Download 1 Thorax

The Thorax
1
Anatomage Table
Instructors Guide- Thorax
Table of Contents
Thorax 1- Skeletal System........................................................................................................................3
1: Vertebral Column..............................................................................................................................3
2: Thoracic Cage ...................................................................................................................................5
3: Sternum.............................................................................................................................................7
Suggested Clinical Correlates (CC): ................................................................................................9
Thorax 2- Muscular System....................................................................................................................10
1: Superficial (Extrinsic) Back Muscles..............................................................................................10
2: Deep (Intrinsic) Back Muscles........................................................................................................11
3: Muscles of Respiration....................................................................................................................12
Suggested Clinical Correlates (CC): ..............................................................................................13
Thorax 3- Respiratory System and Pulmonary Cavities.........................................................................14
1: Trachea and Primary Bronchi .........................................................................................................14
2: Chest Cavities..................................................................................................................................16
3: Pulmonary Cavities, Pleura, and Lungs..........................................................................................18
4: Root of Lung...................................................................................................................................21
5: Diaphragm and Associated Structures.............................................................................................23
Suggested Clinical Correlates (CC): ..............................................................................................26
Thorax 4-Cardiovascular System in Inferior Mediastinum....................................................................27
1: Boundaries of the Inferior Mediastinum.........................................................................................27
2: Surfaces of the Heart.......................................................................................................................28
3: Cardiac Circulation.........................................................................................................................30
4: Coronary Vessels.............................................................................................................................33
Suggested Clinical Correlates (CC): ..............................................................................................36
Thorax 5- Superior and Posterior Mediastinum......................................................................................37
1: Boundaries of the Superior Mediastinum........................................................................................37
2: Vessels of the Superior Mediastinum .............................................................................................39
3: Additional Contents of the Superior Mediastinum..........................................................................41
4: Boundaries and Contents of the Posterior Mediastinum.................................................................42
Suggested Clinical Correlates (CC): ..............................................................................................45
Appendix..................................................................................................................................................46
2
Thorax 1- The Skeletal System
1: Vertebral Column
•
Describe the characteristics of a typical thoracic vertebrae
•
Identify and describe the structures involved in the overlap of thoracic vertebrae and the
resulting type of movement allowed
Thoracic Vertebrae (1-12)
1. a. Thoracic Vertebrae (Posterior)
Lamina
Pedicle
Spinous process T6
Transverse process
Vertebral body T6
Vertebral foramen
1. b. Vertebral Arch (Superior)
3
Intervertebral foramen T6/T7 &
T7/T8
IV disc T6/T7 & T7/T8
Spinous process T6-T8
Vertebral body T7 &T8
1. c. Intervertebral Foramen
Inferior articular facet T5
Inferior vertebral notch
Spinous process T4-T6
Superior articular facet T5
Superior vertebral notch
Zygopophysial joint T4/T5
&T5/T6
1. d. Zygopophysial Joint (Low Visibility)
4
2: Thoracic Cage
•
Describe the make-up and organization of the thoracic cage
•
Identify the relevant features of a typical rib
•
Classify the 12 ribs as either true, false, or floating
Clavicle
Costal cartilages
Manubrium
Sternal angle
Sternum
True Ribs (1-7)
Xiphoid process
2. a. True Ribs
Costal cartilages
False Ribs (8-10)
2. b. False Ribs
5
Floating Ribs (11-12)
2. c. Floating Ribs
Costal Angle, Body, Head, Neck
and Tubercle of Rib
Lamina
Spinous process
Transverse process
Vertebral body T6
2. d. Posterior Rib Articulation (Superior)
Angle of rib
Articulate tubercle
Costal angle
Head of Rib
Neck of Rib
Spinous process
Transverse process
2. e. Costal Angle
6
3: Sternum
•
Name the parts of the sternum
•
Explain the use of the manubriosternal joint (sternal angle) in rib counting
Clavicle
Costal cartilage
Jugular notch
Manubrium
Sternal angle
Sternum
Xiphoid process
3. a. Sternum and Manubrium
Interchondral joint
Costal cartilage
Costochondral joint
Sternum (body)
Manubriosternal joint
Manubrium
3. b. Chondral Joints
7
Costal cartilage 7th-10th Ribs
Xiphoid process
3. c. Costal Margin
8
Suggested Clinical Correlates (CC):
Jefferson Fracture
Type 3 Odontoid Fracture
Case 0118 Fracture of C1 Vertebra
Left Hip Subluxation
Right Hip Dislocation
Case 0319 Spina Bifida
Complex Fractures of T5 and T6
Fractures of Right and Left Humeri
Fractures of Left Clavicle
Sternum, and Right 3rd, 4th &5th Ribs
Case 0244 Gunshot Tracks
9
Thorax 2- The Muscular System
1: Superficial (Extrinsic) Back Muscles
•
Identify the Trapezius, Latissimus dorsi, Levator scapulae, and the Rhomboid major and minor
•
Describe the attachments and functions of these large extrinsic muscles of the back
Acromial end of clavicle
Acromion process
Spine of scapula
Spinous process C7, T12
Trapezius (Upper, Middle, and
Lower Fibers)
1. a. Trapezius
9th, 12th Rib
Iliac crest
Inferior angle of scapula
Intertubercular grove
Latissimus dorsi
Posterior superior iliac spine
(PSIS)
Spinous process T7, L5
1. b. Latissimus Dorsi
10
Medial (Vertebral) border of
scapula
Rhomboid major
Rhomboid minor
SP T2-T5,
Spine of scapula
Spinous process C7, T1
1. c. Rhomboids (Low-visibility)
2: Deep (Intrinsic) Back Muscles
•
Identify the erector spinae as a group and describe the three muscles within this group
•
Describe attachments and function of these muscles unilaterally and bilaterally
10th-12th Rib
Erector spinae (muscle group)
Iliac crest
Iliocostalis
Longissimus
Posterior superior iliac spine
(PSIS)
Spinalis
2. a. Erector Spinae
11
3: Muscles of Respiration
•
Name the three intercostal muscles and describe their functions
•
Identify the muscles of respiration
DiaphragmaticIntercostal
muscles
Intercostal space
Posterior intercostal a.
Rib (Cut)
3. a. Intercostal Space
Diaphragm
Intercostal muscles
Pectoralis major
Rectus abdominis
3. b. Diaphragm and Accessory Muscles of Respiration
12
Suggested Clinical Correlates (CC):
Diffuse Muscular Atrophy
Case 0319 Spina Bifida
Joined Diaphragm
Thoraco-amphilophus Conjoined Twin
Case 0210 Conjoined Twins
Diaphragmatic Hernia of Small Intestine Into
Thoracic Cavity
Case 0338 Diaphragmatic Hernia
13
Thorax 3- Respiratory System and Pulmonary Cavities
1: Trachea and Primary Bronchi
•
Describe the difference between the conducting and respiratory portions of the respiratory
system
•
Describe the location and branching pattern differences between the right and left pulmonary
structures
Apex
Costodiaphragmatic recess
R. and L. Dome of diaphragm
R. and L. Primary bronchus
Trachea
1. a. Chest X-ray
Carina
R. and L. Primary bronchus
Trachea
1. b. Trachea
14
Carina
R. Primary bronchus
R. Secondary bronchus
R. Tertiary bronchus
Trachea
1. c. Right Bronchi
Carina
L. Primary bronchus
L. Secondary bronchus
L. Tertiary bronchus
Trachea
1. d. Left Bronchi
15
Carina
Esophagus
R. and L. Primary bronchus
1. e. Carina
2: Chest Cavities
•
Describe the location and contents of the thoracic cavities
•
Describe the various locations of both the visceral and parietal pleura
Esophagus
Mediastinal cavity
R. and L. Pleural cavity
R. and L. Primary bronchus
Trachea
2. a. Thoracic Cavities (Inferior)
16
Costal parietal pleura
Diaphragmatic parietal pleura
Mediastinal parietal pleura
R. Pleural cavity
2. b. Right Pleural Cavity
Cervical parietal pleura
Costal parietal pleura
Mediastinal parietal pleura
R. Pleural cavity
2. c. Costal Parietal Pleura
Costal surface of R. lung
Diaphragmatic surface of R. lung
R. pulmonary cavity
Visceral pleura (on lung surface)
2. d. Right Pulmonary Cavity
17
2nd Rib
Anterior inferior mediastinum
Middle inferior mediastinum
Posterior inferior mediastinum
Sternal angle
Superior mediastinum
T4/T5 IV disc
T5&T5 vertebral body
2. e. Mediastinal Cavity (Left Lateral)
3: Pulmonary Cavities, Pleura, and Lungs
•
Describe the differences between the right and left lungs
•
Describe the difference between the parietal and the pleural cavities
Apex
Diaphragmatic surface of R.
Lung
R. Dome of diaphragm
Sternal angle
Sternum (body)
T4&T5 Vertebral body
Upper, middle, and lower lobe
3. a. Chest X-ray (Lateral)
18
Apex
Base
Upper, middle, and lower lobes
3. b. Lobes of Right Lung
Apex
Base
Diaphragmatic surface of R.
Lung
Upper, middle, and lower lobe
3. c. Surfaces of Right Lung
Apex
Base
Cardiac impression
Cardiac notch
Costal surface of L. Lung
Lingula
Upper and lower lobe
3. d. Lobes of Left Lung (Medial View)
19
Apex
Cardiac impression
Costal surface of L. Lung
Lingula
Upper and lower lobe
3. e. Surfaces of Left Lung
20
4: Root of Lung
•
Describe the contents and features of the root of the lungs
Left Plueral cavity
Left Pulmonary a.
Left Pulmonary bronchus
Left Pulmonary v. (inferior)
Left Pulmonary v. (superior)
Mediastinal parietal pleura
4. a. Hilum of Left Lung
Left plueral cavity
Left pulmonary a.
Left pulmonary bronchus
Left pulmonary v. (inferior)
Left pulmonary v. (superior)
4. b. Root of Left Lung
21
Left pulmonary a.
Pulmonary trunk
Right pulmonary a.
Right ventricle
4. c. Pulmonary Arteries (Superior)
Left atrium
Left pulmonary v. (inferior)
Left pulmonary v. (superior)
Right pulmonary v. (inferior)
Right pulmonary v. (superior)
4. d. Pulmonary Veins (Superior)
Left pulmonary a.
Left pulmonary v. (inferior)
Left pulmonary v. (superior)
Pulmonary trunk
Right pulmonary a.
Right pulmonary v. (inferior)
Right pulmonary v. (superior)
4. e. Pulmonary Vessels (Posterior)
22
5: Diaphragm and Associated Structures
•
Describe the corresponding vertebral levels of the main structures passing through the
diaphragm
Inferior vena cava
IVC through caval foramen
Right dome of diaphragm
5. a. Caval Foramen (Low Visibility)
Ascending aorta
Esophagus
Esophagus through esophageal
hiatus
Left atrium
Right primary bronchus
T4 &T5 Vertebral body
Trachea
5. b. Pathway of Esophagus (Low Visibility)
23
Eosphagus through esophageal
hiatus
Esophagus
Trachea
5. c. Esophagus in Posterior Mediastinum
Descending (thoracic) aorta
Esophagus
Esophagus through esophageal
hiatus
Middle and posterior inferior
mediastinum
5. d. Esophageal Hiatus (Inferior, Low Visibility)
Aorta through aortic hiatus
Aortic arch
Descending (thoracic) aorta
Descending aorta
Diaphragm
5. e. Aortic Hiatus (Low Visibility)
24
Left dome of diaphragm
Right dome of diaphragm
5. f. Domes of the Diaphragm
Costodiaphragmatic recess
Diaphragmatic surface of right
lung
Left dome of diaphragm
Diaphragmatic surface of left
lung
Right dome of diaphragm
5. g. Costodiaphragmatic Recess
25
Suggested Clinical Correlates (CC):
Centrilobular Nodularity within Right Lung
with Air Trapping
Diffuse Bilateral Peribronchial Thickening
Diffuse Cystic and Cylindrical Bronchiectasis
Peripheral Mucous plugging
Case 0319 Cystic Fibrosis
Bronchiectasis
Cholecystectomy
Subglottic Trachea, Mild Intimal Hyperplasia
Case 0210 Tracheal Stent
Bronchial Stenosis
Parenchymal Opacity
Case 0131 Bronchial Stent
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Thorax 4-Cardiovascular System in Inferior Mediastinum
1: Boundaries of the Inferior Mediastinum
•
Describe the location of the inferior mediastinum and identify its contents
Body of sternum
Sternal angle
T5-T9 Vertebral body
Xiphoid process
1. a. Boundaries of the Inferior Mediastinum
Body of sternum
Manubrium
Sternal Angle
Trachea
T5-T10 Vertebral body
1. b. Chest X-ray (Lateral)
27
Apex of heart
Body of sternum
L. Ventricle
Manubrium
R. Atrium
Xiphoid process
1. c. Anterior Heart Silhouette
2: Surfaces of the Heart
•
Describe the external features of the heart and great vessels
•
Explain how to determine whether a heart is right or left dominant
Apex of heart
Manubrium
R. and L. Ventricle
R. Atrium
R. Auricle
2. a. Anterior Surface of Heart
28
Inferior vena cava
R. Atrium
R. Ventricle
Superior vena cava
2. b. Right Surface of Heart
Ascending aorta
Descending aorta
L. Atrium
L. Auricle
L. Ventricle
2. c. Left Surface of Heart
L. Atrium
L. Ventricle
R. and L. Inferior pulmonary v.
R. and L. Pulmonary a.
R. and L. Superior pulmonary v.
Trachea
2. d. Posterior Surface of Heart
29
Body of sternum
Descending Aorta
L. Atrium
L. Ventricle
R. Ventricle
2. e. Inferior Surface of Heart
3: Cardiac Circulation
•
Describe the internal features of the chambers of the heart and cardiac circulation
Coronary sinus
Inferior vena cava
R. Atrium
Superior vena cava
3. a. Venous Return to Right Atrium
30
Inferior vena cava
R. Atrium
R. Auricle
R. Ventricle
Superior vena cava
Tricuspid valve
3. b. Tricuspid Valve (Low Visibility)
Interventricular septum
Pulmonary semilunar valve
Pulmonary trunk
R. Atrium
R. Ventricle
Tricuspid valve
3. c. Right Ventricle
Interventricular septum
L. Ventricle
Pulmonary semilunar valve
Pulmonary trunk
R. Ventricle
3. d. Pulmonary Semilunar Valve (Low Visibility)
31
L. Atrium
L. Inferior pulmonary v.
L. Superior pulmonary v.
R. Inferior pulmonary v.
R. Superior pulmonary v.
3. e. Left Atrium
Bicuspid valve
L. Atrium
L. Ventricle
3. f. Bicuspid Valve (Low Visibility)
Apex of heart
Bicuspid valve
L. Atrium
L. Ventricle
3. g. Left Ventricle (Superior)
32
Apex of heart
Bicuspid valve
Interventricular septum
Left atrium
Left ventricle
Right atrium
Right ventricle
3. h. Interventricular Septum
Aortic semilunar valve
Apex of heart
Ascending aorta
Left ventricle
3. i. Aortic Semilunar Valve (Low Visibility)
4: Coronary Vessels
•
Identify and describe the course of the right and left coronary arteries
•
Describe the location of the sites of anastomosis between the coronary arteries
•
Identify and describe the course of the cardiac veins and coronary sinus
33
Aortic arch
Aortic semilunar valve
Ascending aorta
Left ventricle
4. a. Ascending Aorta
Aortic arch
Aortic semilunar valve
Ascending aorta
Descending aorta
Left ventricle
Pulmonary trunk
4. b. Aortic Arch
Right atrium
Right auricle
Right coronary a.
Right marginal a.
Right ventricle
4. c. Right Coronary Artery
34
Anterior interventricular a.
(LAD)
Ascending aorta
Left circumflex branch
Left coronary a.
4. d. Left Coronary Artery (Superior)
Anterior interventricular a.
(LAD)
Left auricle
Left circumflex branch
Left coronary a.
Left vnetricle
Right ventricle
4. e. Anterior Interventricular Artery (Low Visibility)
Coronary sinus
Coronary sulcus
Left atrium
Left ventricle
4. f. Coronary Sinus (Posterior)
35
Suggested Clinical Correlates (CC):
Left Ventricular Outflow Track Gradient
Paroxysmal Atrial Fibrillation Status Post Aortic
Valve Repair with St. Jude Prosthetic
Mechanical Aortic Valve
Case 0204 Hypertropic Cardiomyopathy
Left Common Carotid Artery
Left Subclavian Artery
Stenosis of Right Common Carotid Artery
Case 0198 Takayasu Arteritis
Right Atrial Enlargement
Right Ventricular Hypertrophy
Case 0165 Tetrology of Fallot
36
Thorax 5- Superior and Posterior Mediastinum
1: Boundaries of the Superior Mediastinum
•
Describe the location and boundaries of the superior mediastinum
1st Rib
Boundary of thoracic inlet
Clavicular notch
Jugular notch
Manubrium
Vertebral body T1
1. a. Thoracic Inlet (Superior)
Manubrium
Sternal angle
Vertebral body T1-T4
1. b. Anterior and Posterior Boundaries
37
1st Rib
2nd Rib
Vertebral body T1-T4
1. c. Chest X-ray (AP)
1st Rib
2nd Rib
Manubrium
Sternal angle
Sternum (body)
Vertebral body T1-T4
1. d. Chest X-ray (Lateral)
38
2: Vessels of the Superior Mediastinum
•
Describe the difference between the branching pattern of the great vessels within the superior
mediastinum on the right and left sides
Aortic arch
Ascending aorta
Brachiocephalic trunk
Descending aorta
Left common carotid a.
Left subclavian a.
Right common carotid a.
Right subclavian a.
2. a. Branches off the Aortic Arch
Brachiocephalic trunk
Internal thoracic a.
Right common carotid a.
Right subclavian a.
Vertebral a.
2. b. Brachiocephalic Trunk
39
Aortic arch
Inferior thyroid a.
Internal thoracic a.
Left common carotid a.
Left subclavian a.
Left subclavian a.
Left vertebral a.
Thyrocervical trunk
2. c. Left Subclavian a. (Posterior)
Dorsal scapular a.
Inferior thyroid a.
Internal thoracic a.
Left common carotid a.
Left subclavian a.
Suprascapular a.
Thyrocervical trunk
Transverse cervical a.
Vertebral a.
2. d. Thyrocervical Trunk (Posterior)
Internal jugular v.
Left brachiocephalic v.
Left subclavian v.
Right brachiocephalic v.
Right subclavian v.
Superior vena cava
2. e. Brachicephalic vv.
40
3: Additional Contents of the Superior Mediastinum
•
Describe the boundaries and contents of the superior mediastinum
Aortic arch
Ascending aorta
Esophagus
Esophagus
Manubrium
Sternal angle
Sternum (body)
Trachea
Trachea
Vertebral body T2&T3
3. a. Trachea and Esophagus
Carina
Left main bronchus
Right main bronchus
Trachea
3. b. Silhouette of Trachea and Main Bronchii
41
Carina
Esophagus
Left main bronchus
Right main bronchus
Trachea
3. c. Respiratory and Alimentary Systems
4: Boundaries and Contents of the Posterior Mediastinum
•
Describe the boundaries and contents of the posterior mediastinum
Pericardial sac
Vertebral body T5-T12
4. a. Boundaries of the Posterior Mediastinum
42
Descending (Thoracic) Aorta
Esophagus
Left Pleural Cavity
Pericardium
Right Pleural Cavity
Vertebral body T5
4. b. Lateral Boundaries of the Posterior Mediastinum
Aortic arch
Ascending aorta
Descending aorta
Posterior intercostal a.
Thoracic aorta
4. c. Descending (Thoracic) Aorta
Azygos arch
Azygos v.
Left superior intercostal
Posterior intervostal v.
Right brachiocephalic v.
Right superior intercostal
Superior vena cava
4. d. Azygos Vein
43
Azygos v.
Descending (Thoracic) Aorta
Esophagus
Inferior vena cava
Left Dome of Diaphragm
Posterior intercostal a.
Right dome of diaphragm
T8 vertebral body
4. e. Contents of the Posterior Mediastinum (Superior)
44
Suggested Clinical Correlates (CC):
Anteriosclerotic Calcification
Percutaneous Coronary Intervention
Stable Ascending Thoracic Aortic Aneurysm
Stent
Case 0163 Chest Aortic Aneurysm
Persistent Ductus Arteriosus
Post Aortic Valve Replacement
Case 0154 Heart Valve Replacement
Limited Intimal Tear of Ascending Aorta
Variant Aortic Arch Anatomy
Case 01347 Aberrant Right Subclavian Artery
45
Appendix
Thorax 1-Skeletal System
Library Case: 0204
Goal(s):
Describe and identify (1) each vertebrae within the vertebral column, (2) make-up of a thoracic cage
(or rib cage), (3) joints in the thoracic cage and surrounding structures
Annotated Anatomy:
1: Vertebral Column
10th -12th Rib, Inferior articular facet T5, Inferior
vertebral notch, Intervertebral foramen T6/T7,
T7/T8, IV disc T6/T7, T7/T8, Lamina, Pedicle,
Spinous process T4-T8, Superior articular facet T5,
Superior vertebral notch, T1-T12, Transverse
process, Vertebral body T6-T8, Vertebral foramen,
Zygopophyseal joint T4/T5, T5/T6
2: Thoracic Cage
1st-12th Rib, Angle of 6th rib, Articulate tubercle,
Body of rib, Clavicle, Costal cartilage 2nd - 10th Rib,
Head of 6th rib, Jugular notch, Lamina, Manubrium,
Neck of 6th rib, Spinous process T6, Sternal angle,
Sternum (body) , Vertebral body T6, Xiphoid
process
3: Sternum
Clavicle, Costal cartilage 2nd - 7th rib,
Costochondral joint, Interchondral joint, Jugular
notch, Manubriosternal joint, Manubrium, Sternal
angle, Sternum (body), Xiphoid process
46
Thorax 2-Muscular System
Library Case: 0204
Goal(s):
Identify, describe structures, and discuss clinical correlates of (1) Superficial and deep muscles of the
thorax and back, (2) intrinsic muscles involved in respiration
Annotated Anatomy:
1: Superficial (Extrinsic) Back
Muscles
9th, 12th Rib, Acromial end of clavicle, Acromion
process, Iliac crest, Inferior angle of scapula,
Intertubercular grove, Latissimus dorsi, Medial
(Vertebral) border of scapula, Posterior superior
iliac spine (PSIS), Rhomboid major, Rhomboid
minor, SP T2-T5,Spine of scapula, Spinous process
C7, T1, T7, T12, L5, Trapezius (Upper, Middle,
and Lower Fibers)
2: Deep (Intrinsic) Back Muscles
10th-12th Rib, Erector spinae (muscle group), Iliac
crest, Iliocostalis, Longissimus, Posterior superior
iliac spine (PSIS), Spinalis
3: Muscles of Respiration
Diaphragm, DiaphragmaticIntercostal muscles,
Intercostal muscles, Intercostal space, Pectoralis
major, Posterior intercostal a., Rectus abdominis,
Rib (Cut)
47
Thorax 3- Respiratory System and Pulmonary Cavities
Library Case: 0010
Goal(s):
Identify, describe structures, and discuss clinical correlates of (1) the conducting portion of the
respiratory system, and (2) the lungs and the significance of its pleural cavities
Annotated Anatomy:
1: Trachea and Primary Bronchi
Apex, Carina, Costodiaphragmatic recess, Left
dome of diaphragm, Left primary bronchus, Left
secondary bronchus, Left tertiary bronchus, Right
dome of diaphragm, Right primary bronchus, Right
secondary bronchus, Right tertiary bronchus, T4,
T5 Vertebreal body, Trachea
2: Chest Cavities
2nd Rib, Anterior inferior mediastinum, Cervical
parietal pleura, Costal parietal pleura, Costal
surface of R. lung, Diaphragmatic parietal pleura,
Diaphragmatic surface of R. lung, Esophagus
Mediastinal cavity, Mediastinal parietal pleura,
Middle inferior mediastinum, Posterior inferior
mediastinum, R. and L. Pleural cavity, R. and L.
Primary bronchus, R. Pleural cavity, R. pulmonary
cavity, Sternal angle, Superior mediastinum, T4/T5
IV disc, T5&T5 vertebral body, Trachea, Visceral
pleura (on lung surface)
3: Pulmonary Cavities, Pleura, and
Lungs
Apex, Base, Cardiac impression, Cardiac notch,
Cardiac surface of left lung, Diaphragmatic surface
of right lung, Lingula, Lower lobe, Middle lobe,
Right dome of diaphragm, Sternal angle, Sternum
(body), T4, T5 Vertebral body, Upper lobe
4: Root of Lung
Left atrium, Left pleural cavity, Left primary
bronchus, Left pulmonary a., Left pulmonary v.
(inferior), Left pulmonary v. (superior), Mediastinal
parietal pleura, Pulmonary trunk, Right ventricle
5: Diaphragm and Associated
Structures
Aorta through aortic hiatus, Aortic arch
Ascending aorta, Costodiaphragmatic recess,
Descending (thoracic) aorta, Descending aorta,
Diaphragm, Diaphragmatic surface of left lung,
Diaphragmatic surface of right lung, Esophagus,
48
Esophagus through esophageal hiatus, Inferior vena
cava, IVC through caval foramen, Left atrium, Left
dome of diaphragm, Middle and posterior inferior
mediastinum, Right dome of diaphragm, Right
primary bronchus, T4 &T5 Vertebral body, Trachea
49
Thorax 4 - Cardiovascular System in Inferior Mediastinum
Library Case: 0010
Goal(s):
Identify, describe structures, and discuss clinical correlates of (1) the inferior mediastinum, (2) external
features, coronary vessels, and protective coverings of the heart, (3) chambers, valves, and circulation
of blood through the heart in cardiac rhythm
Annotated Anatomy:
1: Boundaries of the Inferior
Mediastinum
Aortic arch, Apex of heart, Ascending aorta, Body
of sternum, Left superior pulmonary v.,
Manubrium, Pulmonary trunk, Sternal angle, T5T10 Vertebral body, Trachea, Xiphoid process
2: Surfaces of the Heart
Apex of heart, Ascending aorta, Descending aorta,
Inferior vena cava, Left atrium, Left auricle, Left
inferior pulmonary v., Left pulmonary a., Left
superior pulmonary v., Left ventricle, Manubrium,
Right atrium, Right auricle, Right inferior
pulmonary v., Right pulmonary a., Right superior
pulmonary v., Right ventricle, Superior vena cava,
Trachea
3: Cardiac Circulation
Aortic semilunar valve, Apex of heart, Ascending
aorta, Bicuspid valve, Coronary sinus, Inferior vena
cava, Interventricular septum, Left atrium, Left
inferior pulmonary v., Left superior pulmonary v.,
Left ventricle, Pulmonary semilunar valve,
Pulmonary trunk, Right atrium, Right auricle,
Right inferior pulmonary v., Right superior
pulmonary v., Right ventricle, Superior vena cava,
Tricuspid valve
4: Coronary Vessels
Anterior interventricular a. (LAD), Aortic arch,
Aortic arch, Aortic semilunar valve, Apex of heart,
Ascending aorta, Coronary sinus, Coronary sulcus,
Descending aorta, Left atrium, Left auricle, Left
circumflex branch, Left coronary a., Left ventricle,
Pulmonary trunk, Right atrium, Right auricle, Right
coronary a., Right martinal a., Right ventricle
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Thorax 5- Superior and Posterior Mediastinum
Library Case: 0010
Goal(s):
Identify locations, describe structures, and discuss clinical correlates of (1) the superior mediastinum,
and (2) the posterior mediastinum
Annotated Anatomy:
1: Boundaries of the Superior
Mediastinum
1st, 2nd Rib, Boundary of thoracic inlet, Clavicular
notch, Jugular notch, Manubrium, Sternal angle,
Sternum (body), Vertebral body T1-T4
2: Vessels of the Superior
Mediastinum
Aortic arch, Ascending aorta, Brachiocephalic
trunk, Descending aorta, Dorsal scapular a.,
Inferior thyroid a., Internal jugular v., Internal
thoracic a., Left brachiocephalic v., Left common
carotid a., Left subclavian a., Left vertebral a.,
Right common carotid a., Right subclavian a.,
Right subclavian v., Superior vena cava,,
Suprascapular a., Thyrocervical trunk, Transverse
cervical a., Vertebral a.
3: Additional Contents of the
Superior Mediastinum
Aortic arch, Ascending aorta, Carina, Esophagus,
Left main bronchus, Manubrium, Right main
bronchus, Sternal angle, Sternum (body), Trachea,
Vertebral body T2, T3
4: Boundaries and Contents of the
Posterior Mediastinum
Aortic arch, Ascending aorta, Azygos arch, Azygos
v., Decending aorta, Descending (thoracic) aorta,
Esophagus, Inferior vena cava, Left dome of
diaphragm, Left pleural cavity, Left superior
intercostal v., Pericardial sac, Pericardium,
Posterior intercostal a., Right brachiocephalic v.,
Right dome of diaphragm, Right pleural cavity,
Right superior intercostal v., Superior vena cava,
Thoracic aorta, Vertebral body T5-T12
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