Regional anatomy of thorax

山东大学医学院 解剖教研室
李振华

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 Parts and regions of the thorax
Boundaries
 Superiorly－jugular notch,
sternoclavicular joint,
superior border of clavicle,
acromion, spinous
processes of C7
 Inferiorly－xiphoid process,
costal arch, 12th and 11th
ribs, vertebra T12
Regions
 Thoracic wall

 Thoracic cavity

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 Landmarks of thorax
 Jugular notch corresponds with
 The 2th thoracic vertebra in male,
the 3th thoracic vertebra in female
 Sternal angle corresponds with
 Connects 2nd costal cartilage
laterally
 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

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 Landmarks of thorax
 Xiphoid process－
xiphisternal synchondrosis
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

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 Thoracic wall
Superficial structures
 Skin
 Superficial fascia
 Superficial aa.
 Superficial vv.
 Thoracoepigastric v.
 Lateral thoracic v.
 Superficial nn.
 Supraclavicular n.
 Anterior and lateral cutaneous
branches of intercostal n.

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 Lymphatic 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

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 Thoracic wall
Deep structures
 Deep fascia
 Superficial layer
 Deep layer—clavipectoral fascia
 Muscles of thorax
 Subclavius
 Pectoralis major

 Pectoralis minor

 Serratus anterior

 Intercostales externi

 Intercostales interni

 Intercostales intimi

 Endothoracic fascia 胸内筋膜

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 Intercostal space

Posterior intercostal v.

Posterior intercostal a.
Intercostal n.

Technique for
thoroacocentesis
(in midaxillary line)
Intercostal nerve block

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 Internal thoracic vessels
 Internal thoracic a.&v.
胸廓内动脉和静脉
 Descends into thorax 1.2cm
lateral to edge of sternum
 Ends at the sixth costal
cartilage by dividing
musculophrenic and superior
epigastric arteries
 Parasternal ln. 胸骨旁淋巴结

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 The Mediastinum 纵隔

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 The Mediastinum 纵隔
Concept
 All of organs between the left and
right mediastinal pleurae is called
mediastinum.
 It extends from the sternum in
front to the vertebral column
behind, and from the thoracic inlet
above to the diaphragm below.

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 Subdivisions of mediastinum

 Superior mediastinum 上纵隔

 Inferior mediastinum下纵隔
 Anterior mediastinum 前纵隔
 Middle mediastinum 中纵隔
 Posterior mediastinum 后纵隔

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 Left side of mediastnum 纵隔左侧面
Left subclavian a.
Thoracic duct
Left vagus n. Aortic arch
Left recurrent n.
Phrenic n. & Thoracic aorta
pericardiacophrenic a.
Sympathetic trunk
Root of lung

Pericardium

Esophagus Greater splanchnic n

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Right side of mediastnum 纵隔右侧面
Trachea
Right vagus n. Superior vena cava
Arch of azygos v. Phrenic n. &
pericardiacophrenic a.
Azygos v.
Root of lung
Sympathetic trunk

Esophagus Pericardium

Inferior vena cava

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 Superior mediastinum 上纵隔

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 Superior mediastinum 上纵隔
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

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 Superior mediastinum 上纵隔
Contents
 Middle layer
 Aotic arch and its three
branches
 Phrenic n.
 Vagus n.

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 Superior mediastinum 上纵隔

Contents
 Posterior layer
 Trachea
 Esophagus
 Thoracic duct

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 Relations of aortic arch
 Anteriorly and to the left
 Pleura
 Lung
 Phrenic n.
 Pericardiacophrenic vessels
 Vagus n.
 Posteriorly and to the right
 Trachea
 Esophagus
 Left recurrent n.
 Thoracic duct
 Deep cardiac plexus

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 Relations of aortic arch
 Superiorly
 Its three branches
 Left brachiocephalic v.
 thymus
 Inferiorly
 Pulmonary a.
 Arterial ligament
 Left recurrent n.
 Left principal bronchus
 Superficial cardiac plexus

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 Triangle of ductus arteriosus
动脉导管三角
 Boundaries
 Phrenic n.
 Left vagus n.
 Left pulmonary a.
 Contents
 Arterial ligament
 Left recurrent n.
 Superficial cardiac plexuses

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 Triangle of ductus arteriosus
动脉导管三角

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Inferior mediastinum 下纵隔

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 Inferior mediastinum 下纵隔
Anterior mediastinum 前纵隔
 Location－posterior to body of sternum
and attached costal cartilages, anterior
to heart and pericardium
 Contents
 Fat

 Remnants of thymus gland

 Anterior mediastinal lymph nodes

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 Inferior mediastinum 下纵隔
Middle mediastinum 中纵隔
 Location－between anterior
mediastinum and posterior
mediastinum
 Contents
 Heart and pericardium

 Beginning or termination of great

vessels
 Phrenic nerves

 Pericardiacophrenic vessels

 Lymph nodes

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 Inferior mediastinum 下纵隔
Posterior mediastinum 后纵隔
 Location－posterior to heart and
pericardium, anterior to vertebrae
T5－T12

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 Inferior mediastinum 下纵隔
Posterior mediastinum 后纵隔
 Contents:
 Esophagus
 Vagus n.
 Thoracic aorta
 Azygos system of veins
 Thoracic duct
 Thoracic sympathetic trunk
 Posterior mediastinal lymph nodes

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 Relations of esophagus

 Anteriorly
 Trachea
 Bifurcation of trachea
 Left principal branchus
 Left recurrent n.
 Right pulmonary a.
 Anterior esophageal plexus
 Pericardium
 Left atrium
 Diaphragm

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 Relations of esophagus

 Posteriorly
 Posterior esophageal plexus
 Thoracic aorta
 Thoracic duct
 Azygos v.
 Hemiazygos v.
 Accessory hemiazygos v.
 Right posterior intercostal v.

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 Relations of esophagus
 Left
 Left common carotid a.
 Left subclavian a.
 Aortic arch
 Thoracic aorta
 Superior part of thoracic duct
 Right
 Arch of azygos v.

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 Relations of thoracic aorta
 Anteriorly
 Left root of lung
 Pericardium
 Esophagus
 Posterior
 Hemiazygos v.
 Accessory hemiazygos v.
 Right
 Azygos v.
 Thoracic duct
 Left－mediastinal pleura

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 Mediastinal spaces 纵隔间隙
 Retrosternal space 胸骨后间隙
lies beween sternum and endothoracic
fascia
 Pretracheal space 气管前间隙
lies within superior mediastinum,
between trachea, bifurcation of
trachea and aortic arch
 Retroesophagus space食管后间隙
lies within superior mediastinum,
beween esophagus and endothoracic
fascia

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 ★You must identify follow structures！
Thoracic wall
 Intercostales externi
 Intercostales interni
 Posterior intercostal a.
 Intercostal n.
 Internal thoracic a.
 Diaphragm
 Central tendon
 Aortic hiatus
 Esophageal hiatus
 Vena cava foramen
 Costodiaphragmatic recesse
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Superior mediastinum
 Left brachiocephelic v.
 Right brachiocephelic v.
 Superior vena cava
 Aortic arch
 Brachiocephalic trunk
 Left common carotid artery
 Left subclavian a.
 Phrenic n.
 Vagus n.
 Left recurrent n.
 Arterial ligament
 Trachea
 ★You must identify follow structures！

Middle mediastinum Lung

 Pericardium  Apex of lung
 Phrenic nerves  Base of lung
Posterior mediastinum  Hilum of lung
 Esophagus  Root of lung
 Vagus n.  Cardiac notch
 Thoracic aorta  Lingual in left lung
 Azygos veins
 Horizontal and oblique fissures
 Thoracic duct
 Superior, middle and inferior
 Thoracic sympathetic trunk
lobs of right lung
 Greater splanchnic n
 Superior and inferior lobs of
left lung

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