The document provides a detailed overview of the topographic anatomy of the thorax, including the layers of the chest wall, specific anatomical structures such as the diaphragm, pleura, and mediastinum, as well as important nerves and blood vessels. It also discusses various surgical procedures relevant to thoracic anatomy, including thoracotomy, CABG, and techniques for draining fluid from the thoracic cavity. Additionally, the document covers the clinical implications of thoracic conditions, including infections and the importance of prompt diagnosis and treatment.

1. TOPOGRAPHIC ANATOMY OF THORAX
MARIYAM MUBASHIRA
M2255P

2. LAYERS AND SPACES OF CHEST WALL
The chest wall is composed of several layers and spaces.
Layers of the chest wall from superficial to deep are:
Skin
Subcutaneous tissue
Muscles (pectoralis major and minor, serratus anterior, intercostal muscles)
Innermost intercostal muscles
Endothoracic fascia
Parietal pleura
The spaces of the chest wall are:
The pleural cavity - the space between the visceral and parietal pleura where the lungs are located.
The intercostal spaces - the spaces between adjacent ribs where the intercostal muscles and nerves run.
The costodiaphragmatic recess - the space between the diaphragm and the lower edge of the lung.

3. LAYERS AND SPACES OF CHEST WALL

4. CLINICAL ANATOMY OF MAMMARY GLAND AND INTERCOSTAL SPACE
• The mammary gland is a specialized glandular structure that is located in the anterior chest wall. It is composed of glandular tissue,
connective tissue, and adipose tissue. The glandular tissue is responsible for producing and secreting milk during lactation, while the
adipose tissue provides structural support.
• The intercostal space is the space between adjacent ribs and is filled with intercostal muscles, nerves, and vessels. There are 11 pairs
of intercostal spaces, with the first space being located between the first and second ribs, and the 11th space between the 11th and 12th
ribs. The intercostal muscles are important for respiration, as they contract during inspiration and relaxation during expiration, and
are innervated by the intercostal nerves.

5. NERVES OF THORAX
• Phrenic nerve - originates from the cervical spine (C3-C5) and provides motor
innervation to the diaphragm, the main muscle responsible for breathing.
• Intercostal nerves - there are 11 pairs of intercostal nerves that run along the
intercostal spaces between the ribs. They provide sensory innervation to the skin
and muscles of the chest wall, and also supply the intercostal muscles.
• Vagus nerve - originates from the brainstem and travels through the neck and
thorax. It supplies the heart, lungs, and digestive organs with parasympathetic
innervation, and also provides sensory innervation to the throat and larynx.
• Sympathetic trunk - runs along either side of the spinal column and is responsible
for the sympathetic nervous system's fight-or-flight response. It provides
innervation to the blood vessels, sweat glands, and smooth muscles of the thorax.
• Thoracic splanchnic nerves - these are branches of the sympathetic trunk that
innervate the abdominal organs and glands.

6. NERVES OF THORAX

7. VESSLES OF THORAX
The thorax contains many important blood vessels that supply blood to the organs and tissues in the chest, as well as the upper limbs and
head. Some of the major vessels of the thorax include:
• Aorta - the largest artery in the body, originates from the left ventricle of the heart and runs down the thorax. It branches into many
smaller arteries that supply blood to the organs and tissues in the chest, as well as the rest of the body.
• Superior and inferior vena cava - these are the largest veins in the body, and they drain blood from the upper and lower body,
respectively, into the right atrium of the heart.
• Pulmonary arteries and veins - these vessels are responsible for carrying blood to and from the lungs for gas exchange.
• Internal thoracic artery - a branch of the subclavian artery that supplies blood to the anterior chest wall, including the mammary gland.
• Intercostal arteries and veins - these vessels run along the intercostal spaces and supply blood to the muscles and other structures in
the chest wall.
• Brachiocephalic trunk - a major artery that originates from the aorta and supplies blood to the head and upper limbs.
• Thoracic duct - the largest lymphatic vessel in the body, runs through the thorax and drains lymph from the lower body and left side of
the head and neck.

8. VESSLES OF THORAX

9. SURGICAL ANATOMY OF INTERNAL THORACIC ARTERY
The internal thoracic artery (ITA) is a branch of the subclavian artery that descends along the inside of the thoracic
cage on either side of the sternum. It is also known as the internal mammary artery (IMA) because it supplies blood
to the mammary gland and the anterior chest wall . During cardiac surgery, the ITA is often used as a graft to
bypass blocked coronary arteries. The left ITA is preferred for grafting because of its longer length and better
patency rates compared to the right ITA. To access the ITA, a small incision is made in the chest wall, and the muscle
and connective tissue are carefully dissected to expose the artery.
The bp of the pt is above 180
REFLEXOGENOUS ZONES
• Intercostal spaces- Stimulation of these muscles and nerves can elicit reflex responses, such as coughing or deep
breathing.
• Tenderness over the chest wall - Palpation of the chest wall can elicit reflex responses, such as localized pain or
tenderness.
• Nipple-areolar complex - Stimulation of the nipple-areolar complex can elicit reflex responses, such as nipple erection
or contraction of the mammary gland.
• Costal cartilages - Stimulation of these cartilages can elicit reflex responses, such as pain or discomfort.
• Pericardium -Stimulation of the pericardium can elicit reflex responses, such as palpitations or changes in heart rate.

10. SURGICAL ANATOMY OF INTERNAL THORACIC ARTERY

11. SURGICAL ANATOMY OF ANTERIOR AND POSTERIOR MEDIASTINUM
• The anterior mediastinum is the area located in front of the heart and behind the
sternum. It contains a variety of structures, including the thymus gland, lymph nodes, fat,
and blood vessels.
• The posterior mediastinum is located behind the heart and extends from the inferior
thoracic aperture (opening at the bottom of the thoracic cavity) to the diaphragm. It
contains important structures such as the thoracic aorta, esophagus, vagus nerve,
sympathetic trunk, thoracic duct, azygos vein, and hemiazygos vein.
• The middle mediastinum is the central part of the mediastinum and contains the heart,
pericardium, and main bronchi. During surgical procedures in the middle mediastinum, it
is important to protect the heart and pericardium, which are critical structures for
maintaining cardiac function.

12. SURGICAL ANATOMY OF ANTERIOR AND POSTERIOR
MEDIASTINUM

13. TOPOGRAPHIC ANATOMY OF DIAPHRAM
The diaphragm is a dome-shaped muscle that separates the thoracic and abdominal cavities. It is the primary muscle
responsible for respiration, contracting and relaxing to change the volume and pressure within the chest cavity.
DIAPHRAM HAS TREE PARTS;
The sternal part arises from the posterior surface of the xiphoid process of the sternum.
The costal part arises from the inner surface of the lower six ribs and their cartilages.
The lumbar part arises from the anterior surfaces of the upper two lumbar vertebrae and their intervertebral
discs.
The DIAPHRAGM HAS THREE OPENINGS:
The caval opening, which transmits the inferior vena cava
The esophageal opening, which transmits the esophagus and vagus nerves
The aortic opening, which transmits the aorta, thoracic duct, and azygos vein
PROJECTION OF THE DIAPHRAGM ON THE THORAX:
The diaphragm separates the thoracic and abdominal cavities, and its shape can be visualized on a chest X-ray or CT
scan. The central tendon of the diaphragm is located at the level of the T8 vertebral body, and the dome of the
diaphragm can be seen at the level of the T12 vertebral body.

14. TOPOGRAPHIC ANATOMY OF DIAPHRAM

15. TOPOGRAPHIC ANATOMY OF PLEURA
The pleura is a serous membrane that lines the inside of the thoracic cavity and
covers the lungs. It consists of two layers: the visceral pleura, which covers
the lungs, and the parietal pleura, which lines the thoracic cavity
The parietal pleura can be divided into several regions:
Cervical pleura: Covers the apex of the lung and extends into the neck.
Costal pleura: Covers the inner surface of the thoracic wall and is attached to
the ribs and intercostal muscles.
Diaphragmatic pleura: Covers the upper surface of the diaphragm.
Mediastinal pleura: Covers the lateral aspect of the mediastinum.
The left and right has the main thing tht is been periosteum of the thorax.

16. TOPOGRAPHIC ANATOMY OF PLEURA

17. Projection of the pleura on the thorax:
The pleura can be visualized on chest X-rays and CT scans. On a frontal chest
X-ray, the pleura can be seen as a thin line that follows the contours of the
lungs. The costal pleura is visible as a curved line along the inner surface of the
ribs, and the diaphragmatic pleura is visible as a horizontal line along the upper
surface of the diaphragm. The mediastinal pleura is not visible on a frontal
chest X-ray.
Simple chest xray has than been the main pain of the patient

18. TOPOGRAPHIC ANATOMY OF LUNG AND LUNG ROOT
• The lungs are surrounded by the pleura and are separated from the mediastinum by the
mediastinal pleura. The bronchi and blood vessels that supply the lungs enter and exit through the
hilum, which is located on the medial surface of each lung.
• The lung root is the area of the lung where the bronchi, pulmonary arteries, and pulmonary veins
enter and exit. It is located at the hilum of each lung and is covered by the mediastinal pleura.
• Left and lateral periosteum is the visceral pain
Projection of the lungs on the thorax:
The lungs can be visualized on chest X-rays and CT scans. On a frontal chest X-ray, the lungs can be
seen as a pair of asymmetrical, cloud-like structures that fill the thoracic cavity. The right lung is
larger and higher than the left lung, and the horizontal fissure that separates the upper and middle
lobes of the right lung can be seen as a diagonal line on the X-ray. The oblique fissure that
separates the lower lobe from the upper and middle lobes of both lungs can also be seen on a
frontal chest X-ray.

19. TOPOGRAPHIC ANATOMY OF LUNG AND LUNG ROOT

20. Projection of the lungs on the thorax

21. ARGUMENTATION OF PUS SPREADING IN THORAX
Pus spreading in the thorax can occur due to several reasons, including infections such as pneumonia, lung abscess, empyema, and
tuberculosis. the argumentation for pus spreading in the thorax can be based on several factors:
• Anatomy of the respiratory system: The respiratory system is complex and interconnected, with many pathways for the spread
of infection. For example, the bronchial tree branches out into smaller and smaller airways, providing ample opportunity for
pathogens to travel deep into the lungs.
• Immune system response: The immune system response to infection can also contribute to the spread of pus in the thorax. When
the body detects an infection, it sends white blood cells to the area to fight off the pathogen.
• Delayed diagnosis and treatment: In some cases, pus spreading in the thorax can occur due to delayed diagnosis and treatment. If
an infection is not diagnosed and treated promptly, it can continue to spread and cause more damage to the lung tissue.
• Underlying health conditions: Underlying health conditions such as chronic obstructive pulmonary disease (COPD), cystic fibrosis,
and immune system disorders can increase the risk of infections and make it more difficult for the body to fight off pathogens
In conclusion, It is important to diagnose and treat infections promptly to prevent the spread of pus and minimize the risk of
complications.

22. BASIC SURGICAL OPERATION ON ORGANS OF THORACIC CAVITY
The organs of the thoracic cavity include the heart, lungs, esophagus, and
trachea. There are several surgical operations that can be performed on these
organs, depending on the specific condition or disease.
• Thoracotomy.
• Coronary artery bypass grafting (CABG)
• Heart valve repair or replacement
• Lung transplant
• Esophagectomy.
• Tracheostomy

23. THORACOTOMY
Thoracotomy: This is a surgical procedure that involves making an incision in the chest wall to access the
organs of the thoracic cavity. It is commonly used for procedures such as lung resection, lobectomy, and
pneumonectomy. The main thing that is seen is in the axillary cavity has been offen been erected and also
been the main thing of the criteria.the last part has been the thorax and it is injecting of the labectalol and
also the butric and pyruvic acid

24. CABG
Coronary artery bypass grafting (CABG): This is a surgical procedure that involves rerouting
blood around blocked or narrowed arteries to improve blood flow to the heart. It is typically
performed on patients with coronary artery disease.so the patient came with an abdominal
lesion pain and also has cardiac infarction and low flow of hemmorage and the patient used
the pyruvic acid and also caused the poison and artery bypass also has been detected by
the patients history and this the main yellow jaundice which also seen in children under 2 to
7 years old

25. ESOPHAGECTOMY
Esophagectomy: This is a surgical procedure that involves removing a portion of the
esophagus. It is commonly used to treat conditions such as esophageal cancer or Barrett's
esophagus.this is seen in patient that suffer from the hemmoragic infarction and also the
main thing is the thoractonomoconics that also known as thoracic fever /thoracocentesis.
So the patients history shows a variety of eryrocytic influence in plasmic condition and this
cause thee ecg to be abnormal r is greater than p.

26. HEART VALVE REPAIR OR REPLACEMENT
Heart valve repair or replacement: This surgical procedure involves repairing or replacing
damaged heart valves. It is commonly used to treat conditions such as aortic stenosis,
mitral valve regurgitation, and mitral valve stenosis. The valve may be repaired using a ring
to support the damaged valve, or the entire valve may be removed and replaced by an
artificial valve.

27. TRACHEOSTOMY
Tracheostomy: This is a surgical procedure that involves creating a hole in the front of the
neck and inserting a tube into the trachea to help the patient breathe. It is typically used in
patients with severe respiratory distress or who require long-term mechanical
ventilation.drugs like doperidol and removal of cutaneous and epidermis of the skin.

28. INCISIONS MADE IN CASE OF MASTITIS
Mastitis of the thorax, also known as chest wall abscess, is a rare condition that can occur due to bacterial
infection of the breast tissue or underlying chest muscles. Treatment for mastitis of the thorax typically
involves a combination of antibiotics and drainage of the abscess. In cases where the abscess is large or
has not responded to antibiotics, an incision may be required to drain the pus and relieve pressure on the
surrounding tissues. The incision is typically made over the abscess and can be either left open or closed
with sutures depending on the size and location of the abscess.
The breast has a huge lump causing the pain in the mamilla and maxilla of breast.has you already know that

29. INTERCOSTAL BLOCK
An intercostal block is a type of regional anesthesia that involves the injection of local anesthetic into the
nerves that run along the ribs in the thorax (chest) area. The purpose of an intercostal block is to provide
pain relief for surgical procedures or for conditions that cause pain in the chest wall or abdomen.
During an intercostal block, the patient is typically positioned on their side, and the skin over the injection
site is cleaned with an antiseptic solution. A small needle is then inserted into the space between two ribs,
and the local anesthetic is injected into the nerves in that area. Drugs like haloperidol doperidol are used.

30. RATIONAL SURGICAL ACCESSES ON THORACIC CAVITY
There are several rational surgical accesses to the thoracic cavity,
depending on the location and extent of the pathology or injury being
treated. The most common approaches include:
•Median sternotomy
•Thoracotomy
•Video-assisted thoracoscopic surgery (VATS
•Robotic-assisted thoracic surgery.

31. MEDIAN STERNOTOMY
Median sternotomy: This is a vertical incision made through the sternum (breastbone) to
access the heart and major blood vessels of the chest.the blockage of theleft and and right
artery and aortic stenotic valve is the main cause of the disease we usually use giggle saw
and pean forceps for this thing .

32. VATS
Video-assisted thoracoscopic surgery (VATS): This is a minimally invasive approach that uses small
incisions and a camera to visualize the inside of the chest cavity. This approach is often used for
procedures such as lung biopsies, pleural effusion drainage, or removal of small lung tumors.
If there is a slight increase of the morphine it causes psychotic disorders and also the thing that is also
known as git

33. ROBOTIC-ASSISTED THORACIC SURGERY
Robotic-assisted thoracic surgery: This is a newer technique that uses a robotic system to
perform minimally invasive procedures on the thoracic cavity. The surgeon controls the
robot from a console, which provides a 3D view of the surgical site and greater precision in
manipulating surgical instruments.

34. THORACOCENTESIS AND PERICARDIOCENTESIS
• Thoracentesis and pericardiocentesis are medical procedures used to drain fluid from the chest and
pericardial cavity, respectively.
• Thoracentesis is a procedure used to remove excess fluid or air from the pleural cavity, which is the
space between the lungs and chest wall. The procedure involves inserting a needle or catheter through
the chest wall and into the pleural space to drain the fluid or air. Thoracentesis can be performed as a
diagnostic procedure to determine the cause of the fluid buildup, or as a therapeutic procedure to
relieve symptoms such as shortness of breath.

35. PERICARDIOCENTESIS
Pericardiocentesis is a procedure used to remove excess fluid or blood from the pericardial
cavity, which is the space surrounding the heart. The procedure involves inserting a needle
or catheter through the chest wall and into the pericardial space to drain the fluid or blood.
Pericardiocentesis is usually performed as a therapeutic procedure to relieve symptoms
such as chest pain, shortness of breath, or low blood pressure.

36. SURGICAL TREATMENT OF PENETRATING AND NON-PENETRATIN THORACIC WOUND
The surgical treatment of penetrating and non-penetrating thoracic wounds depends on the
location, extent, and severity of the injury.
• Penetrating thoracic wounds, such as those caused by gunshot or stab wounds, typically
require immediate surgical intervention. The primary goals of surgery are to control
bleeding, repair damaged tissues, and prevent or treat any associated injuries, such as
lung contusions or lacerations. Depending on the location and extent of the injury, surgical
approaches may include thoracotomy, video-assisted thoracoscopic surgery (VATS), or
robot-assisted thoracic surgery.
• Non-penetrating thoracic injuries, such as those caused by blunt trauma or motor vehicle
accidents, may also require surgical intervention in severe cases. The type of surgery will
depend on the specific injury, but may include procedures such as rib fixation or repair,
lung resection repair, or pericardial repair.

37. SURGICAL TREATMENT OF PENETRATING AND NON-PENETRATIN THORACIC WOUND

38. PUNCTURE OF SUBCLAVIAN VEIN
Puncture of the subclavian vein in the thorax is a medical procedure used to access the central venous circulation through
the subclavian vein, which is located beneath the collarbone in the thorax. Once the location of the subclavian vein is
identified, a needle or catheter is inserted through the skin and into the vein. The healthcare provider will advance the
needle or catheter carefully to ensure that it enters the vein and not any surrounding structures. Once the needle or
catheter is properly positioned, it can be used to deliver medication, nutrition, or fluids directly into the bloodstream or for
other diagnostic or therapeutic purposes.

39. THORACOTOMY AND SUBPERIOSTAL RESECTION OF THE RIB
Thoracotomy and subperiosteal resection of the rib are surgical procedures that involve the
removal of one or more ribs to access the chest cavity and treat certain conditions.
• Thoracotomy is a surgical procedure that involves making an incision between the ribs to
access the chest cavity. The incision can be made either anteriorly (through the front of the
chest), laterally (through the side of the chest), or posteriorly (through the back of the
chest). Thoracotomy may be performed to treat conditions such as lung cancer, pleural
effusion, or empyema (a collection of pus in the pleural cavity).
• Subperiosteal resection of the rib is a surgical procedure that involves the removal of a
portion of the rib without damaging the underlying lung tissue. The procedure is often
performed to treat conditions such as rib fractures or tumors involving the chest wall.
During the procedure, the surgeon makes an incision over the affected rib and carefully
separates the muscle and periosteum (the tissue that covers the bone) to access the rib. The
rib is then removed using surgical instruments, and the periosteum and muscle are repaired.

40. THORACOTOMY AND SUBPERIOSTAL RESECTION OF THE
RIB

41. EMERGENCY PRINCIPLES OF SURGICAL TREATMENT ON THE CHEST WALL – PLASTY
(CLOSING) OF THE OPEN PNEUMOTHORAX.
An open pneumothorax, also known as a "sucking chest wound," is a potentially life-threatening injury that occurs when a hole in the chest
wall allows air to enter the pleural space, causing the lung to collapse. Emergency principles of surgical treatment on the chest wall may
include plasty or closing of the open pneumothorax.
The primary goal of treating an open pneumothorax is to restore negative pressure in the pleural space and prevent further air from
entering. One emergency surgical treatment option is to perform a chest wall plasty or closure of the open wound.

42. SURGICAL PECULIARITIES IN CHILDREN.
surgical peculiarities in children include:
• Smaller size: Children are smaller in size than adults, which can make surgical
access and manipulation more challenging.
• Different anatomy: The anatomy of children's organs and tissues is different from
that of adults, and they have developing structures that need to be considered.
• Risks of general anesthesia: Children are more susceptible to the risks associated
with general anesthesia, such as respiratory complications, postoperative nausea
and vomiting, and delayed recovery.
• Unique pathologies: Children may have different types of conditions than adults,
such as congenital anomalies, tumors, and infections
• Growth and development: Surgery in children may affect their future growth and
development, particularly in the case of surgical procedures that involve the
chest wall or spine.

43. NOTIONS OF SURGICAL INTERVENTIONS ON THE HEART.
Surgical interventions on the heart are performed to treat various cardiovascular
diseases and conditions:
• Coronary artery bypass grafting (CABG)
• Heart valve replacement or repair
• Aneurysm repair
• Heart transplant
• Ventricular assist device (VAD)
• Transcatheter aortic valve replacement (TAVR)
• Atrial fibrillation surgery: This surgical procedure is used to treat atrial fibrillation,
which is an irregular heartbeat. The procedure involves creating scar tissue in the
upper chambers of the heart to block the electrical signals causing the irregular
heartbeat. [https://youtu.be/IrY_EuL4CVk]

44. TAVR
Transcatheter aortic valve replacement (TAVR): This is a minimally invasive
procedure used to treat aortic stenosis, where a new valve is implanted inside the
diseased valve through a small incision.

45. ANEURYSM REPAIR
Aneurysm repair: An aneurysm is a bulge in the blood vessel caused by weakening of the
wall. Surgical repair involves replacing the weakened section of the blood vessel with a
graft.

46. VAD
Ventricular assist device (VAD): A VAD is a mechanical pump implanted in the chest that helps
the weakened heart to pump blood. This device may be used as a bridge to transplant or as a
long-term treatment for heart failure.

47. THANK
YOU