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Thorax Anatomy

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Learn the anatomy of the thorax in one hour!

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Thorax Anatomy

  1. 1. THORAX ANATOMAY OF Dr. Rajith Eranga www.rermedapps.com
  2. 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. 3. THORACIC WALL Bones Sternum, 24 Ribs, 12 Thoracic vertebrae Muscles a. Intrinsic Muscles Intercostals, Subcostals, Transverse Thoracis a. Extrinsic Muscles Pectoralis Major & Minor, Serratus anterior, Subclavius
  4. 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. 5. STERNUM – Vertebral Levels 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. 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. 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. 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. 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. 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. 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. 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. 13. DIAPHRAGM – Basic Anatomy 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. 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. 15. PLEURA – Basic Anatomy Components • Parietal Pleura • Cervical • Costal • Diaphragmatic • Mediastinal • Visceral Pleura Surface Marking (Read)
  16. 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. 17. PLEURA - Pleural Recesses 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. 18. LUNGS - Basic Anatomy 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. 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. 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. 21. LUNGS – Lymphatic Drainage 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. 22. LUNGS – Bronchopulmonary Segments 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. 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. 24. MEDIASTINUM - Divisions • Superior Mediastinum • Inferior Mediastinum a. Anterior Mediastinum b. Middle Mediastinum c. Posterior Mediastinum
  25. 25. PERICARDIUM Layers of Pericardium Fibrous Pericardium 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. 26. PERICARDIUM Recesses • Transverse Sinus • Oblique Sinus Functions • Fixes the heart • Prevents overfilling • Lubrication • Protection from infections
  27. 27. PERICARDIUM Blood Supply • Pericardiophrenic artery • Internal thoracic artery • Musculophrenic artery • Thoracic Aorta Innervation Phrenic nerve (C3,4,5)
  28. 28. CHAMBERS OF HEART Right Atrium 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. 29. CHAMBERS OF HEART Right Ventricle 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. 30. CHAMBERS OF HEART Left Atrium Inflow – 4 Pulmonary veins Outflow – Mitral valve Cavity Two compartments • Posterior – Smooth (sinus venousus) • Anterior – Rough (true atrium) – Pectinate muscles
  31. 31. CHAMBERS OF HEART Left Ventricle Inflow – Mitral valve Outflow – Aorta Cavity - two compartments • Smooth part (near aortic vestibule) • Rough part – trabecular carniae Thickest Myocardium
  32. 32. HEART – Atrioventricular Valves 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. 33. HEART – Atrioventricular Valves 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. 34. HEART - Semilunar Valves 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. 35. HEART – Arterial Supply 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. 36. HEART – Venous Drainage 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. 37. OESOPHAGUS – Basic Anatomy • 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. 38. 1. Adventitia 2. Muscularis Propria (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. 39. THORACIC DUCT Drain lymph from 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. 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. 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. 42. THANK YOU  END OF THE LECTURE

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