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Topographical Anatomy
|
| Structure/Space |
Description/Boundaries |
Significance |
| mediastinum, posterior |
between pericaridal sac and vertebral bodies |
contains esophagus, descending thoracic aorta, azygos
system, thoracic duct, and lymph nodes |
Muscles
|
| Muscle |
Origin |
Insertion |
Action |
Innervation |
Notes |
| innermost intercostal |
upper borders of ribs at midportion |
fibers course up and medially to insert on the inferior
margin of the rib above |
keeps intercostal space from blowing out or sucking in
during respiration |
intercostal nerves (T1-T11) |
innermost intercostal, subcostalis, and transversus
thoracis mm. lie deep to the intercostal neurovascular bundle |
| internal intercostal |
upper border of rib |
lower border of rib above, coursing up and medially in
front |
keeps intercostal space from blowing out or sucking in
during respiration |
intercostal nerves (T1-T11) |
continuous posteriorly with the internal intercostal
membrane at rib angles |
| subcostalis |
angle of ribs |
angle of rib 2-3 ribs above origin |
compresses intercostal spaces |
intercostal nerves |
subcostalis, transversus thoracis & innermost
intercostal mm. make up the innermost intercostal muscle layer |
Nerves
|
| Nerve |
Source |
Branches |
Motor |
Sensory |
Notes |
| vagus |
medulla: dorsal motor nucleus (preganglionic
parasympathetic) and nucleus ambiguus; superior and inferior ganglia |
auricular br., pharyngeal br., superior laryngeal,
superior & inferior cervical cardiac brs., recurrent laryngeal,
thoracic cardiac brs., brs. to pulmonary plexus, esophageal plexus,
anterior & posterior vagal trunks |
intrinsic muscles of larynx, pharynx (except
stylopharyngeus), & palate (except tensor veli palatini);
preganglionic processes synapse in small ganglia within or near viscera
of thorax and abdomen; postganglionic processes from these ganglia
supply smooth muscles of respiratory tree & gut (proximal to splenic
flexure), heart or are secretomotor to mucous glands of larynx,
respiratory tree, pharynx & gut, digestive glands |
skin of external auditory meatus; viscera of head, neck,
thorax & abdomen proximal to splenic flexure; taste to epiglottis |
also known as: CN X, 10th cranial nerve; passes through
jugular foramen; vagus means "wanderer" in reference to its
extensive distribution to the body cavities |
| splanchnic, thoracic |
neurons in intermediolateral cell column of spinal
levels T5-T12; nerves appear to arise by multiple contributions from
sympathetic trunk |
greater thoracic splanchnic (formed by union of brs.
emerging from ganglia T5-T9); lesser thoracic splanchnic (formed by
union of brs. emerging from ganglia T10-T11); least thoracic splanchnic
(formed by union of brs. emerging from ganglion T12) |
to pre-aortic or prevertebral ganglia in abdomen;
postganglionic processes from prevertebral ganglia supply smooth muscles
of vessels and adrenal medulla which releases epinephrine and
norepinephrine |
pain from abdominal viscera |
pass through crura of diaphragm; greater thoracic
splanchnic synapses in celiac & superior mesenteric ganglia; lesser
thoracic splanchnic synapses in aorticorenal ganglion; least thoracic
splanchnic synapses in renal plexus (Greek,
splanchna = viscera) |
| sympathetic chain
ganglia |
pregang. symp. via white rami communicans of VPR of
T1-L2 |
postgang. symp. via gray rami communicans to all spinal
ns.; internal & external carotid ns.; cervical cardiac brs.;
thoracic visceral brs.; greater, lesser & least thoracic splanchnic
ns.; lumbar splanchnic ns.; sacral splanchnic ns. |
dilator pupillae, vascular smooth muscle, arrector pili
muscles, sweat glands, adrenal medulla, heart, lungs & gut (moderate
muscle contractions, not initiate) |
pain from viscera |
located parallel & lateral to vertebral bodies in
neck, thorax & abdominopelvic cavity |
| stellate ganglion |
pregang. symp. via white rami communicans of T1 |
postgang. symp. via gray rami communicans to C8&
T1; thoracic visceral br. |
vascular smooth muscle, arrector pili muscle, sweat
glands of C8 & T1 cutaneous distribution on chest & upper limb;
vascular smooth muscle of lungs |
pain from lungs |
stellate is the frequent fusion of inferior cervical
ganglion & T1 ganglion of sympathetic trunk |
| Laryngeal, recurrent |
vagus |
esophageal brs., tracheal brs., cardiac brs.,
pharyngeal brs., inferior laryngeal n. |
upper esophagus, lower pharynx, laryngeal ms. (except
cricopharyngeus); smooth muscle of trachea; secretomotor to mucous
glands in upper esophagus, lower pharynx, larynx below vocal fold,
trachea; cardiac muscle of heart (slow rate, decrease force of
contraction) |
upper esophagus, lower pharynx, larynx below vocal
folds, GVA from heart |
right recurrent hooks posteriorly around right
subclavian a.; left recurrent hooks posteriorly around aortic arch &
ligamentum arteriosum |
| intercostal |
VPR of T1-11 |
lateral & anterior cutaneous brs. |
intercostal muscles, abdominal wall muscles (via
T7-11), muscles of forearm & hand (via T1) |
skin of chest & abdomen anterolaterally, skin of
upper limb medially (via T1-2) |
travels below post. intercostal a. in the intercostal
space |
| esophageal plexus |
right & left vagus nn.; thoracic visceral brs. of
sympathetic trunk |
anterior & posterior vagal trunks |
parasympathetic from vagus supplies smooth muscle &
glands of thoracic esophagus & abdominal gut proximal to splenic
flexure; sympathetics from thoracic visceral brs. supply vascular smooth
muscle in esophageal vessels |
vagus: GVA from esophagus & abdominal gut proximal
to splenic flexure; thoracic visceral brs.: pain from esophagus |
|
| cardiac plexus |
cardiac brs. of vagus & cervical sympathetic trunk,
thoracic visceral ns. |
continuous with coronary & pulmonary plexus |
moderate heart muscle (parasymp. decreases rate &
force of contraction; symp. increases rate & force of contraction);
vascular smooth muscle of heart & lungs (symp.); smooth muscle &
mucous glands of bronchial tree (parasymp.) |
|
|
| cardiac |
vagus, cervical sympathetic trunk |
|
heart (parasymp.: decrease rate & force of
contraction; symp.: increase rate & force of contraction); bronchial
tree & lungs via pulmonary pleuxs |
heart, bronchial tree & lungs |
vagus has 2 (sup. & inf.) cervical cardiac brs.
& 1 or more thoracic br.; cervical symp. trunk usually gives 3
(sup., middle & inf.) cardiac brs. |
| 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 |
|
Arteries
|
| Artery |
Source |
Branches |
Supply |
Notes |
| aortic arch |
continuation of ascending aorta |
brachiocephalic trunk, left common carotid, left
subclavian, continues as descending thoracic aorta |
entire body except heart |
|
| 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
diaphragm |
|
| brachiocephalic trunk |
aortic arch |
right common carotid, right subclavian |
right side of head & neck; right upper limb and
right side of chest wall |
|
| 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 & internal carotid (terminal brs.) |
most of head & upper neck |
|
| costocervical trunk |
subclavian |
deep cervical & supreme intercostal |
muscles of neck posteriorly, first 2 posterior
intercostal arteries |
|
| esophageal |
descending thoracic aorta |
|
lower 2/3rds of thoracic esophagus |
there are usually two, although there may be three
esophageal brs. of aorta; anastomoses with esophageal brs. of left
gastric a. |
| intercostal, posterior |
supreme/highest intercostal (upper 2 spaces),
descending thoracic aorta (3rd-11th spaces) |
posterior br., spinal br., anterior br., collateral br.,
lateral cutaneous br. |
intercostal muscles posteriorly & laterally &
overlying muscles, spinal cord & vertebral column & back muscles,
skin & superficial fascia posteriorly & laterally |
|
| phrenic, superior |
descending thoracic aorta (2 small brs.) |
|
diaphragm |
|
| pulmonary trunk |
right ventricle |
right & left pulmonary |
lungs |
|
| subclavian |
brachiocephalic (right), aortic arch (left) |
1st part: vertebral, thyrocervical trunk, internal
thoracic; 2nd part: costocervical trunk; 3rd part: dorsal scapular
(70%); continuous with axillary a. at lateral border of rib 1 |
neck, brain, spinal cord, thyroid gland & larynx,
shoulder, chest muscles, upper limb |
anterior scalene muscle passes anterior to subclavian
a., dividing it into 3 parts |
| subcostal |
decending thoracic aorta |
spinal br., collateral br., lateral cutaneous br. |
vertebra & spinal cord; muscles, skin & fascia
of upper abdominal wall |
|
Veins
|
| Vein |
Tributaries |
Drains Into |
Region Drained |
Notes |
| pulmonary |
lobar vv. |
left atrium |
lungs |
usually two pulmonary vv. per side, superior &
inferior; empty into left atrium |
| brachiocephalic |
formed by union of subclavian & internal jugular
vv.; tributaries: vertebral, thymic, inferior thyroid, internal thoracic,
1st posterior intercostal, left superior intercostal (to left
brachiocephalic) |
left & right brachiocephalic vv. unite to form
superior vena cava |
head, neck, upper limb, anterior chest wall |
at its origin, left brachiocephalic v. receives
thoracic duct; at its origin, right brachiocephalic v. receives right
lymphatic duct |
| vena cava, inferior |
formed by union of paired common iliac vv; tributaries:
lumbar vv. 4-1, right. ovarian/testicular, renal vv., right suprarenal
v., right inferior phrenic v., hepatic vv. |
right atrium |
body below diaphragm |
|
| vena cava, superior |
formed by union of paired brachiocephalic vv.;
tributary: azygos arch |
right atrium |
body above diaphragm except for pulmonary vv. &
coronary vv. |
|
| azygos |
formed by union of ascending lumbar & subcostal vv.;
tributaries: posterior intercostals 11-2 (right superior intercostal),
hemiazygos, accessory hemiazygos, esophageal, right bronchial |
superior vena cava |
lateral & posterior abdominal/chest wall, esophagus,
bronchial tree |
may connect with inferior vena cava; arch of azygos
passes superior to root of lung |
| intercostal, posterior |
lateral cutaneous v. |
1st: brachiocephalic; 2nd-4th: superior intercostal;
right 5th-11th: azygos; left 5th-7th or 8th: accessory hemiazygos; left
9th-11th: hemiazygos |
intercostal space including skin, muscles &
adjacent ribs; spinal cord segment & corresponding vertebra |
|
| intercostal, superior |
2nd-4th posterior intercostal vv. |
right: arch of azygos; left: left brachiocephalic |
intercostal spaces 2-4 |
|
| hemiazygos |
formed by union of left ascending lumbar &
subcostal vv.; tributaries: left posterior intercostal vv. 11-9 or 8,
esophageal vv. |
azygos v. |
lower posterolateral chest wall on left side |
levels drained may vary |
| hemiazygos, accessory |
left posterior intercostal vv. 4-7 or 8, left bronchial
vv., esophageal vv. |
azygos v. |
middle posterolateral chest wall on left side |
levels drained may vary |
| esophageal |
|
azygos & hemiazygos vv. |
esophagus |
connect with esophageal brs. of left gastric, forming
potential portal-caval venous anastomosis (esophageal varices when
enlarged) |
Lymphatics
|
| Structure |
Location |
Afferents from |
Efferents to |
Regions drained |
Notes |
| bronchomediastinal trunk |
along brachiocephalic v. |
union of efferents from paratracheal nodes, parasternal
nodes, anterior mediastinal nodes |
left: thoracic duct; right: right lymphatic duct |
thoracic wall & viscera, medial part of breast |
right bronchomediastinal trunk receives lymph from
lower lobe of left lung; bronchomediastinal trunk may drain to venous
system separately on either side |
| bronchopulmonary nodes |
hilum of lung |
pulmonary nodes |
tracheobronchial nodes |
lung |
also known as: hilar nodes |
| hilar nodes |
at hilum of lung |
pulmonary nodes |
tracheobronchial nodes |
lung |
also known as: bronchopulmonary nodes |
| mediastinal nodes, anterior |
posterior aspect of sternum |
|
bronchomediastinal trunk |
thymus, anterior diaphragm & pericardium, some
heart |
|
| mediastinal nodes, posterior |
along azygos system of veins & esophagus |
|
thoracic duct & inferior & superior
tracheobronchial nodes |
posterior mediastinum, posterior aspect of heart &
pericardium, posterior diaphragm |
|
| paratracheal nodes |
lateral to trachea & esophagus |
superior tracheobronchial nodes |
bronchomediastinal trunk |
lungs, trachea, upper esophagus, larynx below vocal
folds |
|
| pulmonary nodes |
within the lung parenchyma |
|
bronchopulmonary/hilar nodes |
lung parenchyma, bronchial tree within lungs |
|
| tracheobronchial nodes, inferior |
inferior to tracheal bifurcation |
bronchopulmonary nodes |
right superior tracheobronchial nodes |
lower lobes of lungs, middle & post. mediastinum |
|
| tracheobronchial nodes, superior |
superolateral to tracheal bifurcation |
bronchopulmonary nodes, inferior tracheobronchial nodes
(to right) |
paratracheal nodes |
lungs, middle & post. mediastinum |
inferior tracheobronchial nodes drain lymph from lower
lobe of left lung to right superior tracheobronchial nodes |
| horacic duct |
between esophagus & thoracic vertebral bodies |
union of lumbar lymph trunks, sometimes dilated to form
cisterna chyli |
junction of left internal jugular v. and left
brachiocephalic v. |
body below diaphragm, left side of body above diaphragm |
largest lymph vessel; passes up through aortic hiatus
on right side of aorta, swings to left side of esophagus at T4-T5 disc |
Viscera/Fascia
|
| Organ |
Location/Description |
Notes |
| fascia, endothoracic |
connective tissue between inner aspect of chest wall
& costal parietal pleura |
equivalent to transversalis fascia layer of the abdomen |
| pleura, visceral |
serous lining on the surfaces of the lungs; extends
into oblique & horizontal fissures |
does not have pain fibers |
| esophagus |
connects: superiorly with laryngopharynx at lower
border of cricoid cartilage; inferiorly it passes through diaphragm at
T10 vertebral level to reach stomach |
upper third is skeletal muscle innervated by recurrent
laryngeal, lower 2/3rds is smooth muscle innervated by vagus via
esophageal plexus |
| trachea |
lies anterior to the esophagus; extends from vertebral
level C6 to T4/T5 disc; connects above to cricoid cartilage via
cricotracheal ligament |
bifurcation into primary bronchi is marked by the
carina |
| carina |
keel-shaped cartilage lying within tracheal bifurcation |
|
| bronchi |
|
bronchi may be classified as primary, secondary (lobar),
and tertiary (segmental) |
| bronchi, primary |
extend from tracheal bifurcation at T4/T5
intervertebral disc to hilum of lung |
|
| bronchi, secondary |
branch from primary bronchi; 3 on right: upper, middle
& lower; 2 on left: upper & lower |
also known as: lobar bronchi; right primary bronchus is
shorter, larger in diameter and more vertically oriented than the left
so that aspirated foreign bodies tend to lodge in the right primary
bronchus |
| bronchi, tertiary or segmental |
branch from secondary (lobar) bronchi in following
pattern: r. upper lobar: apical, anterior & posterior; r. middle
lobar: medial & lateral; r. lower lobar: superior, anterior basal,
post. basal, medial basal, lateral basal; l. upper lobar: apicoposterior,
anterior, superior lingular, inferior lingular; l. lower lobar: superior,
anteromedial basal, posterior basal, lateral basal |
also known as: segmental bronchi |
| lungs |
right divided into three lobes: upper, middle &
lower; left has two lobes: upper & lower |
|
| fissure, oblique |
separates upper lobe from lower lobe (both lungs), and
middle lobe from lower lobe (right lung) |
extends from level of T3 vertebra posteriorly to 6th
costochondral junction anteriorly |
| fissure, horizontal |
separates middle lobe from upper lobe (right lung only) |
extends from 5th rib at mid-axilla along 4th rib to
sternum anteriorly |
| lobe, inferior |
right: possesses 5 bronchopulmonary segments - superior,
anterior basal, posterior basal, medial basal, lateral basal; left:
possesses 4 bronchopulmonary segs. - superior, anteromedial basal,
posterior basal, lateral basal |
|
| lobe, middle |
right lung only; possesses 2 bronchopulmonary segments:
medial & lateral |
|
| lobe, superior |
right: possesses three bronchopulmonary segments -
apical, anterior & posterior; left: possesses four bronchopulmonary
segments - apicoposterior, anterior, superior lingular, inferior
lingular |
|
| cardiac notch |
concavity or notch along anterior border of left lung |
separates lingula below from upper portion of superior
lobe of left lung |
| lingula |
lower portion of superior lobe of left lung; below
cardiac notch |
|
Clinical Terms
|
| Term |
Definition |
| chylothorax |
accumulation of chyle (lymph from the GI tract) in the
thoracic cavity |
| mediastinal emphysema |
presence of air in the mediastinal tissues due to
leakage of air from the tracheobronchial tree, usually as a result of
trauma. Air from the mediastinum can track cephalically and may
sometimes be palpated in the subcutaneous tissues of the neck and upper
torso. |
| tracheo-esophageal fistula (upper esophageal atresia) |
congenital anomaly in which the upper esophagus ends (atresia)
and does not connect with the stomach, and the lower esophagus connects
to the trachea (tracheoesophageal fistula); a common complication seen
shortly after birth is an aspiration pneumonia - infants will
demonstrate excessive salivation, gagging, and coughing with feeding,
poor feeding and a bluish discoloration of the skin (cyanosis);
treatment involves the surgical repair of the esophagus before the child
can take anything by mouth |
| visceral pain |
pain relating to the viscera (i.e., splanchnic);
mediated by the autonomic nervous system |
| referred pain |
pain that is felt somewhere other than a region from
which it originates; mediated by the autonomic nervous system |
| carcinoma |
any of the various types of malignant (invasive)
neoplasm derived from epithelial tissue in several sites, occurring more
frequently in skin, bronchi, stomach, and prostate gland in men, and in
the breast, cervix, and skin in women |
| tachycardic |
patient with a rapid beating of the heart, defined as
over 100 beats/minute |
| edematous |
swollen due to excessive fluid accumulation in the
intercellular tissue space |
| hematoma |
a collection of blood that is confined and usually
clotted, due to a break in the wall of a blood vessel |
| radical neck dissection |
a common major operation performed to remove
malignancies of the head and neck; the neck must be opened laterally and
the majority of the sternocleidomastoid muscle is removed along with the
regional cervical lymph nodes, the jugular vein, accessory nerve,
submaxillary and parotid glands |
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Potete
inviare a