1. Axial Skeleton: Thorax
HESC310
11/16/2018
Axial Skeleton: Thorax
Clinical correlations
Chest tube insertion.
../reserve/chesttubeinsertion_nejm2007.wmv
Dev et al (2007). NEJM 357(15):e15.
This video is graphic and long (16 m): may stop after section 7 (10 m).
Vocabulary: pneumothorax, hemothorax, pleural effusion, empyema, chylothorax, bleeding diatheses, coagulopathy.
Intrathoracic rib. (See next slide.)
Chung and Pipavath (2009). NEJM 361 (26):
Empyema = pus in pleural space; chylothorax = lymph (usually from thoracic duct) in pleural space; bleeding diathesis ~= coagulopathy = abnormal bleeding, inability of blood to clot
Axial Skeleton

2. Clinical correlation: Intrathoracic rib. Chung and Pipavath (2009)
Clinical correlation: Intrathoracic rib. Chung and Pipavath (2009). NEJM 361 (26): See notes.
Chung and Pipavath (2009). Intrathoracic rib. NEJM 361 (26): 2557.
A 67-year-old woman who had a history of breast cancer and who had undergone chemoradiotherapy 10 years earlier underwent routine follow-up chest radiography. The images revealed right axillary surgical clips from previous breast-cancer surgery (Panels A and B, arrows) and a vertically oriented structure similar in density to adjacent bone within the right hemithorax (Panels A and B, arrowheads). This finding was consistent with a supernumerary intrathoracic rib. Supernumerary intrathoracic ribs are most common on the right side and arise from abnormal segmentation of adjacent sclerotomes. Although the condition is usually asymptomatic, it can occasionally cause symptoms if it is associated with fibrous bands or connections to other structures. The presence of an intrathoracic rib is usually an incidental finding and does not warrant further evaluation or intervention.