Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
THORACIC CAGE
1
View slides @ www.slideshare.net
Maj Dr Rishi Pokhrel
NAIHS
2
Learning objectives
• Thoracic inlet and outlet
• Typical intercostal space
– Boundaries and contents
– muscles
• Atypical...
4
Thorax - boundaries
5
Superior Thoracic Aperture
6
Plane of Inlet
7
45°
Suprapleural membrane/ Sibson’s fascia
8
9
Suprapleural membrane: Relations
Inf thoracic aperture-Diaphragm- ant view
10
Thoracic skeleton ant view
11
12
Thoracic skeleton post view
Typical rib
13
14
Atypical ribs
Thoracic vertebrae
15
Sternum and Joints
16
17
Layers in thoracic wall
Intercostal muscles
 External
 Internal
 Innermost
 Subcostalis
 Intercostalis intima
 Sternocostalis {transversus t...
19
Intercostal muscles
20
External and internal intercostal muscles
21
External and internal intercostal muscles
22
External and internal intercostal muscles
Subcostalis, Intercostalis intima & Sternocostalis
23
Intercostal arteries, nerves, and vein
24
Intercostal nerve
25
Intercostal nerve & its branches
26
TYPICAL INTERCOSTAL NERVE
1. Lateral cutaneous with anterior and posterior
branches.
2. Anterior cutaneous nerve with medi...
• T1 and T2 give branch to brachial plexus
• T1 has no lat or ant cutaneous branch
• T2 has lateral cutaneous (intercostob...
Intercostal Arteries
29
Intercostal arteries
30
31
Anterior
intercostal
Arteries
Absent in 10th
& 11th
space
32
Posterior
intercostal
Arteries
Intercostal veins
anterior and posterior
35
Azygos system
36
Lymphatic drainage
37
Atypical intercostal space
• Typical space: typical nerve, rib and vertebra.
• Nerve: T3 - T6
• Ribs: 3 - 9
• Vertebrae: 2...
Typical intercostal space
• 3rd
- 6th
space
39
MOVEMENTS OF RIB CAGE
40
Muscles of respiration
Inspiration
• Quiet
– Diaphragm
– External intercostal
• Forceful
– Sternocleidomastoid
– Serratus ...
Applied anatomy
42
Cervical Rib Syndrome
43
44
Gorilla rib
Shape
of
chest
45
Barrel chest
• Large ribcage, round torso
• Increase in the A-P diameter of the chest wall
• Causes
– Normal
– Acromegaly
...
47
Barrel chest
Pectus excavatum
• Commonest congenital deformity of anterior
chest wall
• Several ribs and the sternum grow
abnormally.
•...
49
Pectus
excavatum
Rachitic rosary
• Aka beading of the ribs
• Prominent knobs of bone at the costochondral
joints
• Knobs - beads under the ...
Rachitic rosary
51
Pectus carinatum
• Opposite of pectus excavatum protrusion of
the sternum and ribs
• Aka pigeon chest
• Overgrowth of cart...
Pectus carinatum
53
Applied anatomy
• Thoracotomy – incisions
• Anterolateral
• Posterolateral
• Anterior
• Notching of ribs <– obstruction of...
Pleural tap / Paracentesis thoracis
55
56
?
Upcoming SlideShare
Loading in …5
×

Thoracic cage

7,736 views

Published on

Description of thoracic cage

Published in: Health & Medicine

Thoracic cage

  1. 1. THORACIC CAGE 1 View slides @ www.slideshare.net Maj Dr Rishi Pokhrel NAIHS
  2. 2. 2
  3. 3. Learning objectives • Thoracic inlet and outlet • Typical intercostal space – Boundaries and contents – muscles • Atypical intercostal space • Muscles of respiration 3
  4. 4. 4
  5. 5. Thorax - boundaries 5
  6. 6. Superior Thoracic Aperture 6
  7. 7. Plane of Inlet 7 45°
  8. 8. Suprapleural membrane/ Sibson’s fascia 8
  9. 9. 9 Suprapleural membrane: Relations
  10. 10. Inf thoracic aperture-Diaphragm- ant view 10
  11. 11. Thoracic skeleton ant view 11
  12. 12. 12 Thoracic skeleton post view
  13. 13. Typical rib 13
  14. 14. 14 Atypical ribs
  15. 15. Thoracic vertebrae 15
  16. 16. Sternum and Joints 16
  17. 17. 17 Layers in thoracic wall
  18. 18. Intercostal muscles  External  Internal  Innermost  Subcostalis  Intercostalis intima  Sternocostalis {transversus thoracis } 18
  19. 19. 19 Intercostal muscles
  20. 20. 20 External and internal intercostal muscles
  21. 21. 21 External and internal intercostal muscles
  22. 22. 22 External and internal intercostal muscles
  23. 23. Subcostalis, Intercostalis intima & Sternocostalis 23
  24. 24. Intercostal arteries, nerves, and vein 24
  25. 25. Intercostal nerve 25
  26. 26. Intercostal nerve & its branches 26
  27. 27. TYPICAL INTERCOSTAL NERVE 1. Lateral cutaneous with anterior and posterior branches. 2. Anterior cutaneous nerve with medial and lateral cutaneous branch. 3. Lie within the intercostal space. 4. Supply structure within its space. 27
  28. 28. • T1 and T2 give branch to brachial plexus • T1 has no lat or ant cutaneous branch • T2 has lateral cutaneous (intercostobrachial) nerve but no branches • T7 to T11 cross their corresponding spaces to supply the anterior abdominal wall. • Typical : T3 to T6 28 TYPICAL INTERCOSTAL NERVE
  29. 29. Intercostal Arteries 29
  30. 30. Intercostal arteries 30
  31. 31. 31 Anterior intercostal Arteries Absent in 10th & 11th space
  32. 32. 32 Posterior intercostal Arteries
  33. 33. Intercostal veins anterior and posterior 35
  34. 34. Azygos system 36
  35. 35. Lymphatic drainage 37
  36. 36. Atypical intercostal space • Typical space: typical nerve, rib and vertebra. • Nerve: T3 - T6 • Ribs: 3 - 9 • Vertebrae: 2 - 8 38
  37. 37. Typical intercostal space • 3rd - 6th space 39
  38. 38. MOVEMENTS OF RIB CAGE 40
  39. 39. Muscles of respiration Inspiration • Quiet – Diaphragm – External intercostal • Forceful – Sternocleidomastoid – Serratus anterior – Lattisimus dorsi Expiration • Quiet – Passive recoil of diaphragm • Forceful – Rectus abdominis – Internal intercostal – Serratus posterior inferior 41
  40. 40. Applied anatomy 42
  41. 41. Cervical Rib Syndrome 43
  42. 42. 44 Gorilla rib
  43. 43. Shape of chest 45
  44. 44. Barrel chest • Large ribcage, round torso • Increase in the A-P diameter of the chest wall • Causes – Normal – Acromegaly – Emphysema – Osteoarthritis of joints of thorax 46
  45. 45. 47 Barrel chest
  46. 46. Pectus excavatum • Commonest congenital deformity of anterior chest wall • Several ribs and the sternum grow abnormally. • Caved-in or sunken appearance of the chest • Aka cobbler's chest, sunken chest, or funnel chest • Asymptomatic to severe cardiac / pulmonary symptoms 48
  47. 47. 49 Pectus excavatum
  48. 48. Rachitic rosary • Aka beading of the ribs • Prominent knobs of bone at the costochondral joints • Knobs - beads under the skin of the rib cage, • Beads of a rosary • Cause - Rickets 50
  49. 49. Rachitic rosary 51
  50. 50. Pectus carinatum • Opposite of pectus excavatum protrusion of the sternum and ribs • Aka pigeon chest • Overgrowth of cartilage causing the sternum to protrude forward • Causes • During pubertal growth in males • Congenital ? hereditary • Post- surgical i.e. median sternal thoracotomy • Turner syndrome, Marfan syndrome, Ehlers Danlos Syndrome, Morquio syndrome, Noonan syndrome, Trisomy 18, Trisomy 21, homocystinuria, osteogenesis imperfecta, multiple lentigines syndrome, Sly syndrome and Scoliosis. 52
  51. 51. Pectus carinatum 53
  52. 52. Applied anatomy • Thoracotomy – incisions • Anterolateral • Posterolateral • Anterior • Notching of ribs <– obstruction of aorta 54
  53. 53. Pleural tap / Paracentesis thoracis 55
  54. 54. 56 ?

×