THORAX OS powerpoint


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THORAX OS powerpoint

  1. 2. <ul><li>Is an irregularly shaped cylinder with a narrow opening superiorly and relatively large opening inferiorly </li></ul>
  2. 3. <ul><li>Boundaries: </li></ul><ul><ul><li>root of the neck superiorly and diaphragm inferiorly, thoracic wall laterally </li></ul></ul><ul><li>Has flexible musculoskeletal wall consists of vertebrae, ribs, muscles and the sternum </li></ul>
  3. 4. <ul><li>Left and right pleural cavity each surrounding a lung </li></ul><ul><ul><li>Separated from each other by the mediastinum </li></ul></ul><ul><li>Mediastinum </li></ul><ul><ul><li>A thick soft tissue partition oriented longitudinally in a median sagittal position </li></ul></ul><ul><ul><li>Contains the heart, esophagus, trachea, major nerves and systemic blood vessels </li></ul></ul>
  4. 5. <ul><li>1. Breathing </li></ul><ul><li>2. Protection of vital organs </li></ul><ul><li>3. Conduit </li></ul>
  5. 6. <ul><li>A. Thoracic Wall </li></ul><ul><li>Consists of skeletal elements and muscles </li></ul><ul><li>Boundaries: </li></ul><ul><li>Posteriorly </li></ul><ul><li>T1-12 vertebrae and </li></ul><ul><li>IV discs </li></ul><ul><li>Laterally </li></ul><ul><li>12 ribs on each side </li></ul><ul><li>Anteriorly </li></ul><ul><li>sternum </li></ul>
  6. 7. <ul><li>B. Superior thoracic aperture </li></ul><ul><li>Boundaries: </li></ul><ul><li>Posteriorly </li></ul><ul><li>body of T1 vertebra </li></ul><ul><li>Laterally </li></ul><ul><li>medial margin of rib 1 </li></ul><ul><li>Anteriorly </li></ul><ul><li>manubrium </li></ul><ul><li>IV disc between T2-T3 – same horizontal plane with the superior margin of the manubrium </li></ul>
  7. 8. <ul><li>Inferior thoracic aperture </li></ul><ul><li>large and expandable </li></ul><ul><li>Boundaries: </li></ul><ul><li>Posteriorly </li></ul><ul><li>body of T12 vertebra </li></ul><ul><li>Posterolaterally </li></ul><ul><li>12th rib and distal end of 11th rib </li></ul><ul><li>Anterolaterally </li></ul><ul><li>distal cartilaginous ends of 7th -10th ribs </li></ul><ul><li>Anteriorly </li></ul><ul><li>xiphoid process </li></ul><ul><li>IV disc between T9-T10 – same horizontal plane with the joint between the coastal margin and sternum </li></ul>
  8. 9. <ul><li>D. Diaphragm </li></ul><ul><li>- Closes the inferior thoracic aperture </li></ul><ul><li>- Is not flat but has a dome shape: right dome ( reach up to 5th rib ) is higher than the left </li></ul><ul><li>-During its contraction, there is a decrease on the height of the dome and an increase on the volume of the thorax </li></ul>
  9. 10. <ul><li>E. Mediastinum </li></ul><ul><li>- A thick midline </li></ul><ul><li>partition </li></ul><ul><li>Boundaries : </li></ul><ul><li>Anteriorly </li></ul><ul><li>Sternum </li></ul><ul><li>Posteriorly </li></ul><ul><li>thoracic vertebra </li></ul><ul><li>Superiorly </li></ul><ul><li>superior thoracic aperture </li></ul><ul><li>Inferiorly </li></ul><ul><li>inferior thoracic aperture </li></ul>
  10. 11. <ul><li>Divisions: horizontal plane passing from sternal angle to IV disc of T4-T5 </li></ul><ul><li>A . Superior mediastinum </li></ul><ul><li>B. Inferior mediastinum </li></ul><ul><li>• subdivided by the pericardium: </li></ul><ul><li>I. anterior mediastinum – lies between the sternum and the pericardium </li></ul><ul><li>II. middle mediastinum – consists of the pericardium and heart </li></ul><ul><li>III. posterior mediastinum – lies between the pericardium and the thoracic vertebra </li></ul>
  11. 12. <ul><li>F. Pleural Cavities </li></ul><ul><li>- Situated on either side of the mediastinum </li></ul><ul><li>- Lined by a mesothelial membrane called the pleura </li></ul><ul><li>A. Parietal pleura – lining the walls of the thoracic cavity </li></ul><ul><li>B. Visceral pleura – lines those that reflected from the mediastinum and onto the surfaces of the lungs </li></ul><ul><li>Costodiaphragmatic recess – the largest and clinically most important; it lies inferiorly between thoracic wall and diaphragm </li></ul>
  12. 13. <ul><li>IV disc between T4-T5: one of the most significant structure at its horizontal plane </li></ul><ul><li>• Passes through the sternal angle anteriorly, marking the position of the anterior articulation of the coastal cartilage of the 2nd rib with the sternum </li></ul><ul><li>• Separates the superior and inferior mediastinum, marks the position of the superior limit of pericardium </li></ul><ul><li>• Marks where the arch of the aorta begins and ends </li></ul><ul><li>• Passes through the site where the superior vena cava penetrates the pericardium to enter the heart </li></ul><ul><li>• Is the level at which the trachea bifurcates into right and left main bronchi </li></ul><ul><li>• Marks the superior limit of the pulmonary trunk </li></ul>
  13. 14. <ul><li>Arteries </li></ul><ul><li>Thoracic aorta, internal thoracic arteries, interior and posterior intercostal arteries </li></ul><ul><li>B. Nerves </li></ul><ul><li>Intercostal nerves – innervates the wall, related parietal pleura and associated skin </li></ul><ul><li>C. Dermatomes - T2-T12 </li></ul>
  14. 16. <ul><li>CHEST </li></ul>
  15. 17. <ul><li>• External to the thoracic wall and anchors the upper limb to the trunk </li></ul><ul><li>• Consists of: </li></ul><ul><li>A superficial compartment containing skin, superficial fascia and breasts </li></ul><ul><li>A deep compartment containing muscles and associated structures </li></ul>
  16. 18. <ul><li>Arterial supply </li></ul><ul><li>axillary artery branches </li></ul><ul><li>Internal thoracic artery branches </li></ul><ul><li>2 nd -4 th intercxostal arteries </li></ul><ul><li>Lymphatic drainage </li></ul><ul><li>axillary nodes </li></ul><ul><li>Venous Drainage </li></ul><ul><li>axillary, internal thoracic and intercostal veins </li></ul><ul><li>Innervation </li></ul><ul><li>Breasts -2 nd -6 th </li></ul><ul><li>intercostal nerves </li></ul><ul><li>Nipple – 4 th intercostal </li></ul><ul><li>nerve </li></ul>
  17. 19. <ul><li>MUSCLES: </li></ul><ul><li>pectoralis major </li></ul><ul><li>Pectoralis minor </li></ul><ul><li>Subclavius </li></ul><ul><li>originates from the ant. Thoracic wall and inserts into bones of the upper limb </li></ul>
  18. 20. <ul><li>CLINICAL CONDITION: </li></ul><ul><li>Breast Cancer </li></ul><ul><ul><ul><li>F > M </li></ul></ul></ul><ul><ul><ul><li>one of the most common malignancies in women </li></ul></ul></ul><ul><ul><ul><li>Develops in the cells of the acini, lactiferous ducts and lobules of the breast </li></ul></ul></ul><ul><li>Mastectomy </li></ul><ul><ul><li>surgical removal of the breast </li></ul></ul><ul><ul><li>might damage the long thoracic nerve that innervates the SA causing paralysis  Winged scapula </li></ul></ul>
  19. 21. <ul><li>HEART </li></ul>
  20. 22. <ul><li>Is a broad central partition that separates the two laterally placed pleural cavities </li></ul><ul><li>It contains: thymus gland </li></ul><ul><li>Pericardial sac </li></ul><ul><li>Heart </li></ul><ul><li>Trachea </li></ul><ul><li>Major Arteries and Veins </li></ul><ul><li>DIVISIONS: </li></ul><ul><li>1. Superior Mediastinum </li></ul><ul><li>2. Inferior Mediastinum </li></ul><ul><li>a. Anterior </li></ul><ul><li>b. Middle </li></ul><ul><li>c. Posterior </li></ul>
  21. 23. <ul><li>MIDDLE MEDIASTINUM </li></ul><ul><li>- Contains the pericardium, heart, origins of the great vessels, various nerves and smaller vessels </li></ul><ul><li>PERICARDIUM </li></ul><ul><li>- Is a fibroserous sac surrounding the heart and the roots of the great vessels </li></ul><ul><li>Consists of: </li></ul><ul><li>1. Fibrous pericardium </li></ul><ul><li>2. Serous pericardium </li></ul>
  22. 25. <ul><li>I. FIBROUS PERICARDIUM </li></ul><ul><li>- Is a tough connective tissue outer layer that defines the boundaries of the middle mediastinum </li></ul><ul><li>- Is a cone-shaped bag with its base on the diaphragm and its apex continuous with the adventitia of the great vessels </li></ul><ul><li>Attachments: </li></ul><ul><li>Base – attached to the central tendon of the </li></ul><ul><li>diaphragm and to a muscular area of the </li></ul><ul><li>diaphragm on the left side </li></ul><ul><li>Anteriorly – attached to the posterior surface of the </li></ul><ul><li>sternum by sternopericardial ligaments </li></ul><ul><li>phrenic nerves and pericardiacophrenic vessels </li></ul>
  23. 26. <ul><li>II. SEROUS PERICARDIUM </li></ul><ul><li>- Is thin and consists of: </li></ul><ul><li>A. Parietal layer </li></ul><ul><li>• Lines the inner surface of the fibrous </li></ul><ul><li>pericardium </li></ul><ul><li>B . Visceral layer </li></ul><ul><li>• Adheres to the heart and forms its outer </li></ul><ul><li>covering </li></ul><ul><li>Pericardial Cavity – a narrow space that contains a small amount of fluid between the two layers of serous pericardium allows the uninhibited movement of the heart </li></ul>
  24. 27. <ul><li>CARDIAC ORIENTATION </li></ul><ul><li>• apex of this pyramid projects forward, </li></ul><ul><li>downward and to the left </li></ul><ul><li>• base is opposite the apex and faces in </li></ul><ul><li>a posterior direction </li></ul>
  25. 28. <ul><li>• Is quadrilateral and directed posteriorly </li></ul><ul><li>• It consists of: </li></ul><ul><ul><li>The left atrium </li></ul></ul><ul><ul><li>A small portion of the right atrium </li></ul></ul><ul><ul><li>The proximal parts of the great veins (sup. And inf. Vena cava, pulmonary veins) </li></ul></ul><ul><li>Is fixed posteriorly to the pericardial wall , opposite to the bodies of T5-T8 or when standing T6-T9 </li></ul>
  26. 29. <ul><li>• Is formed by </li></ul><ul><li>the </li></ul><ul><li>inferolateral </li></ul><ul><li>part of </li></ul><ul><li>the left </li></ul><ul><li>ventricle </li></ul><ul><li>• Positioned </li></ul><ul><li>deep to </li></ul><ul><li>the left 5th </li></ul><ul><li>intercostal </li></ul><ul><li>space </li></ul>
  27. 30. <ul><li>Anterior Surface </li></ul><ul><li>• Faces anteriorly and consists mostly of the right ventricle with some of the right atrium on the right and some of the left ventricle on the left </li></ul>
  28. 31. <ul><li>Diaphragmatic Surface </li></ul><ul><li>• Faces inferiorly, rests on </li></ul><ul><li>the diaphragm </li></ul><ul><li>• Separated from the </li></ul><ul><li>base of the heart by the </li></ul><ul><li>coronary sinus and </li></ul><ul><li>extends from the base </li></ul><ul><li>to the apex of the heart </li></ul><ul><li>• Consists of the left </li></ul><ul><li>ventricle and the small </li></ul><ul><li>portion of the right </li></ul><ul><li>ventricle separated by </li></ul><ul><li>the posterior </li></ul><ul><li>interventricular groove </li></ul>
  29. 32. <ul><li>Left pulmonary surface </li></ul><ul><li>• Faces the left lung </li></ul><ul><li>• Is broad and convex and consists of </li></ul><ul><li>the left ventricle and a portion of the </li></ul><ul><li>left atrium </li></ul><ul><li>Right pulmonary surface </li></ul><ul><li>• Faces the right lung </li></ul><ul><li>• Is broad and convex, consists of the </li></ul><ul><li>right atrium </li></ul>
  30. 33. <ul><li>Right and Left margins </li></ul><ul><li>• Same as the right and left pulmonary surfaces of the </li></ul><ul><li>heart </li></ul><ul><li>Inferior margin </li></ul><ul><li>• The sharp edge between the anterior and </li></ul><ul><li>diaphragmatic surfaces of the heart </li></ul><ul><li>• Formed by the right ventricle and small portion of the </li></ul><ul><li>left ventricle near the apex </li></ul><ul><li>Obtuse margin </li></ul><ul><li>• Separates the anterior and left pulmonary surfaces </li></ul><ul><li>• It is round and extends from the left auricle to the </li></ul><ul><li>cardiac apex </li></ul><ul><li>• Formed by the left ventricle and superiorly by a small </li></ul><ul><li>portion of the left auricle </li></ul>
  31. 34. <ul><li>• Are external grooves </li></ul><ul><li>I Coronary sulcus </li></ul><ul><li> Circles the heart, separating the atria from the ventricles </li></ul><ul><li> It contains the right coronary artery, the small cardiac </li></ul><ul><li>vein, the coronary sinus, and circumflex branch of the left </li></ul><ul><li>coronary artery </li></ul><ul><li>II. Anterior and Posterior Interventricular Sulci </li></ul><ul><li> Separates the 2 ventricles </li></ul><ul><li>A. Anterior interventricular sulcus </li></ul><ul><li> Located on the anterior surface of the heart </li></ul><ul><li> Contains the anterior interventricular artery and the great </li></ul><ul><li>cardiac vein </li></ul><ul><li>B. Posterior Interventricular sulcus </li></ul><ul><li> Located on the diaphragmatic surface of the heart </li></ul><ul><li> Contains the posterior interventricular artery and the </li></ul><ul><li>middle cardiac vein </li></ul>
  32. 36. <ul><li>THANK YOU! </li></ul>