thoracic duct.
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6. Regarding the airways:
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