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Lateral
Pleura and lungs
Openings of the Thorax
Thoracic outlet (inlet)
Anterior: superior part of manubrium sterni
Lateral: 1st ribs
Posterior: T1
Openings of the Thorax
Lower opening
Anterior: xiphisternal joint
Lateral: costal margin
Posterior: T12
Structure of the Thoracic Wall
Anterior: sternum and costal cartilages
Lateral: ribs and intercostal spaces
Posterior: thoracic vertebra
Superior: suprapleural membrane
Inferior: diaphragm
Sternum
Flatbone
3 parts:
Manubrium sterni
Body of the sternum
Xiphoid process
Costal Cartilages
Hyaline cartilage
Connects the upper 7 ribs to the sternum
and the 8th-10th ribs to the cartilage above
them
Function: gives elasticity and mobility of
the thoracic wall
Ribs
12 pairs
Attached posteriorly in the thoracic
vertebrae
1st 7 pairs: attached anteriorly in the
sternum
8th-10th pairs: attached to each other and
to 7th rib via costal cartilages
11th-12th pairs: no anterior attachment
Typical Rib
Long, twisted, flat bone
Superior border: round and smooth
Inferior border: sharp and thin, has costal
groove
Typical Rib
Head
Neck
Tubercle
Shaft
Angle
Intercostal Spaces
3 muscles of respiration
External intercostals
Internal intercostals
Innermost intercostals
External Intercostal Muscles
Superficial layer
Downward and forward
tubercle to the costochondral junction
Anterior intercostal membrance
Internal Intercostal Muscle
Intermediate layer
Downward and backward
Sternum to the angle of the ribs
Posterior intercostal membrane
Innermost Intercostal Muscle
Deepest layer
Incomplete muscle layer
Crosses more than one intercostal space
Internal: endotracheal fascia and parietal
pleura
External: intercostal nerves and vessels
Suprapleural Membrane
Dense fascial layer
Lateral: medial border of 1st rib
Superior: tip of C7 transverse process
Medial: investing layer of the thorax into
the neck
Functions: resists changes in intrathoracic
pressure and protects cervical pleura
Endotracheal Fascia
Thin layer of connective tissue
Function: separates parietal pleura to the
thoracic wall
Diaphragm
Primarymuscle of respiration
Dome shaped
Openings:
Aortic-thoracic duct, azygos vein
Esophageal- vagus nerves, (L) gastric vessels
Caval- terminal branches of ® phrenic nerve
Thoracic Cavity
Median (mediastinum)
Lateral
Mediastinum
Movable partition
Superior: thoracic outlet, root of the neck
Inferior: diaphragm
Anterior: sternum
Posterior: T12
Mediastinum
Content: thymus, heart and large blood
vessels, trachea, esophagus, thoracic duct
and LN, vagus and phrenic nerve,
sympathetic trunk
Mediastinum
Superior
Inferior
Anterior
Middle
posterior
Superior Mediastinum
Anterior:manubrium sterni
Posterior: T1-T4
Content: thymus, large veins and arteries,
trachea, esophagus, thoracic duct,
sympathetic trunk
Inferior Mediastinum
Anterior:body of sternum
Posterior: T5-T12
Content: thymus, heart within the
pericardium, phrenic nerve, esophagus,
thoracic duct, descending aorta,
sympathetic trunk
Pleurae
Parietal:lines the thoracic wall
Visceral: covers the outer surface of the
lungs
Pleural Space
Slitlikespace
Filled with pleural fluid
Function: covers the surface of the pleura
and minimizes friction
Visceral Pleura
Approximates the surface of the lungs
Pulmonary plexus (ANS)
Sensitive to stretch
insensitive to pain and touch
Parietal Pleura
Cervical
Costal
Diaphragmatic
Mediastinal
Parietal Pleura
Sensitive to touch, pain, T, P
Costal: intercostal nerves
Mediastinal: phrenic nerves
Diaphragmatic: phrenic nerves and lower
6 intercostal nerves
Costodiaphragmatic recess
Scapular line: 2 inches
MAL: 3 inches
MCL: 1 inch
Surface Landmarks of the Pleura
Cervical: 2.5cm above the junction of
medial and mid 3rd of clavicle
Anterior:
®- behind the SCJ to the XS
(L)- same as ®
4thCC= lateral margin of sternum (cardiac notch)
then going sharply to the XSJ
Surface Landmarks of the Pleura
Posterior
MCL: 8th rib
MAL: 10thrib
Lateral border of erector spinae: 12th rib
Trachea
Mobile tube
5 inches long, 1 inch in diameter
Fibroelastic wall with U-shaped bars of
hyaline cartilage
Lined with trachealis posteriorly
Trachea
From the cricoid cartilage (C6) to the
sternal angle (T4)
Bifurcates into bronchus (Carina)
Branches of the vagus and recurrent
laryngeal nerves
Sympathetic trunk
Trachea
Anterior: sternum, thymus, (L)
brachiocephalic vein, origins of BC and (L)
CC artery, arch of aorta
Posterior: esophagus, (L) recurrent
laryngeal nerve
®: azygos vein, ® vagus nerve, pleura
(L): arch of aorta, (L) CC artery, (L)
subclavian artery, (L) vagus nerve, (L)
phrenic nerve, pleura
Right Main Bronchus
Wider, shorter, more vertical
2.5cm long
Divisions
Superior lobar
Middle lobar
Inferior lobar
Left Main Bronchus
Narrower, longer, more horizontal
5cm long
Divisions:
Superior lobar
Inferior lobar
Lungs
Conical in shape
Situated on either side of the mediastinum
Covered with visceral pleura
Blunt apex
Concave base
Convex costal surface
Concave mediastinal surface
Lungs
Medially: hilum
Left lung: cardiac notch
Right Lung
Slightlylarger
Divided:
Upper
Middle
lower
Left Lung
Divided:
Upper
Lower
Lung Fissures
Oblique fissure:
Inferior
border upward and backward across
the medial and costal surfaces until it reaches
the posterior border 2 ½ inches below the
apex
Lung Fissures
Oblique fissure:
Rootof the scapular spine, obliquely
downward, laterally and anteriorly, following
the course of the 6th rib to the 6th CC junction
Lung Fissures
Horizontal fissure:
Across the costal surface at the level of 4th
costal cartilages to meet the oblique fissure
in the MAL
Lung Fissures
Horizontal fissure:
4th CC to meet the oblique fissure in MAL
Bronchopulmonary Segment
Anatomic,
functional and surgical units
Components:
Segmental bronchus
Branch of pulmonary artery
Lymphatic vessel
Autonomic nerve supply
Bronchopulmonary Segment
Primary (Main) bronchus
Secondary (Lobar) bronchus
Tertiary (Segmental) bronchus
Bronchopulmonary Segment
Subdivision of the lung lobe
Pyramid in shape
Surrounded by connective tissue
Has segmental bronchus, segmental
artery, lymph vessels, autonomic nerves
Segmental vein lies between the adjacent
bronchopulmonary segment
Can be removed surgically
Bronchopulmonary Segment
Right lung
Superior
Apical, posterior, anterior
Middle
Lateral, medial
Inferior
Superior (apical), medial basal, anterior basal,
lateral basal, posterior basal
Bronchopulmonary Segment
Left lung
Superior
Apical, posterior, anterior, superior lingular, inferior
lingular
Inferior
Superior (apical), medial basal, anterior basal,
lateral basal, posterior basal
Bronchopulmonary Segment
Main bronchus
Lobar bronchus
Segmental bronchus
Bronchioles
Terminal bronchioles
Respiratory bronchioles
Alveolar ducts
Alveolar sacs
Respiratory Zone
Respiratory bronchiole
Alveolar duct
Alveoli
Alveoli
Alveolar duct
Alveolar sac
Alveolus
Lungs
Bronchial arteries descending aorta
Bronchial veins azygos and hemiazygos
veins
Pulmonary artery alveoli
Pulmonary vein left atrium