PART 20 — CHEST WALL

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Study use: Rapid revision of chest-wall anatomy, intercostal neurovascular relations, pleural-procedure landmarks, rib and sternal trauma, flail chest, pulmonary contusion, chest-wall deformities, Poland syndrome, and selected rib/chest-wall tumors. Emergency points are intentionally concise and should be interpreted with physiology and associated intrathoracic injury.

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Priority Guide: 🔴 Core / Must Know | 🟠 Important | 🟡 Additional

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🎯 High-Yield Overview

• Main intercostal bundle = VAN in the costal groove along the inferior rib border.
• Pleural access → upper border of the lower rib; chest drains use the triangle of safety.
• Simple rib fracture → analgesia + pulmonary hygiene + search for deeper injury.
• Flail segment: classic teaching = ≥3 adjacent ribs fractured at ≥2 sites; paradoxical movement → flail chest.
• Inspiration → flail segment moves in; expiration → out.
• Respiratory compromise in flail injury is strongly linked to pulmonary contusion + pain/splinting.
• First-rib/sternal/scapular fractures are high-energy warning injuries.
• Pectus excavatum = depressed sternum; pectus carinatum = protruding/pigeon chest.
• Poland syndrome = unilateral pectoralis-major deficiency ± ipsilateral hand anomaly.
• Child/young patient + painful rib mass + onion-skin reaction → think Ewing sarcoma.

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RED FLAGS: Severe respiratory distress, shock, open/sucking chest wound, large hemothorax, paradoxical chest movement with hypoxemia, vascular/neurologic signs after upper-rib trauma, or rapidly enlarging chest-wall mass requires urgent trauma/surgical assessment.

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1. BONY CHEST WALL & RIB ANATOMY

2. INTERCOSTAL VAN, TRIANGLE OF SAFETY & PLEURAL ACCESS

3. RIB & STERNAL FRACTURES

4. FLAIL CHEST, PULMONARY CONTUSION & MASSIVE HEMOTHORAX

5. OPEN CHEST WOUND & TRAUMA DIFFERENTIATION