The doctor is trying to decide where in the intercostal space to insert the chest tube. Which area should be chosen to minimise risk of injury to important structures?

Based on insertion along the mid-axillary line, at which level should the doctor insert the chest tube to avoid damaging the diaphragm and intra-abdominal organs? Use this image showing the relations of the pleural cavity to help you decide.

Source: Rohen, J. W., Yokochi, Chihiro, & Lütjen-Drecoll, Elke. (2011). Color atlas of anatomy : a photographic study of the human body (7th ed.). Wolters Kluwer Health/Lippincott Williams & Wilkins ; Schattauer.

A patient presents following a fall from a horse and requires an intercostal catheter to be inserted for a right sided pneumothorax. A typical intercostal catheter (or chest tube) is a large-bore, thick, plastic tube (picture shown) and may cause injury to various structures if placed incorrectly.

The doctor does not recall the recommendations for chest tube insertion. They consider placing the tube at the midaxillary line, 8th intercostal space on the right side. If the doctor proceeds with inserting the chest tube at this site, which structures are MOST LIKELY to be damaged?

What angle should the needle be inserted in relation to the skin (i.e., in which direction should the tip of the needle pass as it proceeds from superficial to deep)?

What position should the patient be in during the procedure?

A patient presents with a moderately large pleural effusion. To obtain a sample of fluid, the patient needs to have a “pleural tap”, i.e. a procedure where a needle is inserted into the pleural space and fluid is drained. What is a suitable location to consider performing this procedure?

Referring to the image above, where is the kidney hilum located in relation to the vertebral level?

Besides visualising the gallbladder, ultrasound is also useful for assessing organs such as liver and kidneys. Identify the following structures A-C.

This is an ultrasound showing stones in the gallbladder. Can you determine how many gallstones are present?

Besides performing a procedure ie ERCP (as above), there are other less invasive imaging modalities that can be useful in visualising the biliary system. One of it being CT cholangiogram, where the contrast dye is given and CT scan was performed at specific timing to capture images as shown on the radiopaedia link https://radiopaedia.org/cases/normal-ct-intravenous-cholangiogram?lang=us. Based on the image below, how many gallstones can you visualise in the gallbladder?