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1. Breast carcinoma with axillary node enlargement
Case: A 45-year-old woman presents with a lump in the upper outer quadrant of her breast and palpable axillary lymph nodes.
Q: Why are axillary nodes commonly involved?
A: Because 75% of lymph from the breast drains to axillary nodes, especially anterior (pectoral) group.
2. Long thoracic nerve injury during mastectomy
Case: After axillary lymph node clearance, patient develops winging of scapula.
Q: Which muscle is paralyzed?
A: Serratus anterior (nerve supply: long thoracic nerve).
3. Injury to medial pectoral nerve
Case: Patient after chest wall surgery shows weakness of pulling shoulder forward.
Q: Which muscle is affected?
A: Pectoralis minor (draws scapula forward and downward).
4. Subclavian vessel injury
Case: Following clavicle fracture, bleeding noted from beneath clavicle.
Q: Which muscle protects subclavian vessels?
A: Subclavius muscle.
5. Cephalic vein cutdown
Case: Central venous access is taken via cephalic vein in deltopectoral groove.
Q: Which fascia must be pierced?
A: Clavipectoral fascia.
6. Pectoralis major rupture (athlete)
Case: Weightlifter develops chest pain and swelling at anterior axillary fold after heavy lifting.
Q: Which movement is lost?
A: Adduction and medial rotation of arm (pectoralis major action).
7. Pectoralis minor as surgical landmark
Case: In axillary surgery, artery is divided into 3 parts by a muscle.
Q: Which muscle is this?
A: Pectoralis minor.
8. Subpectoral abscess spread
Case: Tuberculous abscess in chest wall extends into axilla beneath pectoralis major.
Q: Through which fascial plane does it spread?
A: Pectoral fascia → clavipectoral fascia → axilla.
9. Poland’s syndrome
Case: Newborn with absence of sternocostal part of pectoralis major, ipsilateral limb smaller.
Q: Which congenital anomaly is this?
A: Poland’s syndrome.
10. Carcinoma of breast with peau d’orange
Case: Breast skin thickened and pitted like orange peel.
Q: What causes this?
A: Obstruction of cutaneous lymphatics in breast carcinoma.
11. Nipple retraction
Case: A 42-year-old woman has a breast lump with retracted nipple.
Q: What is the anatomical cause?
A: Fibrosis around lactiferous ducts pulls the nipple inward.
12. Infraclavicular fossa swelling
Case: A patient presents with a pulsatile swelling below clavicle.
Q: Which artery is likely involved?
A: Thoracoacromial artery (pierces clavipectoral fascia).
13. Injury to lateral pectoral nerve
Case: During surgery, nerve piercing clavipectoral fascia is cut.
Q: Which muscle is primarily affected?
A: Pectoralis major.
14. Axillary tail of breast lump
Case: A woman presents with a lump in the axilla continuous with breast tissue.
Q: What is this extension called?
A: Axillary tail of Spence.
15. Accessory breast tissue
Case: A young female has an extra swelling in the axilla that enlarges during lactation.
Q: What is the condition?
A: Polymastia (accessory breast tissue along milk line).
16. Subpectoral abscess drainage
Case: A tuberculous abscess from chest wall spreads into axilla beneath pectoralis minor.
Q: Which fascia directs its spread?
A: Clavipectoral fascia.
17. Clavipectoral fascia surgical importance
Case: Surgeon exposes axilla and identifies fascia pierced by cephalic vein.
Q: Name the fascia.
A: Clavipectoral fascia.
18. Retromammary abscess
Case: A woman develops abscess behind breast, breast becomes immobile on chest wall.
Q: Which space is involved?
A: Retromammary space.
19. Suspensory ligament of axilla
Case: In axillary surgery, a ligament is seen maintaining hollow of axilla.
Q: What is this structure?
A: Suspensory ligament of axilla (extension of clavipectoral fascia).
20. Pectoralis minor syndrome
Case: Patient has pain and vascular compression signs when arm is elevated.
Q: Which muscle causes thoracic outlet compression?
A: Pectoralis minor (compresses neurovascular bundle).
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