The thorax contains the heart, lungs and major blood vessels. It is divided into three compartments - the two pleural cavities containing the lungs and the mediastinum between the lungs containing the heart, trachea and esophagus. The thoracic wall is made up of the vertebrae posteriorly, ribs laterally, and sternum anteriorly. The lungs are further divided into lobes and segments and are supplied by the bronchial tree which is innervated by the pulmonary plexus. Lymph from the lungs drains to tracheobronchial and mediastinal nodes.

1. The thorax is an irregularly shaped cylinder
thoracic cavity subdivided into three major
compartments:
 a left and a right pleural cavity
 Mediastinum
Functions
Breathing
Protection of vital organs
Conduit

2. Thoracic wall
 Posteriorly twelve thoracic vertebrae
and intervertebral discs
 Laterally, the wall is formed by ribs
 Anteriorly, the wall is made up of
the sternum

3. Superior thoracic aperture
 posteriorly body of TI
 Laterally medial margin of rib I
 anteriorly manubrium.
intervertebral disc
between vertebrae
TII -TIII.
The superior margin
of the manubrium is

4. Inferior thoracic aperture
■ posteriorly body of vertebra TXII
■posterolateraly rib XII and the distal end of
rib XI
■ antrolaterally costal margine distal
cartilaginous ends of ribs VII to X
■ anteriorly xiphoid process.
 Covered by diaphragm
 Right dome
level rib V
 Left dome
Xiphosternal
joint
TIX and TX

7. Mediastinum
 Superior
 Inferior
Anterior/middle/posterior

8. Vertebral level TIV/V
 position of rib II as a reference for
counting ribs
 superior limit of the pericardium
 where the arch of the aorta begins and
ends
 superior vena cava penetrates the
pericardium
 trachea bifurcates into right and left
main bronchi
 superior limit of the pulmonary trunk.

10. RELATIONSHIP TO OTHER REGIONS
Neck
pleural cavity extends approximately 2 to 3
cm above rib I trachea , esophagus, ..
Upper limb
axilla
Abdomen
 Caval opening
 Esophageal hiatus
 Aortic hiatus

12.  T1 innervate upper limb
 T2 Highest thoracic dermatome
 T6 level of xiphoid process

17. Blood supply
 Medially: internal thoracic, 2-4th
intercostal
 Laterally: superior thoracic,
thoracoacromial, subscapular

19. Brest cancer
develops in :
 cells of the acini
 lactiferous ducts
 lobules of the breast
 peau d’orange
 cancer en cuirasse
 long thoracic injury =winged scapula

21. Sternum
Manuberium
 Jugular notch
 Articular facet for clavicle and ribs
Body
 Articular facet for ribs 2-7
Xiphoid process
 Articular facet for rib 7

23. Ribs
Proximal end
 Head
 Neck
 Costal tubercle
Body
 Internal and external surface
 Superior and inferior border
 Costal groove
 Costal tubercle
Distal end
Costal cartilage

24. Typical ribs
Rib 2-9
Atypical ribs
Rib 1,10,11,12

29. Cervical ribs
present in approximately 1% of the
population.
 barticulating with vertebra CVII
 Cervical band
thoracic outlet syndrome:
 Abnormal compression of the
brachial plexus
 flail chest

32. Intercostal nerve
 Collateral branch
 Lateral cutaneous
 Anterior cutaneous

34. Thoracic blood
supply
Anterior
wall
1 -6 ant. Intercostal
artery
Internal thoracic
artery
7-10 ant. Intercostal
artery
Musculuphernic
artery
Posterior
wall
1-2 pos. intercostar
artery
Supreme
intercostal artery
3-12 pos. intercostal
artery Thoracic aorta

37. Posterior intercostal artery
 Collateral
 Lateral cutaneous
Anterior intercostal artery
 Perforating
 collateral

40. Lymph drainage
Parasternal node
Bronchomediastinal trunk
Diaphragmatic node
Parasternal node
Prevertebral node
Juxta-esophageal node
Intercostal node
Sup: Bronchomediastinal trunk
Inf: thoracic duct

41. chest tube insertion
 between the anterior axillary and
midaxillary lines
 in either the fourth or fifth intercostal
space
 positioning the tube on the
superior border of a rib or at the lowest
position in the intercostal space

44. Diaphragm blood supply:
 Pericardiophernic
 Musculophernic
 Superior phrenic
 Inferior phernic
Vein drainage:
Brachiocephalic
Azygous system
Left Renal vein
IVC
Innervation : phrenic nerve

45. pleura
 visceral pleura
 parietal pleura
 costal part
 diaphragmatic part
 mediastinal part
 Cervical pleura or dome
 suprapleural membrane
Laterally: medial margin rib 1
Medially: transvers process C7
 Root of lung: T5-T7

46. Innervation
 Visceral pleura
Visceral afferent
 Parietal pleura
Intercostal nerve (somatic afferent)
pain would be felt in relation to the
thoracic wall
Phrenic nerve
Pain from these areas would refer lateral neck
and the supraclavicular region of the
shoulder

47. Pleural recesses
 Costomediastinal recesses
 Costodiaphragmatic recesses

49. lung
Base
Apex
Surface
 Costal surface
 Mediastinal surface(hilum)
Border
 Anterior/ Posterior/ Inferior

50.  Hilum
■ a pulmonary artery,
■ two pulmonary veins,
■ a main bronchus,
■ bronchial vessels,
■ nerves, and lymphatics.

51. Right lung
Oblique fissure
Posteriorly: spinous process T4
Laterally: 5intercostal space
Anteriorly: rib 6
Transvers fissure
Anteriorly: 4th intercostal space
Pos: cross with oblique fissure in 5th rib

52. Right lung adjacent
■ heart
■ inferior vena cava,
■ superior vena cava,
■ azygos vein, and
■ esophagus.

53. Left lung
Oblique fissure
 Posteriorly: spinous process T3/T4
 Laterally: 5TH intercostal space
 Anteriorly: rib 6

54. Left lung adjacent
■ heart,
■ aortic arch,
■ thoracic aorta, and
■ esophagus.

57. Bronchopulmonary segments
 functionally independent region
 Removable without affecting adjacent
regions

60. pulmonary plexus
anterior pulmonary plexus
posterior pulmonary plexus
Include
sympathetic trunks
vagus nerves
Function
 the vagus nerves constrict the bronchioles
 the sympathetic system dilates the
bronchioles

61.  Lymphatic drainage
Superficial
deep lymph tracheobronchial nodes
Superficial
lymph
deep
lymph
Tracheobronchial
node
bronchomediastinal
trunks
Pos.mediastinum