TOPOGRAFICA

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Topographic Anatomy - ANATOMIA TOPOGRAFICA DEL TORACE COMPLETO

Structure/Space

Description/Boundaries

Significance

sternal angle

the junction of the manubrium and body of the sternum

it is an anterior projection located at the level of the costal cartilage of rib 2; an important landmark for internal thoracic anatomy

superior mediastinum

superior to the transverse plane passing throught the sternal angle and the junction of vertebrae T4/T5

main contents include: thymus, brachiocephalic veins, superior vena cava, arotic arch and the roots of its major branches, vagus (X) and phrenic nerves, left recurrent laryngeal n., trachea, esophagus, thoracic duct


Arteries

Artery

Source

Branches

Supply to

Notes

aorta, ascending

left ventricle of the heart

left and right coronary aa.

heart, entire body

ascending aorta is the shortest part of the aorta; it continues as the aortic arch

aortic arch

the continuation of the ascending aorta

brachiocephalic trunk, left common carotid a., left subclavian a.

the entire body except the heart

aortic arch continues as the descending thoracic aorta; the fibrous ligamentum arteriosum connects to the inferior surface of the aortic arch and it marks the location of the fetal ductus arteriosus aortic arch continues as the descending thoracic aorta (Greek, aorta = to lift)

aorta, descending thoracic

continuation of aortic arch

posterior intercostal aa. 3-11, subcostal aa., left bronchial aa. (2), esophageal aa. (~3), mediastinal brs., superior phrenic aa.

thoracic wall, lungs, posterior mediastinum, body below the respiratory diaphragm

descending thoracic aorta passes posterior to the diaphragm (aortic hiatus) at the level of the T12 vertebral body; it is continuous with the abdominal aorta

brachiocephalic trunk

aortic arch

right common carotid a., right subclavian a.

right side of the head and neck; right upper limb and right side of the chest wall

there is only one brachiocephalic trunk (Latin, bracchium = arm, Latin/Greek, cephalicus/kephalikos = head)

bronchial, left

descending thoracic aorta

right bronchial (occasionally)

lower trachea, bronchial tree

usually 2 in number

carotid, common

brachiocephalic trunk (right), aortic arch (left)

external carotid a., internal carotid a.

most of the head and upper neck

common carotid a. bifurcates at the level of the superior border of the thyroid cartilage; the internal carotid a. and the external carotid a. are its terminal brs.; the carotid sinus and carotid body are located at the bifurcation (Greek, kara = head)

subclavian

brachiocephalic a. (right), aortic arch (left)

1st part: vertebral a., thyrocervical trunk, internal thoracic a.; 2nd part: costocervical trunk; 3rd part: dorsal scapular a. (70%)

neck, brain, spinal cord, thyroid gland, larynx, shoulder, chest muscles, upper limb

subclavian a. is continuous with the axillary a., the name change occurs at the lateral border of the first rib; anterior scalene muscle passes anterior to the subclavian a., dividing it into 3 parts ("clavian" refers to the clavicle)

thoracic, internal

subclavian a. (1st part)

pericardiacophrenic a., perforating brs., anterior intercostal aa., mediastinal brs., thymic brs., musculophrenic a., superior epigastric a.

mediastinum, anterior thoracic wall, anterior abdominal wall, respiratory diaphragm

internal thoracic a. is also known as: internal mammary a.


Veins

Vein

Tributaries

Drains Into

Region Drained

Notes

azygos

union of ascending lumbar & subcostal; post. intercostals 11-2 (rt. sup. intercostal), hemiazygos, accessory hemiazygos, esophageal, rt. bronchial

sup. vena cava

lateral & post. abdominal/chest wall, esophagus, bronchial tree

may connect with inf. vena cava; arch of azygos passes sup. to root of lung

brachiocephalic

union of subclavian & internal jugular; vertebral, thymic, inferior thyroid, internal thoracic, 1st post. intercostal, left sup. intercostal (to left brachiocephalic)

left & right brachiocephalic unite to form sup. vena cava

head, neck, upper limb, anterior chest wall

at its origin, left brachiocephalic receives thoracic duct, right receives right lymphatic duct

intercostal, posterior

spinal trib., posterior trib., collateral trib., lateral cutaneous trib.

1st: brachiocephalic; 2nd-4th: superior intercostal; right 5th-11th: azygos; left 5th-7th or 8th: accessory hemiazygos; left 9th-11th: hemiazygos

intercostal space & muscles & adjacent ribs, spinal cord segment & vertebra

 

intercostal, superior

2nd-4th posterior intercostal

right: arch of azygos; left: left brachiocephalic

intercostal spaces 2-4

 

jugular, anterior

submental, communicating

external jugular

anterior neck superficially

 

jugular, external

union of posterior division of retromandibular & posterior auricular; post. external jugular, transverse cervical, suprascapular, anterior jugular

subclavian

head & neck, shoulder

 

thoracic, internal

union of musculophrenic and superior epigastric; ant. intercostal, perforating

right - superior vena cava; left - left brachiocephalic

anterior chest wall and upper anterior abdominal wall

 

thymic

 

left brachiocephalic

thymus (or thymic fat in adult)

 

thyroid, inferior

 

left brachiocephalic

thyroid gland inferiorly

 

vena cava, inferior

union of paired common iliacs; lumbar vs. 4-1, rt. ovarian/testicular, renal vs., rt. suprarenal, rt. inferior phrenic, hepatic vs.

rt. atrium

body below diaphragm

 

vena cava, superior

union of paired brachiocephalics; azygos arch

rt. atrium

body above diaphragm except for pulmonary vs. & heart

 


Lymphatics

Structure

Location

Afferents from

Efferents to

Regions drained

Notes

pulmonary nodes

within the lung parenchyma

lymphatic vessels from the parenchyma of the lung

bronchopulmonary (hilar) nodes

lung parenchyma, bronchial tree within the lungs

pulmonary nodes are located along the larger bronchi of the lung

bronchopulmonary nodes

hilum of the lung

pulmonary nodes

tracheobronchial nodes

lung

bronchopulmonary nodes are also known as: hilar nodes

tracheobronchial nodes, inferior

inferior to tracheal bifurcation

bronchopulmonary nodes, left side inferior tracheobronchial nodes drain into right inferior tracheobronchial nodes

right superior tracheobronchial nodes

lower lobes of the lungs; middle mediastinum; posterior mediastinum

left inferior tracheobronchial nodes drain to the right side

tracheobronchial nodes, superior

superolateral to the tracheal bifurcation

bronchopulmonary (hilar) nodes

paratracheal (tracheal) nodes

lungs, middle mediastinum, posterior mediastinum

inferior tracheobronchial nodes drain lymph from the lower lobe of the left lung to the right superior tracheobronchial nodes

tracheal (paratracheal) nodes

coursing along the lateral surface of the trachea and esophagus

superior tracheobronchial nodes

bronchomediastinal trunk

lungs, trachea, upper esophagus, the part of the larynx below the vocal folds

paratracheal nodes are an important group of nodes in cases of pulmonary infection or lung cancer; also known as: tracheal nodes


Nerves

Nerve

Source

Branches

Motor

Sensory

Notes

cardiac plexus

cardiac brs. of the vagus n. and cervical sympathetic trunk; thoracic visceral nn.

no named branches

moderates heart muscle (parasympathetic: decreases rate and force of contraction; sympathetic: increases rate and force of contraction); vascular smooth muscle of the heart & lungs (sympathetic); smooth muscle & mucous glands of bronchial tree (parasympathetic)

pain from the heart and lungs

cardiac plexus is continuous with the coronary and pulmonary plexuses; thoracic visceral nn. carry pain from the heart to the upper thoracic spinal cord segments resulting in pain referred to the left upper limb in the T1 and T2 dermatomes

pulmonary plexus

continuous with cardiac plexus, thoracic visceral ns., pulmonary brs. of vagus

 

smooth muscle & glands of bronchial tree (parasymp.); vascular smooth muscle of lungs (symp.)

located along pulmonary vessels & primary bronchi in root of lung

 

phrenic n.

ventral primary rami of spinal nerves C3-C5 (cervical plexus)

no named branches

skeletal muscle of the respiratory diaphragm

diaphragmatic pleura; some fibers contributed to the pericardium and to the adjacent mediastinal and costal pleurae

phrenic n. crosses the anterior surface of the anterior scalene m.

recurrent laryngeal n.

vagus n. (X)

esophageal brs., tracheal brs., cardiac brs., pharyngeal brs., inferior laryngeal n.

upper esophagus, lower pharynx, laryngeal mm. (except cricopharyngeus); smooth muscle of the trachea; secretomotor to mucosal glands in the upper esophagus, lower pharynx, larynx below the vocal fold, trachea; cardiac muscle of the heart (slows heart rate, decreases force of contraction)

upper esophagus, lower pharynx, larynx below the vocal folds, GVA from heart

right recurrent laryngeal n. loops posteriorly around the right subclavian a.; left recurrent laryngeal n. loops posteriorly around the aortic arch and ligamentum arteriosum; the inferior laryngeal br. supplies all intrinsic muscles of the larynx EXCEPT the cricothyroid m.

vagus n.

medulla: dorsal motor nucleus (GVE preganglionic parasympathetic); inferior ganglion (GVA); nucleus ambiguus (SVE); superior ganglion (GSA); inferior ganglion(SVA)

auricular br., pharyngeal br., superior laryngeal, superior and inferior cervical cardiac brs., recurrent laryngeal n., thoracic cardiac brs., brs. to the pulmonary plexus, brs. to the esophageal plexus, anterior and posterior vagal trunks

SVE: intrinsic muscles of the larynx, pharynx (except stylopharyngeus), and palate (except tensor veli palatini); GVE: smooth muscle of the respiratory tree & gut (proximal to the left colic flexure), heart; secretomotor: mucous glands of the larynx, respiratory tree, pharynx and gut; secretomotor to digestive glands

GSA: skin of the external auditory meatus; GVA: viscera of head, neck, thorax & abdomen proximal to the left colic flexure; SVA: taste from the epiglottis

also known as: CN X, 10th cranial nerve; the vagus n. passes through the jugular foramen to exit the posterior cranial fossa; vagus means "wanderer" in reference to its extensive distribution to the body cavities


Viscera/Fascia

Organ/Part of Organ

Location/Description

Notes

apex of lung

the blunt superior surface of the lung projecting above the level of the 1st rib into the root of the neck; covered by cervical pleura

 

base of lung

the inferior surface of the lung that contacts the dome of the diaphragm

also called the diaphragmatic surface

cardiac notch

indents the anteroinferior aspect of the superior lobe of the left lung

creates the lingula, a tongue-like process of the superior lobe

fissure, oblique

deep groove in the surface of the lung that separates the upper lobe from the lower lobe (both lungs), and the middle lobe from the lower lobe (right lung)

oblique fissure extends from the level of the T3 vertebra posteriorly to the 6th costochondral junction anteriorly

fissure, horizontal

deep groove in the surface of the lung that separates the middle lobe from the upper lobe (right lung only)

horizontal fissure extends from the 5th rib at the mid-axillary line along the 4th rib to the sternum anteriorly

lingula

lower portion of superior lobe of left lung; below cardiac notch

 

lobe, inferior

the portion of the lung supplied by the inferior lobar bronchus

inferior lobe of the right lung: possesses 5 bronchopulmonary segments - superior, anterior basal, posterior basal, medial basal, lateral basal; inferior lobe of the left lung: possesses 4 bronchopulmonary segments - superior, anteromedial basal, posterior basal, lateral basal

lobe, middle

the portion of the right lung supplied by the middle lobar bronchus

middle lobe is found in the right lung only; it possesses 2 bronchopulmonary segments: medial and lateral; lingula of the inferior lobe of the left lung is equivalent to the middle lobe of the right lung

lobe, superior

the portion of the lung supplied by the superior lobar bronchus

superior lobe of the right lung: possesses three bronchopulmonary segments - apical, anterior and posterior; superior lobe of the left lung: possesses four bronchopulmonary segments - apicoposterior, anterior, superior lingular, inferior lingular

lung

the portion of the respiratory system where exchange of gasses occurs between the air and the blood; located in the thoracic cavity

paired; right lung is divided into three lobes: superior, middle and inferior; left lung has two lobes: superior and inferior

main (primary) bronchus

pass inferolaterally from the bifurcation of the trachea at the level of the sternal angle to the hilum

the right main bronchus is wider, shorter and runs more vertically than the left main bronchus; the left main bronchus passes inferior to the arch of the aorta and anterior to the esophagus and thoracic aorta

lobar (secondary) bronchi

branches of the main bronchus

two on the left; three on the right

lingular bronchus

bronchus branch located in the lingula of the left lung

 

segmental (tertiary) bronchi

branches of the lobar bronchi

 

bronchopulmonary segments

branches of the segmental bronchi

pyramidal-shaped segment of the lung, with it's apex facing the root and its base at the pleural surface; these are the largest subdivisions of a lobe, separated by septa, and are named according to the segmental broncus supplying it

hilum

medial surface of the lung

the point at which the structures forming the root - the main bronchus, pulmonary vessels, bronchial vessels, lymphatic vessels, and nerves - enter and leave the lung

carina

keel-shaped cartilage lying within the tracheal bifurcation

carina trachealis is an important landmark during endoscopy of the bronchial tree

trachea

main airway that lies anterior to the esophagus

trachea extends from vertebral level C6 to the level of the T4/5 intervertebral disc; superiorly it is connected to the cricoid cartilage via the cricotracheal ligament; it bifurcates into two primary bronchi (Greek, trachys = rough)


Clinical Terms

Term Definition
bronchoscopy an examination used for inspection of the interior of the tracheo-bronchial tree, performance of endobronchial diagnostic tests, taking of specimens for biopsy and culture and removal of foreign bodies
pneumonectomy an operation to remove an entire lung
chronic obstructive pulmonary disease (COPD) a progressive disease process that most commonly results from smoking and mainly affects expiratory air flow. COPD includes chronic bronchitis and emphysema. Obstructive pulmonary disease is characterized by difficulty breathing, wheezing, and a chronic cough; treatment includes absolute avoidance of smoking, bronchodilators and oxygen for those with advanced disease; complications include bronchitis, pneumonia

cyanosis

a dark blue or purple discoloration of the skin due to deficient oxygenation of the blood

ventricular hypertrophy

increase in cell size (not in the number of cells ) of ventricular cells resulting in gross enlargement of the ventricle

laryngoscopy

visualization of the larynx and vocal cords using a fiberoptic scope

bacterial endocarditis

inflammation of the endocardium (the inner lining of the heart that covers the chambers and the valves) due to the presence of bacteria that can lead to deformity of the heart valves

clubbing

broadening of the tips of fingers and toes with an increase in nail curvature that is a sign of decreased blood oxygen in a patient. This is a result of soft tissue proliferation at the distal phalanges.

polycythemia

an above normal red blood cell count

epistaxis

nosebleed

murmur

a finding on that can be indicative of heart disease. Murmurs can result from abnormalities in the heart or vessels that lead to turbulent flow

systolic thrill

palpable vibration in the chest wall during muscular contraction of the heart


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