Lecturer: Ms DS Pillay ROOM 2P24 25 February 2013 Thoracic Wall

 Consists of thoracic cage

 Muscle

 Fascia

Thoracic Cavity 3 Compartments of the Thorax

(Great Vessels)

(Heart)

Superior thoracic aperture Intercostal space Intercostal vasculature

Internal thoracic A

Anterior thoracic A Musculophrenic A

Posterior intercostal A

Superior intercostal A Thoracic aorta

Subcostal a. Veins  Internal thoracic vein: internal surface of ribs, lateral to sternum, drains into brachiocephalic v.

 Anterior thoracic vein: anteriorly between ribs to drain into internal thoracic v.

 Posterior intercostal veins: travel posteriorly between ribs, 1st 3 join to form superior intercostal v. Drain into brachiocephalic system, remaining drain azygous system Intercostal Nerves  They are anterior primary rami of spinal thoracic nerves fromT1 to T11  T3 toT6 are Typical  T12 is called Subcostal  The remaining nerves are called atypical  Each nerve runs in Intercostal space inferior to Intercostal vessels Chest Tube Placement

Thieme Cl. 5.200A Pleural Membranes PARIETAL PLEURA VISCERAL PLEURA

PLEURAL CAVITY (SEROUS FLUID) Parietal Pleura: four parts Cervical (cupular)

costal

mediastinal

diaphragmatic

Why do you tend to feel pain in the parietal pleura and not the visceral pleura? Cervical pleura  Extends up into neck  Lines undersurface of suprapleural membrane  Reaches level of 2.5-4cm above medial 1/3 of clavicle Costal pleura  Lines inner surface of Ribs Intercostal spaces Costal cartilage sides of vertebral bodies Back of sternum Diaphragmatic pleura  Covers thoracic surface of diaphragm

Costodiaphragmatic Recess  Slit-like space between costal & diaphragmatic parietal pleaura  During inspiration, lower margins of lungs descend into recesses  During expiration, lower margin of lungs ascend so that costal & diaphragmatic pleurae come together Mediastinal pleura  Covers & forms lateral boundary of mediastinum  Continuous with visceral pleura  Lungs lie free except at hilum

Costomediastinal Recesses

 Along anterior margins of pleura

 Slit-like spaces between costal & mediastinal pleurae

 During inspiration & expiration, anterior borders of

lungs slide in & out of recess Blood, Nerve & Lymphatic drainage of pleura

Parietal Pleura Visceral Pleura Blood 1. post intercostals 1. bronchial art Supply 2. int thoracic 3. sup intercostals 4. sup phrenic art Nerve  2nd to 12th i/c n  symph fibres from T2 to Supply  sensory fibres only T5 (pain sensitive) (pain insensitive)  phrenic n Lymphatic drain into adj LN on thoracic drain into LN at hilum of Drainage wall lungs (axillary nodes) Features of Right & Left Lung Lobes & fissures : surface anatomy ------Oblique fissure: extends from level of spinous process of T2 vertebra posteriorly to 6th costal cartilage anteriorly. - Horizontal fissure: begins from anterior border at level of 4th costal cartilage, runs horizontally to meet oblique fissure at the midaxillary line ------RT lung LT lung ------Fissures 2 ( oblique & horizontal) 1 (oblique ) - Lobes 3 ( superior, middle & inferior) 2 (superior & inferior ) - Cardiac notch absent present - Lingula absent present - Width wider narrower - Length shorter longer - Base more concave less concave - Hilum contains 2 bronchi contains one bronchus

Oblique Fissure

Inferior Lobe

Left Lung Lateral View Superior Lobe

Oblique Fissure

Left Lung Medial View Lingula Inferior Lobe Pulmonary Artery

Bronchi

Pulmonary Veins

The Hilum Right Lung

Lateral Superior Lobe View

Horizontal Fissure

Middle Lobe

Oblique Fissure

Inferior Lobe Right Lung Medial View

Superior Lobe

Middle Lobe Inferior Lobe The Hilum

Bronchi

Pulmonary Artery

Pulmonary Vein

Pulmonary Ligament Making an Impression

Left Lung Right Lung

Heart Heart

Aortic arch Azygous Vein

Thoracic Aorta Inferior Vena Cava

Esophagus Esophagus

Left Subclavian artery and vein Superior Vena Cava

Right Subclavian artery and vein Medial Views of the Lungs

left right groove for azygos vein left pulmonary pulmonary pulmonary veins arteries arteries

bronchii right pulmonary veins

groove for esophagus

groove diaphragmatic for aorta cardiac recess impression Surface Anatomy

 Lower border of the lung:  Midclavicular line rib 6 Pleura rib 8  Midaxillary line rib 8 Pleura rib 10 • Adjacent to vertebral column rib 10 Pleura rib 12 The anterior borders of lungs lie adjacent to the anterior line of parietal pleura reflection as far as the 4th costal cartilage The left line of pleural reflection moves laterally & inferiorly at cardiac notch to reach level of 6th costal cartilage  Posterior border of the lung: C7 – T10  The difference between the lower border of the lung and the lower border of the pleura indicates the costodiaphragmatic recess distance

Trachea

R & L principal bronchus

Lobular bronchi (secondary) (2L and 3R)

Segmental bronchi (tertiary) (8L, 10R)

Terminal bronchioles

Respiratory bronchioles

Alveolar ducts

Alveolar sacs

Alveoli Bronchopulmonary segment

Right main bronchus

R upper lobe bronchus R middle lobe bronchus R lower lobe bronchus

Segmental bronchi Segmental bronchi Segmental bronchi

Apical Medial Apical Anterior Lateral Anterior Posterior Posterior Medial Lateral Bronchopulmonary segment

Left main bronchus

L upper lobe bronchus L lower lobe bronchus

Segmental Upper branch Lower branch

Apical Anterior Anterior Superior lingular Posterior Apicoposterior Inferior lingular Lateral

Arterial supply of lungs  Pulmonary arteries -Give rise to lobar arteries  Bronchial arteries – supply blood for nutrition of structures that comprise the root of the lung Venous drainage of lungs  Pulmonary veins – -Lobar veins drain into pulmonary veins  Bronchial veins – drain blood in lungs supplied by bronchial arteries  -Left bronchial vein - accessory hemiazygos vein (usually)  -Right bronchial vein - azygos vein

Innervation of lungs

 Lungs and visceral pleura  -Parasympathetic – from Vagus nerve  -Sympathetic – from sympathetic fibers of sympathetic trunk  Parietal pleura – from intercostal and phrenic nerves

THANKS