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Surface Anatomy Thorax

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Surface Anatomy Thorax

  1. 1. Surface anatomy cardio respiratory system IVC- approx 20cm runningdownon righthandside of vertebral column. Sternal angle Suprasternal/JugularNotch Apex of the Heart- 5thintercostal inthe mid-clavicularline SVC 2-3cm RHSof midline Underneathcostal cartilage AortaBifuricatesatL4- justbelowumbilicus Trachearunsverticallydownmidlinefromlarynx (C3-C6) tothe sternal angle (secondcostal cartilage or T4) where itdividesintothe leftandrightmainbronchi. LeftUpperLobe LeftLowerLobe RightLowerLobe RightMiddle Lobe LeftOblique Fissure RightHorizontal Fissure RightUpperLobe The Thorax -BonyCage formedby12 thoracic vertebrae. -Upper7 pairsof ribs articulate anteriorlydirectlywiththe sternumviacostal cartilages. -The 7thrib articulateswiththe sternumandxiphisternum -The costal cartilage of ribs8, 9 and10 articulate withthe ribabove.I.e.10 with9, 9 with8, 8 with7. -The 10th rib,costal cartilage andxiphisternumformthe lowercostal margin. -the 11thand 12th ribsare knownas 'floatingribs'astheyhave no cartilage or bone anteriorly. -The sternal angle (angle of louis) marksthe secondcostal cartilage'sjunctionwiththe sternum. IntercostalSpaces InnermostIntercostal Muscle -The Skin,parietal pleuraandmuscle betweenribsare innervatedbythe intercostal nerves, whichcome off the corresponding thoracicvertebra. -The internal thoracicartery(mammaryartery) onthe anteriorchestwall,branchingfromthe subclaviandescendsverticallyd ownwardslying1cmlaterallytothe sternumbilaterally-thisandit'sbranchthe musculophrenicarterysupplythe anterioraspectof the chestandthe anteriorintercostal arteries. -The posteriorintercostal arteriesare derivedmostlyfromthe descendingthoracicaorta. -There are sitesof anastomosesbetweenthe anteriorandposteriorintercostal arteriesallowingforcollateral circulationin case of obstructiontobloodflowinthe aortadistallytothe originof the subclavianarteries. CardiacNotch Rib External Intercostal Muscle Internal Intercostal Muscle Vein Intercostal Artery Intercostal Nerve Whendoingpleuralaspirationsora percutaneouspneumothorax decompression,insert Needlesuperiortothe rib (Lowerhalf of intercostalspace abovetherib) toavoidneurovascular bundle,whichif hit can causepainandneuritis or bleedinginto thepleural cavity(haemothorax). Lungsand Pleura Right -Lungdividedintothree lobes,Upper,MiddleandLower. -Lunghastwofissures,the oblique andhorizontal. -The horizontal fissurefollowsthe 4thribaroundfromT4 to the articulationof the 4thrib and the sternum -The oblique fissure startsposteriorlyatT2and anteriorlycomestothe 6th ribin the midclavicularline. -Middle lobe onlyausclatedanteriorlyandlaterally. -The Pleurasharesanapex withthe lungabout3cm above the medial partof the clavicle,thenposteriorlydescendingdirectly downtoT12.Anteriorly,the pleuradescendsbehindthe SurfaceAnatomy of the Thorax 13 March 2011 16:57 IMMS Page 1
  2. 2. -The Pleurasharesanapex withthe lungabout3cm above the medial partof the clavicle,thenposteriorlydescendingdirectly downtoT12.Anteriorly,the pleuradescendsbehindthe sternoclavicularjointtowardsthe midlineatthe sternal angle.Fromthere itdescendsverticallydownwardstothe level of the sixthcostal cartilage.The pleurathenmakesitswaylaterally crossingthe 8thrib inthe midclavicularline,the 10th ribin the mid-axillaryline andthentoT12 posteriorly. Left -TwoLobes,UpperandLower -One,obliquefissure (T2-->5/6thrib) -Aorta'imprint'onmediastinal surface -CardiacNotch -PleuraIdenticaltothe right,howeverfromthe sternal angle there isadeviationlaterallyforthe mediastinumandheart.O therwise almostidentical. Pleura -Consistsof acontinuouslayerof tissue,hasaparietal (outwards) surfaceandavisceral(nexttothe lung) surface. -Thereis a potentialspacebetweenthe twosurfaces,withpleuralfluid secretedby mesothelialcells in the spaceto lubrica te andfacilitate movement. -Pleuraconsistsof;anouterlayerof mesothelium,anarrowzoneof loose,fibrocollangenoustissue,anirregularelasticlay er, aninterstitial layer of loosefibrocollagenousstroma(supportive framework) andanilldefinedinternalelastic layerwith shortelastic fibres. IMMS Page 2

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