Thorax
Thorax
Faculty Of Medicine
Thorax
DR. AHMED SALMAN
Associate professor of anatomy & embryology
DR.AHMED SALMAN
THORAX
Is the part of the trunk extending between
the root of the neck & abdomen
DR.AHMED SALMAN
Thorax
Thoracic Wall
Thoracic Cavity
DR.AHMED SALMAN
DR.AHMED SALMAN
Openings of the Thorax
Thoracic outlet
It is an opening between chest cavity and the root of the neck .
Boundaries :
Anteriorly: superior border of the manubrium sterni
Posteriorly : first thoracic vertebra
Laterally : medial borders of the first ribs and their costal cartilages
Structure passing :
Esophagus , trachea and many vessels and nerves.
Dr.Ahmed Salman
Intercostal muscles
Are arranged in tree layers :
1-External intercostal muscle
Ø Its fibres are directed downward and forward
Ø It extends from the inferior border of the rib above to the superior border of the rib below .
2-Internal intercostal muscle
Its fibres are directed downward and backward
It extends from the subcostal groove of the rib above to the upper border of the rib below
Responsible for Expiration
3-Innermost intercostal muscle
4-Subcostal muscle
5-Transverseus thoracis muscles
Nerve Supply
Intercostal nerves
Action :
Respiration
Strengthen the intercostal spaces
DR.AHMED SALMAN
Diaphragm
It is a thin muscular and tendinous septum that separates the chest cavity
above from the abdominal cavity below.
Nerve Supply : Motor nerve supply: The right and left phrenic nerves (C3,
4, 5).
DR.AHMED SALMAN
DR.AHMED SALMAN
Function of the diaphragm
1. Respiration
2. Muscle of abdominal straining: The contraction of the diaphragm is raising the intra-
abdominal pressure
3. Weight-lifting muscle:
4- Thoracoabdominal pump: Pump for blood and lymph
DR.AHMED SALMAN
Opening of the diaphragm :
Opening Level Structures passing through it
Vena Caval 8th thoracic vertebra It transmits the inferior vena cava and terminal
branches of the right phrenic nerve.
Oesophageal 10th thoracic vertebra oesophagus, the right and left vagus nerves
(Oesophagus)opening
Aortic 12th thoracic vertebra aorta, the thoracic duct, and the azygos vein.
DR.AHMED SALMAN
Intercostal nerves
q It is a ventral ramus of thoracic nerves
q There are 11 nerves on each side
q The last one called subcostal nerve
Function of intercostal nerves
ü Sensory : skin – parietal layer of pleura and peritoneum.
ü Motor: muscles of anterior thoracic & abdominal walls.
ü Postganglionic sympathetic: blood vessels, sweat glands.
DR.AHMED SALMAN
Blood supply of thoracic wall
DR.AHMED SALMAN
DR.AHMED SALMAN
q It bounded by thoracic cage ,diaphragm.
q It contains two pleural cavities containing lungs and mediastinum
DR.AHMED SALMAN
Mediastinum
It is the septum between the two pleural cavities.
Boundaries :
Superior: Thoracic outlet
Inferior: Diaphragm
Anterior: Sternum
Posterior: Vertebral column
DR.AHMED SALMAN
DR.AHMED SALMAN
Subdivisions:
Division :
An imaginary line from sternal angle to lower border of 4th thoracic vertebra divide
mediastinum into :
ü Superior mediastinum above the line and inferior mediastinum below the line.
ü Inferior mediastinum divided into :
§ Middle mediastinum contains heart and pericardium
§ Anterior mediastinum in front middle mediastinum
§ Posterior mediastinum behind middle mediastinum
DR.AHMED SALMAN
Mediastinum
Superior Inferior
DR.AHMED SALMAN
DR.AHMED SALMAN
Vein of the head and the neck : internal jugular vein
Vein of the upper limb : subclavian vein
Right internal jugular vein joins right subclavian vein to form right
brachiocephalic vein
Left internal jugular vein joins left subclavian vein to form left
brachiocephalic vein
Right brachiocephalic vein jioins left brachiocephalic vein to form superior
vena cava
DR.AHMED SALMAN
Arch of Aorta
Brachiocephalic Artery
(on Right) Left common carotid Left Subclavian
v1/3 of the heart lies to the right & 2/3 to the left of the median plane.
vThe walls of the heart are composed of three layers from outside :
1- Epicardium
2- Myocardium which is the cardiac muscle
3- Endocardium
DR.AHMED SALMAN 25
DR.AHMED SALMAN 26
Pericardium
ØThe pericardium is a fibroserous sac surrounding the heart and the
roots of the great vessels.
Its function is to :-
1-Restrict excessive movements of the heart.
2-Serve as a lubricated container in which the different parts of the heart
can contract.
DR.AHMED SALMAN 27
Pericardium
Serous
Fibrous
Pericardium
Pericardium
It is thin transparent double
-It is outer sac of pericardium.
layered sac that lies within the
- It is firmly attached to the
diaphragm. fibrous pericardium.
DR.AHMED SALMAN 30
External morphology of the heart
Base : Located posteriorly , it is formed mainly by the left atrium
Apex: Formed by the left ventricle.
It lies at the fifth left intercostal space, 3.5 inch (9 cm) from the midline.
Two surfaces ( anterior or sternocostal and inferior or diaphragmatic).
Four borders :
DR.AHMED SALMAN 31
DR.AHMED SALMAN 32
Borders of the Heart
DR.AHMED SALMAN 34
Heart Chambers
The heart has four chambers two atria and two ventricles
1-Right atrium : It has
-Smooth posterior part and Rough anterior part .
Septal wall : which separates the right atrium from the left atrium
it contains fossa ovalis which was the site of the foramen ovale in the fetus.
DR.AHMED SALMAN 35
Openings into the right atrium:
ØS.V.C. : It returns the blood to the heart from the upper half of the body.
ØI.V.C. : It returns the blood to the heart from the lower half of the body.
ØThe coronary sinus : it drains most of the blood from the heart.
ØRight atrioventricular orifice which is guarded by Tricuspid valve.
DR.AHMED SALMAN 36
Right ventricle
It has
ØSmooth outflow part called infundibulum leads into the pulmonary artery .
ØRough inflow part ,
ØCommunication of Right ventricle
With Right atrium and pulmonary artery
DR.AHMED SALMAN 37
Left atrium
Opening of the left atrium
1-The four pulmonary veins
2-The left atrioventricular orifice is guarded by mitral valve
DR.AHMED SALMAN 38
Left ventricle
The thickness of its wall is 3:1 that of the left ventricle
It has :-
DR.AHMED SALMAN 39
DR.AHMED SALMAN 40
VALVES OF THE HEART
DR.AHMED SALMAN 41
DR.AHMED SALMAN 42
REED ONLY Clinical Anatomy
Incompetent valve leads to regurgitation of blood
Stenosis of the valve leads to heart over load
DR.AHMED SALMAN 43
Blood Supply of heart
DR.AHMED SALMAN 44
Blood Supply of the heart
Arterial Venous
Arises from the anterior aortic sinus of the Arises from the posterior aortic sinus of the
ascending aorta ascending aorta
DR.AHMED SALMAN 46
DR.AHMED SALMAN 47
Conducting system of the heart
qResponsible for initiation and conduction of cardiac impulses.
DR.AHMED SALMAN 48
Parts of Conducting system of the heart
vSinoatrial node ( SA node).
vAtrioventricular node ( AV node).
vAtrioventricular bundle ( bundle of His).
vThe right branch of AV bundle.
vThe left branch of AV bundle.
vThe Purkinje fibers.
DR.AHMED SALMAN 49
Lungs and Pleura
End : At the level of the sternal angle (opposite the disc between the fourth and fifth
thoracic vertebrae).
The trachea is divided into right and left principal (main) bronchi
The trachea is kept patent by the presence of U-shaped bars (rings) of hyaline cartilage
Shorter Taller