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Thorax Anatomy
This document provides an overview of the anatomy of the thorax. It describes the structures that make up the thoracic cage including the sternum, ribs, and thoracic vertebrae. It discusses the divisions of the mediastinum and describes the anatomy of structures in the thorax including the lungs, heart, great vessels, diaphragm, and esophagus. Key details are provided about the lobes and fissures of the lungs, chambers and valves of the heart, arterial and venous supply of the heart, and lymphatic drainage of the lungs.
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Thorax Anatomy
- 1. THORAX ANATOMAY OF Dr. RajithEranga www.rermedapps.com
- 2. THORACIC CAGE -Apertures 1. Superior Thoracic Aperture (Inlet) T1, First rib, Manubrium 2. Inferior Thoracic Aperture (Outlet) T12, Rib 11, Rib 12, Costal margin, Xiphoid process
- 3. THORACIC WALL Bones Sternum, 24Ribs, 12 Thoracic vertebrae Muscles a. Intrinsic Muscles Intercostals, Subcostals, Transverse Thoracis a. Extrinsic Muscles Pectoralis Major & Minor, Serratus anterior, Subclavius
- 4. Parts - Manubrium,Body, Xiphoid Process Joints • Manubriosternal Joint – (Secondary Cartilaginous) • Xiphisternal Joint – (Primary Cartilaginous) • Sternoclavicular joint – (Synovial Saddle) • Sternocostal joint 1st rib - (Primary Cartilaginous) • Sternocostal joints 2nd to 7th ribs– (Synovial Plane) Development From 3 Sternabrae STERNUM – Basic Anatomy
- 5. STERNUM – VertebralLevels T4/T5 Level • Demarcates sup & inf mediastinum • Bifurcation of trachea • Bifurcation of pulmonary trunk • Start & end of arch of aorta • Formation of SVC • Azygos vein joining SVC • Thoracic duct – crossing T2 Level T9 Level T5 to T8 T2 to T4
- 6. THORACIC VERTEBRAE -Classification Classification a. Typical b. Atypical Typical Thoracic Vertebrae Parts – Heart shaped body, Lamina, pedicles, spinous process Unique – Costal facet on body, transverse process Atypical Thoracic Vertebrae T1, T10, T11, T12 – Only single facet on body
- 7. Joints • Intervertebral –Secondary cartilaginous • Costovertebral – Synovial plane • Costotransverse – Synovial Plane Ligaments • Supraspinous • Interspinous • Ligamentum flavum • Posterior longitudinal • Anterior longitudinal THORACIC VERTEBRAE – Joints & Ligaments
- 8. RIBS - Classification Classification A.True/ False/ Floating B. Typical/ Atypical A. Ture Ribs / False Ribs / Floating Ribs 1. True - Ribs 1 to 7 2. False - Ribs 8 to 10 3. Floating - Ribs 11 to 12
- 9. RIBS - Classification B.Typical & Atypical Ribs 1. Typical - Ribs 3 to 9 – Head with 2 demifacets, neck, tubercle, angle, shaft 2. Atypical • Rib 1 - single articular facet, shortest, most curved, horizontal, Scalene Tubercle, grooves • Rib 2 - roughened area for Serratus Anterior • Rib 10 - single articular facet • Rib 11 - single articular facet, no tubercle • Rib 12 - single articular facet, no tubercle, no subcostal groove
- 10. RIBS - Joints& Ligaments Joints • Costovertebral joints – Synovial plane • Costotransverse joints - Synovial plane • Costochondral joints – Primary Cartilaginous • Sternochondral joints – Synovial Plane (Except 1st) • Interchondaral joints – Synovial plane Ligaments 1. (Medial) Costotransverse 2. Lateral costotransverse 3. Superior costotransverse 4. Radiate ligament
- 11. THORACIC WALL -Muscles Intrinsic Muscles 1. External Intercostals 2. Internal Intercostals 3. Innermost Intercostals 4. Subcostals 5. Transverse Thoracis Extrinsic Muscles • Pectoralis Major & Minor • Serratus Anterior • Serratus Posterior Superior • Serratus Posterior Inferior
- 12. THORACIC WALL -Intrinsic Muscles External IC Internal IC Innermost IC Subcostals Sternocostalis Tubercle to Costochondral junction Sternum to Angle Incomplete layer Near angle, Run 2-3 ribs below Lower sternum to 2nd to 6th CC Outer layer Middle layer Inner layer Inner layer Inner layer Anteroinferior Posteroinferior Posteroinferior Posteroinferior Anteroinferior Forced Inspiration Forced Expiration Forced Expiration Forced Expiration Forced Expiration
- 13. DIAPHRAGM – BasicAnatomy Attachments Vertebral – Left Crus (L1-L2), Right Crus (L1-L3) Costal – Lower 6 ribs & costal cartilages Sternal – Xiphoid process Innervation Motor – Phrenic nerve (C3-C5) Sensory – Phrenic nerve & lower intercostal nerves
- 14. DIAPHRAGM - Openings Aortic(T12) Aorta, Thoracic duct, Azygos vein Oesophageal (T10) Oesophagus, 2 Vagal trunks, Left gastric artery Vena Caval (T8) IVC, Right phrenic nerve
- 15. PLEURA – BasicAnatomy Components • Parietal Pleura • Cervical • Costal • Diaphragmatic • Mediastinal • Visceral Pleura Surface Marking (Read)
- 16. PLEURA – Innervation 1.Costal Parietal Pleura Intercostal nerves 2. Mediastinal Parietal Pleura Phrenic nerve 3. Diaphragmatic Parietal Pleura Phrenic nerve + lower 6 IC nerves 4. Visceral Pleura Pulmonary plexus
- 17. PLEURA - PleuralRecesses The potential spaces, where the visceral and parietal pleura are relatively distant (Expiration). 1. Costomediastinal Recess Between costal pleura & mediastinal pleura. Prominent in Left side. 2. Costodiaphragmatic Recess Between costal pleura & diaphragmatic pleura.
- 18. LUNGS - BasicAnatomy Surfaces 1. Costal 2. Diaphragmatic 3. Mediastinal (Revise relations of each lung) Borders 1. Anterior – Sharp (Cardiac notch in L) 2. Inferior – Shap 3. Posterior – Blunt
- 19. LUNGS – Lobes& Fissures Lobes • Left – 2 Lobes (Superior & Inferior) • Right – 3 Lobes (Superior, Middle & Inferior) Fissures 1. Oblique Fissure – Runs superoposterly From - Inferior border To - Posterior border 2. Horizontal Fissure (R Only) – Runs transversely From - Sternum at 4th Rib To - Oblique fissure
- 20. LUNGS - Hilum Structures •Bronchus • Pulmonary artery • Two pulmonary veins • Bronchial arteries & veins • Pulmonary autonomic plexus • Lymphatics & LN Dual blood supply (Pulmonary & Bronchial) So that lung can survive in PE.
- 21. LUNGS – LymphaticDrainage Lymphatic Plexus in Lung • Superficial lymphatic plexus – beneath pleura • Deep lymphatic plexus – around vessels Lymph Drainage Pathway 1. Intrapulmonary LN (within lung) 2. Bronchopulmonary LN (at hilum) 3. Tracheobronchial LN (at bifurcation) 4. Paratracheal LN (beside trachea) 5. Mediastinal Lymph Trunks 6. Brachiocephalic veins (Sometimes via Thoracic duct on L side)
- 22. LUNGS – BronchopulmonarySegments Definition A portion of lung Supplied by a specific segmental bronchus, artery and vein. “Functionally separate divisions of each lobes” Structure Wedge-shaped. Apex at hilum, base at surface. Importance • Pathologies (Eg : Atelectasis, Bronchiectasis) • Bronchoscopy • Surgical Resection
- 23. TRACHOBRONCHIAL TREE Trachea From Cricoid(C6) to Angle of Louis (T4/T5) Bronchi • Left (T6) • Right (T5) - Shorter, Wider & Less vertical • Angle of Carina - 600 (in adult), At T4/T5 (Mid Respiration) Further Divisions Main(1ry) Bronchi Lobar(2ry) bronchi Segmental(3ry) bronchi Conducting bronchioles Terminal bronchioles Respiratory bronchioles Alveolar ducts Alveoli
- 24. MEDIASTINUM - Divisions •Superior Mediastinum • Inferior Mediastinum a. Anterior Mediastinum b. Middle Mediastinum c. Posterior Mediastinum
- 25. PERICARDIUM Layers of Pericardium FibrousPericardium Serous Pericardium a. Parietal layer b. Visceral layer (Epicardium) Attachments of Fibrous Pericardium • Adventitia of great vessels • Central tendon of diaphragm • Sternum – Sternopericarial ligament
- 26. PERICARDIUM Recesses • Transverse Sinus •Oblique Sinus Functions • Fixes the heart • Prevents overfilling • Lubrication • Protection from infections
- 27. PERICARDIUM Blood Supply • Pericardiophrenicartery • Internal thoracic artery • Musculophrenic artery • Thoracic Aorta Innervation Phrenic nerve (C3,4,5)
- 28. CHAMBERS OF HEART RightAtrium Inflow – SVC, IVC, Coronary sinus Outflow – Tricuspid valve Cavity - two compartments – separated by crista terminalis • Posterior – Smooth (sinus venousus) • Anterior – Rough (true atrium) – Pectinate muscles Interatrial Septum – Fossa Ovalis
- 29. CHAMBERS OF HEART RightVentricle Inflow – Tricuspid valve Outflow – Pulmonary Artery (Infundibulum) Cavity two compartments • Smooth part (near infundiculum) • Rough part – trabecular carniae a. Muscular Ridges b. Muscular Bridges c. Papillary Muscles Moderator Band (Septomarginal trabeculae) - RBB
- 30. CHAMBERS OF HEART LeftAtrium Inflow – 4 Pulmonary veins Outflow – Mitral valve Cavity Two compartments • Posterior – Smooth (sinus venousus) • Anterior – Rough (true atrium) – Pectinate muscles
- 31. CHAMBERS OF HEART LeftVentricle Inflow – Mitral valve Outflow – Aorta Cavity - two compartments • Smooth part (near aortic vestibule) • Rough part – trabecular carniae Thickest Myocardium
- 32. HEART – AtrioventricularValves Tricuspid Valve Anterior Cusp Posterior Cusp Septal Cusp 3 sets of Papillary muscles- connect to cusps via cordi tendinae • Anterior – Bulkiest • Posterior • Septal – Often absent • Keep the valve closed during ventricular systole- prevent regurgitation
- 33. HEART – AtrioventricularValves Mitral Valve Anterior Cusp Posterior Cusp • 2 sets of Papillary muscles connect to cusps via cordi tendinae • Anterior - Bulkiest • Posterior • Keep the valve closed during ventricular systole- prevent regurgitation
- 34. HEART - SemilunarValves Semilunar Valves 1. Aortic Valve 2. Pulmonary Valve 3 valve cusps blood fills in diastole valvular closure Aortic Valve Coronary arteries arises from aortic sinuses. Left CA – Anterior coronary sinus Right CA – Posterior coronary sinus
- 35. HEART – ArterialSupply Two Coronary Arteries – From Aortic sinuses 1. LCA Gives off LCx & LAD 2. RCA Gives off RMA & PIVA (70%) • Functional end arteries. • SA & AV node, Posterior 1/3 of IV septum (by PIVA) supplied by RCA. Clinical Coronary Angiogram (SVD, DVD, TVD) Cardiac Dominance (which CA gives off PIVA) {In left dominance (30%) – PIVA from LCA}
- 36. HEART – VenousDrainage Coronary Sinus Receives 5 main tributaries Opens to RA 1. Great cardiac vein – in Anterior IV groove 2. Middle cardiac vein – in Posterior IV groove 3. Small cardiac vein – with RMA 4. Posterior cardiac vein – Posterior aspect of LV 5. Oblique cardiac vein – Posterior aspect of LA Other Veins • Anterior cardiac veins – drain Anterior surface to RA • Venae cordis minimae – drain myocardium to cavity
- 37. OESOPHAGUS – BasicAnatomy • 25 cm fibromuscular tube • From C6 to T11 (At T10 leaves thorax) • Cervical, Thoracic & Abdominal components Blood Supply Inferior thyroid, Thoracic aorta & Left Gastric arteries Lymph Drainage • Superior 1/3 Deep cervical LN • Middle 1/3 Mediastinal LN • Lower 1/3 Coeliac LN
- 38. 1. Adventitia 2. MuscularisPropria (Outer longitudinal & inner circular) • Upper 2/3 Straited muscles • Lower 1/3 Smooth muscles 3. Submucosa – Mucous glands 4. Mucosa – Non-keratinized Stratified squamous epithelium Barret’s Oesophagus - Read OESOPHAGUS - Layers
- 39. THORACIC DUCT Drain lymphfrom 1. Below the diaphragm 2. Left half above the diaphragm From Cisterna Chyli Through aortic opening of diaphragm on vertebral bodies inclines to left at T5 drains to Left Brachiocephalic vein
- 40. THORACIC SYMPATHETIC TRUNK •Runs lateral to vertebral bodies each side • Connecting sympathetic paravertebral ganglia • Behind Medial arcuate ligament become abdominal sympathetic trunk Paravertebral ganglia receives preganglionic nerves. They can, 1. Synapse in the paravertebral ganglia at the same level 2. Ascend in chain & synapse in higher paravertebral ganglia 3. Descend in chain & synapse in lower paravertebral ganglia 4. Travel without synapsing (Splanchnic nerves) to synapse in prevertebral sympathetic ganglia.
- 41. THORACIC SPLANCHNIC NERVES •They are branches of sympathetic train that carry preganglionic fibres to autonomic plexuses. • They synapse in prevertebral ganglia (coeliac, mesenteric, renal etc) • Lie medial to sympathetic trunk 3 Thoracic splanchnic nerves 1. Greater Splanchnic -T5-T9 2. Lesser Splanchnic - T10 & T11 3. Least Splanchnic -T12
- 42. THANK YOU ENDOF THE LECTURE