Regional anatomy of thorax 山东大学医学院 解剖教研室 李振华 SDU. LIZHENHUA
Parts and regions of the thorax Boundaries n Superiorly－jugular notch, sternoclavicular joint, superior border of clavicle, acromion, spinous processes of C 7 n Inferiorly－xiphoid process, costal arch, 12 th and 11 th ribs, vertebra T 12 Regions n Thoracic wall n Thoracic cavity SDU. LIZHENHUA
Landmarks of thorax n Jugular notch corresponds with q n The 2 th thoracic vertebra in male, the 3 th thoracic vertebra in female Sternal angle corresponds with q q q SDU. Connects 2 nd costal cartilage laterally The lower border of 4 th thoracic vertebra The bifurcation of trachea in the adult The beginning of aortic arch which ends posteriorly at the same level The esophagus is crossed by the left main bronchus LIZHENHUA
Landmarks of thorax n n Xiphoid process－ xiphisternal synchondrosis lies opposite the body of the 9 th thoracic vertebra Clavicle q q n n Ribs and intercostal spaces Costal arch q q n Inferior fossa of clavicle Coracoid process Infrasternal angle Xiphocostal angle Papillae SDU. LIZHENHUA
Thoracic wall Superficial structures n Skin n Superficial fascia q q q SDU. Superficial aa. Superficial vv. n Thoracoepigastric v. n Lateral thoracic v. Superficial nn. n Supraclavicular n. n Anterior and lateral cutaneous branches of intercostal n. LIZHENHUA
Lymphatic drainage of breast n n n Into pectoral ln. from lateral and central parts of breast Into apical and supraclavicular ln. from superior part of breast Into parasternal ln. from medial part of breast Into interpectoral ln. from deep part 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 SDU. LIZHENHUA
Thoracic wall Deep structures n Deep fascia q q Superficial layer Deep layer—clavipectoral fascia n Muscles of thorax n Subclavius q Pectoralis major q Pectoralis minor q Serratus anterior q Intercostales externi q Intercostales intimi Endothoracic fascia 胸内筋膜 q SDU. LIZHENHUA
Intercostal space Posterior intercostal v. Posterior intercostal a. Intercostal n. Technique for thoroacocentesis (in midaxillary line) SDU. LIZHENHUA Intercostal nerve block
Internal thoracic vessels n Internal thoracic a. &v. 胸廓内动脉和静脉 q q n Descends into thorax 1. 2 cm lateral to edge of sternum Ends at the sixth costal cartilage by dividing musculophrenic and superior epigastric arteries Parasternal ln. SDU. LIZHENHUA 胸骨旁淋巴结
The Mediastinum 纵隔 SDU. LIZHENHUA
The Mediastinum 纵隔 Concept n n 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. SDU. LIZHENHUA
Subdivisions of mediastinum n n Superior mediastinum 上纵隔 Inferior mediastinum下纵隔 q Anterior mediastinum 前纵隔 Middle mediastinum 中纵隔 q Posterior mediastinum q SDU. LIZHENHUA 后纵隔
Left side of mediastnum 纵隔左侧面 Left vagus n. Left recurrent n. Phrenic n. & pericardiacophrenic a. Root of lung Left subclavian a. Thoracic duct Aortic arch Thoracic aorta Sympathetic trunk Pericardium Esophagus SDU. LIZHENHUA Greater splanchnic n
Right side of mediastnum 纵隔右侧面 Trachea Right vagus n. Arch of azygos v. Azygos v. Sympathetic trunk Esophagus Inferior vena cava SDU. LIZHENHUA Superior vena cava Phrenic n. & pericardiacophrenic a. Root of lung Pericardium
Superior mediastinum 上纵隔 SDU. LIZHENHUA
Superior mediastinum 上纵隔 Locating－from inlet of thorax to plane extending from level of sternal angle anteriorly to lower border of T 4 vertebra posterioly Contents n Superficial layer q q SDU. Thymus Three veins n Left brachiocephelic v. n Right brachiocephelic v. n Superior vena cava LIZHENHUA
Superior mediastinum 上纵隔 Contents n Middle layer q q q SDU. Aotic arch and its three branches Phrenic n. Vagus n. LIZHENHUA
Superior mediastinum 上纵隔 Contents n Posterior layer q q q SDU. Trachea Esophagus Thoracic duct LIZHENHUA
Relations of aortic arch n Anteriorly and to the left q q q n Pleura Lung Phrenic n. Pericardiacophrenic vessels Vagus n. Posteriorly and to the right q q q SDU. Trachea Esophagus Left recurrent n. Thoracic duct Deep cardiac plexus LIZHENHUA
Relations of aortic arch n Superiorly q q q n Its three branches Left brachiocephalic v. thymus Inferiorly q q q SDU. Pulmonary a. Arterial ligament Left recurrent n. Left principal bronchus Superficial cardiac plexus LIZHENHUA
Triangle of ductus arteriosus 动脉导管三角 n Boundaries q q q n Phrenic n. Left vagus n. Left pulmonary a. Contents q q q SDU. Arterial ligament Left recurrent n. Superficial cardiac plexuses LIZHENHUA
Triangle of ductus arteriosus 动脉导管三角 SDU. LIZHENHUA
Inferior mediastinum 下纵隔 SDU. LIZHENHUA
Inferior mediastinum 下纵隔 Anterior mediastinum 前纵隔 n n Location－posterior to body of sternum and attached costal cartilages, anterior to heart and pericardium Contents q Fat q Remnants of thymus gland q Anterior mediastinal lymph nodes SDU. LIZHENHUA
Inferior mediastinum 下纵隔 Middle mediastinum 中纵隔 n n Location－between anterior mediastinum and posterior mediastinum Contents q Heart and pericardium q Beginning or termination of great vessels q Phrenic nerves q Pericardiacophrenic vessels q Lymph nodes SDU. LIZHENHUA
Inferior mediastinum 下纵隔 Posterior mediastinum 后纵隔 n Location－posterior to heart and pericardium, anterior to vertebrae T 5－T 12 SDU. LIZHENHUA
Inferior mediastinum 下纵隔 Posterior mediastinum 后纵隔 n Contents: q q q q SDU. Esophagus Vagus n. Thoracic aorta Azygos system of veins Thoracic duct Thoracic sympathetic trunk Posterior mediastinal lymph nodes LIZHENHUA
Relations of esophagus n Anteriorly q Trachea q Bifurcation of trachea q Left principal branchus q Left recurrent n. q Right pulmonary a. q Anterior esophageal plexus q Pericardium q Left atrium q Diaphragm SDU. LIZHENHUA
Relations of esophagus n Posteriorly q q q q SDU. Posterior esophageal plexus Thoracic aorta Thoracic duct Azygos v. Hemiazygos v. Accessory hemiazygos v. Right posterior intercostal v. LIZHENHUA
Relations of esophagus n Left q q q n Left common carotid a. Left subclavian a. Aortic arch Thoracic aorta Superior part of thoracic duct Right q SDU. Arch of azygos v. LIZHENHUA
Relations of thoracic aorta n Anteriorly q q q n Left root of lung Pericardium Esophagus Posterior q q n Hemiazygos v. Accessory hemiazygos v. Right q q n Azygos v. Thoracic duct Left－mediastinal pleura SDU. LIZHENHUA
Mediastinal spaces 纵隔间隙 n Retrosternal space 胸骨后间隙 lies beween sternum and endothoracic fascia n Pretracheal space 气管前间隙 lies within superior mediastinum, between trachea, bifurcation of trachea and aortic arch n Retroesophagus space食管后间隙 lies within superior mediastinum, beween esophagus and endothoracic fascia SDU. LIZHENHUA
★You must identify follow structures！ Thoracic wall n Intercostales externi n Intercostales interni n Posterior intercostal a. n Intercostal n. n Internal thoracic a. n Diaphragm q Central tendon Aortic hiatus Esophageal hiatus q Vena cava foramen q q n Costodiaphragmatic recesse SDU. LIZHENHUA Superior mediastinum n Left brachiocephelic v. n Right brachiocephelic v. n Superior vena cava n Aortic arch q q q n n n Brachiocephalic trunk Left common carotid artery Left subclavian a. Phrenic n. Vagus n. Left recurrent n. Arterial ligament Trachea
★You must identify follow structures！ Middle mediastinum n Pericardium n Phrenic nerves Posterior mediastinum n Esophagus n Vagus n. n Thoracic aorta n Azygos veins n Thoracic duct n Thoracic sympathetic trunk n Greater splanchnic n SDU. LIZHENHUA Lung n Apex of lung n Base of lung n Hilum of lung n Root of lung n Cardiac notch n Lingual in left lung n Horizontal and oblique fissures n Superior, middle and inferior lobs of right lung n Superior and inferior lobs of left lung
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