I

NTRODUCTI
ON

Grosshumananat omyhaspr ovent obet hebr oadest

andmostdi ff
icul
tcour seforUniv ersi
tyorcol l
ege
students.Especiall
yforthef acultiesofMedi cine,
Pharmacy ,Nur si
ngsciences, BasicMedi calSci ences,
HealthSciencesandsoon.Thi sbook.SMART
ANATOMYPREVI EW -THORAXi sasummar ybook
thathasdet ai
ledkeyf actsinthor acicpar tofhuman
grossanat omy .I
tisespeciallycrucial i
ngui ding
studentthroughMCQexami nations.I tcanal sobe
usedf ortheoryexams.I tisadvisedt hatst udent s
shoulduset hisbookwi t
hanybookofat l
asof
humananat omyf ormor ecompr ehension.THANKS
forchoosingSMARTANATOMYPREVI EW.

Or
okeJohnE.

1
TABLEOFCONTENTS
1.Bodywal
l
2.Thor
aci
cwal
landdi
aphr
agm
3.Joi
nts
4.Muscl
es
5.Membr
anesandspaces
6.Di
aphr
agm
7.Openi
ngsi
ndi
aphr
agm
8.Thor
aci
ccav
ity
9.Medi
ast
inum
10. Gr
eatv
essel
s
11. Car
diacPl
exus
12. Tr
achea
13. Phr
eni
cner
ve
14. Vagusner
ve
15. Thy
mus
16. Hear
t
17. Thor
aci
cduct
18. Az
ygossy
stem ofv
eins
19. Lungs
20. St
ernum
21. Ri
bs

2
BODYWALL
 Wal
loft
hor
ax&abdomenar
eone
t
opogr
aphi
cal
l
yanddev
elopment
all
y.
 TheSki
nisThi
ninf
ront
,andThi
ckbehi
nd.
 Tensi
onl
i
near
eAl
mosthor
izont
alar
oundbody
wal
l
.
 Scar
paf
aci
aissameassuper
fi
cial
per
ineal
f
asci
aov
erpeni
sandscr
otum.
Bl
oodsuppl
y
I
nter
coast
al,subcoat
alandl
umbarAr
ter
ies
suppl
yFl
ankt
issues.
I
nter
nal
thor
aci
c,super
iorandi
nfer
iorepi
gast
ri
c
ar
ter
iessuppl
yVent
ralmi
dli
net
issues
 Thor
acoepi
gast
ri
cvei
nuni
tel
ater
alt
hor
aci
c
andsuper
iorepi
gast
ri
cvei
nabov
eingui
nal
canal
.
Lymphdr
ainage
 Fr
ontofbodyabov
eumbi
l
icusi
sdr
ainedby
Ant
eri
or(
pect
oral
)gr
oup.
 Backoft
hebodyabov
eumbi
l
icusi
sdr
ainedby
Post
eri
orgr
oup
 Fr
ontbel
owumbi
l
icusi
sdr
ainedbyMedi
al
gr
oup
 Lat
eral
andpost
eri
orabdomi
nal
wal
land
per
ineum i
sdr
ainedbyLat
eralgr
oupof
super
iori
ngui
nal
.
Ner
vesuppl
y
 Abov
e2ndr
ibandManubr
ost
ernal
Joi
nt-
supr
acl
avi
cul
arbr
anchofCer
vical
Plex
us(
C4)

3
  Ski
ninupperepi
gast
ri
c-T7
 Umbi
l
ical
-T10
 Supr
apubi
cski
n-L1
I
li
ohy
pogast
ri
candl
ater
alcut
aneousbr
anchof
T12-But
tocks
 Post
eri
orst
ri
pofski
n-post
eri
orr
ami
ofspi
nal
ner
ves
THORACI
CWALLANDDI
APHRAGM
 Roof
edabov
elungbySupr
apl
eur
almembr
ane
 Fl
oor
edbyDi
aphr
agm
 Fl
oori
shi
ghl
yconv
ex
 Upper7r
ibsar
ti
cul
atewi
thst
ernum at
st
ernocoast
alJoi
nt.
 Nex
t3r
ibsar
ti
cul
atewi
theachot
her
.
 8t
hri
bwi
th7t
hcoast
alcar
ti
lagecompl
ete
coast
almar
gin
 Last2car
ti
lagesar
efr
ee.
JOI
NTSOFCOASTALHEADS
 Upperbandofr
adi
antl
i
gamentpasst
obodyof
v
ert
ebr
aabov
e.
 Lowerbandt
over
tebr
abel
ow.
 1str
ibar
ti
cul
ateswi
thT1onl
y.Noti
ncont
act
wi
thC7.
 Last2r
ibsar
ti
cul
atewi
tht
hei
rownv
ert
ebr
ae
onl
y.
COSTOTRANSVERSEJOI
NT
 Tuber
cleofat
ypi
calr
ibhas2f
acet
s.
 Lat
eral
faceti
snonar
ti
cul
ar,
giv
esat
tachment
t
olat
eral
cost
otr
ansv
ersel
i
gament
.

4
  Lowert
wor
ibsdonotpossesst
uber
cle.Makes
nosy
nov
ial
joi
ntwi
thTr
ansv
ersePr
ocess.

COSTOCHONDRALJOI
NTS
 Ev
eryr
ibmakespr
imar
ycar
ti
lagi
nousj
ointwi
th
i
tscoast
alcar
ti
lage.
 Coast
alcar
ti
lagei
sunossi
fi
edant
eri
orpar
tofa
r
ib.
I
NTERCHONDRALJOI
NT
 Adj
acentsur
facesofCost
ochondr
al6&7,
7&8,
8&9ar
euni
tedbysynovi
alj
oint
s.
 9&10ar
euni
tedbyl
igament
ousf
ibr
es.
STERNOCOSTALJOI
NT
 1stcar
ti
lagewi
thmanubr
ium i
spr
imar
ycar
t
j
oint
.
 Manubr
ium &1str
ibar
efi
xedandmov
e
t
oget
her
.
 Nex
t6car
twi
thst
ernum i
ssynovi
alj
oint
.
 2ndr
ibar
ti
cul
atessepar
atel
ywi
thmanubr
ium
andbody
.
MANUBRI
OSTERNALJOI
NT
 Sur
facesar
ecov
eredbyhy
ali
necar
ti
lagewi
th
i
nter
veni
ngf
ibr
ocar
ti
lagi
nousdi
sc.
I
t'
sasy
mphy
sis.
XI
PHI
STERNALJOI
NT
I
sasy
mphy
sis.
 Ossi
fi
cat
ioni
satmi
ddl
eageonwar
ds.
THORACI
CMUSCLES
 Ex
ter
iorEx
ter
nal
int
ercost
alcor
respondst
o

5
 ex
ter
nal
obl
i
gue.
 Mi
ddl
eInt
ernal
int
ercost
alcor
respondst
o
i
nter
nal
obl
i
gue.
I
nnerl
ayercor
respondst
ransv
ersusabdomi
nis.
 Bet
weenMi
ddl
eandI
nter
nal
lay
ersi
s
neur
ovascul
arpl
ane.
Out
erl
ayer
 Ser
rat
usant
eri
orf
rom spi
nouspr
ocessofC
6&7andT1&2v
ert
ebr
ae
 Dor
salscapul
arner
ver
unsdownonpost
sur
faceofSA
 Ser
rat
uspostf
rom spi
nouspr
ocessesof
T11&12andL1&2v
ert
ebr
ae
 Ser
rat
usant
eri
orel
evat
esupperr
ibsdur
ing
r
espi
rat
ion.
 Ser
rat
uspost
eri
ordepr
essl
owerr
ibs
 Levat
orcost
aef
rom t
ipoft
ransv
ersepr
ocess
ofC7t
oT11.Suppl
i
edbyPost
eri
orr
ami
ofC8-
T11.
 Ext
ernali
nter
cost
alf
rom shar
plowerbor
derof
r
ibabov
etosmoot
hbor
derofr
ibbel
ow.
 Bet
weenbonyr
ibsi
smuscl
e;bet
weencoast
al
Car
ti
lagesi
smembr
ane.
Mi
ddl
elayer
I
nter
nal
int
ercost
almuscl
e-f
rom cost
algr
oov
e
t
oupperbor
derofr
ibbel
ow.
 Repl
acedpost
eri
orl
ybypost
eri
ori
nter
cost
al
membr
ane

6
I
nnerl
ayer
 The3muscl
egr
oupscr
ossmor
ethanone
i
nter
cost
alspace
I
npar
aver
tebr
algut
teri
ssubcost
almuscl
es
I
nner
mosti
nter
coast
almuscl
e-f
rom i
nner
sur
faceofr
ibsandl
ater
alpar
toft
hor
aci
cwal
l
.
 Tr
ansv
ersust
hor
aci
s-f
rom postsur
faceof
l
owerst
ernum t
o2nd-6t
hcost
alcar
ti
lages.
I
NTERCOSTALSPACES
 Fr
om abov
edownwar
ds-Vei
n-Ar
ter
y-Ner
ve
 Col
l
ater
alner
veandv
essel
srunal
ongupper
bor
derofr
ibs;
theycanbei
gnor
ed(
because
t
heyar
esmal
l
).
I
NTERCOSTALNERVES
 Col
l
ater
albr
anchr
unsal
ongi
nfer
iorbor
derof
i
tsspace.
 Lat
eral
cut
aneousbr
anchpi
ercei
nter
cost
al
muscl
esandmuscl
esofbodywal
lal
ongmi
d
ax
il
lar
yli
ne.Di
vi
dei
ntoant
eri
orandpost
eri
or
br
anches.
I
nter
cost
alner
veendsasant
eri
orcutner
ve
 Atbackofi
nter
cost
alspace,ner
vecr
osses
i
nter
cost
alar
ter
y.Ner
vel
i
esbehi
ndar
ter
y.
I
nfr
ontofi
nter
coast
alspace,ner
vecr
ossesi
n
f
rontofi
nter
nal
thor
aci
car
ter
y.
 Ant
eri
orr
amusofT1gi
ves1sti
nter
cost
alner
ve
bef
orej
oini
ngbr
achi
alpl
exusT11.
 Lat
eral
cut
aneousbr
anchof2ndi
nter
cost
al
ner
vecr
ossesax
il
lat
oar
m as

7
 i
nter
cost
obr
achi
alner
ve.
 Subcost
alner
vepassbehi
ndl
atar
cuat
eli
g
bel
owar
ter
yandv
ein.
I
NTERCOSTALARTERI
ES
 Atback,
upper2i
nter
coast
alspacesar
e
suppl
i
edbysuper
iori
nter
cost
alar
ter
y.
 Super
iori
nter
coast
alar
ter
yisf
rom 2ndpar
tof
subcl
avi
anar
ter
ybehi
ndscal
eni
usant
eri
or.
 Eachpost
eri
ori
nter
cost
alar
ter
ygi
vesasmal
l
col
l
ater
albr
anch.
 Noant
eri
ori
nter
cost
alar
ter
yint
hel
ast2
i
nter
coast
alspaces.
I
NTERCOSTALVEI
NS
 Ant
eri
orv
ein-muscul
ophr
eni
candI
nter
nal
t
hor
aci
cvei
ns.
I
nlower8spacesf
orm az
ygossy
stem.
 2ndand3r
d,somet
imes4t
hpost
eri
or
i
nter
coast
alv
einsf
orm super
iori
nter
cost
al
vei
ns.
LYMPHDRAI
NAGE
 Ly
mphv
essel
sfol
l
owar
ter
ies.
 Fr
om f
rontofi
nter
coast
alspacespasst
o
ant
eri
ori
nter
cost
alnode(
par
ast
ernal
).
 Fr
om backofi
nter
coast
alspacespasst
o
post
eri
ori
nter
cost
alnode.
I
NTERNALTHORACI
CARTERY
I
sfr
om 1stpar
tofsubcl
avi
anar
ter
y.
 Di
vi
desi
ntosuper
iorepi
gast
ri
cand
muscul
ophr
eni
car
ter
iesatcost
almar
gin.

8
  Accompani
edby2v
enaecomi
tant
est
hat
empt
yint
obr
achi
ocephal
i
cvei
n.
 Per
for
ati
ngbr
anchusual
l
ylar
gei
n2nd,
3rdand
4t
hspacesoff
emal
e(suppl
ybr
east
)
 Suppl
i
esant
eri
orbodywal
lfr
om cl
avi
clet
o
umbi
l
icus.
SUPRAPLEURALMEMBRANE
 At
tachedt
oinnerbor
derof1str
ib,cost
al
car
ti
lageandt
ransv
ersepr
ocessofC7v
ert
ebr
a.
 Notat
tachedt
oneckof1str
ib.
 Li
esi
nobl
i
guepl
aneoft
hor
aci
cinl
et.
subcl
avi
anv
essel
sar
chl
ater
all
yov
eri
t.

DI
APHRAGM
 Fi
brear
isei
ncont
inui
tyoft
ransv
ersus
abdomi
nis
 Ri
ghtdomei
shi
ghert
hanl
eftdome(
nippl
e
l
evel-4t
hspace)
 Lef
tdomer
each5t
hri
b.
 Ri
ghtcr
usf
ixedt
oupper3l
umbarv
ert
ebr
a.
 Lef
tcr
usf
ixedt
oupper2l
umbarVer
tebr
a
 Tendi
nit
isf
ibr
esuni
tatl
evel
ofT12t
ofor
m
medi
anar
cuat
eli
gament
.
 Di
aphr
agm ar
isef
rom backofx
iphi
ster
num i
n
f
ront
.
 Cent
ral
tendoni
nsepar
abl
efr
om f
ibr
ous
per
icar
dium.
OPENI
NGSI
NDI
APHRAGM
 Aor
ti
copeni
ng-i
sopposi
teT12Ver
tebr
a,

9
 behi
ndmedi
anar
cuat
eli
gament
.Itt
ransmi
ts
aor
ta&azygosvei
ntor
ight
,thor
aci
cduct
bet
weent
hem.
 Esophageal
openi
ng-i
sopposi
teT10v
ert
ebr
a,
2.
5cm l
eftofmi
dli
ne,
li
esi
nfi
breofl
eftcr
us.I
t
t
ransmi
tsesophagus,vagalt
runk,
esophageal
br
anchofl
eftgast
ri
cAr
ter
yVei
n&l
ymphat
ics.
 Venacav
alf
oramen-i
sopposi
teT8v
ert
ebr
a,
behi
nd6t
hri
ghtcost
alcar
ti
lage,
bet
weenr
ight
andl
eftl
eav
esofcent
ral
tendon.I
ttr
asmi
tsI
nf
Venacava,
RtPhr
eni
cN.
 Hemi
azy
gospasst
hroughl
eftcr
us.
 Sy
mpat
het
ict
runkpassesbehi
ndmedi
an
ar
cuat
eli
gament
.
 Subcost
alner
veandv
essel
spassbehi
ndl
eft
ar
cuat
eli
gament
.
 Neur
ovascul
arbundl
esof7t
hto11t
h
i
nter
coast
alspacespassbet
weendi
aphr
agm
andTr
ansv
ersusAbdomi
nis.
 Super
iorepi
gast
ti
cvessel
spassbet
ween
x
iphi
ster
nal
and7t
hcost
alf
ibr
esofdi
aphr
agm.
Bl
oodsuppl
yofdi
aphr
agm
 Cost
almar
ginofdi
aphr
agm i
ssuppl
i
edby
l
ower5i
nter
cost
alandsubcost
alar
ter
ies.
 Mai
nfi
bresf
rom cr
uraar
esuppl
i
edbyl
eftand
r
ighti
nfer
iorPhr
eni
car
ter
ies.
Ner
vesuppl
yandact
ion
 Mot
orsuppl
y-Phr
eni
c(C3,
4,5pr
edomi
nant
ly
C4)
.

10
  Pr
ori
ocept
ivet
oper
ipher
y-l
oweri
nter
cost
alN
 Pr
ori
ocept
ivet
ocent
ral
par
t-Phr
eni
cs.
 Maj
oract
ioni
sinspi
rat
ion.
THORACI
CMOVEMENTANDRESPI
RATI
ONOF
DI
APHRAGM
 Di
aphr
agm i
sthemai
ninspi
rat
ional
muscl
e.
 Ex
ter
nal
int
ercost
al-mostact
ivei
ninspi
rat
ion.
I
nter
nal
int
ercost
al-mostact
ivei
nex
pir
ati
on.
 Scal
eneandSt
ernocl
eidomast
oidel
evat
e1st
r
ibandmanubr
ium.
 12t
hri
bisf
ixedt
oquadr
atusl
umbor
um.
 Er
ect
orspi
naeex
tendsspi
ne.
I
nfor
cedex
pir
ati
onl
ati
ssi
musdor
si
compr
essesr
ibs.
I
nspi
rat
ioni
sact
ivecont
ract
ionofabdomi
nal
wal
l
.
 Mov
ementofabdomi
nal
wal
li
spassi
vei
n
t
hor
aci
crespi
rat
ion.
THORACI
CCAVI
TY
 Cont
ainshear
t,gr
eatbl
oodv
essel
s,esophagus,
t
racheaandbi
fur
cat
ion,
thor
aci
cduct
,ly
mph
nodes,
Phr
eni
candv
agusner
ves.
DI
VISI
ONSOFMEDI
ASTI
NUM
I
tsPl
anepassest
hroughbi
fur
cat
ionoft
rachea.
 Az
ygosv
einent
ersSuper
iorv
enacav
aont
he
pl
ane.
 Li
gament
um ar
ter
iosum l
i
esi
nthepl
ane.
SUPERI
ORMEDI
ASTI
NUM
 Esophagusl
i
esagai
nstbodyofT11v
ert
ebr
a.

11
  Tr
acheal
i
esonesophagus.Mayt
ouchj
ugul
ar
not
chofmanubr
ium.
 Tr
acheasl
opesback,
manubr
ium sl
opes
f
orwar
dbel
owt
hor
aci
cinl
et.
 Ar
chofaor
tal
i
eswhol
l
yinSuper
ior
medi
ast
inum.
 Aor
taar
chesov
erbegi
nni
ngofl
eftmai
n
br
onchusandbi
fur
cat
ionofpul
monar
ytr
unk.
 Gr
eatv
essel
skeepl
eftv
agusandapexofl
eft
l
ungawayf
rom cont
actwi
tht
rachea.
 Nost
ruct
uresepar
atet
racheaf
rom r
ightv
agus
ont
her
ightsi
de.
 Vei
nsl
i
einf
rontofar
ter
iesi
nSuper
ior
medi
ast
inum.
 Ri
ghtPhr
eni
cner
vei
sincont
actwi
thr
ight
br
achi
ocephal
i
cvei
nandsuper
iorVenacav
a.
ARCHOFAORTA
 Passesbackov
erl
eftbr
onchust
oreachbody
ofT4v
ert
ebr
a.
 Cr
ossedont
heLef
tbyPhr
eni
candv
agus
ner
ves.Phr
eni
cner
vei
nfr
ontofl
ungs,
vagus
behi
ndl
ungs.
 Bet
weent
henl
i
esy
mpat
het
icandv
agal
br
anchest
osuper
fi
cial
car
diacpl
exus.
 Lef
tsuper
iori
nter
cost
alv
einpassesdeept
o
Phr
eni
candsuper
fi
cial
tov
agusner
vesacr
oss
ar
ch.
 Lef
trecur
rentl
ary
ngeal
ner
vehooksar
ound
l
i
gament
um ar
ter
iosum ofr
ightsi
de.

12
  Tr
acheaandesophagusl
i
eonr
ightsi
deoft
he
ar
ch.
 Adv
ent
it
ial
lay
eroft
hear
chcont
ains
bar
orecept
orsf
orr
efl
excont
rol
ofhear
trat
e.
Br
achi
ocephal
ict
runk
 Br
achi
ocephal
ict
runkar
isesal
i
ttl
etol
eftof
body
'smi
dli
ne.
 Di
vi
desi
ntor
ightcommoncar
oti
dandr
ight
subcl
avi
anar
ter
iesbehi
ndRtst
ernocl
avi
cul
ar
j
oint
.
 Hasnobr
anchex
ceptf
orr
aret
hyr
oideai
ma
ar
ter
y.
 Ter
minat
ionofl
eftbr
achi
ocephal
i
cvei
nli
esi
n
f
rontoft
hear
ter
y.
Lef
tcommoncar
oti
dar
ter
y
 Ar
isesbehi
ndbr
achi
ocephal
i
ctr
unkon
conv
exi
tyoft
hear
ch.
 Passesal
ongsi
det
racheai
ntoneck.
 Hasnobr
anchesi
nmedi
ast
inum.
Lef
tsubcl
avi
anar
ter
y
 Ar
isesbehi
ndl
eftcommoncar
oti
d.Bot
hruns
upwar
dst
oget
her
.
 Mov
esawayf
rom l
eftcommoncar
oti
ddi
rect
ly
behi
ndl
eftst
ernocl
avi
cul
arj
oint
.
LI
GAMENTUM ARTERI
OSUM
I
sthef
ibr
ousr
emnantofduct
usar
ter
iosus.
 Passesf
rom commencementofl
eftpul
monar
y
ar
ter
ytoconcav
ityofaor
ti
car
ch.
 Li
esal
mosthor
izont
al.

13
  Lef
trecur
rentl
ary
ngeal
ner
vehooksar
oundi
t.
 Super
fi
alpar
tofcar
diacpl
exusl
i
esant
eri
ort
oit
.
 Deeppar
tofcar
diacpl
exusi
soni
tsr
ight
bet
weenaor
ti
car
chandTr
acheal
bif
urcat
ion.
BRACHI
OCEPHALI
CVEI
NS
 For
medbehi
ndst
ernocl
avi
cul
arj
ointbyi
nter
nal
j
ugul
arandsubcl
avi
anv
eins.
I
tisf
ormedmedi
alt
oscal
enusant
eri
or.
I
nter
nal
jugul
arv
einl
i
esl
ater
alt
ocommon
car
oti
dar
ter
yint
henecki
nfr
ontofupperpar
t
ofscal
enusant
eri
or.
 Subcl
avi
anv
einl
i
esl
ater
alt
oandt
heni
nfr
ont
oft
hel
owerpar
tofscal
enusAnt
eri
or.
Ri
ghtbr
achi
ocephal
icvei
n
 Commencesbehi
ndr
ightst
ernocl
avi
cul
arj
oint
.
 Recei
vesr
ightj
ugul
ar,
subcl
avi
anand
br
onchomedi
ast
inal
lympht
runkati
ts
commencement
.
Lef
tbr
achi
ocephal
icvei
n
I
tscommencementr
ecei
vest
hor
aci
cduct
.
 Recei
vesv
ert
ebr
alandi
nter
nal
thor
aci
cvei
ns.
 Pr
etr
acheal
fasci
apassesbehi
ndt
hev
ein.
SUPERI
ORVENACAVA
 Commencesatl
owerbor
derof1str
ightcost
al
car
ti
lagebyconf
luenceof2br
achi
ocephal
i
c
v
eins.
 Passesbehi
ndr
ightbor
derofst
ernum.
 Pi
ercesper
icar
dium atl
evel
of2ndcost
al
car
ti
lage.

14
  Ent
ersupperbor
derofr
ightat
ri
um atl
ower
bor
derof3r
dcost
alcar
t.
 Recei
vesaz
ygosv
einbehi
ndst
ernal
angl
e.
 Nov
alv
esi
nSVC,
brachi
ocephal
i
candaz
ygos
v
enoussy
stem.

CARDI
ACPLEXUS
 Br
anchesent
erper
icar
dium t
oaccompany
cor
onar
yar
ter
ies
 Super
fi
cial
par
tli
esi
nfr
ontofl
i
gament
um
ar
ter
iosum.
 Deeppar
tisl
arger
,li
est
ori
ghtofl
i
gament
um
ar
ter
iosum,
inf
rontofTr
acheal
bif
urcat
ionand
behi
ndaor
ti
car
ch.
 Recei
vessy
mpat
het
icf
ibr
esf
rom C6-
T5
sy
mpat
het
icgangl
i
aofbot
hsi
des.
 Recei
vespar
asy
mpat
het
icf
ibr
esf
rom v
agi
in
cer
vical
cour
seandbot
hrecur
rentl
ary
ngeal
ner
ves.
 Pai
nfi
bresr
unwi
thsy
mpat
het
icner
ves.

TRACHEA
I
stheCont
inuat
ionofl
ary
nx
 Thet
racheat
ouchest
hej
ugul
arnot
choft
he
manubr
ium.
 Commencesbel
owcr
icoi
dcar
ti
lageatC6l
evel
,
5cm abov
ejugul
arnot
ch.
I
tis10cm l
ong,and2cm i
ndi
amet
er.
 3mm i
nfi
rsty
earofl
i
fe.

15
  Mayr
each15cm i
nful
li
nspi
rat
ion,
bif
urcat
ion
descendi
ngt
oT6l
evel
.
Thor
aci
cpar
toft
rachea
I
nfr
ontofi
tismanubr
ium,
ster
nohy
oid&
st
ernot
hyr
oid.
 Ri
ghtv
agusi
sincont
actwi
thr
ightsi
deof
t
rachea.
 Ri
ghtbr
achi
ocephal
i
cvei
n&SVCar
e
ant
erol
ater
alt
otr
achea.
 Lef
tcommoncar
oti
dandsubcl
avi
anar
ter
ies
ar
eont
hel
eft
.
 Aor
tacur
vesbackwar
dsov
erl
eftbr
onchus.
 Lef
trecur
rentl
ary
ngeal
ner
vepassi
ngr
oov
e
bet
weent
racheaandesophagus.
Bl
oodsuppl
y
I
nfer
iort
hyr
oidandbr
onchi
alar
ter
ies.
 Vei
nsdr
aint
oinf
eri
ort
hyr
oidv
ein.
Lymphdr
ainage
 Pr
etr
acheal
andpar
atr
acheal
Ner
vesuppl
y
 Mucousmembr
anei
ncl
udi
ngpai
n-v
agi
and
Recur
rentl
ary
ngeal
ner
ve
 Smoot
hmuscl
eandbl
oodv
essel
s-
sy
mpat
het
icf
ibr
esf
rom uppergangl
i
a.
PHRENI
CNERVE(
C3,
4,5)
 Ar
isepr
inci
pal
l
yfr
om C4.
 Behi
ndsubcl
avi
anv
ein.
 Cr
ossesant
eri
ort
ovagus.
 Runst
hroughmedi
ast
inum i
nfr
ontofl
ungs.

16
  Eachi
sincont
actwi
thmedi
ast
inal
pleur
a
l
ater
all
ythr
oughouti
tsl
engt
h.
Ri
ghtPhr
eni
cner
ve
 Rel
atedmedi
all
ywi
thv
enousst
ruct
ure
t
hroughoutt
hor
aci
ccour
se.
 Passest
hroughcent
ral
tendonofdi
aphr
agm
al
ongsi
deI
nfer
iorVenaCav
a.
Lef
tPhr
eni
cner
ve
 Rel
atedmedi
all
ytoar
ter
ial
str
uct
ures
t
hroughoutt
hor
aci
ccour
se.
 Cr
ossesaor
ti
car
chl
ater
alt
osuper
ior
i
nter
cost
alv
ein.
I
nfr
ontofv
agusner
ve.
 Runsdownper
icar
dium ov
erl
eftv
ent
ri
cle
t
owar
dsapexofhear
t.
 About2/
3ofPhr
eni
cner
vef
ibr
esar
emot
ort
o
di
aphr
agm.
 Ther
estar
esensor
ytodi
aphr
agm,
per
icar
dium,
pl
eur
a,et
c.
 Pai
nfr
om di
aphr
agmat
icper
it
oneum i
sfel
tat
shoul
dert
ip(
C4)
.
VAGUSNERVE
 Ri
ghtv
agusi
ncont
actwi
tht
rachea.
 Lef
ttv
agushel
dawayf
rom t
racheabygr
eat
ar
ter
ies.
 Lef
tvaguscr
ossesar
chmedi
alt
olef
tsuper
ior
i
nter
cost
alv
ein.
 Ri
ghtv
agusl
i
esont
racheamedi
alt
oar
chof
az
ygosv
ein.

17
  Eachv
aguspassesbehi
ndl
ungr
oot
s.
 Lef
tvagusgi
vesof
frecur
rentl
ary
ngeal
branch
onar
chofaor
ta.
 Lef
trecur
rentl
ary
ngeal
ner
vehooksar
ound
l
i
gament
um ar
ter
iosum.
 Lef
trecur
rentl
ary
ngeal
ner
veascendsi
ngr
oov
e
bet
weent
racheaandesophagus.
 Ri
ghtr
ecur
rentl
ary
ngeal
ner
vei
sgi
venof
fat
r
ootofneck.
 Ri
ghtr
ecur
rentl
ary
ngeal
ner
vehooksar
ound
r
ightsubcl
avi
anar
ter
y.
 Bot
hlar
yngeal
ner
vesgi
vebeachest
odeep
car
diacpl
exus.
 Bot
hLar
yngeal
ner
vessuppl
ytr
acheaand
adj
acentesophagusandl
ary
nx.
 Esophagusl
i
esagai
nstv
ert
ebr
aeatbackof
super
iormedi
ast
inum.
 Thor
aci
cductl
i
esl
eftt
oesophagus.

ANTERI
ORMEDI
ASTI
NUM
 Cont
ainst
hymus,
per
icar
dial
li
gament
s,f
ew
l
ymphnodesandbr
anchesofI
nter
nal
thor
aci
c
ar
ter
y.
THYMUS
 Usual
l
ymostpr
omi
nenti
nchi
l
dren,
ext
endf
rom
4t
hcost
alcar
ti
laget
olowerpol
eoft
hyr
oid
gl
and.
 Li
esbehi
ndst
ernohy
oid,
ster
not
hyr
oid,
manubr
ium,
upperpar
tofbodyofst
ernum and

18
 adj
acentcost
alcar
ti
lages.
 Li
esi
nfr
ontofper
icar
dium,
aor
ti
car
ch,
br
achi
ocephal
i
cvei
nandt
rachea.
Bl
oodsuppl
y
I
nfer
iort
hyr
oidandi
nter
nal
thor
aci
car
ter
ies.
Lymphdr
ainage
 Noaf
fer
entl
ymphdr
ainage.
 Ef
fer
entdr
ainst
opar
ast
ernal
,tr
acheobr
onchi
al,
br
achi
ocephal
i
cnodes.
MI
DDLEMEDI
ASTI
NUM
 Cont
ainsper
icar
dium,
hear
t,par
tsofgr
eat
v
essel
s,l
ungr
oot
s,phr
eni
cner
ve,
deeppar
tof
car
diacpl
exus.
PERI
CARDI
UM
Fi
brousper
icar
dium
 Out
ersi
ngl
elay
eredf
ibr
oussac.
 Br
oadbaseov
erl
i
escent
ral
tendonof
di
aphr
agm.
 Medi
ast
inal
pleur
aisadher
entt
oit
.
 Connect
edt
obackofst
ernum by
st
ernoper
icar
dial
li
gament
s.
 Suppl
i
edbyi
nter
nal
thor
aci
car
ter
y.
Ser
ousper
icar
dium
I
sRef
lect
edar
oundr
ootofgr
eatv
essel
s.
 Tr
ansv
ersesi
nusi
sthepassagebet
ween
ascendi
ngaor
taandpul
monar
ytr
unk.
 Obl
i
guesi
nusi
sthespacebehi
ndhear
t
bet
weenl
eftat
ri
um andf
ibr
ousper
icar
dium.

19
Ner
vesuppl
y
 Phr
eni
cner
ve.

Bl
oodsuppl
y
I
nter
nal
thor
aci
car
ter
y
 Vei
nsdr
aint
oaz
ygossy
stem
Per
icar
dialdr
ainage
 Needl
epasst
hroughcent
ral
tendonof
di
aphr
agm.
HEART
 Li
esobl
i
quel
yint
hor
ax.
 Longax
isi
sdownwar
dst
olef
ttoapex
.
 Ri
ghtsi
dechamber
sar
eant
eri
ort
olef
tsi
de
chamber
s.
 At
ri
aar
etol
eftoft
hei
rvent
ri
cles.
 At
ri
aandv
ent
ri
cul
arsept
ali
e45°t
osagi
tt
al
pl
ane.
 Pl
aneofat
ri
ovent
ri
cul
arv
alv
eor
if
icesl
i
e90°t
o
sept
alpl
ane.
 Ri
ghtbor
deri
sri
ghtat
ri
um.
I
nfer
iorbor
deri
smost
lyr
ightv
ent
ri
clewi
th
smal
lpor
ti
onofl
eftv
ent
ri
cle.
 Lef
tbor
deri
smost
lyl
eftv
ent
ri
cle,
upper
most
par
tisaur
icl
eofl
eftat
ri
um.
 Ant
eri
orsur
facei
smai
nlyr
ightv
ent
ri
cle,
right
at
ri
um onr
ight
,st
ri
pofl
eftv
ent
ri
cleonl
eft
.
I
nfer
iorsur
facei
s1/
3ri
ghtv
ent
ri
cleand2/
3
l
eft
tvent
ri
cle.
 Post
eri
orsur
facei
slef
tvent
ri
cle.

20
  Apexi
slef
tvent
ri
cle.

Sur
facemar
king
 About1/
3li
eri
ghtt
omi
dli
ne
 Ri
ghtbor
der=l
owerbor
derofr
ight3r
dcost
al
car
ti
laget
ori
ght6t
hcost
alcar
ti
lage.
I
nfer
iorbor
der=r
ight6t
hcost
alcar
ti
laget
o
apex(
lef
tt5t
hInt
ercoast
alspacei
n
Mi
dcl
avi
cul
arl
i
ne)
 Lef
tbor
der=apext
olowerbor
derofl
eft2nd
cost
alcar
ti
lage2cm f
rom st
ernal
mar
gin.
Fi
brousskel
etonofhear
t
 Hear
tmuscl
esar
eat
tachedt
oit
.
 At
ri
ovent
ri
cul
arconduct
ingbundl
eist
heonl
y
phy
siol
ogi
cal
connect
ionbet
weenat
ri
aand
v
ent
ri
cles.
 Membr
anouspar
tofi
nter
vent
ri
cul
arsept
um i
s
at
tachedt
ofi
brousskel
eton.
 Membr
anouspar
tsmeetatcent
ral
fibr
ousbody
.
Ri
ghtat
ri
um
 Li
esbet
weensuper
iorv
enacav
aandI
nfer
ior
v
enacav
a.
 For
msr
ightbor
derofhear
t.
 Lef
tat
ri
um l
i
esbehi
ndr
ightat
ri
um.
I
nter
iori
ssmoot
htor
ightofcr
ist
ater
minal
i
s.
 Openi
ngofcor
onar
ysi
nusl
i
esabov
esept
al
cuspoft
ri
cuspi
d.
I
nter
atr
ial
sept
um f
ormspost
eri
orwal
labov
e
openi
ngofCor
onar
ysi
nus.

21
Ri
ghtvent
ri
cle
 At
ri
ovent
ri
cul
argr
oov
eisal
mostv
ert
ical
.
 At
ri
ovent
ri
cul
argr
oov
eLodgescor
onar
ysi
nus
 Ri
ghtv
ent
ri
clenar
rowsasi
tpassesupwar
ds
t
owar
dspul
monar
ytr
unk.
 Sept
omar
ginal
trabecul
acont
ainspar
tofr
ight
br
anchofconduct
ingbundl
e.
 Tr
icuspi
dguar
dsr
ightat
ri
ovent
ri
cul
aror
if
ice.
 Tr
icuspi
dhas3v
alv
esandcanadmi
tti
pof3
f
inger
s.
 Cr
ispsar
eat
tachedt
ofi
brousat
ri
ovent
ri
cul
ar
r
ing.
 Edgesofcuspsr
ecei
veat
tachmentofchor
dae
t
endi
neae.
Lef
tat
ri
um
 Post
eri
orwal
lrecei
vescor
onar
ysi
nus.
I
tsCav
ityi
ssmoot
hwal
l
edex
cepti
naur
icl
es.
 Bi
cuspi
dmi
tr
alv
alv
eadmi
tst
ipof2f
inger
s.
 Ant
eri
orcuspofmi
tr
alv
alv
eist
hickerandmor
e
r
igi
dthanpost
eri
or.
Lef
tvent
ri
cle
I
tswal
li
s3t
imesast
hickasr
ightv
ent
ri
cle.
 Ant
eri
orpapi
l
lar
ymuscl
eisl
argert
hanpost
eri
or
ones.
I
tsLumeni
sci
rcul
ari
ncr
osssect
ion.Thati
s
r
ightv
ent
ri
clei
scr
escent
.
 Membr
anouspar
tofsept
um l
i
esbet
weenl
eft
v
ent
ri
cleandr
ightat
ri
um.
 Aor
ti
cor
if
icel
i
eatl
owerl
evel
thatpul
monar
y

22
 or
if
icet
oit
sri
ght
.
St
ruct
ureofhear
tval
ves
 Thecuspsofmi
tr
alandt
ri
cuspi
dval
vesdonot
meetedgeandedge.
 3cuspsofpul
monar
yandaor
ti
cval
vesl
i
eedge
t
oedge.
Sur
facemar
kingsofval
ves
 Baseoft
ri
cuspi
dandmi
tr
alv
alv
es=v
ert
ical
li
ne
ov
ert
hel
owerpar
tofst
ernum.
 Tr
icuspv
alv
eli
esbehi
ndmi
dli
neofl
ower
st
ernum.
 Mi
tr
alv
alv
eli
eshi
gher
,tol
eftopposi
te4t
hlef
t
cost
alcar
ti
lage.
 Aor
ti
candpul
monar
yor
if
ices=behi
ndl
eft
bor
derofst
ernum,
lev
elof3r
dint
ercost
alspace
and3r
dcost
alcar
ti
lager
espect
ivel
y.
 Tr
icuspi
dval
vebeati
shear
dov
eri
tssur
face.
 Mi
tr
alv
alv
eisapexbeat
.
 Aor
ti
cval
vei
sri
ghtst
ernal
mar
gini
n2nd
i
nter
cost
alspace.
 Pul
monar
yval
vei
slef
tst
ernal
mar
gini
n2nd
i
nter
cost
alspaceov
erpul
monar
ytr
unk.
GREATVESSELS
 Ascendi
ngaor
taandpul
monar
ytr
unkshar
ed
commonsl
eev
eofper
icar
dium
 Ascendi
ngaor
taandpul
monar
ytr
unkar
einsi
de
f
ibr
ousper
icar
dium
 The6v
einsshar
eacommonsl
eev
eofser
ous
per
icar
dium.

23
  4Pul
monar
yvei
nsandi
nfer
iorv
enacav
aar
e
1cm orl
essi
nper
icar
dium whi
l
esuper
iorv
ena
cav
ais3t
imest
hatdi
stancei
nper
icar
dium
bef
oreent
eri
ngat
ri
um.
Ascendi
ngaor
ta
 Ri
ghtcor
onar
yar
ter
yar
isef
rom antsi
nus.
 Lef
tcor
onar
yar
ter
yar
isef
rom postsi
nus.
Pul
monar
ytr
unk
 Di
vi
desunderconcav
ityofaor
ti
car
chandi
n
f
rontofl
eftmai
nbr
onchusi
ntor
ightandl
eft
pul
monar
yar
ter
ies.
Conduct
ingsyst
em ofhear
t
I
mpul
sesar
econduct
edt
oat
ri
ovent
ri
cul
arnode
v
iaat
ri
alcar
diacmuscl
efi
bres.
 Si
nuat
ri
alnodesi
tuat
edonwal
lofr
ightat
ri
um,
bel
owSuper
iorv
enacav
aatt
opofsul
cus
t
ermi
nal
i
s.
 At
ri
ovent
eicul
arnodesi
tuat
edi
nri
ghtat
ri
um i
n
i
nter
atr
ial
sept
um,Lef
tofcor
onar
ysi
nus.
 At
ri
ovent
ri
cul
arbundl
erunsal
ongI
nfer
ior
bor
derofmembr
anouspar
tofi
nter
vent
ri
cul
ar
sept
um.
Bl
oodsuppl
ytohear
t
 Ri
ghtcor
onar
yar
ter
yfr
om ant
eri
oraor
ti
csi
nus,
Gi
vesof
fcor
nusar
ter
y(anat
omosewi
thsi
mil
ar
br
anchf
rom l
eftcor
onar
yar
ter
y),Suppl
i
es
At
ri
ovent
ri
cul
ari
n60%ofhear
ts,Hasal
oop
wher
epost
eri
ori
nter
vent
ri
cul
arar
ter
yisgi
ven
of
f.

24
  Lef
tcor
onar
yar
ter
yfr
om Lef
tpost
eri
oraor
ti
c
si
nus,
emer
gesbet
weenl
eftaur
icl
eand
i
nfundi
bul
um ofr
ightv
ent
ri
cle.
 Ci
rcumf
lexar
ter
ygi
vesof
fsi
noat
ri
alnodal
ar
ter
yin40%ofhear
ts.
 Ant
eri
ori
nter
vent
ri
cul
arar
ter
yismostaf
fect
ed
bydi
sease.
I
n10%ofhear
tsr
ightcor
onar
yar
ter
yisshor
ter
t
hanusual
,Post
eri
orI
nter
vent
ri
cul
arar
ter
yis
r
epl
acedbycont
inuat
ionofci
rcumf
lexar
ter
y.
 Cor
onar
ysi
nusl
i
esi
npost
eri
orpar
tof
At
ri
ovent
ri
cul
argr
oov
e.
 Gr
eatcar
diacv
einaccompani
esant
eri
or
I
nter
vent
ri
cul
arandci
rcumf
lexar
ter
ies.
 Mi
ddl
ecar
diacv
einaccompani
espost
eri
or
i
nter
vent
ri
cul
arv
ein.
 Smal
lcar
diacv
einopensi
ntol
owerendof
cor
onar
ysi
nus.
 Post
eri
orv
einofl
eftv
ent
ri
cleandsmal
lobl
i
gue
v
einsj
oinscor
onar
ysi
nus.
v
enaecor
dismi
nimaeopensdi
rect
lyi
nto
r
espect
ivechamber
s(mostf
requenti
nri
ght
at
ri
um)
.

Lymphdr
ainageofhear
t
 Dr
ainbackal
ongcor
onar
yar
ter
ies.
 Empt
yint
otr
acheobr
onchi
aland
br
achi
ocephal
i
cnodes.

25
Ner
vesuppl
y
 Car
diacpl
exus.
POSTERI
ORMEDI
ASTI
NUM
I
t'
sBoundedpost
eri
orl
ybyT5t
oT12,
ant
eri
orl
y
byper
icar
dium.
 Cont
ainsesophagus,
thor
aci
caor
ta,
azy
gos,
hemi
azy
gos,
accessor
yHAV,
thor
aci
cductand
l
ymphnodes
DESCENDI
NGAORTA
 Commencesatl
owerbor
derofT4.
 Leav
espost
eri
ormedi
ast
inum atT12l
evel
.
 Gi
vesof
f9pai
rsofposti
nter
cost
alar
ter
ies,
a
pai
rofsubcost
alar
ter
ies,
bronchi
alar
ter
ies,
esophageal
vessel
s,per
icar
dial
andPhr
eni
c
br
anches.
ESOPHAGUS
 Begi
nsatl
owerbor
derofcr
icoi
dcar
ti
lageatC6
l
evel
.
 Passt
hroughdi
aphr
agm atT10.
 Endsi
nabdomenatT12l
evel
.
I
s25cm l
ong.
 Commencesi
nmi
dli
ne,
incl
i
nest
olef
t,r
etur
ns
t
omi
dli
neatT5l
evel
.
 Dev
iat
esagai
ntol
eftatT7l
evel
.
 Passi
nfr
ontofdescendi
ngaor
ta.
 Pi
ercedi
aphr
agm 2.
5cm t
olef
tofmi
dli
ne.
 Cr
ossedbyaor
ti
car
chonl
eftandaz
ygoson
r
ighti
nsuper
iormedi
ast
inum.
 Thr
oughouti
tsl
engt
h,Tr
acheai
sindi
rectant

26
 r
elat
iont
oit
.
 Cr
ossedant
eri
orbyl
eftmai
nbr
onchusand
r
ightpul
monar
yar
ter
y.
 Thor
aci
cducti
spost
eri
ort
oesophagus.
 Post
eri
orl
yhemi
azy
gos,
Accessor
yhemi
azy
gos
v
ein,
andr
ightpost
eri
ori
nter
cost
alar
ter
ies
cr
ossmi
dli
nebehi
ndesophagus.
Const
ruct
ions
 Cr
icophar
yngeal
sphi
nct
er15cm f
rom i
nci
sor
t
eet
h.
 Cr
ossedbyaor
ti
car
ch22cm.
 Cr
ossedbyLtpr
inci
pal
bronchus27cm.
 Wher
eitpassest
hroughdi
aphr
agm 38cm f
rom
i
nci
sort
eet
h.
Bl
oodsuppl
y
 Upperesophagus-i
nfer
iort
hyr
oidar
ter
y.
 Mi
ddl
epor
ti
on-esophageal
brf
rom aor
taand
br
onchi
alar
ter
y.
 Lowerpar
t-esophageal
brofLtgast
ri
cAr
ter
y.
Lymphdr
ainage
 Cer
vical
par
t-deepcer
vical
node.
 Thor
aci
cpar
t-t
racheobr
onchi
alandpost
medi
ast
inal
nodes.
 Abdomi
nal
par
t-Ltgast
ri
candcel
i
acnodes.
Ner
vesuppl
y
 Upperpar
t-r
ecur
rentl
ary
ngeal
ner
ve.
 Mi
ddl
eandl
owerpar
tsf
rom t
hor
aci
c
sy
mpat
het
icandgr
eat
erspl
anchni
c.
 Par
asy
mpat
het
icsuppl
y-v
agusner
ve.

27
  Esophageal
pai
nisr
efer
redt
oneck,
arm and
t
hor
aci
cwal
l
.

LYMPHATI
CDRAI
NAGEOFTHORAX
 Super
fi
cial
lymphoft
hor
aci
cwal
ldr
aini
nto
ax
il
lar
ynode.
 Ly
mphcl
oset
ost
ernum -par
ast
etnal
.
 Pect
oral
regi
on-i
nfer
iordeepcer
vical
node.
 Ly
mphf
rom deepersi
nusesoft
hor
aci
cwal
l-
i
ntr
athor
aci
cnode.
 Par
ast
ernal
nodei
ssi
tuat
edatant
eri
orendsof
upper5I
nter
coast
alspacesal
ongi
ntr
athor
aci
c
ar
ter
y.
I
nter
cost
alnodes-post
eri
orendsofi
nter
cost
al
spaces.
 Di
aphr
agmat
icnodes-t
hor
aci
csi
deof
di
aphr
agm.
 Post
eri
ormedi
ast
inal
node-behi
ndper
icar
dium
onesophagusanddescendi
ngaor
ta.
 Super
iort
racheobr
onchi
alnodes-angl
e
bet
weent
racheaandmai
nbr
onchi
.
I
nfer
iort
racheobr
onchi
alnodes-angl
ebet
ween
t
hebr
onchi
.
 Par
atr
acheal
nodes-f
rontandsi
desoft
rachea.
 Br
achi
ocephal
i
cnodes-super
iormedi
ast
inum
ant
eri
ort
obr
achi
ocephal
i
cvei
n.
THORACI
CDUCT
 Commencesatupperendofci
ster
nchy
lion
l
evel
wit
hT12bet
weenaor
taandaz
ygosv
ein.

28
  Li
esal
ongr
ightsi
deofesophagus.
I
ncl
i
net
olef
tandpassbehi
ndesophagusatT5
l
evel
.
 Li
esant
eri
ort
ori
ghtaor
ti
cint
ercost
alar
ter
ies
andt
ermi
nal
branchofhemi
azy
gosand
accessor
yhemi
azy
gosv
eini
nthor
ax.
 Li
espost
eri
ort
oar
chofaor
taandl
eft
t
subcl
avi
anar
ter
yinsuper
iormedi
ast
inum.
 Car
ri
esal
ll
ymphf
rom l
owerpar
tofbodyand
dr
ainsal
ll
ymphoft
hebodyex
ceptf
rom r
ight
upperl
i
mbandr
ight
thal
foft
hor
axandhead
andneck.
 Ri
ghtl
ymphat
icductdr
ainsr
ighti
nter
cost
aland
r
ightbr
onchomedi
ast
inal
nodes.
AZYGOSSYSTEM OFVEI
NS
 Thor
aci
cwal
landl
umbarr
egi
onar
edr
ainedby
post
eri
ori
nter
coast
alandl
umbarv
einsi
nto
az
ygossy
stem.
Azygosvei
n
 For
medbyuni
onofascendi
ngl
umbarand
subcost
alv
einsofr
ightsi
de.
 Goest
hroughaor
ti
copeni
ngofdi
aphr
agm.
 Lat
eral
tot
hor
aci
cduct
.
 Ar
chov
erhi
l
um ofr
ightl
ungandendsi
n
super
iorv
enacav
aatT4l
evel
.
 Recei
vesl
ower8post
eri
ori
nter
cost
alv
eins.
 Recei
vessuper
iori
nter
cost
alv
einofr
ightsi
de
ati
tsconv
exi
ty.
 Twohemi
azy
gosv
einsj
oinatT7andT8l
evel
s.

29
Hemi
azygosvei
ns
 Theymaycommuni
cat
ebutusual
l
ydr
ain
separ
atel
yint
oaz
ygosv
einbehi
ndesophagus.
 Recei
vel
eft
tlower8post
eri
ori
nter
cost
alv
eins,
4each.
 For
medi
nabdomenbyuni
onofl
eftascendi
ng
l
umbarandsubcost
al(
usual
l
ycommuni
cat
e
wi
thl
eftr
enal
vei
n)v
eins.
 Passesupt
hroughl
eftcr
usofdi
aphr
agm.
 Recei
vesv
einf
rom l
oweresophagus.
 Super
iorv
eini
stheaccessor
ieshemi
azy
gos
v
ein(
recei
vesbr
onchi
alv
einf
rom l
eft
tlung)
.
THORACI
CSYMPATHETI
CTRUNK
 Notacont
entofpost
eri
ormedi
ast
inum.
I
ts12gangl
i
ali
eantt
oheadsofr
ibs.
 Li
esantt
oneckof1str
ib.
 Lowestgangl
i
ali
elat
eral
tocor
respondi
ng
v
ert
ebr
albodi
es.
 Recei
vespr
egangl
i
oni
cwhi
ter
amusf
rom ant
r
amusofcpdspi
nal
ner
ve.
 Leastspl
anchni
cner
vel
eav
es12t
hgangl
i
on.
 Lesserspl
anchni
ccomesf
rom 10t
hand11t
h
gangl
i
a.
 Gr
eat
erspl
amchni
cisf
ormedbybrf
rom 5t
hto
9t
hgangl
i
a.
 Passesbehi
ndmedi
alar
cuat
eli
gamentof
di
aphr
agm.
PLEURA
 Par
iet
alPl
eur
aat
tachedt
oInf
eri
orsur
faceof

30
 supr
apl
eur
almembr
aneandmedi
ast
inal
sur
faceofper
icar
dium.
 Pl
eur
alcav
ityi
sacompl
etel
ycl
osedspace.
 Par
iet
alPl
eur
aex
tendsf
urt
hert
hant
hei
nfer
ior
l
ungedge.
Vessel
sandner
ves
 Ar
ter
ial
suppl
y-i
nter
cost
al,
int
ernal
thor
aci
c
andmuscul
ophr
eni
c.
 Venousdr
ainagei
stoaz
ygosv
ein.
I
nter
coast
alner
vessuppl
i
escost
over
tebr
al
pl
eur
a.
 Phr
eni
cner
ve-di
aphr
agmat
icpl
eur
a(dome)
.
I
nter
coast
alner
ve-di
aphr
agmat
icpl
eur
a
(
per
ipher
y).
 Phr
eni
cner
ve-medi
ast
inal
pleur
a.
 Vi
scer
alPl
eur
aisbybr
onchi
alv
essel
s.
 Vi
dcer
alPl
eur
ahasaut
onomi
cner
voussuppl
y,
i
nsensi
ti
vet
oor
dinar
yst
imul
i
.
Sur
facemar
kings
 Pl
eur
adoesnotex
tendabov
eneckof1str
ib.
 Li
neofpl
eur
alr
efl
exi
onsl
opesf
rom
St
ernocl
avi
cul
arj
ointt
oit
sfel
l
owatst
ernal
angl
e(2ndr
ibl
evel
).
 Thepassv
ert
ical
l
ybehi
ndst
ernum t
o4t
hcost
al
car
ti
lage.
 Eacht
urnsl
ater
all
yat6t
hcost
alcar
ti
lage.
 Cr
ossesmi
dcl
avi
cul
arl
i
neat8t
hri
b.
 Andcr
ossmi
dax
il
lar
yli
neat10t
hri
b.
 Lowerbor
dercr
ossest
he12t
hri
batl
ater
al

31
 bor
derofer
ect
orspi
nae.

LUNGS
Lungr
oot
s
Ltl
ungr
oot
 Upperpar
toccupi
edbyl
eftpul
monar
yar
ter
y.
 Bel
owi
tisl
eftbr
onchus.
 Twopul
monar
yvei
nsonei
nfr
ontandot
her
bel
owt
hebr
onchus.
 Thesev
essel
sar
eencl
osedi
nsl
eev
eofpl
eur
a.
Rtl
ungr
oot
 Br
onchust
oupperl
obeandbr
anchof
pul
monar
yar
ter
ytoupperl
obeor
igi
nat
e
out
sidet
hel
ung.
 Upperl
obebr
onchusandi
tsar
ter
yar
eabov
e
l
evel
ofmai
nbr
onchusandpul
monar
yar
ter
y.
Ar
ter
iesl
yi
ngi
nfr
ontoft
hei
rbr
onchi
.
 Eachr
ootcont
ainsbr
onchi
alv
essel
s,
aut
onomi
cner
vesandl
ymphnodesand
channel
s.

PULMONARYARTRI
ES
 Lef
tpul
monar
yar
ter
yat
tachedt
oundersur
face
ofaor
ti
car
chbyl
i
gament
um ar
ter
iosum.
 Spi
ral
sov
ert
opofl
eftbr
onchus.
 Ri
ghtpul
monar
yar
ter
yisl
ongert
hanl
eft
.
 Passbel
owcar
inaant
eri
ort
oesophagus.
 Ant
eri
ort
ori
ghtmai
nbr
onchusatl
ungr
oot
.

32
LUNGFI
SSURES
 Onr
ight
tlunghor
izont
alf
issur
epassf
rom
ant
eri
ormar
gini
ntoobl
i
guef
issur
e.
 Vi
scer
alpl
eur
aex
tendsi
nwar
dst
oli
nedept
hof
f
issur
es.
 Theobl
i
qui
tyoft
hef
issur
eensur
esbet
ter
ex
pansi
onoft
heapexoft
hel
ung.
I
nlef
tlungl
owestandmostmedi
alpar
tof
upperl
obei
sli
ngual
whi
chf
ormsboundar
yof
car
diacnot
ch.
SURFACEMARKI
NGS
 Hi
l
um l
i
esbehi
nd3r
dand4t
hcost
alcar
ti
lageat
st
ernal
mar
ginandl
evel
wit
hT5-
7ver
tebr
ae.
 Lowerbor
derofl
ungsl
i
e2r
ibshi
ghert
han
pl
eur
alr
efl
exi
on.
 Mi
dcl
avi
cul
arl
i
ne-6t
hri
b.
 Mi
dax
il
lar
yli
ne-8t
hri
b.
 Lat
eral
bor
derofer
ect
orspi
nae-10t
hri
b.
 Obl
i
guef
issur
eindi
cat
edbyl
i
nej
oini
ngspi
neof
T3(
opposi
tepost
eri
orendof5t
hri
b)t
o6t
hri
b
i
nmi
dcl
avi
cul
arl
i
ne.
 Onr
ightt
he4t
hcost
alcar
ti
lageov
erl
i
es
hor
izont
alf
issur
ebet
weenupperandmi
ddl
e
l
obes.
 Hor
izont
alandobl
i
guef
issur
esmeeti
nmi
d
ax
il
lar
yli
ne.

LOBARANDSEGMENTALBRONCHI
 Ri
ghtmai
nbr
onchus2.
5cm l
ongandshor
ter
,

33
 wi
derandmor
ever
ti
cal
thanl
eft(
5cm l
ong)
.
 Ri
ghtmai
nbr
onchusgi
vesupperl
obebr
onchus
out
sidehi
l
um.
 Lef
tmai
nbr
onchusdi
vi
deswi
thi
nhi
l
um i
nto
upperandl
owerl
obarbr
onchi
.
 Vei
nsofr
ightmai
nbr
onchusdr
aint
oaz
ygos.
 Thoseofl
eftmai
nbr
onchusdr
aint
oaccessor
y
hemi
azy
gosv
ein.
 Apexofeachl
ungsegmenti
sdi
rect
edt
owar
ds
hi
l
um
 Li
ngul
apar
tofl
eftupperl
obehassuper
iorand
i
nfer
iorsegment
s.
 Onl
eft
t,medi
alandant
eri
orbasal
segmentand
l
ater
alandpost
eri
orbasal
segment
sar
isef
rom
commonst
em br
onchi
.
 Mat
eri
alaspi
rat
edbyasupi
nepat
ientgr
avi
tat
e
i
ntoapi
cal
segmentofr
ightl
owerl
obe
(
commonsi
teofaspi
rat
ionpneumoni
aand
abscessf
ormat
ion)
.
Bl
oodsuppl
ytol
ungs
 Twobr
onchi
alar
ter
iesonl
eftar
edi
rectbr
anch
f
rom aor
ta.
 Oneonr
ightcomesf
rom 3r
dri
ghtpost
i
nter
cost
alar
ter
y.
 Pul
monar
yar
ter
ydi
vi
deswi
thbr
onchi
.
 Ev
erybr
onchi
isaccompani
edbyabr
anchof
pul
monar
yar
ter
y.
 Pul
monar
yar
ter
ySuppl
i
esnobr
onchusbut
av
eol
i(suppl
i
est
hem nut
ri
ent
sex
ceptox
ygen)
.

34
  Ther
e'sanast
omosi
sbet
weenbr
onchi
aland
pul
monar
yar
ter
iesatpr
ecapi
l
lar
ylev
el.
STERNUM
Manubr
ium
 Manubr
ium andbodyconnect
edbysecondar
y
car
ti
lagenousj
oint
.
 Manubr
ium i
s4si
dedbr
oaderabov
ethanbel
ow.
I
nter
clav
icul
arl
i
gamenti
sadher
entonj
ugul
ar
not
ch.
 Ant
eri
orsur
facei
smai
nlycov
eredby
at
tachmentofPect
oral
i
smaj
orand
St
ernocl
eidomast
oid.
 St
ernohy
oidandst
ernot
hyr
oidar
eat
tachedt
o
upperpar
tofpost
eri
orsur
face.
 For
msant
eri
orwal
lofsuper
iormedi
ast
inum.
Bodyofst
ernum
 Hasar
ti
cul
arf
acet
sforl
owerbor
derofT2
cost
alcar
ti
lageandT3-
7cost
alcar
ti
lages.
 Al
lar
ti
cul
ati
onar
esy
nov
ial
joi
nts.
 Pmaj
orar
isesant
eri
oral
mostt
omi
dli
ne.
 Tr
ansv
ersust
hor
aci
sar
isesf
rom post
eri
or
sur
facel
owerdown.
 Xi
phoi
dpr
ocesspr
oject
sfr
om postmar
ginof
l
owerendf
orat
tachmentofl
i
neaal
ba
Sur
facemar
kings
 Jugul
arnot
ch-upperbor
derofT3
 St
ernal
angl
e-l
owerbor
derofT4
 Lowerendofst
ernum -l
owerbor
derofT8.

35
TYPI
CALRI
B
 2nd-10t
hri
bar
ety
pical
ribs.
 Hashead,
neckandshaf
t;t
uber
clepr
oject
s
post
eri
orf
rom l
ater
alendofneck.
Head
 Lowerf
aceti
sver
ti
cal
andAr
ti
cul
ateswi
thi
ts
ownv
ert
ebr
a.
 upperf
acetar
ti
cul
ateswi
thv
ert
ebr
aabov
e.
 Eachmakessy
nov
ial
joi
nt.
Neck
I
ncl
i
nesbackwar
dswhent
racedf
rom headt
o
t
uber
cle.
Tuber
cle
 Smoot
hmedi
alf
acetmakessy
nov
ial
joi
ntwi
th
Tr
ansv
ersepr
ocessofi
tsownv
ert
ebr
a.
 Roughl
ater
alf
acetgi
vesat
tachmentt
olat
eral
cost
otr
ansv
ersel
i
gament
.
Shaf
t
 Headsl
i
eathi
gherl
evel
thanant
eri
orends.
 Degr
eeoft
orsi
oni
smostmar
kedi
n7-
9thr
ib.
 Ex
ter
nal
int
ercost
almuscl
ear
isef
rom shar
p
l
owerbor
der
.
I
nter
nal
int
ercost
almuscl
eat
tachedt
othe
cost
algr
oov
e.
 Tr
ansv
erset
hor
aci
smuscl
eat
tachedt
oinner
sur
faceofshaf
t.
ATYPI
CALRI
BS
FI
RSTRI
B
 St
rongest
,br
oadest
,fl
att
estandmostcur
ved

36
 r
ib
 Super
iorsur
facei
spar
tofr
ootofneck.
I
nfer
iorsur
facei
spar
tofr
oofoft
hor
aci
ccav
ity
.
 Pl
aneofshaf
tis45°t
othehor
izont
al.
 Tuber
clei
smostpost
eri
orandhi
ghestpar
t.
 Headi
ssmal
l
,car
ri
esf
acetf
orsy
nov
ial
joi
nt
wi
thupperpar
tofbodyofT1.
 Sy
mpat
het
ict
runkl
i
esi
ncont
actwi
thant
eri
or
bor
derofneckal
ongsi
dehead.
 Fi
bresofbr
achi
alpl
exusi
ncont
actwi
tht
her
ib
ar
eal
lT1wi
thC8abov
e.
 Tendonofscal
enusant
eri
ori
sat
tachedt
othe
t
uber
cle.
 Subcl
avi
usar
isesf
rom uppersur
faceofbone
andcar
ti
lageof1str
ib.
11t
hri
b
 Hasheadwi
thsi
ngl
efacetf
orT11v
ert
ebr
a,
shor
tneck,
sli
ghtangl
e,not
uber
cle,
shal
l
ow
Cost
agr
oov
e.
12t
hri
b
 Hassi
ngl
efacetf
orT12v
ert
ebr
a,not
uber
cle,
noangl
eandnocost
algr
oove.
OSSI
FICATI
ONOFSTERNUM
 Pr
imar
ycent
reappearabout5t
hfet
almont
h.
 Oneort
woi
nmanubr
ium,
oneort
woi
neach
si
deof4pi
ecest
ofor
m body
.
 Fusi
onoccurbt
wnpuber
tyand25y
rs.

37
OSSI
FICATI
ONOFRI
BS
 Pr
imar
ycent
res-8t
hwkoff
etal
li
featangl
e
 Secondar
ycent
resf
orheadandt
uber
cle-
puber
ty
 Fusi
onwi
thshaf
t-af
ter20y
rs
 Unossi
fi
edantpar
tremai
nsascost
alcar
ti
lages
COSTALCARTI
LAGES
 For
m pr
imar
ycar
ti
lagi
nousj
oint
satex
tremi
ti
es
of12r
ibs.
 Car
ti
lagei
ncr
easei
nlengt
hfr
om 1stt
o7t
hri
b
(
longest
)
 5t
hto10t
hri
bbendf
rom downwar
dsl
opet
o
upwar
dsl
opet
ost
ernum.
 Medi
alendf
orm sy
nov
ial
joi
ntswi
thst
ernum of
car
ti
lageabov
e.
 Car
ti
lageof11&12t
hri
bshav
efr
eepoi
nted
ant
eri
orends.
 Al
lcar
ti
lagesespeci
all
yof1str
ibcal
cif
iesand
ossi
fi
esaf
termi
ddl
eage.

38