September

16, 2013

ANATOMY: INTRODUCTION TO THE THORACIC REGION DR. LAYGO

Thoracic Region
Thoracic Cavity Made up of Thoracic Cage
- Sternum
- Costal Cartilage mediates as an indirect
attachment for sternum and anterior ribs
- Ribs
- Thoracic Vertebra Where posterior ribs are
attached
- Diaphragm Lower boundary
- Thoracic Inlet Superior boundary, level of
thoracic notch, at the level between T2 and
T3
Thoracic Cage
Shape: truncated cone
Boundaries:
Anterior wall (Sternum, anterior part of 10 ribs)
Lateral wall (ribs)
Posterior wall (12 thoracic vertebrae and
posterior part of the ribs)

Apertures:
Superior aperture (thoracic inlet)
Measurement: 2 x 4 inches
Boundaries:
Body of 1st thoracic vertebrae
1st rib
1st costal cartilage
Upper border of manubrium sterni
Diaphragm of aperture: Sibsons fascia
- Extension of deep cervical fascia.
- Encloses 1st part of subclavian artery, internal
thoracic vessels and is also attached to the

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cervical/costal pleura pleural covering of

apical portion of the lungs
Inferior aperture (thoracic outlet)

Boundary:
Diaphragm
Two major division of the thoracic cavity:
Median partition (mediastinum)
Parts of mediastinum:
1) Anterior mediastinum
2) Middle mediastinum
3) Posterior mediastinum
Laterally (pleurae and lungs)
- Visceral and parietal pleura
- Visceral pleura attached to lungs
- Parietal pleura superficial to viscera and
close to thoracic cage
- Pleural cavity space between parietal and
visceral pleura.

Breast (See Miracles In Life Everyday)

Base: 2nd 6th ribs
Lateral: anterior axillary line

September
16, 2013

ANATOMY: INTRODUCTION TO THE THORACIC REGION DR. LAYGO

Medially: lateral border of the sternum

Stages of development
1. Prepubertal
2. Breast budding
3. Enlargement
4. Secondary mound
5. Single contour of breast
Parts:
1. 15 20 lobes
2. Lactiferous ducts
-Ampulla: dilated portion
3. Areola
4. Tubercles alveolar glands
Areolar glands of Montgomery: small rounded
elevations
5. Suspensory ligaments
-Separates the fibrous septa
6. Axillay tail: also called axillary tail of Spence
-small part
-Extends upward and laterally
Retromammary space - Space between the mammary
gland and pectoralis fascia
-Supernumerary breast- Multiple nipples present,
usually located at along the mammary line/ milk line

Breast Quadrants:

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BLOOD SUPPLY
1. Axillary artery
-Superior thoracic
-Lateral thoracic: supplies lateral part
-Thoracoacromial: supplies superior portion
2. Internal mammary artery: branch of subclavian
artery; supplies medial part
3. Intercostals artery: perforating branch; supplies
posterior portion; branch of aorta
4. Subscapular artery
Venous
1. Internal thoracic/ mammary vein eventually
drain at subclavian vein brachiocephalic
drainage
2. Lateral thoracic/ mammary vein drainage of
lateral side eventually draining to axillary vein
brachiocephalic drainage
Lymphatic drainage
2 Major groups of lymphatic drainage:
Axillary group of lymph node (LN)
-75% of breast drains on it
Internal mammary group of lymph nodes
-Lateral part of breast
-25% of breast drains on it
Others:
1. External mammary group of LN
-Average of 1.7 LN
-Lying on lateral side pectoralis major muscle
-Medial side of axilla
2. Scapular LN
-Average of 5.8 LN/ 5-7 LN
-Lying together with scapular vessels
-Thoracodorsal branch of scapular vessel
3. Central axillary LN
-Area where most number of LN are found
-12-15 LN

September
16, 2013

ANATOMY: INTRODUCTION TO THE THORACIC REGION DR. LAYGO

-Located within axillary fat pad

-Lymph node that is easily palpable
4. Interpectoral/ rotters LN
-1.4 LN
-Lying between pectoralis major and minor muscles
5. Axillary vein LN
-Lying on ventral and caudal part of the lateral axillary
vein
-Average of 10.7 LN
-Second largest group of LN
6. Subclavian LN/ subclavicular group of LN
-3.5 LN/ 3-5 LN
-Underneath the subclavian vein
7. subareolar plexus of Sappey (Thorek)

1. P
a
g
e
t
s

Disease
2.
3.
4.

Breast dimpling
Nipple discharges
Peau d Orange skin of the

orange
If you want to change your grade you have to be willing
to be uncomfortable
Notetakers:
ARANCA, Voltaire
BUCCAT, Noel
YAP, Janel

***Average Lymph Node of 35.3 lymph nodes

3 Parts of Axillary Lymph Node:
a. LEVEL 1
- all axillary nodes lateral to pectralis minor
- axillary vein group
- external mammary
- scapular
b. LEVEL 2
- located underneath pectoralis minor
- central group
- some subclavian
c. LEVEL 3
- axillary lymph node located medial to pectoralis
minor
apical or subclavicular

Abnormal Findings:

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