CHEST ANATOMY

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Diaphragm
 Left Dome of Diaphragm- reaches as high as the upper border of the 5th rib
 Right Dome of Diaphragm- reaches the lower border of the 5th rib
 Central Tendon- found at level of the xiphisternal joint
 Dome supports the right and left lungs; central tendon supports the heart
 Nerve Supply:
o Motor: Right and Left Phrenic Nerves (C3,4,5)
o Sensory: Periphery of diaphragm- lower 5 intercostal nerves; Parietal
pleura and peritoneum- phrenic nerve
 Functions:
o Muscle of inspiration
o Muscle of abdominal straining
o Weight-lifting muscle
o Thoracoabdominal pump
 Openings
o Fig 2-16
o Aortic opening- T12; transmits the aorta, the thoracic duct, and the
azygos vein
o Esophageal opening- T10; transmits the esophagus, the right and
left vagus nerves, the esophageal branches of the left gastric
vessels, and the lymphatics from the lower third of the
esophagus.
o Caval opening- T8; transmits inferior vena cava and terminal
branches of the right phrenic nerve.

Internal Thoracic Artery

- supplies the anterior wall of the body from the clavicle to the umbilicus
- branch of the first part of the subclavian artery
- ends on 6th ICS
- Branches
o Two anterior intercostal arteries- supply upper six intercostal
spaces
o Perforating arteries
o pericardiacophrenic artery
o Mediastinal arteries
o Superior epigastric artery- supplies the rectus muscle as far as the
umbilicus
o Musculophrenic artery- supplies the lower intercostal spaces and
the diaphragm

Internal Thoracic Vein

- Drains into brachiocephalic vein

Muscles:
Levatores Costarum
- 12 pairs
- Inspiratory muscle
- Raises rib below
- Nerve supply: thoracic spinal nerve
Serratus Posterior Superior Muscle
- Inspiratory muscle
- Elevates ribs
- Nerve supply: intercostal nerve
Serratus Posterior Inferior Muscle
- Expiratory muscle
- Depresses ribs
- Nerve supply: intercostal nerve

Surface Anatomy

Suprasternal notch- opposite to T2 vertebrae

Sternal angle of Louie- between T4 and T5 vertebrae; laterally is 2 nd rib; ribs may
count at this point
Xiphisternal joint- lies on T9 vertebrae
Subcostal angle- inferior end of sternum; 7th costal cartilages
Costal margin= formed by 7th-10th rib cartilage’ ends at 11th and 12th rib
Ribs
1st rib- cannot be palpated; lies deep to clavicle
Diaphragm
- Behind xiphesternal joint
- In midrespiratory position, right dome of diaphragm arches upward as far as
5th rib
Nipple
- Males: 4th ICS; females: not constant position
Apex beat of heart
- Formed by left ventricle
- 5th ICS from the midline
Anterior axillary fold- formed by pectoralis major muscle
Posterior axillary fold- formed by latissimus dorsi muscle
Posterior Chest wall
- First spinous process to be felt- C7 vertebrae (vertebrae prominens)
- Scapula
o Superior angle- T2 vertebrae
o Spine- T3 vertebrae
o Inferior angle- T7 vertebrae
Trachea
- from the lower border of the cricoid cartilage (opposite of the C6 vertebra) to
the level of the sternal angle in the thorax
Lungs
Lower border of lung- 6th-10th rib
Posterior border of lung-from C7 vertebrae to T10 vertebrae
Oblique fissure- from 6th rib to 6th costochondral junction
Horizontal fissure- 4th costal cartilage