Download Thoracic wall - yeditepe anatomy fhs 121

The Two Fridas 1939 by Frida Kahlo
Kaan Yücel M.D., Ph.D.
01. 10. 2013
the part between the neck and the abdomen
Chest X-ray
1.1. REGIONS/T ERMS
Thoracic cavity
cavity between neck and
abdomen
protected by the thoracic wall.
Thoracic wall
bounds the thoracic cavity.
formed by the skin, bones,
fasciae, and muscles.
Thoracic cage
bony portion of the thoracic
wall
thoracic skeleton
1.2. SURFACES OF THE THORAX
STERNUM & COSTAL CARTILAGES
anteriorly
12 THORACIC VERTEBRAE & POST. RIBS posteriorly
RIBS & INTERCOSTAL SPACES laterally
Posterior surface
12 thoracic vertebræ &
posterior parts of the ribs
Anterior surface
sternum & costal
cartilages
Lateral surfaces
ribs, separated by the
intercostal spaces
1.3. BOUNDARIES OF THE THORAX
Superior
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Jugular notch
Sternoclavicular joint
Superior border of clavicle
Acromion
Spinous processes of C7
Inferior
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Xiphoid process
Costal arch
12th and 11th ribs
Vertebra T12
1.4. CONTENTS OF THE THORAX
Organs of the cardiovascular, respiratory, digestive,
reproductive, immune, and nervous systems
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thoracic cage (skeleton)
muscles between the ribs
skin
subcutaneous tissue
muscles, and fascia covering its anterolateral aspect.
The mammary glands of the breasts lie within the
subcutaneous tissue of the thoracic wall.
2.1. FUNCTIONS OF THE THORACIC WALL
1) Protects vital thoracic and abdominal organs
2) Resists the negative (sub-atmospheric) internal pressures
generated by the elastic recoil of the lungs and inspiratory
movements.
3) Provides attachment for and support the weight of the
upper limbs.
4) Provides the origins of many of the muscles that move
and maintain the position of the upper limbs relative to
the trunk.
5) Provides attachments for muscles of the abdomen, neck,
back, and respiration.
3. SKELETON OF THE THORACIC WALL
1) 12 pairs of ribs and associated costal cartilages
2) 12 thoracic vertebrae and the intervertebral (IV) discs
interposed between them
3) Sternum
4. THORACIC APERTURES
‘Thoracic inlet’
‘Thoracic outlet’
4.1. Superior thoracic aperture
“doorway” between the thoracic cavity and the neck and upper limb
bounded:
Posteriorly vertebra T1
Laterally 1st pair of ribs and their costal cartilages
Anteriorly superior border of the manubrium
 Trachea
 Esophagus
 nerves, and vessels that supply
and drain the head, neck, and
upper limbs.
4.2. Inferior thoracic aperture
By closing the inferior thoracic aperture, the diaphragm separates the thoracic and
abdominal cavities almost completely.
bounded:
Posteriorly 12th thoracic vertebra
Posterolaterally 11th and 12th pairs of ribs
Anterolaterally joined costal cartilages of ribs 7-10 costal margins
Anteriorly xiphisternal joint
5. MOVEMENTS OF THE THORACIC WALL
One of the principal functions of the thoracic wall and the diaphragm is to alter the
volume of the thorax and thereby move air in and out of the lungs.
During breathing, the dimensions of the thorax change in
vertical, lateral, and A-P directions.
Diaphragm contracts Depression
Diaphragm relaxes  Elevation (during passive expiration)
Elevation &depression of the ribs
DERMATOMES
Skin area supplied by a segment of the spinal cord
Through its posterior ramus and the lateral and anterior cutaneous
branches of its anterior ramus, most thoracic spinal nerves (T2-T12)
supply a strip-like dermatome of the trunk extending from the
posterior median line to the anterior median line.
T2- Sternal angle
T4- Nipple
T6- Xiphoid process
T8- Costal arch
T10-Umbliculus
T12-Midpoint between umbilicus and
symphysis pubis
2. BREASTS
Reproduction, back pain
Aesthetics, and breast cancer
Mammary glands & associated skin -connective tissues.
modified sweat glands in the superficial fascia anterior to the
pectoral muscles and the anterior thoracic wall.
2. BREASTS
Mammary glands:
Series of ducts and associated secretory lobules.
Form 15 to 20 lactiferous ducts open
nipple.
Nipple is surrounded by a circular pigmented area of skin
areola (L. small area).
FEMALE BREASTS
NON-LACTING WOMEN – PREDOMINANT COMPONENT: FAT
LACTING WOMEN- PREDOMINANT COMPONENT: GLANDULAR TISSUE
The breast rests on a bed
extends transversely from
lateral border of the sternum
mid-axillary line
vertically from the 2nd through 6th ribs
75% (lateral
breast quadrants)
Axillary lymph
nodes
Most of the
remaining
(medial breast
quadrants)
parasternal lymph
nodes or to the
opposite breast
Lymph from inferior quadrants may pass deeply to
abdominal lymph nodes.
Trapezoidal in A-P dimensions
Tipped-over pyramid in 3-D
crucial organ of the human body
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Right heart (Suction)
poorly- oxygenated(venous) blood
from the body
superior vena cava & inferior vena cava
right atrium
right ventricle
pulmonary arteries
lungs
Left heart (Pumping)
well- oxygenated (arterial) blood
from the lungs
pulmonary veins
left atrium
left ventricle
aorta
the body
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right and left atria & right and left ventricles
Atrium – plural atria
Ventricles
Receiving chambers
Discharging chambers
cardiac cycle
1. Ventricular filling (diastole)
2. Ventricular emptying (systole)
Blood pressure
120-80 mm/Hg
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The fibrous skeleton of the heart
Keeps the orifices of the AV & semilunar valves patent
prevents them from being overly distended by an increased volume of blood.
Provides attachments for the valves & myocardium.
Forms an electrical «insulator»
separating impulses of the atria & ventricles  they contract independently
surrounding and providing passage for the initial part of the AV bundle
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coronary sulcus (atrioventricular groove)
between atrium & ventricles
anterior & posterior interventricular (IV) sulci (grooves)
between right and left ventricles
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apex located inferiorly & base located superiorly
Apex projects forward, downward and to the left
Base faces in a posterior direction
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Anterior (sternocostal) surface
o mostly of right ventricle
o some of the right atrium on the right
o some of the left ventricle on the left
Diaphragmatic (inferior) surface
o formed mainly by the left ventricle
o partly by the right ventricle
o related to central tendon of diaphragm.
Right pulmonary surface
o formed by the right atrium.
Left pulmonary surface
o left ventricle & a portion of left atrium.
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RIGHT ATRIUM
forms the right border of the heart
Receives venous blood from the SVC, IVC, and coronary sinus.
Through the right atrioventricular orifice,
discharges the poorly oxygenated blood it has received
into the right ventricle.
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RIGHT VENTRICLE
forms
largest part of the anterior surface of the heart
a small part of the diaphragmatic surface
almost the entire inferior border of the heart.
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interventricular septum (IVS)
obliquely placed partition between the right and left ventricles, forming part of the walls of each
muscular and membranous parts
Bulges into the cavity of the right ventricle.
Superiorly and posteriorly, a thin membrane, forms the much
smaller membranous part of the IVS.
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LEFT ATRIUM
forms most of the base of the heart
right and left pulmonary veins enter here.
Tubular, muscular left auricle,
Its wall trabeculated with pectinate muscles.
A semilunar depression in
the interatrial septum
Floor of the oval fossa
surrounding ridge
Valve of the oval fossa
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LEFT VENTRICLE
forms the apex of the heart, left (pulmonary) surface & border, most of the diaphragmatic surface.
Compared to the right ventricle
Walls 2-3 times thicker
Trabeculae carneae finer and more numerous
Cavity longer
Anterior & posterior papillary muscles larger
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aortic valve
semilunar valve
between the left ventricle & ascending aorta
obliquely placed.
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mitral valve
double-leaflet mitral valve
Guards the left AV orifice.
Has two cusps, anterior and posterior.
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6. SEMILUNAR VALVES
Semilunar cusps of the pulmonary valve anterior-right-left
Seminular cusps of the aortic valve posterior-right-left
concave when viewed superiorly
no tendinous cords to support
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VASCULATURE OF THE HEART
coronary arteries & cardiac veins
embedded in fat
course across the surface of the heart just deep to the epicardium.
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first branches of the aorta
supply the myocardium and epicardium
Anastomoses between the branches of the
coronary arteries exist, which enables the
development of the collateral circulation.
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STIMULATING, CONDUCTING, &
REGULATING SYSTEMS OF HEART
1. sinuatrial (SA) node
initiates the heartbeat & coordinates contractions of the four heart chambers
2.atrioventricular (AV) node
3.bundles
highly specialized conducting fibers for conducting impulses rapidly to different areas of the heart
o Propagation of the impluse
o Simultaneous contraction of the cardiac striated muscle cells
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pacemaker of the heart
@junction of the SVC & right atrium
near to the superior end of the sulcus terminalis
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pacemaker of the heart
stimulated by sympathetic division of the autonomic nervous system to
accelerate the heart rate
inhibited by parasympathetic division
to return to or approach its basal rate.
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a smaller collection of nodal tissue than the SA node
in the posteroinferior region of the interatrial septum
near the opening of the coronary sinus
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JOURNEY OF THE SIGNAL
Generated @ SA node
Passed through the walls of the right atrium
Propageted by the cardiac muscle
Signal passed from SA node to AV node
Distributed to the ventricles through the AV bundle
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AV bundle
the only bridge between the atrial and ventricular myocardium
passes from the AV node
through the fibrous skeleton of the heart and along the
membranous part of the IVS.
@ junction of membranous & muscular parts of the IVS
divides into : right bundle & left bundle.
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right and left bundles
proceed on each side of the muscular IVS deep to the endocardium
then ramify into
subendocardial branches (Purkinje fibers)
extend into the walls of the respective ventricles.
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autonomic nervous system, cardiac plexus
Cardiac plexus
posterior to the ascending aorta and bifurcation of the pulmonary trunk
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autonomic nervous system, cardiac plexus
Parasympathetic supply
presynaptic fibers of the vagus nerves
Slows the heart rate
Reduces the force of the contraction
Constricts the coronary arteries saving energy
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sympathetic supply
presynaptic fibers
cell bodies in the intermediolateral cell columns
(IMLs) of the superior 5 or 6 thoracic segments
postsynaptic sympathetic fibers
cell bodies in the cervical and superior thoracic
paravertebral ganglia of the sympathetic trunks.
causes increased heart rate
increased impulse conduction,
increased force of contraction,
increased blood flow through
the coronary vessels increased
activity.
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9. SEPTAL DEFECTS
Atrial Septal Defects (ASD)
congenital anomaly of the interatrial septum
a hole between the two atria
What happens?
Oxygenated blood from the lungs
Left atrium
Right atrium
More blood in the right heart
Results in
enlargement of
right atrium & ventricle
dilation of the pulmonary trunk
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Ventricular Septal Defects (VSD)
rank first on all lists of cardiac defects
membranous part of the IVS common site of VSDs
What happens?
Oxygenated blood from the ventricles
Left ventricle
Right ventricle
Results in
in pulmonary blood flow
severe pulmonary disease
(hypertension)
cardiac failure
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10. VALVULAR
HEART DISEASES
Disturb pumping efficiency of the heart.
Stenosis (narrowing) or insufficiency
Both result in an increased workload for the heart.
Valvuloplasty repairing the heart valves
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Scarring and shortening of the cusps results in insufficiency
Restricts the outflow of the left ventricle
Leads to the hypertrophy of the myocardium
During ventricular systole, blood regurgitates back to the left atrium
A hurt murmur will be heard.
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Narrowing of the mitral orifice.
Restricts the outflow of the left atrium.
A murmur will be heard during atrial contraction.
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Narrowing of the pulmonary valve due to the fused cusps.
Restricts the outflow of the right ventricle.
Leads to the hypertrophy of the myocardium.
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Incomplete closure of the cusps due to thickening of their free
margins due to a disease.
During diastole, blood regurgitates back to the right ventricle from
the pulmonary trunk.
Heart murmur could be heard.
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most frequent valve abnormality
Blood is unable to flow freely from left ventricle to aorta.
A result of degenerative calcification, fusion of the aortic cups as a
result.
Causes extra work for the heart, resulting in left ventricular
hypertrophy.
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During diastole blood regurgitates from aorta back to the left
ventricle.
A hurt murmur will be heard during diastole.
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a pathologic sound
could be heard by stethoscope.
produced due to the turbulence caused by the blood passing from
a narrow opening into a larger vessel or chamber.
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tricuspid valve
behind the right half of the sternum opposite
4th intercostal space
mitral valve
behind the left half of the sternum opposite
4th costal cartilage
pulmonary valve
behind the medial end of the 3rd left costal
cartilage and adjoining part of the sternum
aortic valve
behind the left half of the sternum opposite
3rd intercostal space.
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S1
produced by contraction of the ventricles
closure of the tricuspid & mitral valves (AV valves)
S2
produced by the sharp closure of the aortic & pulmonary valves
hear sounds produced at each valve with the minimum of distraction or interference
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mitral valve apex beat
tricuspid valve
fifth left intercostal space,
right half of lower end of the body of the sternum
9 cm from the midline
pulmonary valve
medial end of the second left intercostal space
aortic valve
medial end of the second right intercostal space
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PERICARDIUM
fibroserous membrane, covers the heart & beginning of its great vessels
a closed sac with two layers
fibrous pericardium
serous pericardium
parietal layer
visceral layer –heart & great vessels
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fibrous pericardium
continuous superiorly w/ tunica adventitia of the great vessels & w/pretracheal layer of deep cervical fascia
Continuous inferiorly w/ central tendon of the diaphragm
Attached anteriorly to the sternum by sternopericardial ligaments
Site of continuity pericardiacophrenic ligament
Inner surface lined by parietal layer of the serous pericardium
Protects the heart against sudden overfilling.
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pericardial cavity
potential space between opposing layers of the
parietal & visceral layers of serous pericardium
contains a thin film of fluid : pericardial fluid
enables the heart to move and beat in a frictionless environment.
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GREAT VESSELS
formed by the union of
internal jugular & subclavian veins
posterior to the sternoclavicular (SC) joints.
brachiocephalic veins unite
to form the SVC.
@ inferior border of the 1st right costal
cartilage
shunt blood from the head,
neck, & upper limbs
right atrium.
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Returns blood from all structures superior to the diaphragm
except the lungs & heart.
Passes inferiorly and ends by entering right atrium of the heart.
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begins at the aortic orifice.
only branches coronary arteries, arising from the aortic sinuses.
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curved continuation of the ascending aorta
begins posterior to the 2nd right sternocostal (SC) joint at the level
of the sternal angle.
ligamentum arteriosum remnant of the fetal ductus arteriosus
root of the left pulmonary artery
inferior surface of the arch of the aorta
The usual branches of the arch
1) brachiocephalic trunk
2) left common carotid artery
3) left subclavian artery.
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first and largest branch of the arch of the aorta
arises posterior to the manubrium.
ascends superolaterally
divides into right common carotid & right subclavian arteries.
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second branch of the arch of the aorta
arises
o posterior to the manubrium,
o slightly posterior and to the left of the brachiocephalic trunk.
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third branch of the arch of the aorta
arises from the posterior part of the
arch
posterior to left common carotid artery.
ascends lateral to trachea & left
common carotid artery.
Leaves the thorax and enters the
root of the neck.
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responsible for detecting changes in blood chemistry, primarily oxygen content
monitor changes in blood pressure
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Abdominal aorta
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