A-THE A-THE THORACIC THORACIC WALL WALL
Boundaries Boundaries
Posteriorly Posteriorly by by the the thoracic thoracic part part of of the the vertebral vertebral column column Anteriorly Anteriorly by by the the sternum sternum and and costal costal cartilages cartilages Laterally Laterally by by the the ribs ribs and and intercostal intercostal spaces spaces Superiorly Superiorly by by the the suprapleural suprapleural membrane membrane
Inferiorly Inferiorly by by the the diaphragm, diaphragm, which which separates separates the the thoracic thoracic cavity cavity from from the the abdominal abdominal cavity cavity
1- STERNUM
It is a flat bone Divides into three parts: 1-Manubrium sterni
2-Body of the sternum
3- Xiphoid process
The sternal angle (angle of Louis)
formed by the articulation of the manubrium with the body of the sternum
Lies at the level of
second costal cartilage
The point from which all costal cartilages and ribs are counted
2-Ribs
There are 12 pairs of ribs, all of which are attached posteriorly to the thoracic vertebrae. The ribs are divided into three categories according to their relation to the sternum: True ribs: The upper seven pairs are attached anteriorly to the sternum by their costal cartilages False ribs: The 8th, 9th, and 10th pairs of ribs are attached anteriorly to each other and to the 7th rib by means of their costal cartilages.
Floating ribs: The 11th and 12th pairs have no anterior attachment
Typical Rib
A typical rib is a long, twisted, flat bone having a rounded, smooth superior border and a sharp, thin inferior border
The inferior border forms
THE COSTAL GROOVE
which accommodates the intercostal vessels and nerve. intercostal vein intercostal artery intercostal nerve VAN A rib has a head, neck, tubercle, shaft, and angle
3-The Vertebral Column
is composed of 33 vertebrae
7 cervical
12 thoracic
5 lumbar
5 sacral (fused to form the sacrum)
4 coccygeal (the lower 3 are commonly fused)
A typical thoracic vertebra consists of: 1-a rounded body anteriorly (body bearing) 2-a vertebral arch
posteriorly.
(protect the spinal cord) They enclose a space called The vertebral foramen through which run the spinal cord and its coverings
The vertebral arch gives rise to seven processes:
a-One spinous b-Two transverse c- Four articular (2 superior 2 inferior)
Characteristics of a Typical Thoracic Vertebra
The body is heart shaped The vertebral foramen is small and circular The spines are long and inclined downward
Costal facets are present on the sides of the bodies for articulation with the heads of the ribs
Costal facets are present on the transverse processes for articulation with the tubercles of the ribs
The body and the vertebral arch are connected by means of pedicles
The pedicles are notched on their upper and lower borders Forming the superior and inferior vertebral notches.
On each side the superior notch of one vertebra and the inferior notch of an adjacent vertebra together form an intervertebral foramen.
These foramina, in an articulated skeleton, serve to transmit the spinal nerves and blood vessels.
4-The diaphragm
The diaphragm is a thin muscular and tendinous septum that separates the chest cavity above from the abdominal cavity below
The diaphragm is the most important muscle of respiration.
It is
dome shaped and
consists of a peripheral muscular part and a centrally placed tendon
Main Openings in the diaphragm The inferior vena cava passes through the central tendon at approximately vertebral level T8
The esophagus passes through the muscular part of the diaphragm, approximately at vertebral level T10
The aorta passes behind the posterior attachment of the diaphragm at vertebral level T12
Nerve supply of the diaphragm
The phrenic nerves
5-Intercostal Spaces
1-SKIN 2-SUPERFISCIAL FASCIA 3- THREE MUSCLES OF RESPIRATION: THE EXTERNAL INTERCOSTAL THE INTERNAL INTERCOSTAL THE INNERMOST INTERCOSTAL MUSCLE 4-THE ENDOTHORACIC FASCIA 5-THE PARIETAL PLEURA.
The intercostal nerves and blood vessels run between the intermediate (internal intercostal) and deepest layers (innermost intercostal) of muscles They are arranged in the following order from above downward:
INTERCOSTAL VEIN INTERCOSTAL ARTERY INTERCOSTAL NERVE (VAN)
The external intercostal muscle
the most superficial layer. Its fibers are directed
downward and forward
The Internal Intercostal Muscle
forms the intermediate layer. Its fibers are directed
downward and backward
The innermost intercostal muscle
Forms the deepest layer
It is an incomplete muscle layer and crosses more than one intercostal space within the ribs.
B-CHEST CAVITY
The chest cavity is bounded by the chest wall and below by the diaphragm
The chest cavity can be divided into
MEDIAN PARTITION CALLED THE MEDIASTINUM
LATERALLY PLACED PLEURAE AND LUNGS
2-Pleurae The pleurae and lungs lie on either side of the mediastinum within the chest cavity FORMATION OF THE LUNGS
Each lung bud invaginates the wall of the cavity and then grows to fill a greater part of the cavity
the lung is covered with visceral pleura and the thoracic wall is lined with parietal pleura
The original cavity is reduced to a slitlike space called the pleural cavity as a result of the growth of the lung.
Each pleura has two parts:
1- Parietal layer, which lines
A-The thoracic wall
2- Visceral layer:
completely covers the outer surfaces of The lungs
The parietal and visceral layers of pleura are separated from one another by a slit like space
The Pleural Cavity
Trachea
The trachea is a mobile cartilaginous and membranous tube It begins in the neck as a continuation of the larynx at the lower border of the cricoid
cartilage at the level of the
sixth cervical vertebra
ends at the carina by dividing into right and left principal (main) bronchi at the level of the sternal angle (opposite the disc between the fourth and fifth thoracic vertebrae).
Principal Bronchi The right principal (main) bronchus 1-wider 2-shorter 3- more vertical than the left 4-is about 1 in. (2.5 cm) long
The left principal (main) bronchus is 1-narrower 2-longer 3-more horizontal than the right 4- is about 2 in. (5 cm) long.
INHALED FOREIGN BODIES
Inhalation of foreign bodies into the lower respiratory tract is common, especially in children Because the right bronchus is the wider and more direct continuation of the trachea foreign bodies tend to enter the right instead of the left bronchus
Lungs
In the child, they are pink, but with age, they become dark because of the inhalation of dust particles that become trapped in the phagocytes of the lung.
The lungs are situated so that one lies on each side of the mediastinum.
Each lung is conical, covered with visceral pleura
Each lung has a blunt apex, which projects upward into the neck for about 1 in. (2.5 cm) above the clavicle a concave base that sits on the diaphragm a convex costal surface, which corresponds to the concave chest wall a concave mediastinal surface, which is molded to the pericardium and other mediastinal structures At about the middle of mediastinal surface is the a depression in which the bronchi, vessels, and nerves that form the root enter and leave the lung. The anterior border is thin and overlaps the heart The posterior border is thick and lies beside the vertebral column
hilum
Right Lung The right lung is slightly larger than the left is divided by the oblique and horizontal fissures into three lobes: THE UPPER MIDDLE LOWER LOBES
Left Lung
The left lung is divided by a similar oblique fissure into two lobes: the upper and lower lobes There is no horizontal fissure in the left lung
1-Pulmonary artery Superior in position
superior
3-Main bronchus Posterior in position 2-Pulmonary veins Inferior in position
For the Practical sessions you do need to recognize the following (1, 2 & 3) according to their anatomical positions
posterior inferior
anterior
