ARTERIES OF THORACIC WALL
Aorta
1. aortic arch
a. left subclavian artery
b. left common carotid
c. brachiocephalic trunk
i. right sublavian artery
ii. right common carotid
2. thoracic aorta
a. posterior intercostal arteries (3-11)
b. subcostal artery – along the border of the 12th rib (for
the muscles of the thoracic abdominal wall)
3. abdominal aorta
1. subclavian artery
a. internal thoracic artery
i. anterior intercostal arteries (1-6)
ii. musculophrenic artery (in the 6h IC space)
1. anterior intercostal arteries (7-9)
iii. superior epigastric artery -
b. costocervical trunk
i. supreme posterior intercostal arteries = superiror intercostal artery
1. 1st posterior intercostal artery
2. 2nd posterior intercostal artery
POSTERIOR IC ARTERIES
right post. IC art. have a longer course than the left post. IC art.
give off a posterior branch
small collateral branch
pass through the IC space – VAN (costal groove)
thorugh the endothoracic fascia between the pleura and internal intercostal
membrene -> then through the innermost IC and internal IC muscles.
anastomose with anterior IC arteries
ANTERIOR IC ARTERIES
supply the IC muscles and send branches through them to supply the pectoral
muscles, breasts, and skin
absent from the inferior two IC spaces; these spaces are supplied only by the
posterior intercostal arteries and their collateral branches.
VEINS OF THORACIC WALL
IC veins (VAN)
o 11 paris of posterior IC veins
o 1 pair of subcostal veins
o anterior IC veins
internal thoracic veins - accompany the internal thoracic arteries
posterior branches intervertebral veins
posterior IC veins
1st-> enter the brachiocephalic veins
2nd, 3rd, 4th -> form the superior intercostal vein
right superior IC vein -> azygos vein - > superior vena cava (SVC)
left superior IC vein -> empties into the left brachiocephalic vein
th th
4 -11 -> end in azygos/hemizygos venous system -> drain to SVC
NERVES OF THORACIC WALL
1. 12 pairs of thoracic spinal nerves
a. posterior rami – for the joints, muscles and skin of the back
b. anterior rami
i. intercostal nerves (T1-11) - (dermatomes and myotomes)
1. typical IC nerves: T3-T6
a. collateral branches
b. anterior cutaneous branches above the sternum
c. lateral cutaneous branches
d. muscular branches
2. atypical IC nerves
T1: divides into a large superior (goes to the brachial
plexus) and small inferior part (1st IC nerve – has no
cutaneous branches)
T1 and T2: course the internal surface of the rib
T2 and T3: give a brach – the intercostobrachial nerve
T7-T11: become thoracoabdminal nerves
ii. subcostal nerve (T12)
2. nerves of the brachial plexus (C5-T1)
a. long thoracic nerve
b. medial and lateral pectoral nerve
c. subclavian nerve
d. accessory phrenic nerve
FASCIA OF THORACIC WALL
1. pectoral fascia
a. clavipectoral fascia
2. endothoracic fascia
a. suprapleural membrane
MUSCLES OF THRACIC WALL
1. intrinsic = true
a. serratus posterior - proprioception
i. superior
ii. inferior
b. levatores costarum - elevate the ribs
c. intercostal
i. external (11 pairs) - inspiration
ii. internal (11 pairs) - expiration
iii. innermost
d. subcostal
e. transversus thoracis – week expiratory function
2. extrinsic = accessory
a. subclavius
b. pectoralis maior
i. clavicular part
ii. sternal part
iii. abdominal part
c. pectoralis minor
d. serratus anterior
The diaphragm is the primary muscle of inspiration.
JOINTS OF THORACIC WALL
intervertebral joints
sternoclavicular joints
costochondral joints
interchondral joints
sternocostal joints
manubriosternal joint
xiphosternal joint
costovertebral joints
o costotransverse joints
SUPERIOR THORACIC APERTURE
posterior: T1 vertebrae
laterally: 1st pair of ribs + costal cartilages laterally: 1st pair of ribs + costal cartilages
anterior: superior border of manubrium
o slopes antero-inferiorly
o bigger transverse diameter
INFERIOR THORACIC APERTURE
posterior: T12 vertebrae
posterolaterally: 11th & 12th rib
anterolaterally: joint costal cartilages od ribs 7-10
anteriorly: xiphosternal joint
Thoracic skeleton
1. sternum
2. ribs, costal cartilages
3. thoracic vertebrae
STERNUM
1. manubrium
a. jugular notch/suprasternal notch
b. clavicular notches (sternoclavicular joint)
c. syndrochosis of the first rib
d. manubriosternal joint – sternal angle (angle of Louis)
2. sternum
a. costal notches
b. transverse ridges
3. xiphoid process
a. xiphisternal joint – infrasternal angle
RIBS
1. true (vertebrosternal) 1-7
o attach directly to the sternum through their own costal cartilages
2. false (bertebrochondral) 8-10
o cartilages connect to the cartilage of the riba bove (indirect connection to
sternum)
4. floating (vertebral, free) 11,12
o rudimentary cartilages
TYPICAL RIBS (3-9)
o head (crest of the head, 2 facets)
o neck
o tubercle (articular and nonarticular part)
o body/shaft – costal angle, costal groove
ATYPICAL RIBS
o 1st rib – the broadest, shortest and most curved; single facet on the head, 2
grooves crossing the superior surface (subclavian vessels); scalene tubercle
o 2nd rib – tuberosity for serratus anterior on the superior surface
o 10th, 11th, 12th – one facet on the head
o 11th, 12th – short, no neck, no tubercle
costal cartilages, costal margin
intercostal spaces – 11 (widest anterolaterally, widen with inspiration)
subcostal space
THORACIC VERTEBRAE
o body
o vertebral arch
o seven processes
1. billateral costal facets (demifacets) on the bertebral bodies (articulate
wirh heads of ribs)
superior and inferior costal facets (posterolaterally)
atypical thoracic vertebrae – whole facets (T1, T10, T11, T12)
the convex superior articular facets of the superior articular
processes face mainly posteriorly and slightly laterally, whereas the
concave inferior articular facets of the inferior articular processes
face mainly anteriorly and slightly medially
2. costal facets on the transverse processes (articulate with rib tubercules,
except for the inferior 2-3 thoracic vertebrae
3. long inferorly slanting spinous processes
BREASTS
The bed of the breast extends transversely from the lateral border of the sternum to
the midaxillary line and vertically from the 2nd through 6th ribs. Two thirds of the
bed are formed by the pectoral fascia overlying the pectoralis major; the other third,
by the fascia covering the serratus anterior.
Between the breast and the pectoral fascia is a loose subcutaneous tissue plane or
potential space—the retromammary space (bursa).
A small part of the mammary gland may extend along the inferolateral edge of the
pectoralis major toward the axillary fossa, forming an axillary process or tail (of
Spence).
Suspensory ligaments (of Cooper)
subclavian arteries –> internal thoracic artery-> anterior intercostal branches
axillary artery -> lateral thoracic and thoracoabdominal arteries
thoracic aorta -> posterior intercostal arteries (2,3,4)
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axillart vein
internal thoracic vein
Nipple, areola & lobules -> subareolar lymphatic plexus
>75% (most of the brest, lateral breast quadrants)- axillary lymph nodes->
-> anterior/pectoral lymph nodes
15% (medial breast quadrants) – parasternal lymph nodes OR opposite breast
(inferior breast quadrants – abdominal lymph nodes -> inferior phrenic lymph
nodes
from the skin -> axillary nodes (ipsilateral), inferior deep cervical and infraclavicular
lymph nodes
axillary lymph nodes (LN) -> clavicular (infraclavicular and supraclaviular) LN ->
subclavian lymphatic trunk
parasternal LN -> bronchomediastinal lymphatic trunks
= join and form -> jugular lymphatic trunk -> right lymphatic duct -> right venous angle
-> thoracic duct (left) -> left venous angle
- into the brachiocephalic veins
NERVES
anterior and lateral cutaneous branches of the 4th–6th intercostal nerve
