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ANATOMY TABLES

THORAX, MUSCLES OF RESPIRATION, PLEURA AND PLEURAL CAVITIES

Osteology
Bone
rib 3-9
head
(typical ribs)
neck

Structure

Description
posteromedial end; articulates with semi facets of
adjacent vertebral bodies
constriction lateral to head
posteroinferior projection lateral to neck; articulates
with transverse process of vertebra
shaft is twisted
marked angulation of body lateral to tubercle
on inner surface of inferior border of body;
accommodates intercostal neurovascular bundle
superior surface, between grooves for subclavian vein
& artery; attachment of scalenus anterior

tubercle
body
angle
costal groove (sulcus)
rib 1
rib 2
rib 8-10
rib 11-12
sternum

scalene tubercle
articulates via costal cartilage with
sternum at sternal angle
belong to "false" ribs; (8 10)
articulate via costal cartilages with
costal cartilage of rib 7
"floating" ribs; anterior ends do not
articulate with sternum, indirectly or
directly
manubrium
jugular (suprasternal) notch
sternal angle
body
xiphoid process

attachment of scalenus posterior, shaft is not twisted

superior part
superior border of manubrium, between clavicular
notches
junction of manubrium & body; located at the level of
the T4/T5 intervertebral disk
articulates with manubrium & xiphoid process
variable in size, shape & ossification; articulates with
body at the level T9

Muscles
Muscle
external
intercostal

innermost
intercostal

Origin

Insertion

Action
elevates rib, keeps
lower
upper border of rib
intercostal space
border
below, coursing,
from blowing out
of rib
down & medially
or sucking in
above
in front
during respiration
upper
depresses rib,
fibers course up
borders
keeps intercostal
and medially to
of ribs
space from
insert on the
below at
blowing out or
inferior margin of
midsucking in during
the rib above
portion
respiration

Innervation

Notes

intercostal continuous with the external


nerves (T1- intercostal membrane anteriorly
T11)
at the costochondral junction
innermost intercostal,
intercostal
subcostalis, and transversus
nerves (T1thoracis mm. lie deep to the
T11)
intercostal neurovascular bundle
1

Muscle
internal
intercostal

Origin
upper
border
of rib
below

Insertion

Action
depresses rib,
lower border of rib keeps intercostal
above, coursing up space from
and medially in
blowing out or
front
sucking in during
respiration

angle of
angle of 2-3 ribs
subcostalis ribs
above origin
below

Innervation

intercostal continuous posteriorly with the


nerves (T1- internal intercostal membrane at
T11)
rib angles

depresses ribs,
intercostal
compresses
nerves
intercostal spaces

depresses ribs,
posterior
transversus
costal cartilages of compresses
aspect of
thoracis
2-6 ribs
thorax for forced
sternum
expiration

Notes

intercostal
nerves 2-6

subcostalis, transversus thoracis


& innermost intercostal mm.
make up the innermost
intercostal muscle layer
transversus thoracis, subcostalis
& innermost intercostal mm.
make up the innermost
intercostal muscle layer

Nerves
Nerve

Source

Branches

ventral
primary
lateral & anterior
intercostal
rami of T1- cutaneous brs.
T11
subcostal

phrenic
vagus

ventral
primary
rami of
T12
brs. of C3C5 ventral
primary
rami
medulla:
dorsal
motor
nucleus
(preganglio
nic
parasympat
hetic) and
nucleus
ambiguus;
superior
and inferior
ganglia

lateral & anterior


cutaneous brs.

Motor
intercostal muscles;
abdominal wall
muscles (via T7-T11);
muscles of forearm &
hand (via T1)

Sensory
skin of chest &
abdomen
anterolaterally; skin of
medial side of upper
limb (via T1-T2)

Notes
travels below
posterior
intercostal a. in
the intercostal
space

skin of the
muscles of abdominal
anterolateral
wall
abdominal wall

pericardial brs.

diaphragm

auricular br.,
pharyngeal br.,
superior laryngeal,
superior & inferior
cervical cardiac
brs., recurrent
laryngeal, thoracic
cardiac brs.,
anterior and
posterior brs. to
pulmonary plexus,
esophageal plexus,
anterior &
posterior vagal
trunks

intrinsic muscles of
larynx, pharynx
(except
stylopharyngeus), &
palate (except tensor
veli palatini);
preganglionic
processes synapse in
small ganglia within or
near viscera of thorax
and abdomen;
postganglionic
processes from these
ganglia supply smooth
muscles of respiratory
tree & gut (proximal
to splenic flexure),

pericardium &
mediastinal,
diaphragmatic &
costal pleurae
skin of external
auditory meatus;
viscera of head, neck,
thorax & abdomen
proximal to splenic
flexure; taste to
epiglottis

crosses the
anterior surface
of the anterior
scalene m.
also known as:
CN X, 10th
cranial nerve;
passes through
jugular
foramen; vagus
means
"wanderer" in
reference to its
extensive
distribution to
the body
cavities

heart or are
secretomotor to
mucous glands of
larynx, bronchial tree,
pharynx & gut,
digestive glands

Arteries
Artery

intercostal,
posterior

internal
thoracic

superior
epigastric

Source
Branches
supreme/highest
intercostalsbranch of
posterior br., spinal br.,
subclavian:
anterior br., collateral
(upper 2 spaces),
br., lateral cutaneous br.
descending
thoracic aorta
(3rd-11th spaces)
pericardiophrenic,
perforating brs., anterior
subclavian (1st intercostal aa.,
part)
mediastinal brs., thymic
brs., musculophrenic a.,
superior epigastric a.

bronchial,
left
bronchial,
right
pulmonary
trunk

internal thoracic
(upper 6 spaces),
musculophrenic
(7-10th spaces)
descending
right bronchial
thoracic aorta
(occasionally)
third right
posterior
intercoctal
right ventricle

right & left pulmonary

Notes

intercostal muscles
posteriorly & laterally &
overlying muscles, spinal
cord & vertebral column
& back muscles, skin &
superficial fascia
posteriorly & laterally
mediastinum, anterior
is continuous as
thoracic & abdominal
superior epigastric
walls, respiratory muscles,
artery
diahragm

upper rectus abdominis,


upper abdominal wall

internal thoracic

Musculophr
anterior intercostal
internal thoracic
enic
(spaces 7-10 or 11)
intercostal,
anterior

Supply

direct continuation of
the internal thoracic a.;
anastomoses with
inferior epigastric
within rectus
abdominis m.

anterior diaphragm,
intercostal spaces 7-10 or
11 anteriorly
intercostal muscles
anteriorly, overlying
muscles skin

2 anterior intercostals
per side per space,
running above &
below the ribs

lower trachea, bronchial


tree

usually 2 in number

lower trachea, bronchial


tree

usually 1 in number

lungs

Veins
3

Vein

Tributaries

intercostal,
posterior

lateral
cutaneous v.

intercostal,
superior

2nd-4th
posterior
intercostal vv.

Drains Into

Region Drained
intercostal space
1st: brachiocephalic; 2ndincluding skin,
4th: superior intercostal;
muscles & adjacent
right 5th-11th: azygos; left
ribs; spinal cord
5th-7th or 8th: accessory
segment &
hemiazygos; left 9th-11th:
corresponding
hemiazygos
vertebra

Notes

right: arch of azygos; left:


intercostal spaces 2-4
left brachiocephalic

pulmonary

lobar vv.

left atrium

lungs

azygos

right 5th-11th
posterior
intercostals,
accessory
hemiazygos,
hemiazygos

superior vena cava

posterior wall of
thorax and abdomen,
bronchi, eosophagus

usually two pulmonary vv.


per side, superior &
inferior; empty into left
atrium

Topographic Anatomy
Structure/Space
Boundaries/Description
parasternal line location: vertical line passing beside sternum

Significance

inferior border of lung with visceral pleura


crosses it at level of 6 rib;
inferior border of parietal pleura crosses it at
level of 7 rib
inferior border of lung with visceral pleura
anterior axillary location: vertical line passing through
crosses it at level of 7 rib;
line
anterior border of axilla
inferior border of parietal pleura crosses it at
level of 8 rib
inferior border of lung with visceral pleura
location: vertical line passing through middle crosses it at level of 8 rib;
midaxillary line
of axilla
inferior border of parietal pleura crosses it at
level of 9 rib
inferior border of lung with visceral pleura
posterior axillary location: vertical line passing through
crosses it at level of 9 rib;
line
posterior border of axilla
inferior border of parietal pleura crosses it at
level of 10 rib
inferior border of lung with visceral pleura
location: vertical line passing through
crosses it at level of 10 rib;
scapular line
inferior scapular angle
inferior border of parietal pleura crosses it at
level of 11 rib
Structure/Space
Boundaries/Description
Significance
paravertebral
location: vertical line passing beside
inferior border of lung with visceral pleura
line
vertebral column
crosses it at level of 11 rib;
4
midclavicular
line

location: vertical line passing through


midshaft of clavicle

nipple

sternal angle
suprasternal
(jugular) notch
thoracic inlet
thoracic outlet

inferior border of parietal pleura crosses it at


level of 12 rib
may be used to help locate apex of heart,
location: 4th intercostal space in male and
approx. 4 finger breadths from midline in
prepuberal female
left 5th intercostal space, or middle lobe of
right lung
horizontal plane through sternal angle
location: junction of manubrium & body of
passes through T4/5 intervertebral disc,
sternum (manubriosternal symphysis), where
marking inferior boundary of superior
costal cartilage of 2nd rib attaches to sternum
mediastinum
location: superior border of manubrium
jugular venous arch located above it
between sternoclavicular joints
boundaries:T1 vertebral body; clavicular &
marks boundary between neck and superior
jugular notches of manubrium; inner borders
mediastinum
of 1st ribs
boundaries: 12th ribs, costal cartilages of ribs
closed by thoraco-abdominal diaphragm
7-12, xiphisternal joint, T12 vertebral body

Lymphatics
Structure

Location

Afferents from

Efferents to

union of efferents left: thoracic


along
from paratracheal duct; right:
bronchomedia
brachiocep nodes, parasternal right
stinal trunk
halic v.
nodes, anterior
lymphatic
mediastinal nodes duct
bronchopulmo hilum of
nary nodes
lung

pulmonary nodes

tracheobronchial nodes

hilar nodes

at hilum of
tracheobronpulmonary nodes
lung
chial nodes

mediastinal
nodes,
anterior

posterior
aspect of
sternum

bronchomediastinal
trunk

mediastinal
nodes,
posterior

along
azygos
system of
veins &
esophagus

thoracic duct
& inferior &
superior
tracheobronchial nodes

Structure

Location

Afferents from

Efferents to

paratracheal
nodes

lateral to
trachea &
esophagus

superior
tracheobronchial
nodes

bronchomediastinal trunk

Regions drained

Notes
right bronchomediastinal
trunk receives lymph
from lower lobe of left
thoracic wall &
lung;
viscera, medial part
bronchomediastinal
of breast
trunk may drain to
venous system
separately on either side
also known as: hilar
lung
nodes
also known as:
lung
bronchopulmonary
nodes
thymus, anterior
diaphragm &
pericardium, some
areas of heart
posterior
mediastinum,
posterior aspect of
heart &
pericardium,
posterior diaphragm
Regions drained
Notes
lungs, trachea,
upper esophagus,
larynx below vocal
folds
5

within the
Bronchopul- lung parenchyma,
pulmonary
lung
monary/hilar bronchial tree
nodes
parenchym
nodes
within lungs
a
tracheobronch inferior to
right superior lower lobes of
bronchopulmonar
ial nodes,
tracheal
tracheobronc lungs, middle &
y nodes
inferior
bifurcation
hial nodes
post. mediastinum
superolater
tracheobronch
al to
ial nodes,
tracheal
superior
bifurcation

bronchopulmonar
y nodes, inferior paratracheal
tracheobronchial nodes
nodes (to right)

lungs, middle &


post. mediastinum

inferior tracheobronchial
nodes drain lymph from
lower lobe of left lung to
right superior
tracheobronchial nodes

Viscera/Fascia
Organ
fascia,
endothoracic

Location/Description
connective tissue between inner aspect of chest wall &
costal parietal pleura
serous lining of pleural cavity; visceral pleura covers
pleura
lungs; parietal pleura lines the walls of pleural cavity
serous lining of pleural cavity extending above level of 1st
pleura, cervical
rib; continuous inferiorly with costal & mediastinal
parietal
pleura; reinforced by scalene fascia
serous lining of pleural cavity on the ribs, costal
cartilages, & intercostal mm.; continuous anteriorly with
mediastinal parietal pleura at costomediastinal reflection;
pleura, costal
continuous posteriorly with mediastinal pleural at
parietal
vertebral bodies; continuous inferiorly with diaphragmatic
pleura at costodiaphragmatic reflection; continuous
superiorly with cervical pleura above 1st rib
serous lining of pleural cavity on superior surface of
pleura,
diaphragm; continuous superiorly with costal pleura at
diaphragmatic
costodiaphragmatic reflection; continuous superomedially
parietal
with mediastinal pleura at mediastinodiaphragmatic
reflection
serous lining of pleural cavity lying on lateral surface of
mediastinum; continuous anteriorly with costal pleura at
pleura, mediastinal costomediastinal reflection; continuous inferiorly with
parietal
diaphragmatic pleura; continuous posteriorly with costal
pleura lateral to vertebral bodies; continuous superiorly
with cervical pleura above level of 1st rib

Notes
equivalent to transversalis
fascia layer of the abdomen
parietal pleura is sensitive to
pain but visceral pleura is not
also known as: cupula or
cervical dome