148 SURGICAL APPLIED ANATOMY, tchnp. ix. 



The apex of the lung extends into the neck, 

 and reaches a point from one to two inches above the 

 anterior end of the first rib. It lies behind the clavicle, 

 anterior scalene muscle, and subclavian vessels. The 

 right lung commonly extends higher up than the 

 left. 



The pleura has been opened in careless operations 

 on the subclavian artery, and has also been torn in 

 dragging deep-seated tumours from the base of the 

 nock. The pleura and lung have been wounded in 

 stabs of the neck and by fragments of bone in severe 

 fractures of the clavicle. Cervical abscesses have opened 

 into the pleura, and, apart from this, pleurisy has fol- 

 lowed inflammation of the cellular tissue at the root of 

 the neck. 



Hernia of the lung into the neck has occui-red 

 during violent coughing, an appreciable tumour being 

 produced (Dr. Knox, Lancet, vol. i. ; 1885). 



Cervical ribs. These structures have led to 

 many errors in diagnosis, have been mistaken for ex- 

 ostoses, and where the subclavian artery is carried 

 over them have led to the diagnosis of aneurism. They 

 are met with at all ages and in both seses, and repre- 

 sent the cervical ribs of lower mammals. As a rule, 

 one such rib is found on either side of the seventh 

 cervical vertebra; sometimes it is movable, sometimes 

 it is ankylosed to the vertebra and its transverse 

 process. It may be very short, and represented only 

 by a head, neck, and tubercle. Such forms have been 

 mistaken for exostoses. It may be long, and may then 

 end free, or be joined to the first rib, or the first 

 costal cartilage by ligament, or even by cartilage. 

 In such instances the subclavian artery passes over 

 the cervical rib, and its distinct pulsation under such 

 circumstances has led to the diagnosis of aneurism. 

 To the longer cervical ribs the scalenus anticus, and 

 possibly the scalenus medius, may be attached. 



