In this pppt I have described surgical anatomy of chest wall, lungs and mediastinum. This will be useful to medical students, surgical residents and surgons

1. Anatomy of Chest wall,Lungs and
Mediastinum
Dr R S Dhaliwal
MBBS,MS,DNB(Surgery),M.Ch,DNB(CTVSurgery),
FACS,FCCP,FICA,FNCCP,FIACS
Prof. of CTV Surgery, UCMS
Former, Prof & HOD, CTV Surgery,
PGIMER,Chandigarh

2. Chest wall
• The thorax is upper part of trunk bounded by 12
ribs, vertebrae and sternum.It contains trachea ,
two lungs , heart and great vessels, esophagus
and lymph nodes.
• There are two thoracic apertures or openings .
Superior thoracic aperture also called as thoracic
inlet and inferior thoracic aperture . Head and
neck and upper limbs communicate with thoracic
cavity through thoracic inlet .It is bounded by
body of first thoracic vertebra, Inferior thoracic
aperture opens into peritoneal cavity

3. Thoracic Inlet (Superior aperture )

4. Inferior thoracic aperture
The posterior aspect of the thorax. (Inferior thoracic aperture
visible at bottom.)
Latin apertura thoracis inferior
[

5. Chest wall
• Skelton- The bony framework is bounded by the 12 thoracic
vertebrae postly, from which 12 sets of bony ribs articulate
and curve around, connecting with the manubrium, sternum,
and costal cartilage anteriorly
• The central anterior chest is defined by the sternum, which
consists of 3 separate bones , manubrium first,then sternal
body, and then xiphoid process. These are flat polygonal
bones .The manubrium is located at the level of the T3 and
T4 vertebra and is widest and thickest of 3 sternal bones. A
palpable landmark on manubrium is jugular or suprasternal
notch, which is bounded on either side by the medial ends
of the clavicles. The sterno manubrial junction(Angle of
Louis ) is projected . The body of sternum is located at the
level of T5-T9 vertebrae. The xiphoid process is the smallest
and thinnest bone. It often has a point, it can be blunt, bifid,
or curved. The xiphoid is cartilaginous in younger people but
is nearly ossified by age 40.

6. Chest wall
• The first 7 ribs, called true ribs, are attached to the sternum
and manubrium directly. The 8th-10th ribs called False ribs
are attached via the costal cartilages, while the 11th and
12th ribs remain unattached anteriorly. The 8th-10th ribs are
known as false ribs because they lack direct attachment to
the sternum, and the 11th-12th are referred to as floating
ribs. Posteriorly, the ribs articulate with costal facets of 2
adjacent vertebrae. An articular capsule surrounds the head
of each rib, which is secured by attachments of the radiate
ligament. Each rib also articulates with the transverse
process of its adjacent vertebrae through a costotransverse
joint. The bony ribs then curve around anteriorly, where the
next major junction is the costochondral joint.

7. Chest wall- bones

8. Chest wall
• There are hyaline cartilage joints, and the rib and
cartilage are firmly attached through the
continuity of overlying periosteum and
perichondrium. The ribs/costal cartilages have
various attachments to the sternum. The first
pair of ribs articulates through cartilaginous
joints or synchondroses and is relatively
immobile. The second through seventh pairs of
costal cartilages articulate with the sternum at
synovial joints that move during respiration.
These articular capsules are reinforced by
sternocostal ligaments. This bony architecture
provides attachments for muscles to the neck,
thorax, upper limbs, abdomen, and back.

9. Chest wall -anterior

10. Chest wall posterior

11. Chest wall -Muscles
• Muscles -
1.Intercostals
2. Pectoralis major/minor
3. Serratus anterior
4 Rectus abdominis
5. External & Internal oblique
6 Transversus thoracis and abdominis

12. Chest wall Muscles

13. Chest wall muscles

14. Pleura
• The pleural cavity is the potential space between the two pleura (visceral
and parietal) of the lungs. The pleura is a serous membrane which folds
back onto itself to form a two-layered membrane structure. The thin
space between the two pleural layers is known as the pleural cavity and
normally contains a small amount of pleural fluid. The outer pleura
(parietal pleura) is attached to the chest wall. The inner pleura (visceral
pleura) covers the lungs and adjoining structures, via blood vessels,
bronchi and nerves.
• The parietal pleura is highly sensitive to pain, while the visceral pleura is
not, due to its lack of sensory innervation
• In humans, there is no anatomical connection between the left and right
pleural cavities. Therefore, in cases of pneumothorax, the other lung will
still function normally unless there is a tension pneumothorax or
simultaneous bilateral pneumothorax, which may collapse the
contralateral parenchyma, blood vessels and bronchi.
• The pleural cavity, with its associated pleurae, aids optimal functioning
of the lungs during respiration. The pleural cavity also contains pleural
fluid, which allows the pleurae to slide effortlessly against each other
during ventilation. Surface tension of the pleural fluid also leads to close
apposition of the lung surfaces with the chest wall.

15. Pleurae

16. Pleura - anatomy

17. Arteries of Thorax

18. Lungs
• Two lungs – Right and
Left .Right bigger in size
• -3 Lobes in right lung –
Upper, Middle, Lower
.2 Lobes in left lung
- Upper and Lower
Upper divided into
Upper and Lingula

19. Lungs - lobes

20. Lungs
• Bronchopulmonary segments – Total 18
RT lung having 10 segments-
Upper Lobe -Apical ,Anterior and Posterior
Middle lobe – Medial and Lateral
Lower Lobe - Superior, Medial ,Anterior and
Posterior basal
• Left lung – 8 bronchopulmonary segments
Upper Lobe- Apico Posterior Anterior ,
Lingula - Superior, Inferior
Lower lobe – Superior, Anteromedial basal
Lateral and Posterior basal

21. Lung segments

22. Lung segments

23. Lung Hilum

24. Mediastinum
• It is space in thorax located between thoracic
inlet superiorly, inferiorly by diaphragm, antly by
sternum , postly by spine and laterally by pleural
spaces
• Classically it is divided into four compartments
superior,anterior,middle and posterior. Another
popular division is into three parts –
Anterosuperior, middle and posterior
• Shields classified into three compartments-
Anterior, Middle or visceral and Posterior or para
ventral sulcus

25. Mediastinum

26. Subdivision of mediastinum as seen on cross section
• anterior mediastinum
(1)
• middle mediastinum
(2)
• posterior mediastinum
(3)

27. Boundaries Of Mediatinum
• Anterior - sternum
• Posterior - Vertebral Column
• Superior - Thoracic inlet
• Inferior - Diaphragm
• ** Mediastinum is connected to neck &
retroperitoneum allowing spread of air &
infection

28. Mediastinum

29. Mediastinum

30. Divisions of mediastinum
• Anterior mediastinum
thymus, fat, lymphatics
• Posterior mediastinum
– descending aorta,
esophagus,
- azygos veins, autonomics,
thoracic duct
• Middle mediastinum
– heart, pericardium, aorta,
trachea,
- main bronchi, lymph nodes

31. Mediastinal contents
• Anterior Superior Mediast
• Thymus Gland
• Aortic Arch
• SVC Superior Vena Cava
• Lymph Node
• Parathyroid Gland
• Ectopic Thyroid Tissue
• Posterior Mediastinum
• Esophagus
• Vagus nerves
• Sympathetic Chain
• Thoracic duct
• Thoracic desending aorta
• Middle Mediastinum
• Pericardium
• Heart
• Great Vessels
• Trachea
• Trachea Bifurcation
• Main Bronchi
• Phrenic Nerves
• Hilar Lymph Nodes
• Azygos vein
• Hemiazygosvein
• Paravertebral Lymphnodes

32. Mediastinal Structures

33. Influencing the
life styles even
after 2500
years
Thank you