THE BODY • Sympathetics

Peripheral Organs

T1

Thoracic visceral plexuses

Preganglionic sympathetic nerves
follow somatic nerves to periphery
(glands, smooth muscle)

Heart

L2
Prevertebral plexus

Abdominal viscera

Sympathetic ganglion

Sympathetic trunk

Preganglionic sympathetic Pelvic viscera

Postganglionic sympathetic
Ganglion impar

All sympathetic visceral efferent (motor) nerves originate from

spinal levels T1–L2 and pass into the associated spinal nerves

14
ERRNVPHGLFRVRUJ
 THORAX • Surface anatomy with bones

Jugular notch
Sternoclavicular joint
Clavicle
Acromioclavicular joint
Coracoid process
I

1 II
Manubrium of sternum
Sternal angle

III

IV
Body of sternum
V

Xiphoid process of sternum

VI

VII
Costal margin
VIII

IX
X

Anterior chest wall in a woman

Jugular notch

2 Sternoclavicular joint
Clavicle
Acromioclavicular joint
Coracoid process
I

Manubrium of sternum
II
Sternal angle
III
Body of sternum
IV
Fourth intercostal space

VI
Xiphoid process of sternum

VII

Costal margin
VIII

IX

Anterior chest wall in a man

62
ERRNVPHGLFRVRUJ
 Bony framework 3

Superior thoracic aperture

Vertebra TI (indicated by red line) Vertebra TI Superior angle of scapula
Clavicle
Clavicle
Rib I
Rib I

Manubrium of
sternum
Scapula
Spine of scapula

4 Inferior angle

3 Xiphoid process
of sternum
of scapula

Inferior thoracic
aperture
(indicated by red line)

Rib XI

Vertebra TXII Rib XII

Rib XII
Spinous process
of TXII
Bony framework of thorax Bony framework of thorax
(anterior view) (posterior view)

Trachea

Clavicle

Rib

Superior vena cava

Aortic arch

5 Pulmonary trunk

Right atrium

Left ventricle
Inferior vena cava

Right dome of diaphragm

Left dome of diaphragm

Costodiaphragmatic recess

Positioning of structures in chest.

Radiograph, AP view

63
ERRNVPHGLFRVRUJ
 THORAX • Bony framework
Superior articular process

Demifacet for articulation

Costovertebral joint Superior articular facet
with head of rib II

TI
6 Facet for articulation
with tubercle of rib II
Body
True ribs
I–VII Transverse process

Demifacet for articulation

Intercostal space with head of rib III
I
Inferior articular facet

II
Spinous process
Inferior articular process

TII vertebra (lateral view)

7
Sternocostal joint
Jugular notch
III

10
Articular site
for clavicle
IV
Attachment
site for rib I Manubrium of sternum
V
Costal cartilage

VI Sternal angle
Articular demifacets (manubriosternal
for rib II joint)
VII TXII
XI

XII
VIII Sternum
False ribs Transverse ridges
VIII–XII IX
Floating ribs
X

Costal margin

Articular facets for

ribs III–VI

Body of
sternum

Superior articular process

Superior articular facet Demifacet for articulation
with head of rib X Articular facets for Xiphisternal joint
rib VII

Facet for articulation Xiphoid process

Superior articular process
with tubercle of rib X of sternum
Body
Transverse process Demifacet for articulation
Superior articular facet with head of rib XII

Inferior articular facet

Transverse process
9
Inferior articular process Body
Spinous process
TX vertebra (lateral view)
Spinous process
Inferior articular facet

9 Inferior articular process

TXII vertebra (lateral view)
64
ERRNVPHGLFRVRUJ
 Ribs 3
Neck Tubercle

Head with articular facet

Neck
Articular facet for transverse
Neck Tubercle process of vertebra Head
Head with
Area for attachment of
articular facet
posterior scalene
Area for attachment of
middle scalene
Groove for subclavian artery
Scalene tubercle (attachment
11 Articular facet for
vertebral body

of anterior scalene)

Groove for subclavian vein

Areas for attachment of
serratus anterior
Inferior surface
12
Rib I (posterior view)
Costal cartilage
Articular facets for
vertebral body
Costal cartilage Angle
Rib I (superior surface)
Crest Internal surface

Tubercle
Costal cartilage
Rib II (superior surface) Crest
Costal groove

External surface
Articular facets for vertebral body

Articular facet for transverse

process of vertebra
Nonarticular surface

13
External surface

Costal cartilage Rib V (anterior view)

Internal surface

Costal groove
14
Rib V posterior view

Costal cartilage

Articular facet for

vertebral body
Rib XII (anterior view)

65
ERRNVPHGLFRVRUJ
 THORAX • Articulations
Superior costal facet
Superior articular process

Costal facet of
15
transverse process
Manubrium of sternum

Sternal angle

Intervertebral disc

Facet on inferior
articular process Body of sternum

Inferior costal demifacet Vertebral body

Superior costotransverse ligament

Radiate ligament
Rib V

Costal cartilage

16
Xiphoid process
of sternum

Costovertebral and sternocostal joints

Accessory
ligament
Costal cartilage Sternum
Intervertebral
disc

intra-articular ligament
Paired synovial joints
Costovertebral joints
(lateral view)

17
Rib

Head of rib
Radiate ligament

18
Transverse process Tubercle of rib Scapula
of thoracic vertebra

Body of thoracic vertebra

Lateral costotransverse ligament Synovial joint cavities
Articulation of rib with thoracic vertebra (TIV). Costotransverse ligament
CT image, with contrast, in axial plane
Costovertebral joints
(superior view)
66
ERRNVPHGLFRVRUJ
 Articulations 3

Fibrocartilaginous joint

Costochondral junctions Synovial joint

(two compartments)
and intra-articular ligament

Sternal angle
Manubriosternal joint
(symphysis)

Radiate sternocostal
ligaments

Synovial joint

Xiphisternal joint
19
(symphysis)

Costoxiphoid ligament

Sternum
Costochondral junction Interchondral joints
Costal cartilage

Rib

Sternocostal and interchondral joints

20
Scapula

Thoracic vertebra

Articulation of costal cartilage with sternum.

CT image, with contrast, in axial plane

67
ERRNVPHGLFRVRUJ
 THORAX • Breast

Pectoralis major

Axillary process

21 22
Areola Nipple

Anterior view

Pectoralis minor

Pectoralis major

Rib II Axillary process

Suspensory ligament
Axilla

24
23
Deep (pectoral) fascia Lateral view
Retromammary
(submammary) space
Nipple

Lactiferous sinuses

Intercostal muscles

Lactiferous ducts

Rib VI

Secretory lobules of mammary gland

Sagittal section

68
ERRNVPHGLFRVRUJ
 Breast 3
Left parasternal lymphatic vessel
Internal thoracic artery Left subclavian (lymphatic) trunk
Pectoral branch of
thoraco-acromial artery Apical axillary nodes
Axillary artery

Lateral thoracic artery Central axillary nodes

Pectoralis major Lateral axillary

nodes

25

Axillary process Subscapular axillary

Second thoracic nodes
intercostal nerve
Pectoral axillary nodes
Fourth thoracic
intercostal nerve Drains to opposite side

Drains into abdominal

Areola lymphatics
Parasternal nodes
Sixth thoracic intercostal nerve

Mammary branches of
Arteries and innervation of breast internal thoracic artery Lymphatic drainage of breast

Lateral (axilla) Head (superior)

Pectoralis
major

Nipple Retromammary

26 (submammary)
space

27
Nipple profile

Medial (sternum) Feet (inferior)

Mammography. Craniocaudal (CC) view of a normal right Mammography. Mediolateral oblique (MLO) view of a normal
breast showing a heterogeneously dense appearance right breast showing a heterogeneously dense appearance

69
ERRNVPHGLFRVRUJ
 THORAX • Pectoral region

Subclavian artery
Clavicle
Subclavius
Thoraco-acromial artery
Acromion
Coracoid process

Lateral pectoral
nerve

Pectoralis major Medial pectoral

nerve
Clavipectoral fascia

Pectoralis minor
Right humerus
Left humerus

Lateral thoracic artery

Serratus anterior
Sternum
Cut edge of pectoralis major
External intercostal

External intercostal membrane

28

Pectoralis major muscle and related deep structures

Sternum

Pectoralis major

Internal thoracic artery

Pectoralis minor

Serratus anterior
Scapula

29
Pectoralis major and minor muscles on anterior thoracic wall.
CT image, with contrast, in axial plane

70
ERRNVPHGLFRVRUJ
 Pectoral region 3
Clavicle

Coracoid process

Subclavius

Pectoralis minor
Pectoralis minor

Serratus anterior

30
External intercostal
Serratus anterior

Internal intercostal muscle covered

by external intercostal membrane

Pectoralis minor and the anterior thoracic wall

(pectoralis major removed) External intercostal 31
Splenius capitis Muscles of the lateral thoracic wall
(pectoralis major removed)
Splenius cervicis Vertebra prominens
(spinous process of CVII)
Iliocostalis cervicis

Serratus posterior superior

Splenius cervicis

Longissimus
Posterior layer of
thoracolumbar fascia
covering Iliocostalis

External intercostal

Serratus posterior inferior

32
External oblique

Muscles of the posterior thoracic wall

71
ERRNVPHGLFRVRUJ
 THORAX • Thoracic wall muscles

Internal intercostal
Rib I

Intercostal vein
Intercostal artery

33 Intercostal nerve Manubrium of sternum

External intercostal

34
Body of sternum

Internal intercostal
Innermost intercostal Xiphoid process
Costal groove of sternum
Endothoracic fascia
Parietal pleura
Collateral branches Costal cartilage

External intercostals

External intercostal membrane Intercostal muscles

35
Innermost intercostal Innermost intercostal

External intercostal Transversus thoracis

Subcostals

36
Subcostal muscles of the Transversus thoracis muscles of the
posterior thoracic wall anterior thoracic wall

72
ERRNVPHGLFRVRUJ
 Diaphragm 3
Central tendon of diaphragm
Sternum

37
Caval opening
Central tendon of diaphragm Caval opening

Costal part of
diaphragm 40

Lumbar part of diaphragm Esophageal hiatus

Aortic hiatus

Diaphragm (superior view)

Esophageal hiatus

Rib XII
Rib XI
Lateral arcuate ligament
Left crus Diaphragm within the rib cage
LIII
Median arcuate ligament
Medial arcuate
ligament Aortic hiatus

Right crus

Inferior vena cava

38
39
Right dome
TVIII
Rib V
Left dome

TX Esophageal
hiatus

Aortic hiatus
TXII
Esophagus

Right crus
Aorta Left crus

Major structures that pass through the diaphragm Features of diaphragm

73
ERRNVPHGLFRVRUJ