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September 16,

ANATOMY: INTRODUCTION TO THE THORACIC REGION DR. LAYGO


2013

Thoracic Region Inferior aperture (thoracic outlet)


Thoracic Cavity Made up of Thoracic Cage
- Sternum
- Costal Cartilage mediates as an indirect
attachment for sternum and anterior ribs
- Ribs
- Thoracic Vertebra Where posterior ribs are
attached
- Diaphragm Lower boundary
- Thoracic Inlet Superior boundary, level of
thoracic notch, at the level between T2 and T3
Thoracic Cage
Shape: truncated cone
Boundaries:
Anterior wall (Sternum, anterior part of 10 ribs)
Lateral wall (ribs) Boundary:
Posterior wall (12 thoracic vertebrae and posterior Diaphragm
part of the ribs) Two major division of the thoracic cavity:
Apertures: Median partition (mediastinum)
Parts of mediastinum:
1) Anterior mediastinum
2) Middle mediastinum
3) Posterior mediastinum
Laterally (pleurae and lungs)
- Visceral and parietal pleura
- Visceral pleura attached to lungs
- Parietal pleura superficial to viscera and close
to thoracic cage
- Pleural cavity space between parietal and
visceral pleura.

Superior aperture (thoracic inlet)


Measurement: 2 x 4 inches
Boundaries:
Body of 1st thoracic vertebrae
1st rib
1st costal cartilage
Upper border of manubrium sterni
Diaphragm of aperture: Sibsons fascia
- Extension of deep cervical fascia.
- Encloses 1st part of subclavian artery, internal Breast (See Miracles In Life Everyday)
thoracic vessels and is also attached to the Base: 2nd 6th ribs
cervical/costal pleura pleural covering of apical Lateral: anterior axillary line
portion of the lungs Medially: lateral border of the sternum
Stages of development
Time changes everything. Thats what people say, its not true. Doing things changes things. Not The Anatomy Committee Batch171
doing things leaves things exactly as they were. Dr. House
September 16, ANATOMY: INTRODUCTION TO THE THORACIC REGION DR. LAYGO
2013

BLOOD SUPPLY
1. Prepubertal 1. Axillary artery
2. Breast budding -Superior thoracic
3. Enlargement -Lateral thoracic: supplies lateral part
4. Secondary mound -Thoracoacromial: supplies superior portion
5. Single contour of breast 2. Internal mammary artery: branch of subclavian artery;
Parts: supplies medial part
1. 15 20 lobes 3. Intercostals artery: perforating branch; supplies
2. Lactiferous ducts posterior portion; branch of aorta
-Ampulla: dilated portion 4. Subscapular artery
3. Areola Venous
4. Tubercles alveolar glands 1. Internal thoracic/ mammary vein eventually drain
Areolar glands of Montgomery: small rounded at subclavian vein brachiocephalic drainage
elevations 2. Lateral thoracic/ mammary vein drainage of lateral
5. Suspensory ligaments side eventually draining to axillary vein
-Separates the fibrous septa brachiocephalic drainage
6. Axillay tail: also called axillary tail of Spence Lymphatic drainage
-small part 2 Major groups of lymphatic drainage:
-Extends upward and laterally Axillary group of lymph node (LN)
Retromammary space - Space between the mammary gland -75% of breast drains on it
and pectoralis fascia Internal mammary group of lymph nodes
-Supernumerary breast- Multiple nipples present, usually -Lateral part of breast
located at along the mammary line/ milk line -25% of breast drains on it
Others:
1. External mammary group of LN
Breast Quadrants: -Average of 1.7 LN
-Lying on lateral side pectoralis major muscle
-Medial side of axilla
2. Scapular LN
-Average of 5.8 LN/ 5-7 LN
-Lying together with scapular vessels
-Thoracodorsal branch of scapular vessel
3. Central axillary LN
-Area where most number of LN are found
-12-15 LN

Time changes everything. Thats what people say, its not true. Doing things changes things. Not The Anatomy Committee Batch172
doing things leaves things exactly as they were. Dr. House
September 16,
ANATOMY: INTRODUCTION TO THE THORACIC REGION DR. LAYGO
2013

-Located within axillary fat pad


-Lymph node that is easily palpable
4. Interpectoral/ rotters LN
-1.4 LN
-Lying between pectoralis major and minor muscles
5. Axillary vein LN
-Lying on ventral and caudal part of the lateral axillary vein
-Average of 10.7 LN
-Second largest group of LN
6. Subclavian LN/ subclavicular group of LN
-3.5 LN/ 3-5 LN
-Underneath the subclavian vein
7. subareolar plexus of Sappey (Thorek)

Abnormal Findings:
1. Pagets Disease
2. Breast dimpling
3. Nipple discharges
4. Peau d Orange skin of the
orange
If you want to change your grade you have to be willing to
be uncomfortable

Notetakers:
ARANCA, Voltaire
BUCCAT, Noel
YAP, Janel

***Average Lymph Node of 35.3 lymph nodes

3 Parts of Axillary Lymph Node:


a. LEVEL 1
- all axillary nodes lateral to pectralis minor
- axillary vein group
- external mammary
- scapular
b. LEVEL 2
- located underneath pectoralis minor
- central group
- some subclavian
c. LEVEL 3
- axillary lymph node located medial to pectoralis
minor
- apical or subclavicular

Time changes everything. Thats what people say, its not true. Doing things changes things. Not The Anatomy Committee Batch173
doing things leaves things exactly as they were. Dr. House