thoracic anatomy

1
Mid Axial line Mid Clavicular Line Ribs 12 Ribs off of thoracic vertebrae T1 is where Rib 1 originates 1-6 Ribs articulare with individual COATAL CARTILLAGE (Hyaline) 7-10 are variable: articulate with catallagenous mass 11-12: floating ribs Manubrium Sternal Notch Sternal Angle Angle of Louie Intercostal muscles Function: -fill in ribcage -”keep from popping” -involved in forced inspi/expiration 2 or 3 muscles depending on who you ask Named for the Rib ABOVE 11 pairs Control size of thoracic cavity, elevate and depress ribs, forced breathing External: run Antero-medially (downward) Anteriorly near sternum turns into transparent membrane allowing the internal intercostal to be visible Internal: run Posterolaterally (perpendicular) (upward) Innermost: inner layer of internal separated by VAN Becomes membranous posteriorly near vertebral column Intercostal neurovascular bundle Organized: Superior-Vein-Artery-Nerve-Inferior Run in COSTAL GROOVE on INFERIOR part of rib Posteriorly Intercostal artery fed by AORTA Intercostal vein drains into the AZECA vein Anterior Intercostal artery fed by ANTERIOR INTERNAL THORACIC A. Intercostal vein brains into ANTERIOR INTERNAL THORACIC V ANTERIOR INTERNAL THORACIC aka Internal mammary, Branch off subclavian held in place by ANTERIOR THORASUS TRANSVERSUS MUSCLE This muscle make removing the chest wall with anterior internal thoracic artery intact very difficult External Internal Costal Cartillage Costal Cartillage Vein Artery Nerve Costal Groove Anterior Intercostal Neurovascular bundle Anterior Internal Thoracic Artery and Vein Thoracocentesis CC: for accessing the plural space Drain fluid or Pus or Blood -Important to go above a rib to avoid injuring the intercostal VAN Structurs passed through 1) External intercostal 2) Internal intercostal 3) Innermost intercostal 4) ENDOTHORACIC FASCIA: fused with parietal pleura but distinct 5) Parietal Plura: somatic mesoderm 5) Enter plural cavity = potential space DO NOT ENTER visceral plura (somatic mesoderm fused to lung) DO NOT PUNCTURE LUNG Phrenic Nerve from C4 -Septum Transversarium originally pulled phrenic nerve down then... -It got caught up in PLEUR-PERICARDIAL FOLDS/MEMBRANE when it grew out from the lateral wall to separate the ANTERIOR HEART from the POSTERIOR LUNGS -Musculophrenic ARTERY travels all they way to diaphram -It literally sits in FIBROUS PERICARDIUM -Pericardial-phrenic VESSELS travels with phrenic nerve to the pericardium. -Pericardium is still living tissue and needs a blood supply -Locate Phrenic nerve as a ridge in FIBROUS PERICARDIUM, it is exaggerated by the PERICARDIAL-PHRENIC vein that runs with it PERICARDIAL PHRENIC IS A SLENDER BRANCH OFF OF THE INTERNAL THORACIC -Phrenic nerve + Pericardial-phrenic vessels NAV travels the entire length of the MEDIA STEINUM PERICARDIUM Heart was formed in its OWN SPLANCNIC MESODERM VISCERAL PERICARDIUM that is tightly adhered to heart -Originated from hearts OWN splancnic mesoderm -Underneath the VISCERAL PERICARDIUM is where hearts blood supply runs FIBROUS PERICARDIUM is covered in an amount of fat proportional to body fat -It originated from PLEURO-PERICARDIAL FOLDS -Outer FIBROUS LAYER -Inner SEROUS LAYER: continuous, slimy. -Extends to proximal portion of great vessels Superior Vena Cava Internal Thoracic A Aortic Arch Pulmonary Trunk: ligamentum art. Left Atrium Brachiocephalic Vein = Int Jug + subclavian 1) Brachiocephalic 2) Left Common Carotid 3) Left Subclavian Vagus Nerve CNX Phrenic Nerve C4 Spinal Nerve (anterior/vental ramus) Second Intercostal Inferior Thyroid Thyrocervical Trunk Transvers cervical Suprascapular Vertebral Superficial cervical (dorsal scapular) Scalene anterior (Phrenic n pierces) External Jugular Internal Jugular CNX Phrenic n. Right Common Carotid Inferior Thyroid Aorta Loops over Pulmonary Artery Left Pulmonary artery infront of aorta Right Pulmonary artery behind Aorta Vagus nerve generally lies at the bifurcation of the carotid and the subclavian (on the right side) -CNX dives BEHIND HEART -Supplies heart then goes into the abdomen -Gives off a branch called the RECURRENT LARYNGEAL RECURRENT LARYNGEAL -On left side CNX passes anterioly to Aortic arch -Left CNX gives recurrecnt laryngeal that goes UNDER LIGAMENTUM ARTERIOUSUS and then goes UNDER the AORTIC ARCH and travels back up to larynx -Right CNX can be located anteriorly to the bifurcation of THE COMMON CAROTID AND SUBCLAVIAN -The Right Recurrent Laryngeal passes posteriorly UNDER THE SUBCLAVIAN and travels up to larynx Left Pulmonary artery IN FRONT of aorta Right Pulmonary artery BEHIND Sternoclavicular Ligament Ligamentum Arteriosus Aortic Tricuspid Pulmonary Bicuspid Mitral 2 Spaces (pericardial reflections) 1) Oblique pericardial sinus: between 5 pulmonary veins -Reminance of straight tubular heart folding over -Posterior to heart 2) Transverse pericardial space: space between two outflow tracts -Surgeons use this space for bypasses -Posterior to ASCENDING AORTA + Pulmonary Trunk CC: tamponade CC: Pericarditis Ductus arteriousus In fetal circulation blood in the RV travels into the pulmonary artery with no place to go. The Ductus arteriousus creates a shunt from the pulmonary artery to the Aorta -However the ductus arteriosus joins the aorta posteriorly to the great vessels as to not dilute the blood traveling to the brain. -Within the first 24hrs BRADYKININ causes ductus areteriousus to close off and eventually become a fibrous vestigial connection called the LIGAMETUM ARTERIOUSUS = reminents of ductus arteriousum -LEFT RECURRENT LARYNGEAL loops under Ligamentum Arteriousus -If Ductus arteriousus does not close it may need to be stapled. Rib External Intercostal Internal Intercostal Innermost Intercostal Endothoracic Fasia Parietal Plura Visceral Plura Lungs Pleural Space Rib V A N MEDIA STEINUM: saggital plane through heart Superior from inferior: Line through 1) Manubrio-sternal joint 2) top of heart 3) 5th thoracic vertabrae Above this line is Superior Media-Steinum Below this area is Inferior Media-Steinum Inferior Media-Steinum is subdivided 1) Posterior: behind heart: Lots of stuff in this space 2) Middle: Heart is in the middle 3) Anterior: nothing but fat and lymphnodes Thymus: Right beneath Manubrium Immunological origin CHEST WALL IS REMOVED Lungs wrap around heart The Pleura of the lungs do NOT communicate (this is a good thing, otherwise pneumothorax would be worse) Accessory Hemiazygos left posterior intercostal vein drainage, Right Post Intercostal into Azygos

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  • Mid

    Axi

    al li

    ne

    Mid

    Cla

    vicu

    lar L

    ine

    Ribs12 Ribs o of thoracic vertebraeT1 is where Rib 1 originates1-6 Ribs articulare with individual COATAL CARTILLAGE (Hyaline)7-10 are variable: articulate with catallagenous mass11-12: oating ribs

    Manubrium Sternal Notch

    Sternal AngleAngle of Louie

    Intercostal musclesFunction: -ll in ribcage -keep from popping -involved in forced inspi/expiration

    2 or 3 muscles depending on who you askNamed for the Rib ABOVE 11 pairsControl size of thoracic cavity, elevate and depress ribs, forced breathingExternal: run Antero-medially (downward) Anteriorly near sternum turns into transparent membrane allowing the internal intercostal to be visibleInternal: run Posterolaterally (perpendicular) (upward)Innermost: inner layer of internal separated by VAN Becomes membranous posteriorly near vertebral column

    Intercostal neurovascular bundle Organized: Superior-Vein-Artery-Nerve-Inferior Run in COSTAL GROOVE on INFERIOR part of ribPosteriorly Intercostal artery fed by AORTA Intercostal vein drains into the AZECA veinAnterior Intercostal artery fed by ANTERIOR INTERNAL THORACIC A. Intercostal vein brains into ANTERIOR INTERNAL THORACIC V ANTERIOR INTERNAL THORACIC aka Internal mammary, Branch o subclavian held in place by ANTERIOR THORASUS TRANSVERSUS MUSCLE This muscle make removing the chest wall with anterior internal thoracic artery intact very dicult

    External

    Internal

    Costal Cartillage

    Costal CartillageVeinArteryNerve

    Costal Groove

    Anterior Intercostal

    Neurovascular bundle

    Ant

    erio

    r Int

    erna

    l Tho

    raci

    cA

    rter

    y an

    d Ve

    in

    ThoracocentesisCC: for accessing the plural space Drain uid or Pus or Blood -Important to go above a rib to avoid injuring the intercostal VANStructurs passed through1) External intercostal2) Internal intercostal3) Innermost intercostal4) ENDOTHORACIC FASCIA: fused with parietal pleura but distinct5) Parietal Plura: somatic mesoderm5) Enter plural cavity = potential spaceDO NOT ENTER visceral plura (somatic mesoderm fused to lung)DO NOT PUNCTURE LUNG

    Phrenic Nerve from C4-Septum Transversarium originally pulled phrenic nerve down then...-It got caught up in PLEUR-PERICARDIAL FOLDS/MEMBRANE when it grew out from the lateral wall to separate the ANTERIOR HEART from the POSTERIOR LUNGS

    -Musculophrenic ARTERY travels all they way to diaphram-It literally sits in FIBROUS PERICARDIUM-Pericardial-phrenic VESSELS travels with phrenic nerve to the pericardium. -Pericardium is still living tissue and needs a blood supply-Locate Phrenic nerve as a ridge in FIBROUS PERICARDIUM, it is exaggerated by the PERICARDIAL-PHRENIC vein that runs with it PERICARDIAL PHRENIC IS A SLENDER BRANCH OFF OF THE INTERNAL THORACIC

    -Phrenic nerve + Pericardial-phrenic vessels NAV travels the entire length of the MEDIA STEINUM

    PERICARDIUMHeart was formed in its OWN SPLANCNIC MESODERMVISCERAL PERICARDIUM that is tightly adhered to heart-Originated from hearts OWN splancnic mesoderm-Underneath the VISCERAL PERICARDIUM is where hearts blood supply runs

    FIBROUS PERICARDIUM is covered in an amount of fat proportional to body fat-It originated from PLEURO-PERICARDIAL FOLDS-Outer FIBROUS LAYER-Inner SEROUS LAYER: continuous, slimy.-Extends to proximal portion of great vessels

    SuperiorVenaCava

    Internal Thoracic A

    Aortic Arch

    Pulmonary Trunk: ligamentum art.

    Left Atrium

    Brachiocephalic Vein = Int Jug + subclavian

    1) Brachiocephalic2) Left Common Carotid

    3) Left Subclavian

    Vagus Nerve CNX

    Phrenic Nerve C4

    Spinal Nerve (anterior/vental ramus)

    Second Intercostal

    Inferior Thyroid

    Thyrocervical TrunkTransvers cervical

    Suprascapular

    Vertebral

    Supercial cervical (dorsal scapular)

    Scalene anterior (Phrenic n pierces)

    External Jugular

    Internal Jugular

    CNX

    Phrenic n.

    Right Common Carotid

    Inferior Thyroid

    Aorta Loops over Pulmonary ArteryLeft Pulmonary artery infront of aortaRight Pulmonary artery behind AortaVagus nerve generally lies at the bifurcation of the carotid and the subclavian (on the right side) -CNX dives BEHIND HEART -Supplies heart then goes into the abdomen -Gives o a branch called the RECURRENT LARYNGEALRECURRENT LARYNGEAL -On left side CNX passes anterioly to Aortic arch -Left CNX gives recurrecnt laryngeal that goes UNDER LIGAMENTUM ARTERIOUSUS and then goes UNDER the AORTIC ARCH and travels back up to larynx

    -Right CNX can be located anteriorly to the bifurcation of THE COMMON CAROTID AND SUBCLAVIAN -The Right Recurrent Laryngeal passes posteriorly UNDER THE SUBCLAVIAN and travels up to larynx

    Left Pulmonary artery IN FRONT of aortaRight Pulmonary artery BEHIND

    Sternoclavicular Ligament

    Liga

    men

    tum

    Art

    erio

    sus

    Aortic

    Tricuspid

    Pulmonary

    BicuspidMitral

    2 Spaces (pericardial reections)1) Oblique pericardial sinus: between 5 pulmonary veins -Reminance of straight tubular heart folding over -Posterior to heart 2) Transverse pericardial space: space between two outow tracts -Surgeons use this space for bypasses -Posterior to ASCENDING AORTA + Pulmonary Trunk

    CC: tamponadeCC: Pericarditis

    Ductus arterioususIn fetal circulation blood in the RV travels into the pulmonary arterywith no place to go. The Ductus arteriousus creates a shunt fromthe pulmonary artery to the Aorta-However the ductus arteriosus joins the aorta posteriorly to the great vessels as to not dilute the blood traveling to the brain.-Within the rst 24hrs BRADYKININ causes ductus areteriousus toclose o and eventually become a brous vestigial connection calledthe LIGAMETUM ARTERIOUSUS = reminents of ductus arteriousum-LEFT RECURRENT LARYNGEAL loops under Ligamentum Arteriousus-If Ductus arteriousus does not close it may need to be stapled.

    Rib

    Exte

    rnal

    Inte

    rcos

    tal

    Inte

    rnal

    Inte

    rcos

    tal

    Inne

    rmos

    t Int

    erco

    stal

    En

    do

    th

    ora

    cic

    Fa

    sia

    Pa

    rie

    ta

    l P

    lura

    Vis

    ce

    ra

    l P

    lura

    Lung

    s

    Pleu

    ral S

    pace

    Rib

    VAN

    MEDIA STEINUM: saggital plane through heartSuperior from inferior: Line through 1) Manubrio-sternal joint 2) top of heart 3) 5th thoracic vertabraeAbove this line is Superior Media-SteinumBelow this area is Inferior Media-SteinumInferior Media-Steinum is subdivided 1) Posterior: behind heart: Lots of stu in this space 2) Middle: Heart is in the middle 3) Anterior: nothing but fat and lymphnodes

    Thymus:Right beneathManubriumImmunological origin

    CHEST WALL IS REMOVEDLungs wrap around heartThe Pleura of the lungs do NOT communicate (this is a good thing, otherwise pneumothorax would be worse)

    Accessory Hemiazygos left posterior intercostal vein drainage, Right Post Intercostal into Azygos