Parts and regions of the thorax

Boundaries
• Superior－jugular notch,
sternoclavicular joint,
superior border of clavicle,
acromion, spinous
processes of C7
• Inferior－xiphoid process,
costal arch, 12th and 11th
ribs, vertebra T12
Regions
• Thoracic wall
• Thoracic cavity
Landmarks
• INCISURA
JUGULARIS
STERNI
• ANGULUS STERNI
LOUISI/ludovici
• PROCESSUS
XIPHOIDEUS
 Angulus Sterni
(Costa II)

2
 Landmarks
• Jugular notch corresponds with
– The 2th thoracic vertebra in male,
the 3th thoracic vertebra in female
• Sternal angle connects 2nd
costal cartilage laterally，
corresponds with
– The lower border of 4th thoracic
vertebra
– The bifurcation of trachea in the
adult
– The beginning of aortic arch
which ends posteriorly at the
same level
– The esophagus is crossed by the
left main bronchus
• Xiphoid process－phisternal
junction lies opposite the
body of the 9th thoracic
vertebra
• Clavicle
– Inferior fossa of clavicle
– Coracoid process
• Ribs and intercostal spaces
• Costal arch
– Infrasternal angle
– Xiphocostal angle
• Papillae
5
 Linea sternalis lateralis C
D Linea
Parasternalis

Linea midsternalis
Linea A B E 6
(mediana)medioclavicularis
Linea
LineaScapularis
Axillaris
A B C
7
 Thoracic Wall

• Structure:
skin  fascia  muscle  bone
blood vessels & nerves

• Functions:
1. protection of thoracic
viscera

2. provides the mechanical

function of breathing
• Thoracic cage is an osteo-
cartilagenous conical cage
which has a narrow inlet & a
wide outlet

Boundaries of cavum thorax.

• Ant: Sternum, cartilago
costalis and costa
• Post: Vertebra thoracalis and
costa
• Lat: costa
• Inferior : the diaphragma
SKELETON
• 12 pairs, all are attached
posteriorly to thoracic
vertebrae (VERTEBRA
THORACALIS I – XII)
• Costa vera: upper 7 pairs.
• Costa spuria: 8th,9th &10th
pairs
• Costa fluctuantes: 11th &
12th
 Openings of Thoracic Wall

Boundaries of superior
thoracic opening

Boundaries of inferior thoracic

opening
 APERTURA THORACIS SUPERIOR :

• Ant: Upper border of

manubrium sterni.
• Post: 1st CORPUS
V.THORACALIS
• On each side: 1st Costa & 1st
Cartilago costae
• It is sloping downwards
& forward.
• CRANIO-DORSAL to
CAUDOVENTRAL

12
 APERTURA THORACIS INFERIOR
• CORPUS VERT.THOR.XII
• CARTILAGINIS COSTA VIII – X
• PROCESSUS XIPHOIDEUS
 DIAPHRAGMA THORACIS The
diaphragm closes the thoracic outlet
and separates the thoracic cavity
from the abdominal cavity.

 VENTRO-CRANIAL to CAUDO-DORSAL

13
 ARTICULUS
• JUNCTURA COSTOSTERNALIS
• JUNCTURA COSTOVERTEBRALIS :
ARTICULUS CAPITULI
 ARTICULUS COSTOTRANSVERSALIS

3 14
 MUSCULUS
1) Superficial layer:
Have a role at Extremitas
superior, abdominal wall
: m.pect.major, m.rectus
abd, m.obl.abd.ext,
m.lat.dorsi,
mm.rhomboidei,
m.serratus anterior, etc

15
 Intermedia layer
M.intercostalis externus
M.intercost.internus
11pairs
11 pairs
Membrana
Membrana
intercostalis anterior
intercostalis Posterior

It elevates the rib during

inspiration

Depresses the rib downwards

during expiration
16
 M.transversus thoracis
(anterior)
 M.subcostalis (posterior)
 The diaphragm closes the
thoracic outlet and separates
the thoracic cavity from the
abdominal cavity.

17
 • Subcostalis muscle
• Thin bands of muscle fibers.
• Mainly in lower 6 spaces.
• Only in post. part of spaces.
• Origin: Inner surface & lower
border of rib above.
• Insertion: Upper border of 2nd
or 3rd rib below.
 • Intercostal Spaces
• There are 9 anterior and 11
posterior
• Each space contains:
• 1- Intercostal muscles:
(External, Internal and
transversus thoracicus)
• 2- An Intercostal nerve.
• 3- Intercostal vessels:
• a. Intercostal arteries
(Anterior & Posterior)
• b. Intercostal veins
(Anterior & Posterior).
 • Anterior Intercostal
arteries
• 2 small arteries in each of
the 9 spaces.
• The upper 6 from internal
mammary artery
• The lower 3 from musculo-
phrenic artery
• NB. Internal mammary or
internal thoracic artery is a
branch from1st part of
subclavian artery
 • Posterior Intercostal
arteries
• One in each of the 11
spaces
• 1st & 2nd arise from
superior Intercostal
artery of costocervical
trunk of 2nd part of
subclavian artery
• The lower 9 arteries &
subcostal artery arise
from descending thoracic
aorta.
 Posterior Intercostal veins
• One in each of the 11 spaces.
• On the right:
• 1st drains into Rt. Innominate v.
• 2nd,3rd & sometimes the 4th unite to form
Rt. Superior Intercostal vein (B) which
drains into azygos vein.
• From 5th to 11th & subcostal veins drain
into azygos vein ©.
• On the Left:
• 1st drains into Lt. innominate V.
• 2nd,3rd& sometimes the 4th join to form
Lt. Superior Intercostal vein which drains
into Lt innominate vein.
• 5th,6th,7th, & 8th form superior
hemiazygos vein to azygos vein
• 9th,10th.11th &Subcostal form inferior
hemiazygos vein to azygos vein.
 Azygos Vein
• Connects IVC with SVC S
V
• Begins in abdomen from C
back of IVC at level of L2
• Enters thorax through Aortic
opening of diaphragm on Rt.
side of thoracic duct & aorta.
• In post. Mediastinum it passes
behind Rt. Border of esophagus
& root of rt. Lung I
V
• In sup. Mediastinum (L4) it
C
crosses above the root of rt.
lung
Enters the middle of the back of
the SVC.
 Mammary Glands
• Modified sweat glands
• 15-20 lobes
• Lobes separated by fibrous septa
• Lactiferous duct (1 per lobe)
• Lactiferous sinus (ampulla):
Dilation as duct enters nipple
Structure : glands, fat and fibrous tissue
 Mammary Glands
• Breast extends from 2nd-
3rd rib superiorly to 6th-
7th costal cartilage
inferiorly.
• Extends from lateral
border of sternum to
beyond the anterior
axillary fold.
• Suspensory ligament of
Cooper:
Bundles of collagen
fibers in dermis and
hypodermis.
 The Mediastinum
Concept－all of organs
between the left and right
mediastinal pleurae is
called mediastinum. It
extends from the sternum
in front to the vertebral
column behind, and from
the thoracic inlet above
to the diaphragm below.
It includes all the
structures which lie in
the intermediate
compartments of the
thoracic cavity
 Left side of mediastnum
Left subclavian a.
Thoracic duct
Left vagus n. Aortic arch
Left recurrent n. Thoracic aorta
Phrenic n. &
pericardiacophrenic a.
Sympathetic trunk
Root of lung

Pericardium

Esophagus

Greater splanchnic n
 Right side of mediastnum
Trachea
Left vagus n. Superior vena cava
Arch of azygos v. Phrenic n. &
pericardiacophrenic a.
Azygos v.
Root of lung
Sympathetic trunk

Esophagus Pericardium

Inferior vena cava

 DIVISIONS OF MEDIASTINUM
• It is divided by a horizontal plane
extending from sternal angle to
lower border of 4th thoracic
vertebra into:
1. Superior mediastinum: above the
plane
2. Inferior mediastinum: below the
plane, it is subdivided into:
• Anterior mediastinum: in front of
pericardium
• Middle mediastinum: contains
heart & pericardium
• Posterior mediastinum: behind
pericardium
 SUPERIOR MEDIASTINUM
BOUNDARIES:
• Anterior: manubrium sterni
• Posterior: Upper 4 thoracic
vertebrae
• Superior: Plane of thoracic inlet
• Inferior: Horizontal plane
• On each side: Pleura
 MEDIASTINUM SUPERIOR
Contents :
RETROSTERNAL
• THYMUS
• VENA ANONYMA SINISTRA
• VENA ANONYMA DEXTRA
• VENA CAVA SUPERIOR

32
 MEDIASTINUM SUPERIOR
PREVERTEBRALIS
OESOPHAGUS
TRACHEA
DUCTUS THORACICUS left side of
oesophagus
N.RECURRENS SINISTER : left side of
arcus aortae, ascendens between
trachea - oesophagus

33
 Contents in INTERMEDIA
• ARCUS AORTAE
• N.VAGUS DEXTER
• N.VAGUS SINISTER
• N.PHRENICUS DEXTER
• N.PHRENICUS SINISTER

34
• MEDIASTINUM ANTERIUS
• MEDIASTINUM MEDIUM
• MEDIASTINUM POSTERIUS

ll.nn., soft tissue, fat

35
36
 MEDIASTINUM MEDIUM
• contents : pericardium +
cor, aorta asc, lower half
of vena cava superior ,
terminations of Vena cava
inferior , terminations of
vena azygos, v.pulmonalis
sinistra et dextra and
n.phrenicus dexter et
sinister

37
 MEDIASTINUM POSTERIUS

• CONTENTS:
1. Esophagus (most
anterior structure)
2. Thoracic duct
3. Right & left vagus
4. Descending aorta
5. Azygos &
hemiazygos veins
6. Right & left
sympathetic trunks
& their branches
(splanchnic nerves)
7. Lymph nodes

38
 Inferior mediastinum

Anterior mediastinum
• Location－posterior to body of
sternum and attached costal
cartilages, anterior to heart and
pericardium
• Contents－fat, remnants of
thymus gland, anterior
mediastinal lymph nodes
Middle mediastinum
• Location－between anterior
mediastinum and posterior
mediastinum
• Contents: hart and
pericardium, beginning or
termination of great vessels,
phrenic nerves,
pericardiacophrenic vessels ,
lymph nodes,
Posterior mediastinum
• Location－posterior to heart and
pericardium, anterior to vertebrae
T5－T12
• Contents: esophagus, vagus n.,
thoracic aorta, azygos system of
veins, thoracic duct, thoracic
sympathetic trunk, posterior
mediastinal lymph nodes
AZYGOS & HEMIAZYGOS VEINS
 VEINS
AZYGOS VEIN: (Posterior
mediastinum)
• ORIGIN: by union of right
ascending lumbar & subcostal
veins (passes through aortic
opening of diaphragm)
• END: forms an arch above the root
of right lung & ends in S.V.C.
opposite lower border of T4
• RELATIONS:
1. Anterior: esophagus
2. Posterior: thoracic vertebra
3. Right: right pleura & lung
4. Left: thoracic duct
 VEINS
INFERIOR HEMIAZYGOS:
(Posterior mediastinum)
• ORIGIN: by union of left
ascending lumbar &
subcostal veins (passes
through left crus of
diaphragm)
• END: into azygos vein,
opposite T8
• TRIBUTARIES: left posterior
intercostal veins (9th to
11th), esophageal veins
 VEINS
SUPERIOR HEMIAZYGOS:
(Posterior mediastinum)
• ORIGIN: by left posterior
intercostal veins (4th to 8th)
• END: into azygos vein,
opposite T7
• TRIBUTARIES: left bronchial
veins
INFERIOR VENA CAVA:
(Posterior mediastinum)
• END: passes through vena
caval opening of diaphragm &
opens into right
th
atrium
behind right 6 costal
cartilage