Gr. T.

Popa University of Medicine and Pharmacy Iai,

Romania
Anatomy Department

Dezvoltarea
coloanei
vertebrale

Introduction

The vertebral column is composed of alternating vertebrae and

intervertebral discs supported by robust spinal ligaments and
muscles. All of these elements, bony, cartilaginous, ligamentous,
and muscular, are essential to the structural integrity of the
spine.

The spine serves three vital functions:

protecting the spinal cord and spinal nerves,

transmitting the weight of the body,
providing a flexible axis for movements of the head and the torso.

The vertebral column is capable of extension, flexion, lateral

flexion (side to side), and rotation. However, the degree to which
the spine is capable of these movements varies by region. These
regions, including the cervical, the thoracic, the lumbar, and the
sacrococcygeal spine, form four curvatures

The thoracic and the sacrococcygeal curvatures are established

in fetal development, while the cervical and the thoracic

curvatures develop during infancy. The cervical curvature arises
in response to holding the head upright, while the lumbar
curvature develops as an infant begins to sit upright and walk.

Introduction

Dimensiuni
Lungimea - n medie de 73

cm la brbat i 63 cm la
femeie, reprezentnd 40% din
lungimea total a corpului.
Limea maxim - la baza

sacrului msoar 11 cm.

Diametrul sagital maxim -

la nivelul ultimelor vertebre

lombare atinge 7 cm.

Formarea coloanei vertebrale

Puin timp dup formarea lor, fiecare
somit se mparte n sclerotom,
miotom i dermatom.
n cursul S4, celulele sclerotoamelor
nconjoar mduva spinrii ct i
notocordul prin creterea difereniat
a structurilor adiacente i nu prin
migrare activ:
poriunea
ventral
a
sclerotoamelor
nconjoar
notocordul
i
formeaz
primordiul corpului vertebral
poriunea
dorsal
a
sclerotoamelor nconjoar tubul
neural i formeaz primordiul
arcului vertebral.
Ambele procese sunt controlate de
substane inductorii produse de
notochord (condroitin sulfat) i
respectiv, de tubul neural.

Corpul vertebral
Pe parcursul migrrii sclerotoamelor spre notocord i tubul neural,
acestea se divid ntr-o jumtate cranial i una caudal.
Jumtatea caudal a fiecrui sclerotom fuzioneaz cu jumtatea
cranial a sclerotomului succesiv.
Vertebra rezultat se dispune intersegmentar (ntre nivelurile de
emergen ale nervilor spinali, ce prezint dezvoltare segmentar).

Exist 7 vertebre cervicale derivate

din 8 somite cervicale deoarece:
jumtatea cranial a primului
sclerotom cervical fuzioneaz cu
jumtatea caudal a celui de al
patrulea sclerotom occipital i
contribuie la formarea bazei
craniului.
jumtatea caudal a primului
sclerotom cervical fuzioneaz cu
jumtatea cranial a celui de al
doilea
sclerotom
cervical,
formnd prima vertebr cervical.
.
al optulea sclerotom contribuie la
formarea celei de a aptea
vertebre cervicale (jumtatea
cranial)
i
primei
vertebre
toracice (jumtatea caudal).
primul nerv spinal prsete
canalul
rahidian
ntre
baza
craniului
i
prima
vertebr
cervical, iar al optulea
nerv

 Ca

rezultat
al
resegmentrii
sclerotomale,
nervii
spinali
segmentari prsesc mduva spinrii
ntre vertebre.

Nervii rahidieni (spinali) pstreaz

poziia lor segmentar primar,

formndu-se la nivelul discurilor
intervertebrale; ieirea lor din canalul
rahidian
se
face
prin
gurile
intervertebrale
sau
interpedunculare.
Dup

stadiul precartilaginos, n
sptmna
a
7-a
ncepe
condrificarea prin doi centri care
apar n corpul vertebrei i prin cte
unul n fiecare jumtate a arcului
vertebral,
care
se
formeaz
nconjurnd tubul neural.

Discul intervertebral
Discurile intervetebrale se formeaz ntre corpii
vertebrali, la nivelurile segmentare dintre celulele
mezenchimale localizate ntre prile cefalic i
caudal ale segmentelor sclerotomale originale.
Dei notocordul regreseaz n regiunea corpilor
vertebrali, persist i se lrgete n regiunea
discurilor
intervetebrale,
formnd
nucleul
pulpos.
Fibrele circulare cu originea n celulele sclerotoale
formeaz inelul fibros.
Nucleul pulpos este (probabil) nlocuit de celulele
de origine sclerotomal.

1 partie fixe: sacrum et coccyx

1 partie mobile:
- 7 cervicales
- 12 thoraciques
- 5 lombaires
3 courbures
- cervicale en lordose
- dorsale en cyphose
- lombaire en lordose
Intrt: augmentation de la
rsistance la compression
selon la loi de EULER;
le colonne est dix fois plus
rsistante la compression
quune colonne rectiligne

C urburile coloanei vertebrale

Coloana vertebral nu este rectilinie, ci prezint dou feluri de curburi:

n plan sagital

n plan frontal

1. Curburile n plan sagital (antero-posterior) orientate fie cu convexitatea anterior, numite

lordoze, fie cu convexitatea posterior, numite cifoze.
Coloana vertebral prezint 4 curburi:

curbura cervical cu convexitatea nainte(lordoza)

curbura toracal cu convexitatea napoi(cifoza)

curbura lombar cu convexitatea nainte (lordoza)

curbura sacrococcigian cu convexitatea napoi (cifoza)

n timpul vieii intrauterine coloana vertebral prezint o singur curbur cu convexitatea

posterior

La nou-nscut coloana vertebral prezint

cervicotoracal de cea sacrococcigian.

un

Lordoza cervical apare n lunile 3-5 i este rezultatul ridicrii capului de ctre sugar.

Lordoza lombar apare n jurul vrstei de 2 ani i se datoreaz staiunii verticale i locomoiei.

Curburile sagitale sunt dobndite n cursul vieii.

unghi

lombosacral

ce

separ

cifoza

2. Curburile n plan frontal (transversal)

Sunt mai puin pronunate ca cele n plan

sagital.

n mod obinuit ntlnim:

curbura cervical cu convexitatea la

stnga;

curbura toracal cu convexitatea la

dreapta

curbura lombar cu convexitatea la

stnga.

Curbura
toracal
este
primar,
fiind
determinat de traciunea muchilor mai
dezvoltai la membrul superior drept;
celelalte dou curburi sunt compensatorii,
avnd scopul de a
restabili echilibrul
corporal.

La stngaci, curburile frontale sunt ndreptate

n sens invers.

M ovem ents of the vertebral colum n

The series of vertebral bodies, intervertebral discs, and vertebral arches form a
mobile rod that also protects the spinal cord.

Yet two other requirements for a useful vertebral column must be met:
(1) One should be able voluntarily to produce motion of the column,
(2) there must be mechanisms to restrict excessive movements of any one
vertebra upon another.

Voluntary motion is achieved by having muscles attach to the vertebral arch and
to lever-like processes that extend from it.

Prevention of undesirable intervertebral motion is achieved primarily by the

development of articular processes (zygapophyses) and intervertebral ligaments.
The job of preventing excessive movement between vertebrae is accomplished by
two general mechanisms: (1) the development of articular processes between
adjacent vertebral arches the Orthopaedists call these facet joints, pronouncing
the word facet with the accent on the second syllable.

and (2) the development of ligaments between adjacent vertebral bodies, vertebral
arches, and lever-like processes.

In the thoracic region of the vertebral column, these mechanisms are further aided
by overlapping of the obliquely disposed spinous processes, which limits extension,
and by the pronounced development of the costal processes (i.e., ribs), which have
a very restrictive effect on all movements. In the sacral region, the two general
mechanisms of movement restriction are superseded by fusion of the vertebrae.

If it is necessary to identify the spine of a specific thoracic vertebra on a patient, the patient should be asked to
bend the neck forward so that the examiner may count downward from the easily recognizable spine of C7.
Counting upward to identify higher cervical spines is difficult, since the 6th cervical spine may or may not be

Conform aia extern a coloaneivertebrale

Coloana vertebral considerat n totalitatea ei prezint:

faa anterioar

faa posterioar

dou fee laterale

1. Faa anterioar este format de o coloan cilindric, rezultat din suprapunerea corpurilor
vertebrelor.
2. Faa posterioar prezint pe linia median procesele spinoase, care formeaz mpreun
creasta spinal. Procesele spinoase se pot explora cu mult uurin, mai ales n timpul
flectrii trunchiului. La limita dintre coloana cervical i toracal se vizualizeaz foarte net
procesul spinos al vertebrei C7 (vertebra proeminens); pornind de la acest proces spinos, se
poate numerota fiecare vertebr.

n continuarea proceselor spinoase se exploreaz creasta sacral median, iar n plica

interfesier se pot palpa coarnele sacrale, coarnele coccigelui i hiatul sacral.

De fiecare parte a crestei spinale

vertebralepentru muchii spinali.

se

gsesc

anuri

profunde,

numite

anuri

3. Feele laterale prezint: vrful proceselor transversare, pediculii vertebrali, gurile

intervertebrale i poriunile laterale ale corpilor vertebrali.

Vrful procesului transversar al atlasului poate fi palpat imediat sub procesul mastoidian.

Spinal ligam ents

Supraspinous ligaments

Interspinous ligaments

The extremely important ligamenta flava

The posterior longitudinal ligament

The ligaments that limit excessive flexion of the vertebral column play a
significant role when a person bends the trunk forward while keeping the
knees straight, as if to touch the toes. Interestingly, at the end of such a
movement the muscles that extend the vertebral column cease firing.

Only one ligament prevents excessive extension of the vertebral

column. This is the powerful anterior longitudinal ligament that
starts at the base of the skull and runs down the front of the
vertebral bodies, getting wider as it descends.

It is the anterior longitudinal ligament that will be injured during

hyperextension of the vertebral column caused by external forces. Such
injuries are most commonS in the cervical region during what is called
whiplash of the neck, produced by a force that drives the trunk forward
while the head lags behind. Once the anterior longitudinal ligament in the
cervical region has been strained, the clinician must devise a method for
preventing further stress on this structure. Such a method is a neck collar

Spinal ligam ents

D ezvoltarea
sternului

coastelor

Coastele

se
dezvolt
din
procesele costale ae vertebrelor
toracice,
din
poriunea
sclerotomial a mezodermului
paraaxial.

Sternul se dezvolt independent,

n
mezodermul
somatic
peretelui ventral al corpului.

al

Cele 2 benzi sternale se dezvolt

pe prile laterale ale liniei

mediosagitale,
fuzioneaz
ulterior
pentru
a
forma
manubriul sternal, sternebrele i
procesul xifoid.

Canalul vertebral

Este format prin suprapunerea

gurilor
vertebrale.
Canalul
vertebral se continu n sus
cu
cavitatea neurocraniului, iar n jos
se deschide prin hiatul sacral.
Canalul vertebral urmrete toate
inflexiunile coloanei vertebrale.

Diametrele
canalului
vertebral
variaz: sunt mai mari n regiunea
cervical i lombar, n raport cu
mobilitatea mai mare a coloanei
vertebrale n aceste regiuni. n
regiunea toracal, unde mobilitatea
coloanei vertebrale este mai redus,
diametrele canalului vertebral sunt
mai mici.

CORELAII CLINICE
Coloana vertebrala poate prezenta i curburi
patologice, ca urmare a exagerrii curburilor
normale:
Cifoza patolologic se caracterizeaz prin
accentuarea convexitii posterioare.
Lordoza patologic se caracterizeaz prin
accentuarea convexitii anterioare.
Scolioza const in exagerarea curburilor n
plan frontal.
Curburile patologice ale coloanei vertebrale pot
fi:
ereditare sau dobndite.
Dezvoltarea i funcionarea unor viscere pot fi
influenate n sens negativ de ctre curburile
patologice ale coloanei vertebrale.
Coloana vertebrala poate prezenta i curburi
patologice, ca urmare a exagerrii curburilor
normale:

Defectele
vertebrale
apar
datorit
induciei anormale a sclerotoamelor:
scolioza
spina bifida
anencefalia

Scoliosis
Scoliosis

is
an
abnormal
curvature of the spine. If your
child has scoliosis, the view from
behind may reveal one or more
abnormal curves.Scoliosis runs in
families, but doctors often don't
know the cause. More girls than
boys have severe scoliosis. Adult
scoliosis may be a worsening of a
condition that began in childhood,
but wasn't diagnosed or treated.
In other cases, scoliosis may
result from a degenerative joint
condition in the spine.

Kyphosis

With kyphosis, your spine may look

normal or you may develop a hump.
Kyphosis can occur as a result of
developmental
problems;
degenerative
diseases,
such
as
arthritis of the spine; osteoporosis with
compression
fractures
of
the
vertebrae; or trauma to the spine.

It can affect children, adolescents and

adults.

Lordosis

A normal spine,
when viewed from
behind
appears
straight. However,
a spine affected by
lordosis
shows
evidence
of
a
curvature of the
back
bones
(vertebrae) in the
lower back area,
giving the child a
"swayback"
appearance.

Tuberculosis of the Spine- Potts disease

As a form of extrapulmonary
tuberculosis that impacts the spine,
Potts disease has an effect that is
sometimes described as being a sort
of arthritis for the vertebrae that
make up the spinal column. More
properly known as tuberculosis
spondylitis, Potts disease is named
after Dr. Percivall Pott, an eighteenth
century surgeon who was considered
an authority in issues related to the
back and spine.

Pott's disease is often experienced

as a local phenomenon that begins
in the thoracic section of the spinal
column. Early signs of the presence
of Potts disease generally begin with
back pain that may seem to be due
to simple muscle strain. However, in
short order, the symptoms will begin
to multiply.

TO R A C ELE

SkeletalSystem
The bones of the skeleton form an internal framework to support soft

tissues, protect vital organs, bear the bodys weight, and help us move.
Typically, there are 206 bones in an adult skeleton, although this

number varies in some individuals.

A larger number of bones are present at birth, but the total number

decreases with growth and maturity as some separate bones fuse.

The axial skeleton is composed of the bones along the central axis of

the body,
the skull
the vertebral column
the thoracic cage
The appendicular skeleton consists of the bones of the appendages
upper and lower limbs
the bones that hold the limbs to the trunk of the body.

Thoracic Cage
Borders:
Thoracic vertebrae

posteriorly
Ribs laterally
Sternum and costal
cartilages anteriorly

Forms protective cage

@ heart, lungs, and

other organs
Composed of:
Sternum
Ribs

Thoracic Cage -Sternum

Lies in the

anterior midline
of the thorax
Consists of 3
fused sternebrae
(sections):
The manubrium
The body
The xiphoid

process

Sternum -M anubrium

Handle
Connected to the

Costal Cartilage

first 2 ribs
Clavicular notches
articulate with
clavicles (collarbone)
Clavicular Articular
facets

Sternum -Body
Blade or

gladiolus
Connects with ribs 27
Sides are notched
where it articulates
with the costal
cartilages
4 separate parts until
after puberty

Sternum Xiphoid Process

Tip
Cartilaginous

(hyaline) that
becomes bony over
the years (@40)
Partial attachment of
many muscles

Sternum
3 major anatomical

landmarks:
1. Jugular notch

Central indentation in
manubrium
2. Sternal angle

Manubrium joins the

body
3. Xiphisternal joint

Cartilaginous union
between xiphoid
process and body

Thoracic Cage -Ribs

12 pairs
True ribs
Superior 7 pairs that
attach directly to
sternum by CC
False ribs (8-12)

Inferior 4 pairs (8-10)

and attach indirectly to
sternum
Floating ribs
Ribs 11 and 12 and have
no anterior attachments
(muscles)

Ribs
Typical ribs
# 2-9

Atypical ribs
# 1, 10-12

Increase in length from

1-7
Decrease in length from
8-12
Costal margin

Rib Anatom y TypicalRibs

Dorsal attachment

Head of Rib 2 Demifacets

Superior demifacet
Inferior demifacet of vertebra
above it
Intervertebral disc

Tubercle of Rib
Articulates with Transverse Costal
Facet (Thoracic vertebra)

Ex. Rib #4 articulates with

Superior Demifacet and Transverse
Costal Facet of T4 & Inferior
demifacet of T3

Ventral attachment

Costal cartilage

Rib Anatom y AtypicalRibs

#1 flat and broad, supports subclavian

vessels
#1, and 10-12 articulate with only 1 vertebral
body
#11 and 12 do not articulate with a vertebral
transverse process

Thoracic W allD im ensional

Changes
D
ur
i
ng
Respi
r
at
i
on
Lateral dimensional changes
occur with rib movements.

Elevation of the ribs

increases the lateral

dimensions of the thoracic
cavity, while depression of
the ribs decreases the
lateral dimensions of the
thoracic cavity.

M uscles that M ove the Ribs

The scalenes help increase thoracic cavity dimensions by elevating the first and second
ribs during forced inhalation.

The ribs elevate upon contraction of the external intercostals, thereby increasing the
transverse dimensions of the thoracic cavity during inhalation.

Contraction of the internal intercostals depresses the ribs, but this only occurs during
forced exhalation.

Normal exhalation requires no active muscular effort.

A small transversus thoracis extends across the inner surface of the thoracic cage and
attaches to ribs 26. It helps depress the ribs.

Two posterior thorax muscles also assist with respiration. These muscles are located
deep to the trapezius and latissimus dorsi, but superficial to the erector spinae muscles.

The serratus posterior superior elevates ribs 25 during inhalation, and the serratus
posterior inferior depresses ribs 812 during exhalation.

In addition, some accessory muscles assist with respiratory activities.

The pectoralis minor, serratus anterior, and sternocleidomastoid help with forced
inhalation, while the abdominal muscles (external and internal obliques, transversus
abdominis, and rectus abdominis) assist in active exhalation.

Parts and regions of the thorax

Boundaries
Superior jugular
notch,
sternoclavicular joint,
superior border of
clavicle, acromion,
spinous processes of
C7
Inferior xiphoid
process, costal arch,
12th and 11th ribs,
vertebra T12
Regions
Thoracic wall
Thoracic cavity

Landm arks

Jugular notch corresponds

with

The 2th thoracic vertebra in

male, the 3th thoracic vertebra
in female

Sternal angle connects 2nd

costal cartilage laterally
corresponds with

The lower border of 4th thoracic

vertebra
The bifurcation of trachea in the
adult
The beginning of aortic arch
which ends posteriorly at the
same level
The esophagus is crossed by the
left main bronchus

 Xiphoid process

phisternal junction lies

opposite the body of the
9th thoracic vertebra
Clavicle
Inferior fossa of clavicle
Coracoid process
Ribs and intercostal

spaces
Costal arch
Infrasternal angle
Xiphocostal angle
Papillae

Thoracic w all
Skin
Superficial fascia
Thoracoepigastric v.
Supraclavicular n.
Anterior and lateral

cutaneous
branches of
intercostal n.

Deep fascia

Intercostal space
Posterior intercostal v.
Posterior intercostal a.
Intercostal n.

Lym phatic drainage of breast

Into pectoral ln. from lateral

and central parts of breast
Into apical and
supraclavicular ln. from
superior part of breast
Into parasternal ln. from
medial part of breast
Into interpectoral ln. from
deep part of breast
The lymphatic capillaries of
breast form an anastomosing
network which is continuous
across the midline with that of
the opposite side and with that
of the abdominal wall

Internal thoracic
vessels
Internal thoracic a.&v.
Parasternal ln.

Endothoracic fascia

Boyles Law

The pressure of a gas decreases if the volume of the

container increases, and vice versa.

When the volume of the thoracic cavity increases even

slightly during inhalation, the intrapulmonary pressure
decreases slightly, and air flows into the lungs through
the conducting airways.

Air flows into the lungs from a region of higher pressure

(the atmosphere) into a region of lower pressure (the
intrapulmonary region).

When the volume of the thoracic cavity decreases during

exhalation, the intrapulmonary pressure increases and
forces air out of the lungs into the atmosphere.

Parts and regions of the thorax

Boundaries
Superior jugular
notch,
sternoclavicular joint,
superior border of
clavicle, acromion,
spinous processes of
C7
Inferior xiphoid
process, costal arch,
12th and 11th ribs,
vertebra T12
Regions
Thoracic wall
Thoracic cavity

Landm arks

Jugular notch corresponds

with

The 2th thoracic vertebra in

male, the 3th thoracic vertebra
in female

Sternal angle connects 2nd

costal cartilage laterally
corresponds with

The lower border of 4th thoracic

vertebra
The bifurcation of trachea in the
adult
The beginning of aortic arch
which ends posteriorly at the
same level
The esophagus is crossed by the
left main bronchus

 Xiphoid process

phisternal junction lies

opposite the body of the
9th thoracic vertebra
Clavicle
Inferior fossa of clavicle
Coracoid process
Ribs and intercostal

spaces
Costal arch
Infrasternal angle
Xiphocostal angle
Papillae

Thoracic w all
Skin
Superficial fascia
Thoracoepigastric v.
Supraclavicular n.
Anterior and lateral

cutaneous
branches of
intercostal n.

Deep fascia

Intercostal space
Posterior intercostal v.
Posterior intercostal a.
Intercostal n.

M ED IA S TIN

M ediastinum
Superior

mediastinum
Area above T4/T5

(above

angle of sternum)

Inferior mediastinum
Area below T4/T5

(below

angle of sternum)

Inferior is divided into

Anterior mediastinum
Middle mediastinum
Posterior mediastinum

Superior
M ediastinum

Superior border

Inferior border

Manubrium of sternum

Posterior border

Parietal pleura on each side

Anterior border

Transverse plane from

sternal angle to T4/T5

Lateral borders

Oblique plane from jugular

notch to T1

T1-T4

Contents

Thymus, brachiocephalic
veins, SVC, arch of aorta,
trachea, esophagus, nerves

Superior m ediastinum
Locating from inlet of thorax to plane extending
from level of sternal angle anteriorly to lower
border of T4 vertebra posterioly
Contents

Superficial layer
Thymus
Three veins

Left brachiocephelic v.
Right brachiocephelic v.
Superior vena cava

Middle layer
Aotic arch and its three branches
Phrenic n.
Vagus n.

Posterior layer
Trachea
Esophagus
Thoracic duct

Inferior m ediastinum

Anterior
mediastinum

Location posterior to
body of sternum and
attached costal
cartilages, anterior to
heart and pericardium

Anterior (Inferior)
M ediastinum

Superior border

Inferior border

Body of sternum

Posterior border

Parietal pleura on each

side

Anterior border

Diaphragm

Lateral borders

Transverse plane from

sternal angle to T4/T5

Pericardial sac

Contents

Thymus, fat, small

vessels, lymph nodes

Middle
mediastinum

Location between
anterior mediastinum
and posterior
mediastinum
Contents: hart and
pericardium,
beginning or
termination of great
vessels, phrenic
nerves,
pericardiacophrenic
vessels , lymph
nodes,

Posterior mediastinum

Location posterior to
heart
and
pericardium,
anterior to vertebrae T5
T12
Contents:
esophagus,
vagus n., thoracic aorta,
azygos system of veins,
thoracic
duct,
thoracic
sympathetic trunk, posterior
mediastinal lymph nodes

M iddle
M ediastinum

Region between anterior mediastinum and

posterior mediastinum
Typically referred to as pericardial sac
Will be covered in Thorax 2

Posterior
Mediastinum

Region behind middle

mediastinum
Will be covered in Thorax
3

Left side ofm ediastinum

Left subclavian a.
Thoracic duct
Left vagus n.
Left recurrent n.
Phrenic n. &
pericardiacophrenic a.
Root of lung

Aortic arch
Thoracic aorta
Sympathetic trunk

Pericardium
Esophagus
Greater splanchnic n

Right side ofm ediastnum

Trachea
Left vagus n.
Arch of azygos v.
Azygos v.
Sympathetic trunk
Esophagus
Inferior vena cava

Superior vena cava

Phrenic n. &
pericardiacophreni
Root of lung
c a.
Pericardium

Relations ofesophagus

Anteriorly trachea, bifurcation

of trachea, left principal branchus,
left recurrent n., right pulmonary
a., anterior esophageal plexus,
pericardium,
left
atrium,
diaphragm
Posterior - posterior esophageal
plexus, thoracic aorta, thoracic
duct,
azygos
v.,
hemiazygos
v.,accessory hemiazygos v., right
posterior intercostal v.

 Left left common carotid a., left subclavian a.,

aortic arch, thoracic aorta, superior part of

thoracic duct
Right arch of azygos v.

Relations ofthoracic aorta

Anteriorly left root of lung,

pericardium and esophagus

Posterior hemiazygos v.,
accessory hemiazygos v.,
Right azygos v. and thoracic
duct
Left mediastinal pleura

M ediastinalspaces
Retrosternal space

lies beween sternum and

endothoracic fascia
Pretracheal space lies
within superior
mediastinum, between
trachea, bifurcation of
trachea and aortic arch
Retroesophagus space lies within superior
mediastinum, beween
esophagus and
endothoracic fascia

Anatom y ofthe Breast

Location:
Female
Superior border: 2nd rib
Inferior border: 6th rib
Medial border: Sternum
Lateral border: Midaxillary line
Male
Fourth Intercostal Space, Midclavicular
line

Underlying muscle
Pectoralis major and minor
Part of serratus anterior, external

Anatom y ofthe Breast

Arterial blood supply
Internal thoracic artery
Lateral thoracic artery
Posterior intercostals
Thoracoacromial artery

Venous blood supply

Axillary vein
Internal thoracic vein
Intercostal veins

Innervations
Intercostal nerves

M am m ary G lands
Modified sweat glands
Function only in lactating
females
Role to provide

nourishment and passive

immunity to the neonate
15 to 25 lobes
Lobes made of lobules
Alveoli
Alveoli lined by epithelial

cells
Secrete milk

Lactiferous ducts open to

the nipple

Compound alveolar gland

M am m ary G lands

Suspensory ligament
Lobes surrounded by

adipose and
connective tissue

Areola
Pigmented skin that

surrounds the nipple

M am m ary G lands

S U R FA C E A N ATO M Y

Anterior Surface ofThorax

Palpate the following
Sternum (3 parts)
Jugular notch
Sternal Angle (= 2nd rib)
Clavicle
Costal margin
Infrasternal angle
Xiphosternal joint

Midclavicular Line
Midaxillary Line

Posterior Surface ofThorax

Palpate the following

Spinous Process of C7
Scapula (ribs 2-7)
Scapular spine
Acromion Process
Inferior Angle of Spine
Inferior Border

Locating InternalStructures
Heart deep to

xiphosternal angle
Pleural Cavities
Inferior margin = adjacent
to T12 in Posterior Midline
To Rib 10 at Midaxillary line
To Rib 8 at Midclavicular
line
To Xiphosternal joint
medially
Lungs posterior border is 2

ribs superior to pleural

cavity (rib 8)