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| |
Topographic Anatomy
|
| 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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Potete
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