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    Thorax PDF

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    Panda Mimi
    The document provides an overview of the thoracic wall, including its components, functions, apertures, bones, joints, neurovascular and lymphatic structures. It discusses the skin, fascia, muscles, ribs, sternum, vertebrae and their articulations. It describes the apertures bounded by specific bones. It details the contents and structures passing through the intercostal spaces and diaphragm. The lymphatic drainage pathways and major blood vessels, nerves and muscles are summarized.

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    Thorax PDF

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    32 views33 pages
    The document provides an overview of the thoracic wall, including its components, functions, apertures, bones, joints, neurovascular and lymphatic structures. It discusses the skin, fascia, muscles, ribs, sternum, vertebrae and their articulations. It describes the apertures bounded by specific bones. It details the contents and structures passing through the intercostal spaces and diaphragm. The lymphatic drainage pathways and major blood vessels, nerves and muscles are summarized.

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    The document provides an overview of the thoracic wall, including its components, functions, apertures, bones, joints, neurovascular and lymphatic structures. It discusses the skin, fascia, muscles, ribs, sternum, vertebrae and their articulations. It describes the apertures bounded by specific bones. It details the contents and structures passing through the intercostal spaces and diaphragm. The lymphatic drainage pathways and major blood vessels, nerves and muscles are summarized.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    32 views33 pages

    Thorax PDF

    Uploaded by

    Panda Mimi
    The document provides an overview of the thoracic wall, including its components, functions, apertures, bones, joints, neurovascular and lymphatic structures. It discusses the skin, fascia, muscles, ribs, sternum, vertebrae and their articulations. It describes the apertures bounded by specific bones. It details the contents and structures passing through the intercostal spaces and diaphragm. The lymphatic drainage pathways and major blood vessels, nerves and muscles are summarized.

    Copyright:

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    of 33

    NORTHERN MINDANAO MEDICAL CENTER

    DEPARTMENT OF SURGERY
    “Towards Excellence in Patient Care and Safety”

    THORAX

    CLAIRE D. MESO MD., DPBS


    CONTENT
    • COMPONENTS OF THORACIC WALL
    • FUNCTIONS OF THE THORACIC WALL
    • APERTURES
    • BONES, JOINTS, INTERCOSTAL SPACES
    • NEUROVASCULAR STRUCTURES
    • LYMPHATIC STRUCTURES
    • MUSCLES
    COMPONENTS OF THE THORACIC
    WALL
    • Skin, Superficial and Deep Fascia, and Breast*
    • Muscles
    – Back Muscles*
    – Pectoral Muscles*
    – Thoracic Wall Muscles
    • Bones
    – Thoracic Vertebral Column*
    – Ribs
    – Sternum
    • Neurovascular Structures
    – Arteries, Veins
    – Nerves
    • Lymphatic Structures
    FUNCTIONS OF THE THORACIC WALL

    • Breathing (changes in the lateral and anterior dimensions of the thoracic


    wall)
    • Protection of organs (including abdominal organs like liver, stomach,
    spleen, kidneys)
    • Conduit (passageway)
    APERTURES
    • Superior Thoracic
    Aperture
    • Inferior Thoracic
    Aperture
    SUPERIOR THORACIC APERTURES

    • Narrow, open
    • Boundaries
    – Anteriorly, manubrium
    – Laterally, the medial margin
    of 1st rib on each side
    – Posteriorly, body of 1st
    thoracic vertebra
    • Superior margin of
    manubrium is at level
    between thoracic vertebrae
    2 and 3
    SUPERIOR THORACIC APERTURES

    • Important structures
    present at the superior
    thoracic aperture
    include:
    – Great vessels
    – Apices of the lungs
    – Trachea
    – Esophagus
    INFERIOR THORACIC APERTURES

    • Wide, closed by diaphragm


    • Boundaries
    – Anteriorly,xiphoid process
    – Laterally,costal margins of ribs
    7 to 10, distal end of 11th rib,
    and the 12th rib
    – Posteriorly, body of thoracic
    vertebra 12
    DIAPHRAGM
    • The muscle fibers of the
    diaphragm arise radially,
    from the margins of the
    inferior thoracic aperture,
    and converge into a large
    central tendon
    • The right dome of the
    diaphragm is higher than
    the left, reaching as far as
    the 5th rib
    DIAPHRAGM
    Superior View Inferior View
    DIAPHRAGM
    DIAPHRAGM
    DIAPHRAGM
    • Hiatuses
    – Aortic hiatus
    – Caval hiatus
    – Esophageal hiatus
    DIAPHRAGM
    OPENING LEVEL STRUCTURES
    Caval opening T8 Inferior vena cava and some
    branches of the right phrenic
    nerve
    Esophageal hiatus T10 Esophagus, vagus nerves, and
    some small esophageal arteries
    Aortic hiatus T12 The aorta, the azygous vein, and
    the thoracic duct
    OTHER STRUCTURES PASSING THROUGH THE
    DIAPHRAGM
    • Splanchnic nerves which
    pierces the crura
    • Inferior hemiazygos vein which
    pierces the left crus
    • Psoas major M.
    • Sympathetic trunk (pass deep
    to the medial arcuate ligament)
    • Quadratus lumborum
    • Subcoastal N, Vs (pass deep to
    the lateral arcuate ligament)
    BONES
    • 12 Thoracic vertebrae
    and intervening
    intervertebral discs
    • 12 Ribs and costal
    cartilages on each side
    (12 x 2 = 24)
    • Sternum
    – Manubrium
    – Body
    – Xiphoid process
    THORACIC VERTEBRAE
    • Review the parts of:
    – Typical (T2-T8) and
    – Atypical (T1, T9-T12)
    thoracic vertebrae
    RIBS
    • All ribs articulate with thoracic
    vertebrae posteriorly
    – Most ribs (1st to 8th rib) have 3
    articulations with the vertebral
    column; 9th and 10th have only 2
    articulations; 11th and 12th rib have
    only 1 articulation with the vertebral
    column
    – The head of each rib articulates with
    the body of its own vertebra and
    with the body of the vertebra above
    – As these ribs curve posteriorly, most
    also articulate with the transverse
    process of its vertebra
    RIBS
    • All ribs have costal cartilages at
    their anterior ends
    – The costal cartilages of ribs 1 to 7
    articulate with the sternum
    (TRUE ribs)
    – The costal cartilages of ribs 8 to
    10 articulate with the inferior
    margins of the costal cartilages
    above them (FALSE ribs)
    – Ribs 11 and 12 do not articulate
    with other ribs, costal cartilages,
    or the sternum (FLOATING ribs)
    RIBS
    RIBS
    RIBS
    • Cervical rib, present in
    1% of population, is an
    accessory rib
    articulating with
    cervical vertebra 7 and
    attaching to the
    superior border of the
    anterior aspect of rib 1
    RIBS
    • Intercostal nerves and
    vessels lie in the costal
    groove along the inferior
    margin of the superior rib.
    The nerve is most inferior in
    location and not protected
    by the groove hence has the
    most risk of being injured
    JOINTS
    • Sternocostal Joints
    – 1st Rib – Fibrocartilaginous
    – 2nd To 7th – Synovial
    – Interchondral Joints (Synovial)
    • Manubriosternal Joint
    (Symphysis)
    • Xiphesternal Joint (Symphysis)
    INTERCOSTAL SPACE
    • 11 ICSs
    • Contents
    – Muscles and Membranes
    • External Intercostal
    • Internal Intercostal
    • Innermost Intercostal
    • Membranes
    – Anterior intercostal membrane
    – Posterior intercostal
    membrane
    – Vascular Structures
    • Anterior intercostal
    arteries/veins (9)
    • Posterior intercostal
    arteries/veins (11)
    – Neural Structures
    • Intercostal nerves (11)
    – Lymphatic Structures
    ARTERIES
    • Arteries to the wall arise from 2 sources:
    – Internal thoracic arteries from subclavian
    artery and gives off:
    – 1st – 6th anterior intercostal arteries (2
    per intercostal space)
    – Musculophrenic artery (and superior
    epigastric artery)
    » 7th – 9th anterior intercostal
    arteries (2 per intercostal
    space)
    – Each anterior intercostal artery is
    paired
    – Posterior intercostal arteries
    • Subclavian artery > costocervical trunk >
    supreme (superior) intercostal artery > 1st
    and 2nd posterior intercostal arteries
    • Descending thoracic aorta > 3rd to 11th
    posterior intercostal arteries (note: 12th is
    subcostal artery)
    – Anterior and posterior intercostal arteries
    anastomose, run along inferior margin of
    each rib
    ARTERIES
    LYMPHATIC STRUCTURES
    • Lymph in the thoracic wall
    – > Parasternal nodes (associated with
    internal thoracic arteries)
    • >Bronchomediastinal trunks
    – > Lymphatic ducts (right and left
    - thoracic duct) > Subclavian
    Veins
    – Or may drain directly into
    Subclavian Veins
    – > Intercostal nodes (heads/necks of
    ribs)
    • Upper Intercostal nodes
    – > Bronchomediastinal trunks
    • Lower Intercostal nodes
    – > Thoracic duct
    – Diaphragmatic (phrenic) nodes
    • > Parasternal nodes
    • > Lateral aortic nodes (abdomen)
    LYMPHATIC STRUCTURES
    • Sternal or parasternal (internal
    thoracic) nodes
    – Are placed along the internal thoracic artery.
    – Receive lymph from the medial portion of the
    breast, intercostal spaces, diaphragm, and
    supraumbilical region of the abdominal wall.
    – Drain into the junction of the internal jugular and
    subclavian veins.

    • Intercostal nodes
    – Lie near the heads of the ribs.
    – Receive lymph from the intercostal spaces and the
    pleura.
    – Drain into the cisterna chyli or the thoracic duct.

    • Phrenic nodes
    – Lie on the thoracic surface of the diaphragm.
    – Receive lymph from the pericardium, diaphragm,
    and liver.
    – Drain into the sternal and posterior mediastinal
    nodes.
    NERVES
    • Intercostal nerves (which are the
    anterior rami of thoracic spinal
    nerves) accompany intercostal
    arteries
    MUSCLES
    MUSCLES
    END
    THORACIC WALL

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