Angle of louis

Sternal Angle Of Louis– Surface landmark- It is felt 5 cm below the suprasternal notch as a tranverse prominence. It marks the joint between Manubrium and sternum- Manubriosternal joint. It lies at the level of 2nd costal cartilage anteriorly and between T4-5 vertebra posteriorly. It is a significant landmarks as – 1. Ribs are counted from this level to downwards. 2nd rib lies at sterna angle. 2. It marks the plane of sepraration of superior and inferior mediastinum. 3. Ascending aorta ends, arch of aorta starts and ends and descending aorta begings at this level. 4. Trachea divides into 2 principle bronchi . 5. Azygous vein arches over the roof of the Rt. Lung and opens in SVC. 6. Pulmonary trunk divides into 2 pulmonary arteries below this level. 7. Thoracic duct crosses from right to left side and reaches left side at the level of sterna angle. 8. It marks the upper limit of the base of the heart. 9. Cardiac plexus are situated at the same level. Source: BD Chaurasia Human Anatomy I Medchrome – Online Medical Magazine has been publishing academic medical and health related articles since 2009. Medchrome Networks include Medchrome Videos, Medchrome Answers and has collaboration with Epomedicine – Mnemonics, Simplified Concepts and Thoughts. DISCLAIMER: The Articles and information on Medchrome are NOT intended as a Medical advice. Any information, protocols, illustrations and products contained in this website is for INFORMATION and EDUCATION PURPOSE only. Please consult...

[ The sternal angle (also known as the angle of Louis, angle of Ludovic or manubriosternal junction) is the The sternal angle is a palpable clinical landmark in Anatomy [ ] The sternal angle, which varies around 162 degrees in males, The sternal angle is used in the definition of the It marks the point at which the costal cartilages of the second rib articulate with the sternum. This is particularly useful when counting ribs to identify landmarks as rib one is often impalpable. The counting of ribs is essential when one is attempting to make a thoracic incision. If the wrong rib is counted, access to the internal chest organs can be difficult. Additionally, making an incision at the first or second rib interspace can result in damage to large, important blood vessels and the brachial plexus. Identification of the second rib and thus the second intercostal space inferiorly is also useful when auscultating heart sounds. The optimal location for auscultation of the aortic valve is generally the right second intercostal space, whereas the optimal location for auscultation of the pulmonic valve is generally the left second intercostal space. The superior articular surface is located on the inferior border of the manubrium. The oval inferior margin is roughened for the attachment of the articular disc. The inferior articular surface is located on the superior border of the body of sternum. Both articular surfaces are irregularly shaped and covered by hyaline cartilage. Between t...

Neck Vein Examination & Wave Forms The jugular venous exam is an important aspect of assessing a patient's volume status, especially in patients with heart failure, liver failure and kidney failure. Both elevation of the neck veins and the variations of the neck vein waveforms share valuable information about a patient's diagnosis. • Get the patient to relax, raise the bed so you are not straining. • Take the pillow away; the waveforms are often better seen with the head lying directly against the examining table/bed. • Position the neck until you have the best view. • If you make sure the room is well lit, there is no need for shining a flashlight, penlight or other direct light. • Make your first goal just to see a pulsation, and then decide if it is arterial or venous by applying the following criteria to identify venous waves: • Venous wave is bifid, flicking like a snake's tongue. • It rises when you lower the head of the bed and sinks when you raise the head of the bed. • It changes with respiration, sinking into the chest with inspiration. • It is not palpable. • It is fine to use the external jugular vein, as long as you can see clear wave forms in it. • Commonly, a prominent pulsation is mistaken for that of the carotid artery rather than of the JVP. To differentiate, press on the RUQ while watching the neck. The JVP should rise in all individuals with this maneuver; whereas a carotid pulsation should not change. • The JVP can be assessed on either the right or le...

Table of Contents • • • • • • Although electrocardiograms (ECGs/EKGs) are performed routinely, they are not always done correctly and consistently. As such, I wrote this article to explain the proper electrocardiogram (EKG/ECG) setup and lead placement. The goal is to help standardize all ECGs. Background For decades, I noticed a significant inconsistency in the way electrocardiograms are performed. I asked How to Set Up a 12-Lead Electrocardiogram A 12-lead electrocardiogram uses 10 electrodes. Four (4) of these electrodes are placed on the limbs and six (6) electrodes are placed on the chest (precordium). Please be aware that when setting up an ECG, the words electrode and lead are often used interchangeably. Limb Lead Placement Setting up the limb leads is quite simple. They can essentially go anywhere on the limbs, as long as they are placed symmetrically and do not go over bone. For example, the right and left arm electrodes can go anywhere between the wrists and the shoulders but should be symmetrically placed. Similarly, the right and left leg electrodes can go anywhere between the ankles and the torso, but should also be symmetrically placed. Click here to become an expert in reading ECGs/EKGs with ecgedu.com ECG limb lead placement diagram Watch a video on ECG lead/electrode placement Chest (Precordial) Lead Placement V1: 4th intercostal space, right sternal border V2: 4th intercostal space, left sternal border V3: Midway between leads V2 and V4 V4: 5th intercosta...

Part 1 The Thorax Introduction The clinical anatomy of the thorax, together with the anatomy of radiological and other imaging techniques of the thorax are in daily use in clinical practice. The routine clinical examination of the patient’s chest is little more than an exercise in relating the deep structures of the thorax to the chest wall. Moreover, several commonly undertaken procedures – chest aspiration, insertion of a chest drain or of a subclavian line, placement of a cardiac pacemaker, for example – have their basis, and their safe performance, in sound anatomical knowledge. Surface anatomy and surface markings Much of the working life of an experienced clinician is spent in relating the patient’s surface anatomy to underlying deep structures ( Fig. 1 Lateral view of the thorax – its surface markings and vertebral levels. (Note that the angle of Louis (T4/5) demarcates the lower boundary of the superior mediastinum, the upper margin of the heart and the beginning and end of the aortic arch.) The following bony prominences can usually be palpated in the living subject (corresponding vertebral levels are given in brackets): • superior angle of the scapula (T2); • upper border of the manubrium sterni, the suprasternal notch (T2/3); • spine of the scapula (T3); • sternal angle (of Louis) – the transverse ridge at the manubriosternal junction (T4/5); • inferior angle of the scapula (T8); it also overlies the 7th rib; • xiphisternal joint (T9); • lowest part of the costa...

Article: • • • • • Images: • Gross anatomy The sternal body is the longest of the three parts of the sternum and is widest near its lower end. It is flat anteriorly, slightly concave posteriorly and has concave articular facets along the lateral borders 2. Across the anterior surface at the level of the third, fourth and fifth cartilages are three faint ridges representing the fusion of adjacent sternebrae 1. Articulations The sternal body forms a secondary cartilaginous joint with the 3. The At its superior aspect, the sternal body forms a synovial joint with the inferior aspect of the second 1. Below this are indentations for the third, fourth, fifth and sixth costal cartilages. The inferior angle, along with the xiphisternum, forms a facet for the seventh costal cartilage. Attachments • • • anterior intercostal membrane and • Variant anatomy A Related pathology • • • 1. Sinnatamby, C. and Last, R. Last's anatomy. 12th ed. Edinburgh: Churchill Livingstone/Elsevier, 2011 • 2. Gray Henry, T. Pickering Pick and Robert Howden. Anatomy, descriptive and surgical. 39th ed. New York: Bounty Books, 1977 • 3. Moore KL, Agur AMR, Dalley AF. Clinically oriented anatomy. LWW. ISBN:1451119453. • thoracic skeleton • • • • • • • • variant anatomy • • • • • • • • • • • • • • • • articulations • • • • • • • muscles of the thorax • • • • • • • • • • • • • • • • variant anatomy • • spaces of the thorax • • • • • • • • • • • • thoracic viscera • • • • • • • • • • • • • • • • • • • • • • • • ...

Anatomy def: Manubriosternal junction is a prominent joint between manubrium and body of the sternum (breastbone). Outlander def: Wee Mary MacNab’s chest mound, sweetly straining toward the Dunbonnet. Surrender, Jamie! She kens they both need “this.” 😉 Learn about the manubriosternal junction in Anatomy Lesson #15, Crouching Grants – Hidden Dagger. An adult sternum has three parts: • manubrium (top) • body (middle; a.k.a. gladiolus) • xyphoid process (tip) These parts are typically fused into a single, elongated bony structure in adults. Notably, the juncture between manubrium and body forms an elevated bump, the manubriosternal junction. As this word is a real mouthful, many anatomists and clinicians use the term sternal angle, angle of Louis, or sternal angle of Louis, to supplant manubriosternal junction. (Why use one name when three will do?) And, some anatomists push the envelop further, preferring the term, sternomanubrial joint. So many terms, so little time. Gah! Taking an easier route, the sternal angle of Louis is a splendid topographical feature because it is easily palpated! It is the site where costal cartilages of the second ribs attach to the sternum. The T4 – T5 intervertebral disc also lies at this level. And, that is not all. This angle is used to locate or define some 15 (!!!) clinically significant structures and/or compartments of the chest. A useful example: starting at the second ribs, a practitioner can count intercostal (between ribs) spaces to lo...

Table of Contents • • • • • • • • Definition of Jugular venous Pulse and Pressure Jugular venous pulse is defined as the oscillating top of vertical column of blood in the right Internal Jugular Vein (IJV) that reflects the pressure changes in the right atrium in cardiac cycle. Jugular venous pressure (JVP) is the vertical height of oscillating column of blood. Why is Internal Jugular Vein (IJV) preferred? • IJV is anatomicallty closer to and has a direct course to right atrium while EJV does not directly drain into Superior venacava. • It is valveless and pulsations can be seen. Due to presence of valves in External Jugular vein, pulsations cannot be seen. • Vasoconstriction secondary to hypotension (as in COngestive heart failure) can make EJV small and barely visible. • EJV is superficial and prone to kinking. Why is Right Internal Jugular Vein (IJV) preferred? • Right jugular veins extend in an almost straight line to superior venacava, thus favoring transmission of the hemodynamic changes from the right atrium. • The left innominate vein is not in a straight line and may be kinked or compressed between Aortic Arch and sternum, by a dilated aorta, or by an aneurysm. Evaluation of JVP • Level • Waveform • Respiratory variation in level and wave pattern • Hepatojugular reflux • Venous hum • Liver size and pulsations Technique of measuring JVP 1) Position: Semi-reclining position with 45° angle between the trunk (not the neck) and the bed. Then, turn the head slightly tow...

This is a brief tutorial just to look at some of the important structures which lie at the level of the sternal angle. So the sternal angle is this angle formed between the manubrium of the sternum and the body of the sternum. It's important because we know that this level marks the level of the intervertebral discs which lies between thoracic vertebra T4 and T5. It's an important structure because it marks the location of other structures in the body. We'll take a look at some of the structures which lie at this angle. This sternal angle is also called the Angle of Louis. The mnemonic I use for remembering the structures at the Angle of Louis is RATPLANT. The first structure is the second rib, so the R of RATPLANT. Well, it's really the costal cartilage, but it just helps with the mnemonic. So you've got the second costal cartilage of the second rib articulating with the manubrium and the body of the sternum. And then next, you've got the A of RATPLANT. That refers to the arch of the aorta. I've just isolated those structures here. You can see the beginning and the end of the arch of the aorta lie roughly at this level. The next structure is the trachea. The trachea bifurcates at around this level. So you can see the splitting into the two bronchi at this level. And then next, we've got the pulmonary trunk bifurcation. Just isolating it there, you can see the pulmonary trunk bifurcates into its right and left branches. And then the L refers to two things. So first, we've ...