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Clinical Anatomy & Imaging

A 35 y/o woman with a PMHx significant for invasive ductal cell carcinoma of the left breast just underwent a mastectomy and axillary lymph node dissection for tumor removal two weeks ago. She is here for a post-op check and on exam the following abnormality is noted:

What is the cause of her physical finding?

Clinical Note: More shows winging of the left The physical examinfo: Winged scapula, think long thoracic nerve injury. 5,6,7 wings go to It is not uncommon for the long thoracic nerve to be scapula consistent lymph a long thoracic nerve palsy. with node dissection or by a heaven. injured during axillary The longthe axilla with an nerve carries motor fibers from the nerve roots blow long thoracic outstretched arm. (Theto thoracic nerve innervates the serratus anterior muscle which originates from the upper 8 C5,C6 and C,7)
to 9 ribs and attaches all along the border of the medial scapula. Also known as the boxers muscle, the serratus anterior is responsible for holding the scapula close to the thorax, and rotating the scapula upward to perform movements overhead. Long thoracic nerve

A 35 yo man, with a PMHx significant for total colectomy due to the genetic condition familial adenomatous polyposis (FAP), presents with a mass on his abdomen that has been growing over the past three months. A CT of the abdomen and pelvis was performed showing the following:

What structures is this mass involving?

More The mass Rectustumors present on the abdominal wall is abdominisinfo: Clinical Note: Desmoid are low grade fibrosarcomatous tumors that most likely a on the abdominal wall. They havebe seen desmoid tumor. It can low S typically present External oblique be locally invasive and tend to The most the left rectus abdominis muscle malignant potential but u can infiltrating common tumors of the abdominal wall recur after previous resection.FAPof patients with are possibly crossing 10% associated with desmoid nternal FAP develop b the lineawell as tumors of oblique and desmoid tumors. tumors as alba to involve extracolonic desmoid tumors isabdominis known as Gardners on this the thyroid, bone, sebaceous glandsaswell as other cell types. the right rectus abdominis. Notice that syndrome. TransversusFAP with desmoid tumors is known as c The syndrome of CT image the innominate bone (pelvis) and u Gardners Desmoid tumor syndrome.

psoas muscle are tapparent giving you a quick reference to where in the body this cross a section is located. n Desmoid tum e o u s f a t

Innominate bone

Psoas major

A 40 yo man with a PMHx of asthma presents to your office complaining of a bulge that he has noticed in the midline of is upper abdominal area. It is non tender and he denies any nausea and vomiting. He notes that he is able to reduce the bulge when he applies pressure. A CT scan of the abdomen was obtained and the finding below was identified:

What is the diagnosis? Where is the abdomen is this cross section taken from?

Moreis info: The CTinto the leftmostdiagnostic Note: Clinical for an A hernia this location likely is arising from a Rectus abdominis epigastricLiver ventral wall hernia. The black past incision (incisional hernia) or in a patient hernia, check to see if When examining a potentialwho Gallbladder has had chronic pressure due signalmass increased abdominal(i.e. able to thatpushed back withinis as chronic asthma, COPD, and the mass is air, signifying be the to conditions such reducible this is bowel.mechanicalits smaller diameter it is obesity. Multiple Given mechanisms can also into the abdomen). If the mass is not reducible, cause a hernia such as heavy most likely smallblows toweight lifting, hard bowel but one would not be coughing bouts, sharp the abdomen. that the there completelylikelihood Thelookingabdominal is a high sure without able common hernia of all is an inguinal hernia but at most to be femoral contents withinalso often seen. the fulland umbilical hernias areisthe herniayou ask? CT scan. Where the hernia can become These will be discussed elsewhere. Wellincarcerated which is aamedical emergency. you can place it noticing few structures. The liver is apparent on the right side giving you an gross estimate that this is epigastric. The kidneys are both visible putting you somewhere between the T10 and L1 You can even further localize by noticing the two ribs on the left and the oblique angle they are moving through the plane. These are most likely the false ribs 11 & 12.

11th rib Right kidney Left kidney

12th rib