regional anatomy of thorax 山东大学医学院 解剖教研室 李振华. parts and regions of the...
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Regional anatomy of thorax
山东大学医学院 解剖教研室李振华
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Parts and regions of the thorax
Boundaries Superiorly - jugular notch,
sternoclavicular joint, superior border of clavicle, acromion, spinous processes of C7
Inferiorly - xiphoid process, costal arch, 12th and 11th ribs, vertebra T12
Regions Thoracic wall Thoracic cavity
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Landmarks of thorax Jugular notch corresponds with
The 2th thoracic vertebra in male, the 3th thoracic vertebra in female
Sternal angle corresponds with Connects 2nd costal cartilage later
ally The lower border of 4th thoracic ve
rtebra The bifurcation of trachea in the ad
ult The beginning of aortic arch which
ends posteriorly at the same level The esophagus is crossed by the l
eft main bronchus
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Landmarks of thorax Xiphoid process - xiphister
nal synchondrosis lies opposite the body of the 9th thoracic vertebra
Clavicle Inferior fossa of clavicle Coracoid process
Ribs and intercostal spaces Costal arch
Infrasternal angle Xiphocostal angle
Papillae
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Thoracic wallSuperficial structures Skin Superficial fascia
Superficial aa. Superficial vv.
Thoracoepigastric v. Lateral thoracic v.
Superficial nn. Supraclavicular n. Anterior and lateral cutaneous br
anches of intercostal n.
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Lymphatic drainage of breast Into pectoral ln. from lateral and c
entral parts of breast Into apical and supraclavicular ln.
from superior part of breast Into parasternal ln. from medial p
art of breast Into interpectoral ln. from deep p
art of breast The lymphatic capillaries of breast
form an anastomosing network which is continuous across the midline with that of the opposite side and with that of the abdominal wall
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Thoracic wallDeep structures Deep fascia
Superficial layer Deep layer—clavipectoral fascia
Muscles of thorax Subclavius Pectoralis major Pectoralis minor Serratus anterior Intercostales externi Intercostales interni Intercostales intimi
Endothoracic fascia 胸内筋膜
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Intercostal space
Posterior intercostal v.
Posterior intercostal a.
Intercostal n.
Technique for thoroacocentesis(in midaxillary line)
Intercostal nerve block
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Internal thoracic vessels Internal thoracic a.&v.
胸廓内动脉和静脉 Descends into thorax 1.2cm lat
eral to edge of sternum Ends at the sixth costal cartilag
e by dividing musculophrenic and superior epigastric arteries
Parasternal ln. 胸骨旁淋巴结
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The Mediastinum 纵隔
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The Mediastinum 纵隔
Concept All of organs between the left and
right mediastinal pleurae is called mediastinum.
It extends from the sternum in front to the vertebral column behind, and from the thoracic inlet above to the diaphragm below.
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Subdivisions of mediastinum
Superior mediastinum 上纵隔 Inferior mediastinum 下纵隔
Anterior mediastinum 前纵隔 Middle mediastinum 中纵隔 Posterior mediastinum 后纵隔
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Left side of mediastnum 纵隔左侧面
Root of lung
Pericardium
Phrenic n. & pericardiacophrenic a.
Left vagus n.
Left recurrent n.Thoracic aorta
Sympathetic trunk
Greater splanchnic n
Aortic arch
Thoracic ductLeft subclavian a.
Esophagus
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Right side of mediastnum 纵隔右侧面
Root of lung
Pericardium
Superior vena cava
Phrenic n. & pericardiacophrenic a.
Right vagus n.
Azygos v.
Sympathetic trunk
Esophagus
Arch of azygos v.
Trachea
Inferior vena cava
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Superior mediastinum 上纵隔
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Superior mediastinum 上纵隔
Locating - from inlet of thorax to plane extending from level of sternal angle anteriorly to lower border of T4 vertebra posterioly
Contents Superficial layer
Thymus Three veins
Left brachiocephelic v. Right brachiocephelic v. Superior vena cava
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Superior mediastinum 上纵隔Contents Middle layer
Aotic arch and its three branches
Phrenic n. Vagus n.
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Superior mediastinum 上纵隔
Contents Posterior layer
Trachea Esophagus Thoracic duct
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Relations of aortic arch Anteriorly and to the left
Pleura Lung Phrenic n. Pericardiacophrenic vessels Vagus n.
Posteriorly and to the right Trachea Esophagus Left recurrent n. Thoracic duct Deep cardiac plexus
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Relations of aortic arch Superiorly
Its three branches Left brachiocephalic v. thymus
Inferiorly Pulmonary a. Arterial ligament Left recurrent n. Left principal bronchus Superficial cardiac plexus
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Triangle of ductus arteriosus 动脉导管三角
Boundaries Phrenic n. Left vagus n. Left pulmonary a.
Contents Arterial ligament Left recurrent n. Superficial cardiac plexuses
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Triangle of ductus arteriosus 动脉导管三角
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Inferior mediastinum 下纵隔
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Inferior mediastinum 下纵隔
Anterior mediastinum 前纵隔 Location - posterior to body of sternu
m and attached costal cartilages, anterior to heart and pericardium
Contents Fat Remnants of thymus gland Anterior mediastinal lymph nodes
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Inferior mediastinum 下纵隔Middle mediastinum 中纵隔 Location - between anterior medias
tinum and posterior mediastinum Contents
Heart and pericardium Beginning or termination of great v
essels Phrenic nerves Pericardiacophrenic vessels Lymph nodes
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Inferior mediastinum 下纵隔Posterior mediastinum 后纵隔 Location - posterior to heart and p
ericardium, anterior to vertebrae T5- T12
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Inferior mediastinum 下纵隔Posterior mediastinum 后纵隔
Contents: Esophagus Vagus n. Thoracic aorta Azygos system of veins Thoracic duct Thoracic sympathetic trunk Posterior mediastinal lymph nodes
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Relations of esophagus
Anteriorly Trachea
Bifurcation of trachea
Left principal branchus
Left recurrent n.
Right pulmonary a.
Anterior esophageal plexus
Pericardium
Left atrium
Diaphragm
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Relations of esophagus
Posteriorly Posterior esophageal plexus Thoracic aorta Thoracic duct Azygos v. Hemiazygos v. Accessory hemiazygos v. Right posterior intercostal v.
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Relations of esophagus
Left Left common carotid a. Left subclavian a. Aortic arch Thoracic aorta Superior part of thoracic duct
Right Arch of azygos v.
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Relations of thoracic aorta
Anteriorly Left root of lung Pericardium Esophagus
Posterior Hemiazygos v. Accessory hemiazygos v.
Right Azygos v. Thoracic duct
Left - mediastinal pleura
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Mediastinal spaces 纵隔间隙 Retrosternal space 胸骨后间隙 lie
s beween sternum and endothoracic fascia
Pretracheal space 气管前间隙 lies within superior mediastinum, between trachea, bifurcation of trachea and aortic arch
Retroesophagus space 食管后间隙 lies within superior mediastinum, beween esophagus and endothoracic fascia
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★You must identify follow structures !
Thoracic wall Intercostales externi Intercostales interni Posterior intercostal a. Intercostal n. Internal thoracic a. Diaphragm
Central tendon Aortic hiatus Esophageal hiatus Vena cava foramen
Costodiaphragmatic recesse
Superior mediastinum Left brachiocephelic v. Right brachiocephelic v. Superior vena cava Aortic arch
Brachiocephalic trunk Left common carotid artery Left subclavian a.
Phrenic n. Vagus n. Left recurrent n. Arterial ligament Trachea
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★You must identify follow structures !
Middle mediastinum Pericardium Phrenic nerves Posterior mediastinum Esophagus Vagus n. Thoracic aorta Azygos veins Thoracic duct Thoracic sympathetic trunk Greater splanchnic n
Lung Apex of lung Base of lung Hilum of lung Root of lung Cardiac notch Lingual in left lung Horizontal and oblique fissures Superior, middle and inferior l
obs of right lung Superior and inferior lobs of lef
t lung
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