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Gross Anatomy

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The TRANSVERSE dimension of the thoracic cavity is most affected by:
Movement of the lower ribs

Bucket Handle Movement
The VERTICAL dimension of the thoracic cavity is most affected by:
Movement of the diaphragm
The ANTERIOR-POSTERIOR dimension of the thoracic cavity is most affected by;
Movement of the sternum by the upper ribs

Pump Handle Movement
Movements of the thoracic wall and diaphragm during inspiration are due to:
1.Movement at the costovertebral joints

2. Contraction of the external intercostals muscles

3. Elevation of the sternum

4. Increase in the transverse dimension of the thoracic cavity

5. Contraction of the diaphragm
What are the muscles of INSPIRATION?
External Intercostals
Diaphragm
Sternocleidomastoid
Scalenes
Pectoralis Major
What are the muscles of EXPIRATION?
Internal Intercostals
Transversus Abdominis
Abdominal Muscles
What structures go thru the CAVAL opening of the diaphragm?
IVC
Phrenic Nerves
Lymphatics
What structures go thru the ESOPHAGEAL opening of the diaphragm?
Esophagus
Vagus
Left Gastric Vessels: esophageal branch
What structures go thru the AORTIC opening of the diaphragm?
Aorta
Thoracic Duct
Greater Splanchnic
Azygos Vein
What structures are ANTERIOR to the Trachea?
Sternum
Thymus
Arch of the Aorta
Origins of brachiocephalic and Common carotid
What structures are POSTERIOR to the Trachea?
Esophagus
To the right:
Azygos Vein, Vagus, Pleura

To the left:
Aortic Arch, LCC, LS, Left Vagus, Left Phrenic, Pleura
Why are objects more likely to lodge on the right lung ?
The right bronchus is wider, shorter, and more vertical than the left.
In the right lung the inferior lobe bronchus continues nearly in the same plane as the trachea
What part of the lung portrudes above the clavicle?
The Apex
In the right lung what are the boundaries of the middle lobe?
The oblique and horizontal fissures
Where can the AORTIC VALVE be heard on the chest?
To the RIGHT of the sternum on the 2nd ICS
Inmediately to the Right of the Angle of Louis
Where can the PULMONARY VALVE be heard on the chest?
To the LEFT of the sternum on the 2nd ICS
Inmediately to the Left of the Angle of Louis
Where can the TRICUSPID VALVE be heard on the chest?
To the LEFT of the xiphoid process of the sternum on the 5th ICS
Where can the BICUSPID/MITRAL VALVE be heard on the chest?
To the LEFT of the sternum
Under the left nipple
What surface depressions are present on the RIGHT LUNG?
Tracheal
Esophageal
SVC and IVC
Cardiac
Diaphragmatic
What surface depressions are present on the LEFT LUNG?
Aortic Arch
Descending Aorta
Cardiac
Diaphragmatic
What is the PARASYMPATHETIC effect on the LUNGS?
Bronchial Constriction
Vasodilation
Increase in glandular secretion
Sensory
What is the SYMPATHETIC effect on the LUNGS?
Bronchial Dilation
Vasoconstriction
Name the features of the LINGULA
Part of the lower lobe of the left lung

Homologus to the middle lobe of the right lung

Slides in and out of the costomediastinal recess during breathing

It has two bronchopulmonary segments
What is the PARIETAL PERICARDIUM attached to?
The sternum
The central tendom of the diaphragm
The great vessels: aorta, pulmonary trunk
The VISCERAL PERICARDIUM is continous with:
The FIBROUS PERICARDIUM
The INTERVENTRICULAR sulcus indicates the division of the Right Ventricle and the:
Left Ventricle
What artery supplies the SA NODE?
Right Coronary Artery
Which is the first branch of the aorta?
Right Coronary Artery
The ANTERIOR INTERVENTRICULAR ARTERY/LAD runs with
Great Cardiac Vein
The POSTERIOR INTERVENTRICULAR ARTERY/PAD runs with:
Middle Cardiac Vein
The MARGINAL ARTERY from the right coronary artery runs with:
Small Cardiac Vein
The CIRCUMFLEX ARTERY runs with:
Coronary Sinus
What are the contents of the RIGHT ATRIUM?
Some Can = SVC, IVC
Retarted A = Right Auricle
People Muscle = Pectinate M
Can't That = Cristae Ter
Sing Vaginates =Sinus Ven
Instead Still =Interatr Sep
They Vaginate =Tricusp Val
Start After =SA node
Over Climax = Open Coro S
What are the contents of te RIGHT VENTRICLE?
People = Papillary
Can = Chordae Tendinae
Save = Septomarginal band/mod
Time = Trabeculae Carnae
Cramming = Conus Arteriosus
What are the contents of the LEFT ATRIUM?
Left Auricle
Openings of pulmonary veins
Renmant valve of foramen ovale
Mitral Valve
What are the contents of the LEFT VENTRICLE?
Interventricular Septum
Papillary Muscles
Chordae Tendinae
Trabeculae Carnae
Aortic Vestibule
The right recurrent laryngeal nerve wraps around which structure before ascending to the larynx?
The ligamentum arteriosum

The ligamentum arteriosum can compress the nerve and cause Hoarse Voice
Damage to what structure would obstruct the majority of the venous drainage to the heart?
The Coronary Sinus
What vessel is continous with the RIGHT VENTRICLE?
The Pulmonary Trunk
What provides the force of perfusion for the coronary circulation?
The Left Ventricle
If a patient develops an arrythmia due to occlusion of a coronary artery, which artery would it be?
Right Coronary Artery
Horner's Syndrome Symptoms:
horners syndrome: cancer of apex of the lungs, decrease sympathetics

flushing of skin

retracted eyeball

ptosis: droopy eyelids

constriction of pupil

anhydrosis

anopthalmose (eye sinks into socket)
Horner's Symdrome could be caused by?
Cancer of the Apex of the lungs compressing the sympathetic chain
When the left atrium swells it can press on?
The Esophagus
The LEFT PULMONARY ARTERY is attached to the aorta by:
Ligamentum Arteriosum
All the cardiac veins drain into te Coronary sinus EXCEPT:
The Anterior Cardiac Veins which drain directly into the right atrium
Which valves are OPEN during SYSTOLE?
Aortic and Pulmonary
Which valves are CLOSED during SYSTOLE?
Mitral and Tricuspid
What are the contents of the SUPERIOR MEDIASTINUM?
The Boy ATE Veggies & Turkey

T: Thymus
B: Brachiocephalic veins & SVC
A: Arch of aorta
TE: Trachea & Esophagus
V: Vagus, phrenic, & left recurrent laryngeal
T: Thoracic duct
What are the contents of the POSTERIOR MEDIASTINUM?
DATES:
Descending aorta
Azygos and hemiazygous veins
Thoracic duct
Esophagus
Sympathetic trunk/gangli
Tetralogy of Fallot
Pulmonary Veins Oxygenate Heart By Blood:

Pulmonary stenosis
Ventricular septal defect
Overriding aorta
Hypertrophy
Blue
Babies
Grey vs. white rami communicantes
WhIte = On the Way In to the sympathetic trunk
GrEy = Exiting the sympathetic trunk
Thoracic duct: which half of upper body does it drain?
It drains all of lower body.
Drains Lymph from the Left of the upper body
What are the contents of the MIDDLE MEDIASTINUM?
HARP

Heart
Arch of azygos
Roots of great vessels and lungs
Phrenic nerves
The coronary sulcus is located between the ventricles and the:
Atria
What approach is taken when performing a PERICARDIOCENTHESIS?
Pericardiocenthesis: large needle inserted at the left sternal margin of ICS 4 (ICS 5 or 6)
For this procedure one wants to take the paraxiphoid approach instead the costoxiphoid approach in order to avoid the internal thoracic artery
What approach is taken when performing a THORACOCENTESIS?
Thoracocentesis: surgical puncture of the chest wall to remove excess fluid in the pleural cavity (which reduces ventilation capacity)

A needle is inserted thru an ICS into the pleural cavity. Needle is inserted in the middle of ICS to avoid costal groove inferiorly and collateral vessels superiorly
Which portion of the lung will be closest to the CUPULA?
The Apex
Which condition leads to bony changes visible on X-rays?
Coarctation of the Aorta
Which artery is on the diaphragmatic surface of the heart?
Right Marginal Artery
Which heart chamber is located at the sternal margin of the left 5th ICS?
The Right Ventricle
What structures are deep to the sternum?
Thymus
Arch of Aorta:BCS
SVC
Azygos Vein and Trachea
Esophagus
What is location of the TRANSVERSE SINUS?
_____ SVC, LV

_____ Large vessels: Aorta, P.Trunk
The VISCERAL PERICARDIUM is reflected onto the heart where it forms:
The epicardium (external layer of heart muscle)
What are the two layers of the PERICARDIUM?
The Fibrous pericardium

The Serous pericardium: 2 layer sac
What are the two layers of the SEROUS PERICARDIUM?
Parietal pericardium

Visceral pericardium
The PERICARDIUM is attached to the sternum and the diaphragm by:
The sternopericardial ligament
The central tendon of the diaphragm
What are PERICARDIAL SINUSES?
These are recesses that develop during embryonic folding of the pericardial sac
What are the layers of penetration in the heart?
1. Pericardium
2. Fibrous pericardium
3. Serous sac
4. Parietal layer
5. Pericardial cavity
6. Visceral layer (epicardium)
7. Heart
8. Epicardium
9. Myocardium
10. Endocardium
11. Chambers of the heart
Innervation of the PARIETAL PERICARDIUM:
Phrenic and Vagus Nerves
Innervation of the VISCERAL PERICARDIUM:
Coronary Plexus
SYMPATHETIC effects on the HEART:
Increases HR and force of contraction, causing dilation of the coronary arteries that supply the heart resulting in more oxygen and nutrients to the myocardium
PARASYMPATHETIC effects on the HEART:
Decreases the heart rate and force of contraction, causing constriction of the coronary arteries.
The coronary plexus is formed by:
The cardiac plexus is formed by branches from both the vagus and the sympathetic trunks
What is the innervation to the heart?
Heart is supplied by the ANS from the vagus (parasympathetic) and the sympathetic trunk (T1-T5)
What is the function of the PAPILLARY MUSCLE?
The cusps in the heart valves are attached to the papillary muscles by the chordae tendinae. When the papillary muscle contracts it facilitates the closure of the valves during ventricular systole
What vessel has the SHORTEST intrathoracic course?
IVC
What vessel has the LONGEST intrathoracic course?
Aorta
If you block the SECONDARY BRONCHI of the right lung, you would obstruct blood flow to:
A lobe of the right lung
The phrenic nerve is in contact with:
Phrenic nerve is located b/w the parietal pleura and the fibrous pericardium
Enlarged intercostal arteries are suggestive of:
Coartaction of the aorta
What is the function of the COSTAL GROOVE?
*Conceals intercostals neurovascular bundle: VAN

On inferior border of rib

In upper aspect of ICS

Between the external intercostals and internal intercostals
Placement of the needle between the ICS for thoracocentesis:
Middle of ICS: to avoid intercostal VAN at upper border of ICS and the collateral branches at the lower border of the ICS
What structures are at the ANGLE OF LOUIS?
Second Costal Cartilage

Aortic Arch

Bifurcation of the trachea

T4/T5

Ligamentum arteriosum

Right recurrent laryngeal nerve hooks under ligamentum arteriosum at angle of Louis
SUPERIOR THORACIC APERTURE
First pair of ribs
Manubrium
T1

Contents: trachea, esophagus, vagus and phrenic nerves, and apex of lungs
INFERIOR THORACIC APERTURE
Costal cartilages 7-10
T12
Rib #12
BLOOD SUPPLY to the Anterior aspect of the thoracic wall:
Supplied by the internal thoracic artery

Anterior Intercostal Arteries to

ICS 1-6: come from internal thoracic artery
ICS 7,8,9: come from musculophrenic artery
ICS 10-11: no anterior intercostals arteries
BLOOD SUPPLY to the Posterior aspect of the thoracic wall:
ICS 1: Posterior Intercostal or Highest Intercostal

ICS 2-11: Posterior Intercostal (thoracic aorta)

ICS 12: Subcostal (thoracic aorta)
Lymphatic drainage of the THORACIC DUCT:
• Drains lymph from the whole body EXCEPT:
o right upper extremity
o right thoracic cavity
o right side of head and neck

---→these areas are drained by the right lymphatic duct, which enters the right internal jugular vein
Where does the thoracic duct begin?
Begins as the cisterna chili at the level of L2
COSTODIAPHRAGMATIC RECESS:
Costodiaphragmatic recesses: Lowest area of the pleural cavity into which the lungs expand during inspiration. Here the diaphragmatic pleura is in contact with the costal pleura. A tap may be performed here at ICS 9
What is the innervation of the PARIETAL PLEURA?
Phrenic nerve
Intercostal nerves 1-11
Subcostal nerves
PARASYMPATHETIC effect on the LUNGS/BRONCHI:
Vagus:
Bronchial Constriction
Vasodilation
Increase in glandular secretion
Sensory
SYMPATHETIC effect on the LUNGS/BRONCHI:
Sympathetic Trunk: Vasomotor innervation from T2-T5

Bronchial Dilation
Vasoconstriction
What are the contents of the ANTERIOR MEDIASTINUM?
1. Fatty Tissue
2. Thymus gland (infants)
3. Lymph nodes
Features of the SYMPATHETIC nervous system
Sympathetics:

Paravertebral (in column)

T1-L2

Starts in lateral horn (posterior horn)

Leaves thru ventral root

Goes to sympathetic chain (synapses at sympathetic chain)
Leaves at 4 different places
1. Greater splanchnic T5-T9: synapses at ciliac ganglion (postsynaptic)

2. Lesser splanchnic T10-T11: synapses at superior mesenteric

3. Lowest splanchnic T12: synapses at aorticorenal ganglion (postsynaptic)

4. Lumbar splanchnic L1-L2: synapses at inferior mesenteric---→ once they leave the ganglia they are postsynaptic
Features of the PARASYMPATHETIC nervous system
Craniosacral:

CN 3 oculomotor
CN 7 facial
CN 9 glossopharyngeal
CN 10 vagus

Sacral: S2-S4
LENGHT OF NEURON
Sympathetic: short presynaptic long postsynaptic (travels with arteries everywhere)

Parasympathetic: long presynaptic (vagus nerve) short postsynaptic (viscera of glands)
EFFECTS OF SYMPATHETICS
sympathetic (fight or flight): 1. Dilates conorary arteries an bronchioles 2. Constricts urinary bladder 3. Dilates pupil
EFFECTS OF PARASYMPATHETICS
parasympathetic: rest, sex and
digest

contricts bronchiles and coronary arteries

dilates urinary bladder sphincter

constriction of pupil
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