8/5/2012

BONY THORAX
Contains organs of
respiration, circulation &
digestion
Anterior wall (Short):
Sternum
1st 10 pairs of ribs
Costal cartilages

Lateral wall
ribs

Posterior wall
12 thoracic vertebrae and
the ribs

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BONY THORAX
Superior Aperture (inlet):
Boundaries:
Body of 1st thoracic
vertebra
1st ribs
1st cartilages
Upper border of the
manubrium

Sibsons fascia:
Diaphragm of the inlet
From transverse process
of 7th cervical vert. to the
1st rib
Protects cervical dome of
the pleura
Covered by the scalene
muscles

Inferior Aperture
(outlet):
Boundaries:
12th thoracic vert.
Lowest ribs (7th 12th)
Xiphisternal joint

Respiratory diaphragm

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BONY THORAX
Ribs (Costae):
1.

True ribs
(vertebrosternal ribs)
1st 7 pairs of ribs

2.

False ribs
a.

Vertebrochondral
8th 10th ribs

b.

Vertebral ribs
11th 12th ribs

The 7th & 8th ribs are

the longest

BONY THORAX
Ribs (Costae):
1.

Typical ribs:
3rd to 9th ribs
has head, neck, tubercle
and shaft
Head has 2 facets
connects to two adjacent
vert.
Tubercle connects to the
transverse process
Has rounded shaft
superiorly and sharp edge
inferiorly has costal
groove

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BONY THORAX
Ribs (Costae):
2.

Atypical ribs:
1st, 2nd, 10th, 11th & 12th
ribs
a. 1st rib: (superlative)

Highest, broadest,
strongest, flattest,
shortest & most
curved)
angle coincides w/ its
tubercle
articulates w/ one
vertebra
Has LISFRANC
tubercle attachment of
scalenus anterior

BONY THORAX
Ribs (Costae):
2.

Atypical ribs:
b. 2nd rib:
tubercle is lateral
to its angel
Has attachment to
post. scalene

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BONY THORAX
Ribs (Costae):
2.

Atypical ribs:
a. 10th ribs
One facet in its
head
uncertain rib it
may be floating
rib or attached
w/ the 9th rib w/
a cartilage

b. 11th rib:
single facet in its
head
have no neck nor
tubercle
costal groove not
distinct
c. 12th rib:
one facet in its head
has no tubercle, angle
and costal groove

BONY THORAX
Costal Cartilage:
1st 7 cartilages
articulate w/ the
sternum
8th, 9th and 10th
costal cartilages
joins to form:
Subcostal margins:
formed by cartilages of
7th-10th

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BONY THORAX
Sternum (Breast Bone)
Manubrium
broadest
most massive
3 notches
1.

2 clavicular notch

2. Suprasternal (jugular

notch)

Body
Made up of 4 sternebrae

Xiphoid (ensiform)
process
smallest

Sternal Angle (angle of Louis

or Ludwig)
Where the 2nd rib is
attached

Longitudinal Lines
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

Midsternal line
Lateral sternal line
Mammary line
Parasternal line
Anterior axillary line
Posterior axillary line
Midaxillary line
Scapular line
Paravertebral line
Spinal line

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INTERCOSTAL SPACES
Muscles:
1.

External intercostal
Anterior intercostal
membrane

2.

Internal intercostal
Posterior intercostal
membrane

3.

Transverse thoracis
a. Sternocostalis
b. Innermost intercostal
c.

Subcostal

INTERCOSTAL SPACES
Sternocostalis
(transverse thoracis
/ triangularis sterni):
The most constant
Fails to cross the 1st
two intercostal
spaces
The internal thoracic
vessels descend in
front of it
the pleura is
immediately behind it

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INTERCOSTAL SPACES
Innermost Intercostal:
incomplete and variable
passes from ribs to ribs
it is separated from the
internal intercostal muscle by
the intercostal nerve and
vessels

Subcostal muscle:

INTERCOSTAL SPACES
Intercostal Spaces:
11 intercostal spaces
Upper 9 spaces are closed
3rd intercostal space is the
widest
It is wider on inspiration

Subcostal Groove:
Is located deep surface of the
ribs sharp lower border.
VAN (from above downward)

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BLOOD VESSELS
Arteries:
1.

Posterior intercostal
arteries:
a. Upper 2 branches of the

highest intercostal arteries are

branches of the costocervical
trunk of subclavian artery
b. Lower 9 branches of the
thoracic artery
Each has anterior and posterior
branches

BLOOD VESSELS
Arteries:
2.

Anterior Intercostal
Arteries:
Arise from internal
mammary arteries (upper 6)
Arise from musculophrenic
artery (lower 5)

3.

Subcostal artery:
Since there is no 12th
intercostal space.

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BLOOD VESSELS
Arteries:
4.

Internal Mammary Artery:

Branch of subclavian artery
Divides:
a. Superior epigastric
artery
b. Musculophrenic artery

Intercostal Nerves

12 pairs (11intercostal
and 1 subcostal nerves)
Typical ICN supplies
muscular and skin
except:
1. 1st ICN forms the brachial

plexus
2. 2nd ICN crosses the axilla
supplies the posteromedial
aspect of the arm as
intercostobrachial nerve

2nd-6th ICN thoracic

courses, while 7th-11th ICN
travels partly thoracic and
abdominal

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Intercostal Nerves
Intercostal and Subcostal
nerves
Supplies:
1. External, internal & innermost

intercostal muscles
2. Subcostal & Transversus
3.
4.
5.
6.

thoracis
Levator costarum
External, internal &
transverse abdominis
Rectus abdominis
Pyramidalis

BREAST (MAMMARY
GLAND)

ANATOMY:
Boundaries (foramen
of Langer)
Arterial blood supply
Lymphatic drainage

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DIAPHRAGM
Origin:
1. Sternal (xiphoid process)
2. Costal (lower 6 costal

cartilages)
3. Crura (right & left)
4. Ligaments: (lumbocostal
arches)
a. Lateral arcuate

(Quadratus lumborum)
b. Medial arcuate (psoas
muscle)

Insertion:
Central tendon

DIAPHRAGM
Nerve Innervation:
Phrenic nerve
(C3,C4,C5)

Arterial Supply:
1. Pericardiophrenic

artery (Superior
phrenic artery)
2. Inferior phrenic
artery
3. Musculophrenic
artery
4. Intercostal arteries

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DIAPHRAGM
Foramina:
1. Aortic hiatus: (T12)
a.
b.
c.

2.

Aorta
Thoracic duct
Azygos vein

Esophageal hiatus:
(T10)
a.
b.

3.

R & L vagus nerve

Esophageal branches of left
gastric artery

Inferior vena cava

Hiatus: (T8)
a.
b.
c.

IVC
Right phrenic nerve
Lymphatic vessel

THANK YOU

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