Thoracicwall

LearningObjiective

1.Knowthevertebrallevelsofthejugularnotch,sternalangle,andxiphoidprocess.

2.Mastertheformationandfunctionofintercostalsnervesandthedermatomesofthethoracicwall.

3.Masterthestructureandcontentsofanintercostalspace.

4.Knowthelayersofthoracicwall.

5.Masterthearteries,veins,andnervessupplyingthoracicwall.

Keystone

1.Theconceptofdermatomes.

2.Thestructureandcontentsofanintercostalspace.

3.Thearteries,veins,andnervessupplyingthoracicwall.

QuestionsRequiringShortAnswer

1.Describethestructureandcontentsofanintercostalspace.

2.Whereandhowtoinsertachestdrain?

ReadingandComprehension

Section1IntroductionoftheThorax

Ⅰ.Boundaries

Ⅰ)Superiorly－jugularnotch,sternoclavicularjoint,superiorborderofclavicle,acromion,spinousprocessesofC7

Ⅱ)Inferiorly－xiphoidprocess,costalarch,12thand11thribs,vertebraT12

Ⅱ.Regions

Ⅰ)Thoracicwall

Ⅱ)Thoraciccavity

Ⅲ.Landmarksofthorax

Ⅰ)Jugularnotchcorrespondswith

1.The2ththoracicvertebrainmale

2.The3ththoracicvertebrainfemale

Ⅱ)Sternalanglecorrespondswith

1.Connects2ndcostalcartilagelaterally

2.Thelowerborderof4ththoracicvertebra

3.Thebifurcationoftracheaintheadult

4.Thebeginningofaorticarchwhichendsposteriorlyatthesamelevel

5.Theesophagusiscrossedbytheleftmainbronchus

Ⅲ)Xiphoidprocess－xiphisternalsynchondrosisliesoppositethebodyofthe9ththoracicvertebra

Ⅳ)Clavicle

1.Inferiorfossaofclavicle

2.Coracoidprocess

Ⅴ)Ribsandintercostalspaces

Ⅵ)Costalarch

1.Infrasternalangle

2.Xiphocostalangle

Ⅶ)Papillae

Section2Thoracicwall

Ⅰ.Superficialstructures

Ⅰ)Skin

Ⅱ)Superficialfascia

1.Superficialvv.

(1)Thoracoepigastricv.

(2)Lateralthoracicv.

2.Superficialnn.

(1)Supraclavicularn.

(2)Anteriorandlateralcutaneousbranchesofintercostaln.

Ⅱ.Deepstructures

Ⅰ)Deepfascia

1.Superficiallayer

2.Deeplayer—clavipectoralfascia

Ⅱ)Musclesofthorax

1.Pectoralismajor

2.Subclavius

3.Pectoralisminor

4.Serratusanterior

5.Intercostalesexterni

6.Intercostalesinterni

7.Intercostalesintimi

8.Transversesthoracis

Ⅲ)Intercostalspaces

1.Elevenspacesbetweenribs

2.Filledbyintercostalmuscules

3.Neurovascularbundle

(1)Liebetweenintercostalsesinterniandintimi

(2)Consists,fromabovedownwards,ofvein,arteryandnerve,theveinlyinginacostalgrooveofthecorrespondingrib(remember－VAN)

1)Posteriorintercostalveins

2)Posteriorintercostalarteries

3)Intercostalnerves(anteriorramiT1－T11)

Ⅳ)Endothoracicfascia

Mediastinum

LearningObjiective

1.Knowthesubdivisionsandcontentsofthemediastinum.

2.Knowthevisiblestructuresoftherightandleftsideofmediastinum.

3.Mastertheorderofmainstructuresoftherootoflung.Mastertherelationsoftherootoflung.

4.Masterthecompositionofpericardium.Knowthepositionofpericardialsinuses.

5.Mastertherelationsoftheaorticarch.

6.Mastertheboundariesandcontentsofthetriangleofductusarteriosus.

7.Mastertherelationsofthoracicpartofesophagus.

8.Knowtherelationsofthoracicaorta.

9.Masterthecourseofthethoracicpartofthoracicduct.

10.Knowthedispositionoftheazygosveinandsympathetictrunk.

Keystone

1.Thesubdivisionsandcontentsofthemediastinum.

2.Therelationsoftherootoflung,aorticarch,andthoracicpartofesophagus.

3.Theboundariesandcontentsofthetriangleofductusarteriosus.

QuestionsRequiringShortAnswer

1.Listtheorderofmainstructuresoftherootoflung.

2.Brieflydescribetherelationsofaorticarchandesophagus.

3.Describeboundariesandcontentsofthetriangleofductusarteriosus.

ReadingandComprehension

Section3TheMediastinum

Thethoraciccavityisdividedintoacentralarea,themediastinum,whichcontainstheheartinitspericardialsacandotherstructures,andlateralareascontainingthelungsintheirpleuralsacs.

Ⅰ.Conceptofmediastinum

Ⅰ)Alloforgansbetweentheleftandrightmediastinalpleuraeiscalledmediastinum.

Ⅱ)Itextendsfromthesternuminfronttothevertebralcolumnbehind,andfromthethoracicinletabovetothediaphragmbelow.

Ⅱ.Subdivisionsofmediastinum

Forpurposesofdescription,themediastinumisdividedintosuperiorandinferiormediastinabyanimaginaryplanepassingfromthesternalangleanteriorlytothelowerborderofT4posteriorly.Theinferiormediastinumisfurthersubdividedintothemiddlemediastinum,whichconsistsofthepericardium,andheart;theanteriormediastinum,whichisaspacebetweenthepericardiumandthesternum;andtheposteriormediastinum,whichliesbetweenthepericardiumandthevertebralcolumn.

Ⅰ)Superiormediastinum

1.Locating－frominletofthoraxtoplaneextendingfromlevelofsternalangleanteriorlytolowerborderofT4vertebraposterioly

2.Contents

(1)Superficiallayer

1)Thymus

2)Threeveins

3)Leftbrachiocephelicv.

4)Rightbrachiocephelicv.

5)Superiorvenacava

(2)Middlelayer

1)Aoticarchanditsthreebranches

2)Phrenicn.

3)Vagusn.

(3)Posteriorlayer

1)Trachea

2)Esophagus

3)Thoracicduct

3.Relationsofaorticarch

(1)Anteriorlyandtotheleft

1)Pleura

2)Lung

3)Phrenicn.

4)Pericardiacophrenicvessels

5)Vagusn.

(2)Posteriorlyandtotheright

1)Trachea

2)Esophagus

3)Leftrecurrentn.

4)Thoracicduct

5)Deepcardiacplexus

(3)Superiorly

1)Itsthreebranches

2)Leftbrachiocephalicv.

3)Thymus

(4)Inferiorly

1)Pulmonarya.

2)Arterialligament

3)Leftrecurrentn.

4)Leftprincipalbronchus

5)Superficialcardiacplexus

4.Triangleofductusarteriosus

(1)Boundedby

1)Phrenicn.

2)Leftvagusn.

3)Leftpulmonarya.

(2)Contents

1)Arterialligament

2)Leftrecurrentn.

3)Superficialcardiacplexuses

Ⅱ)Inferiormediastinum－h(huán)asthreesubdivisionsthatextenddownwardfromlowerborderofsuperiormediastinumtodiaphragm

1.Anteriormediastinum

(1)Location－posteriortobodyofsternumandattachedcostalcartilages,anteriortoheartandpericardium

(2)Contents

1)Fat

2)Remnantsofthymusgland

3)Anteriormediastinallymphnodes

2.Middlemediastinum

(1)Location－betweenanteriormediastinumandposteriormediastinum

(2)Contents

1)Heartandpericardium

2)Beginningorterminationofgreatvessels

3)Phrenicnerves

4)Pericardiacophrenicvessels

5)Lymphnodes

3.Posteriormediastinum

(1)Location－posteriortoheartandpericardium,anteriortovertebraeT5－T12

(2)Contents:

1)Esophagus

2)Vagusn.

3)Thoracicaorta

4)Azygossystemofveins

5)Thoracicduct

6)Thoracicsympathetictrunk

7)Posteriormediastinallymphnodes

(3)Relationsofesophagus

1)Anteriorly

①Trachea

②Bifurcationoftrachea

③Leftprincipalbranchus

④Leftrecurrentn.

⑤Rightpulmonarya.

2)Anterioresophagealplexus

①Pericardium

②Leftatrium

③Diaphragm

3)Posteriorly

①Posterioresophagealplexus

②Thoracicaorta

③Thoracicduct

④Azygosv.

⑤Hemiazygosv.