Lecturer: Ms DS Pillay ROOM 2P24 25 February 2013

Lecturer: Ms DS Pillay

ROOM 2P24

25 February 2013

Thoracic Wall

Consists of thoracic cage

Muscle

Fascia

Thoracic Cavity

3 Compartments of the Thorax

(Heart)

(Great Vessels)

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

Thieme Cl. 5.200A

Chest Tube Placement

PARIETAL PLEURA VISCERAL PLEURA

PLEURAL CAVITY (SEROUS FLUID)

Pleural Membranes

Parietal Pleura: four parts Cervical

(cupular)

mediastinal

diaphragmatic

costal

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 Supply

1. post intercostals 2. int thoracic 3. sup intercostals 4. sup phrenic art

1. bronchial art

Nerve Supply

2nd to 12th i/c n sensory fibres only (pain sensitive) phrenic n

symph fibres from T2 to T5

(pain insensitive)

Lymphatic Drainage

drain into adj LN on thoracic wall (axillary nodes)

drain into LN at hilum of lungs

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

Left Lung Lateral View

Inferior Lobe

Oblique Fissure

Left Lung Medial View

Superior Lobe

Inferior Lobe

Oblique Fissure

Lingula

The Hilum

Pulmonary Artery

Bronchi

Pulmonary Veins

Superior Lobe

Oblique Fissure

Horizontal Fissure

Middle Lobe

Inferior Lobe

Right Lung Lateral View

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

groove for azygos vein

right pulmonary arteries

bronchii

diaphragmatic recess

right pulmonary veins

cardiac impression

groove for esophagus

groove for aorta

left pulmonary arteries

left pulmonary veins

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 middle lobe bronchus R upper lobe bronchus R lower lobe bronchus

Segmental bronchi Segmental bronchi Segmental bronchi

Apical

Anterior

Posterior

Medial

Lateral

Apical

Anterior

Posterior

Medial

Lateral

Bronchopulmonary segment

Left main bronchus

L upper lobe bronchus L lower lobe bronchus

Upper branch Lower branch

Anterior

Apicoposterior

Superior lingular

Inferior lingular

Segmental

Apical

Anterior

Posterior

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