Download Nerve Supply of the Perineum and Pelvis

Surface Anatomy of Thorax,
Lungs and Breast
Fady Anis
Objectives
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Anterior Thoracic Wall Planes
Surface markings
Breast
Lungs and Pleura
Anterior Planes
 3 Anterior Planes
• Median Plane
• 2x Midclavicular Plane
 3 Anterolateral Planes
• Anterior Axillary Plane
• Midaxillary Plane
• Posterior Axillary Plane
Other Surface Lines
 Sternal Angle – T4/T5 – Rib 2
 Suprasternal – above sternum
 Xiphisternal – T9 – Rib 7
 Subcostal – L3
Surface Markings
The Breast
 The breast overlies the 2nd-6th Ribs
 Overlying pectoralis major and serratus
anterior
 It contains ~20 lactiferous ducts opening
into nipple
 Nipple is located at the 4th ICS – In males
and varies in females
 Areola = Pigmented area around nipple
The Breast Lymphatic Drainage
 7 Lymph drainage sites :
1.
Apical Axillary LN
2.
Central Axillary LN
3.
Lateral Axillary LN
4.
Pectoral Axillary LN
5.
Supra/infra Clavicular LN
6.
Parasternal Nodes LN
7.
Abdominal LN
Vasculature of the breast
 Medial mammary branches of
anterior intercostal branches of
the internal thoracic artery
 Lateral thoracic
 Thoraco-acromial arteries
 Posterior intercostal arteries,
from the thoracic aorta
Lungs - Pleura
 The pleura of the lungs are divided into 2
different parts:
• Parietal Pleura = Adheres to the Internal
thoracic wall
• Visceral Pleura = Attached to the lungs
 In between the two layers you have the
pleural space which is filled with serous
fluid reducing friction and provides surface
tension to push parietal pleura against
thoracic wall
Pleural Parts
 4 Pleural Parts
1.
Costal part- covers the internal surface of thoracic wall
and is separated from wall by endothoracic fascia
2.
Mediastinal part- lateral aspects of mediastinum
3.
Diaphragmatic part- superior surface of diaphragm
4.
Cervical pleura- extends superior to thoracic inlet into
the root of the neck
3 Pleural Reflections
 Pleural Reflections = Pleural folds / change in direction of
pleura – 1 Anterior, 1 Posterior and 1 Inferior
1.
Sternal line – Costal Pleura continuous with mediastinal
pleura Anteriorly
1.
Costal line – Costal pleura continuous with diaphragmatic
Inferiorly
1.
Vertebral line – Costal pleura becomes continuous with
mediastinal pleura Posteriorly
Parietal Vs. Visceral Pleura
• Visceral pleura:
• 2, 4, 6, 8, 10
• Together cc2-4, cardiac
notch to cc6, midaxillary
cc8, rib 10 posteriorly
• Parietal pleura:
• 2, 4, 6, 8, 10, 12
• Together cc2-4, cardiac
notch to cc6, midclav cc8,
midaxillary cc10, 12 rib
posteriorly
Thoracic Dermatomes
 Nipple - T4
 Xiphoid - T7
 Umbilical – T10
 Suprapubic – L1
Pleural Effusion
QUIZ! (T or F)
1.
The rib overlies Rib 2-6?
• True
2. There are 4 pleural reflections – Diaphragmatic,
Mediastinal, Cervical and costal ?
• False – there are 3 reflections – Sternal, vertebral and costal
3. One of the lymph drainage sites is the medial axillary LN?
• False – Apical, pectoral central and lateral
4. The four branches supplying the breast are Lateral
Thoracic, medial mammary, thoraco-acromial and
posterior intercostal arteries ?
• True
Thank you for listening !
 If you have any questions email the Fadz –
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