. 3 Surfaces (costal, mediastinal & diaphragmatic). o 3 Borders (anterior, postreior & inferior). Contents of the root of the lung: . Bronchus. o Pulmonary A. o 2 Pulmonary Vs. . BronchialAs., Vs & LN Blood supply of the lung: A. Bronchi, CT of the lung & visceral pleura: o Bronchial As + 2 Lt. from descending thoracic aorta &

 

3 hypothenar muscles (Abductor digiti minimi, flexor digiti minimi &

opponens digiti minimi) + 1 muscle superficial to them (Palmaris brevis).

o Central

- 4lumbricals.

- 4 palmar interossei.

- 4 dorsal interossei.

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UPPER LIMB I

- Flexes MPJ

- Extends IPJ

Tendons of

flexor digitorum

Base of

proximal

phalanx

Extensor

expansion

- Extension of IPJ

- Palmar ) adduction of IPJ (Pad)

- Dorsal ) abduction of IPF

Lumbricals + Interossei ) Writing Position (Flexion ln MP Joint + Extension Of lP

Nerve Supplv:

JtE The Ulnar nerye supplies all the intrinsic muscles of the hand except the 3

ry muscles of thenar eminence + lumbricals 1 & 2 (supplied by median nerve).

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The thoran is the house and protect

the heart and lungs. The protective

function of the thoracic wall is

combined with mobility to

accommodate volume changes during

respiration. These two dissimilar

functions, protection and flexibility,

are accomplished by the alternating

arrangement of the ribs and

intercostal muscles. The superficial

fascia of the thorax contains the usual

elements that are common to

superficial fascia in all body regions:

blood vessels, Iymph vessels,

cutaneous nerves, and sweat glands.

In additioq the superficial fascia of

the anterior thoracic wall in the

female contains the mammary glands.

THe 1sr RtB

o Supra-pleural membrane is attached to the inner margin of the 1st rib.

-^_o lf a rib is fractured at two nearby places, the part of rib between two fractured sites

JtL will show Paradoxical movement itvtoves inward during inspiration). tr

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. The opening at the superior end of the rib cage through which cervical

structures enter the thorax,

. lt marks the boundary between the neck & the superior mediastinum.

. Clinically, it is called thoracic outlet.

BOUNDARIES:

Anteri or,' manubrium sterni,

Posterior: T1 vertebral body.

On bolb sides; the 1't ribs & their costal cartilages.

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CONTENTS:

Structures that pass through the thoracic inlet:

o Tubes:

. Nelves:

. ycs

> common carotid arteries

D brachiocephalic trunk

D subclavian arteries

> internal jugular veins

>' brachiocephalic veins

> subclavian veins

SURGICAL IMPORTANCE: Thoracic outlet syndrome

THORAX I

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lr rs

ExreNos eetweeN:

o Sternum anteriorly.

Superior

mediastinum

Anterior

mediastinum

lnferior

mediastinum

Middle Posterior

mediastinum mediastinum

o Vertebral column posteriorly.

o Right & left pleura & lungs on either side.

N.B: The upper border of the sternum is at level of lower border of T2)

SUBDIVIDED INTO

SrEerior medirthurn

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BOUNDARIES

. Anterior: manubrium sterni.

. Posterior: T1 - T+.

. Below: line joining the sternal angle to the lower border of T4.

. Lateral: pleura.

I-rtroFAx

Corurerurs:

. Arteries: aortic arch, innominate artery, left common carotid & Ieft

subclavian.

. -@S: innominate veins & SVC,

o /Verves: the vagus, cardiac, phrenic, and left recurrent nerves.

W. trachea, esophagus and thoracic duct.

Thvmus qland & some LNs.

Goureurs:

. Loose areolar tissue.

. Lymph vessels and nodes.

. Fat.

. Thymus gland (Prominent in children).

. Sterno-pericardial ligaments.

GoNTENTS:

o The heart & pericardium.

o The ascending aorta.

o The superior vena cava with the azygos vein opening into it.

o The pulmonary artery dividing into its two branches.

o The right & left pulmonary veins.

o The phrenic nerves.

. Some bronchial LNs.

o The bifurcation of the trachea & the two bronchi.

Eil L > fne site chosen for pericardiocentesis: Left sth intercostals space.

F o Posterior inter-ventricular artery is a branch of right coronary, while

- anterior inter-ventricu.lar is a branch of left coronary.

a

a

. lsthmus of thyroid gland.

. lnferior thyroid veins.

o Arch of aorta.

. Origin of the left common carotid artery.

o The brachiocephalic trunk ascends at first in front of & then to

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Arteries: thoracic part of the descending aorta.

Veins: azygos & hemi-azygos vein.

Nerves: vagus & thoracic splanchnic nerves,

Esophaous.

Lvmph structures: thoracic duct & some LNs.

45 cm long.

It is the upward continuation of the cisterna chyli.

It enters the thorax through the aortic opening of the diaphragm between the

azygos vein medially & aorta laterally.

Gourse:

. Ascends behind esophagus in the posterior mediastinum bnd crosses

midline at T5.

. Lies superficial (anterior) to the posterior intercostal arteries, crossing

azygos system, the dome of pleura, Lt. vertebral & Lt. subclavian artery.

' At the level of C7, it crosses laterally behind the carotid sheath & anterior

to the vertebral vessels.

It ends at: the confluence of Lt. subclavian vein & Lt. internaljugular vein.

Drains: the lymph from the entire body except Rt. upper limb, Rt. side of

chest & Rt. half of head & neck.

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Each lung has:

o Apex.

o Base.

. 3 Surfaces (costal, mediastinal & diaphragmatic).

o 3 Borders (anterior, postreior & inferior).

Contents of the root of the lung:

. Bronchus.

o Pulmonary A.

o 2 Pulmonary Vs.

. BronchialAs., Vs & LN

Blood supply of the lung:

A. Bronchi, CT of the lung & visceral pleura:

o Bronchial As + 2 Lt. from descending thoracic aorta &

1Rt. from 3d posterior intercostalA.

o Bronchial Vs - Azygous & hemiazygous

B. Alveoli:

o Terminal branches of pulmonary As supply the alveoli with

all its needs except oxygen.

. Trebutaries of pulmonary Vs carrying oxygwnated blood.

Surface anatomy of the lung:

. Apex: 1 inch above the medial 3'd of the clavicle.

o Anterior border:

a. Rt. Lung -+ extend from the apex to the sternoclavicular

joint, sternal angle then vertically to the level of 6th costal

cartilage.

b. Lt. lung -+ extend from the apex to the sternoclavicular

joint, sternal angle then vertically to the level of 4th costal

cartilage, deviates to the Lt. & descend again 1 inch lateral

to sternal margin down to the 6th costal cartilage.

o lnferior border:

e 6th rib (in the midclavicular plane).

: ?o,r' : J'U::"Ti'.,il",i.ililil i co, u mn )

The riaht lunq is different from the left lunq in that:

, It is heavier.

. lt is larger in transverse diameter.

. lt has no cardiac notch.

. lt usually has two fissures.

. lt has 2 bronchi in the hilum.

The diaphragmatic pleura is supplied by the: Lower inte

phrenic nerves.

rcostal nerves

*