Coronal section of the neck at the level of dens of axis (MRI scan, courtesy of

Prof. Heuck, Munich).

Cervical vertebral column and skull with ligaments

(posterior aspect). Posterior arches of atlas and axis removed

to show the membrana tectoria.

Atlanto-occipital and atlanto-axial joints with ligaments

(posterior aspect). Posterior part of occipital bone and posterior

arch of atlas have been removed to show the cruciform

ligament.

1 Cerebellum

2 Occipital condyle

3 Atlanto-occipital joint

4 Atlas

5 Lateral atlanto-axial joint

6 Intervertebral disc

7 Cistern of pons

8 Head of mandible

9 Dens of axis

10 Axis

11 Body of cervical vertebra (C3)

12 External occipital protuberance

13 Foramen magnum

14 Transverse process of atlas

15 Posterior longitudinal ligament

16 Spinous process of cervical vertebra

17 Occipital bone

18 Membrana tectoria

19 Dorsum sellae

20 Clivus

21 Sella turcica

22 Superior orbital fissure

23 Internal acoustic meatus

24 Jugular foramen

25 Hypoglossal canal

26 Superior longitudinal

band of cruciform ligament

27 Alar ligaments

28 Transverse ligament of atlas

29 Inferior longitudinal band of

cruciform ligament

Vertebral Column and Thorax: Joints Connecting to the Head

202

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3

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12

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Vertebral Column and Thorax: Joints Connecting to the Head

Cervical vertebral column in relation to the head

(midsagittal section, medial aspect).

Occipital bone, atlas, and axis (anterior aspect). Occipital bone, atlas, and axis (left lateral aspect).

Atlas and axis in relation to the head (lateral aspect).

1 External occipital protuberance

2 Foramen magnum

3 Atlanto-occipital joint

4 Transverse process of atlas

5 Median atlanto-axial joint

6 Vertebral canal

7 Spinous process of third cervical vertebra

8 Occipital condyle

9 Lateral atlanto-axial joint

10 Occipital bone

11 Atlas

12 Axis

13 Dens of axis

14 Hypoglossal canal

15 Spinous process of axis

Vertebral Column and Thorax: Vertebral Column of the Neck 203

1 Pons

2 Base of skull (clivus)

3 Medulla oblongata

4 Atlas (anterior arch)

5 Dens of axis

6 Intervertebral disc

7 Body of cervical vertebra (C4)

8 Site of larynx

9 Trachea

10 Cerebellum

11 Cerebellomedullary cistern

12 Spinal cord

13 Trapezius muscle

14 Muscles of the neck

15 Spinous process of cervical

vertebra (C7)

16 Internal jugular vein

17 Common carotid artery

18 Vagus nerve (n. X)

19 Larynx

20 Body of cervical vertebra

21 Vertebral artery

22 Spinal nerve with spinal ganglion

23 Transverse process of cervical vertebra

24 Spinous process of cervical vertebra

Horizontal section of the neck at the level of the larynx

(MRI scan, courtesy of Prof. Heuck, Munich).

Midsagittal section of the neck showing the spinal cord

in connection with medulla oblongata (MRI scan, courtesy of

Prof. Heuck, Munich).

204 Surface Anatomy of the Anterior Body in the Female

Surface anatomy of the anterior body wall in the female. Note the

differences in thickness and structure of skin and hairs (compare with the

section below).

1 Clavicle

2 Pectoralis major muscle

3 Areola and nipple

4 Infrasternal angle

5 Costal arch

6 Rectus abdominis muscle

7 Anterior superior iliac spine

8 Inguinal ligament

9 Mons pubis

10 Epidermis

11 Subcutaneous layer

12 Muscles of the back

13 Kidney

14 Body of lumbar vertebra

15 External abdominal oblique

muscle

16 Small intestine

17 Deltoid muscle

18 Anterior serratus muscle

19 External intercostal muscle

20 Internal abdominal oblique

muscle

21 Transverse abdominal muscle

22 Rectus sheath

23 Spermatic cord

24 Pectoralis minor muscle

25 Linea alba

Cross section of the body at the first lumbar vertebra. Note the

differences in thickness of the subcutaneous layers.

Surface Anatomy of the Anterior Body in the Male 205

Surface anatomy of the anterior body wall in the

male. Localization and structure of the muscles can be

identified.

Segments of anterior body wall.

Head’s areas are indicated.

Muscles of the anterior body wall (schematic drawing).

Head’s areas

A = duodenum

B = gallbladder, liver (C3–C4)

C = esophagus (Th4, Th5)

D = liver, gallbladder (Th6–Th11)

E = colon, vermiform appendix

(Th11–12, L1)

F = heart

G = pancreas

H = stomach (C3, C4)

I = heart (Th3, Th4)

K = pancreas (Th8)

L = stomach (Th6–Th9)

M = small intestine (Th10–L1)

N = kidney, ureter, testis (Th10–L1)

O = urinary bladder (Th11–L1)

206 Thoracic Wall

Anterior thoracic wall (posterior aspect). Diaphragm partly removed, posterior layer of rectus sheath

fenestrated on both sides.

1 Sternocleidomastoid muscle (divided)

2 Clavicle

3 Sternothyroid muscle

4 Internal intercostal muscle

5 Transversus thoracic muscle

6 Intercostal arteries and nerves

7 Musculophrenic artery

8 Superior epigastric artery and vein

9 Diaphragm (divided)

10 Rectus abdominis muscle

11 Subclavian artery and brachial plexus

12 First rib

13 Internal thoracic artery and vein

14 Sternum

15 Innermost intercostal muscle

16 Intercostal artery and vein

17 Xiphoid process

18 Linea alba and posterior layer of

rectus sheath

19 Transversus abdominis muscle

Thoracic Wall 207

Thoracic wall (anterior aspect). Left pectoralis major muscle has been divided and reflected.

Note the connection of the cephalic vein with the subclavian vein.

Arrow: medial pectoral nerve.

Thoracic wall (lateral aspect). Pectoralis major and minor muscles have been removed.

A section of the fourth rib has been cut and removed to display the intercostal vessels and

nerve.

1 Mandible

2 Facial artery

3 Submandibular gland

4 Hyoid bone

5 Thyroid cartilage and

sternohyoid muscle

6 Clavicle

7 Subclavius muscle

8 Second rib

9 Anterior cutaneous branches of

intercostal nerves

10 External intercostal membrane

11 Parotid gland

12 External carotid artery

13 Sternocleidomastoid muscle and

cutaneous branches of cervical plexus

14 Supraclavicular nerves

15 Pectoralis major muscle and lateral

pectoral nerves

16 Thoraco-acromial artery and

subclavian vein

17 Pectoralis minor muscle

18 Median and ulnar nerve

19 Thoraco-epigastric vein

20 Cephalic vein and long head of

biceps brachii muscle

21 Lateral thoracic artery and long

thoracic nerve

22 Lateral cutaneous branches of

intercostal nerve

23 Latissimus dorsi muscle

24 Median nerve

25 Axillary artery

26 Intercostobrachial nerves

27 Thoracodorsal nerve

28 Long thoracic nerve

29 Latissimus dorsi muscle

30 Serratus anterior muscle

31 Thoraco-acromial artery

32 Clavicle

33 External intercostal muscle

34 Third rib

35 Internal intercostal muscle

36 Anterior intercostal artery and vein,

and intercostal nerve

37 Costal arch or margin

208

1 Anterior perforating branches

of intercostal nerve

2 Mammary gland

3 External abdominal oblique muscle

4 Rectus sheath (anterior layer)

5 Sternocleidomastoid muscle

6 Clavicle

7 Lateral thoracic artery

and vein

8 Pectoralis major muscle

9 Internal thoracic artery

and vein

10 Serratus anterior muscle

11 Superior epigastric artery

and vein

12 Costal margin

13 Rectus abdominis muscle

14 Cut edge of the anterior layer

of the rectus sheath

15 Subclavian artery

16 Highest intercostal artery

17 Internal thoracic artery

18 Musculophrenic artery

19 Superficial epigastric artery

20 Deep circumflex iliac artery

21 Superior epigastric artery

22 Inferior epigastric artery

23 Superficial circumflex iliac artery

Thoracic wall (anterior aspect). Dissection of the internal thoracic artery and vein.

Left pectoralis major muscle partly removed. Anterior lamina of the rectus sheath on the

left side has been removed.

Main arteries of thoracic and abdominal walls.

Thoracic Wall

Thoracic and Abdominal Walls 209

Anterior thoracic and abdominal walls with superficial muscles. The fascia of pectoralis major muscle and the

abdominal wall have been removed; the anterior layer of the sheath of the rectus abdominis muscle is displayed.

1 Sternohyoid muscle

2 Sternocleidomastoid muscle

3 Supraclavicular nerves (branches of cervical plexus)

4 Deltoid muscle

5 Pectoralis major muscle

6 Anterior cutaneous branches of intercostal nerves

7 External abdominal oblique muscle

8 Lateral cutaneous branches of intercostal nerves

9 Umbilicus and umbilical ring

10 Clavicle

11 Cephalic vein

12 Serratus anterior muscle

13 Linea alba

14 Sheath of rectus abdominis muscle

(anterior layer)

15 Inguinal ligament

210 Thoracic and Abdominal Walls

1 Deltoid muscle

2 Cephalic vein

3 Pectoralis major muscle (divided)

4 Internal intercostal muscle

5 Intercostal artery and vein (intercostal

space, fenestrated)

6 Serratus anterior muscle

7 External abdominal oblique muscle

8 Anterior layer of rectus sheath

9 Iliac crest

10 Superficial epigastric vein

11 Superficial circumflex iliac vein

12 Saphenous opening

13 Superficial inguinal lymph nodes

14 Superficial external pudendal veins

15 Great saphenous vein

16 Nipple

17 Costal margin

18 Subcutaneous fatty tissue

19 Umbilicus

20 Anterior layer of rectus sheath

21 Rectus abdominis muscle

22 Posterior layer of rectus sheath

23 Internal abdominal oblique muscle

24 External abdominal oblique muscle (cut)

25 Transversus abdominis muscle

26 Transversalis fascia and peritoneum

27 Psoas major muscle

28 Body of lumbar vertebra (L4)

29 Quadratus lumborum muscle

30 Medial tract of erector spinae muscle

31 Lateral tract of erector spinae muscle

(longissimus and iliocostalis muscles)

32 Small intestine

33 Left ureter

34 Abdominal aorta

35 Inferior vena cava

36 Descending colon

37 Spinous process

Thoracic and abdominal walls. Right

pectoralis major and minor muscles are

divided. Muscles of thoracic and abdominal

walls on right side are displayed.

Horizontal section of the trunk

at the level of the umbilicus, superior

to arcuate line (inferior aspect).

3

Thoracic and Abdominal Walls 211

1 Deltoid muscle

2 Pectoralis major muscle (divided)

3 Internal intercostal muscle

4 Intercostal artery and vein

5 Rectus abdominis muscle

6 Tendinous intersections

7 External abdominal oblique muscle

8 Anterior superior iliac spine

9 Superficial circumflex iliac vein

10 Superficial epigastric vein

11 Great saphenous vein

12 Cephalic vein

13 Pectoralis major muscle

14 Anterior cutaneous branches of

intercostal nerves

15 Nipple

16 Linea alba

17 Anterior layer of rectus sheath

18 Umbilicus

19 Inguinal ligament

20 Pyramidal muscle

21 Superficial inguinal ring and spermatic

cord

22 Suspensory ligament of penis

23 Longissimus and iliocostalis muscles

24 Multifidus muscle

25 Quadratus lumborum muscle

26 Latissimus dorsi muscle

27 Psoas major muscle

28 Spinous process

29 Body of first lumbar vertebra

30 Transversus abdominis muscle

31 Internal abdominal oblique muscle

Thoracic and abdominal walls. Right

pectoralis major and minor muscles and

anterior layer of rectus sheath have been

removed on the right side.

Horizontal section through the body

at the level of fourth lumbar vertebra;

seen from below. (CT scan.)

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Thoracic and Abdominal Walls

1 Costal margin

2 Rectus abdominis muscle

3 External abdominal oblique muscle

(reflected)

4 Thoraco-abdominal (intercostal) nerves

with accompanying vessels

5 Internal abdominal oblique muscle

6 Arcuate line (arrow)

7 Inferior epigastric artery and vein

8 Ilio-inguinal nerve

9 Position of deep inguinal ring

10 Superficial inguinal lymph nodes

11 Great saphenous vein

12 Linea alba

13 Iliohypogastric nerve

14 Pyramidal muscle

15 Spermatic cord

16 Fundiform ligament of penis

Horizontal section of the trunk superior

to arcuate line (schematic drawing).

1 Anterior layer of rectus sheath

2 Rectus abdominis muscle

3 Posterior layer of rectus sheath

4 Transversalis fascia

5 Transversus abdominis muscle

6 Internal oblique muscle

7 External oblique muscle

8 Thoracolumbar fascia with

superficial and deep layer

9 Lateral column of erector spinae muscle

10 Medial column of intrinsic muscles

of the back

Thoracic and abdominal walls.

External abdominal oblique muscle has been

divided and reflected on both sides. The right

rectus muscle has been reflected medially

to display the posterior layer of rectus sheath.

Arrow: location of arcuate line.

Thoracic and Abdominal Walls 213

1 Rectus abdominis muscle (reflected)

2 External abdominal oblique muscle

(divided)

3 Posterior layer of rectus sheath

4 Umbilical ring

5 Internal abdominal oblique muscle

6 Arcuate line (arrow)

7 Inguinal ligament

8 Inferior epigastric artery and vein

and rectus abdominis muscle

(divided and reflected)

9 Costal margin

10 Linea alba

11 Tendinous intersection

12 Iliohypogastric nerve

13 Ilio-inguinal nerve

14 Pyramidal muscle

15 Spermatic cord

1 Peritoneum

2 Transversalis fascia (green)

3 Transversus abdominis muscle

4 Internal abdominal oblique muscle

5 External abdominal oblique muscle

6 Fascia of external abdominal oblique

muscle (green)

7 Skin

8 Linea alba

9 Rectus abdominis muscle

Transverse sections through the

abdominal wall superior (a) and inferior (b)

to arcuate line.

Thoracic and abdominal walls.

External abdominal oblique muscle has been

divided and reflected on both sides. The right

rectus muscle has been cut and reflected

to display the posterior layer of rectus sheath.

Arrow: location of arcuate line.

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a)

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214 Thoracic and Abdominal Walls: Vessels and Nerves

1 Sternocleidomastoid muscle

2 Deltoid muscle

3 Pectoralis major muscle

4 Anterior cutaneous branches of

intercostal nerves

5 Cut edge of anterior layer of rectus

sheath

6 Rectus abdominis muscle

7 Tendinous intersection

8 External abdominal oblique muscle

9 Lateral femoral cutaneous nerve

10 Femoral vein

11 Great saphenous vein

12 Medial supraclavicular nerves

13 Pectoralis minor muscle (reflected)

and medial pectoral nerves

14 Axillary vein

15 Long thoracic nerve and lateral

thoracic artery

16 Internal thoracic artery

17 Intercostal nerves

18 Lateral cutaneous branches of

intercostal nerves

19 Superior epigastric artery

20 Thoraco-abdominal (intercostal)

nerves

21 Transversus abdominis muscle

22 Posterior layer of rectus sheath

23 Inferior epigastric artery

24 Lateral femoral cutaneous nerve

25 Inguinal ligament and ilio-inguinal

nerve

26 Femoral nerve

27 Femoral artery

28 Spermatic cord

29 Testis

30 Posterior intercostal arteries

31 Internal abdominal oblique muscle

32 Lateral cutaneous branch of

intercostal nerve

33 Dorsal branch of spinal nerve

34 Latissimus dorsi muscle

35 Deep muscles of the back (medial

and lateral tract)

36 Anterior layer of rectus sheath

37 Posterior layer of rectus sheath

38 Thoracolumbar fascia

39 Spinal cord

40 Aorta

41 Ventral root of spinal

42 Dorsal root nerve

Thoracic and abdominal walls (schematic drawing). Note the segmental organization

of the blood vessels and nerves. Right side: superficial layers; left side: deeper layers.

Horizontal section of the

abdominal wall (from below)

showing the location of the

intercostal arteries (left side)

and nerves (right side).

1