Lab 1 - Anatomy of Thoracic Walls, Lower Respiratory Tract

Station 1- Bones
Observe in Plastic Models (articulated and/ dismembered)

1 Thoracic cage
• 12 Thoracic vertebrae posteriorly
• 12 pairs of ribs laterally
• Sternum & costal cartilages anterior-laterally
Thoracic inlet
Bounded by:
• Anteriorly: Jugular notch.
• Posteriorly: T1vertebra.
• Anteriolaterally: Pair of the first ribs & costal cartilages.
Thoracic outlet
Bounded by:
• Anteriorly: the xiphisternal joint.
• Posteriorly: T12 vertebra.
• Anterolaterally: the costal margins (costal cartilage of 7, 8, 9
• Posterolaterally: 11th and 12th pairs of ribs.
2 Thoracic vertebrae: pick up vertebra try to identify:

• Body.
• Pedicle.
• Transverse process.
• Lamina.
• Spine.
• Articular processes (superior & inferior).
• Vertebral foramen
Identify Typical vertebrae(2rd to 9th)

• Bilateral costal facets on the vertebral bodies (superior& inferior)
• Costal facets on the transverse processes for articulation with the tubercles of ribs
• Long, inferiorly slanting spinous processes
Atypical vertebrae:
• T1: complete facet on the upper part & demifacet in the lower part
• T10 to T12: have only one bilateral pair of (whole) costal facets\
• No articular surface on the transverse processes
Prepared by: Dr. Altayeb Abdalla Ahmed and Dr. Elhady Kheir
Reviewed and Approved by: Dr. Altayeb Abdalla Ahmed Page 1
1.c) anterolateral boundary of thoracic cage
1.d) anterior boundary of thoracic inlet
1.f) anterolateral boundary of thoracic inlet
1.g) anterior boundary of thoracic outlet
1.i) anterolateral boundary of thoracic outlet

1.e) posterior boundary of thoracic inlet
1.a) posterior boundary of thoracic cage
1.j) posterolateral boundary of thoracic outlet
1.b) lateral boundary of thoracic cage

1.h) posterior boundary of thoracic outlet
a. Body
b. Pedicle
c. Transverse process
d. Lamina
e. Spine
f. Articular processes (superior & inferior).
g. Vertebral foramen
h. Bilateral costal facets on the vertebral bodies (superior& inferior)
i. Costal facets on the transverse processes for articulation with the tubercles of ribs
Station 2 Bones
Observe in Plastic Models (articulated and/ dismembered)
1 Ribs:- pick up rib try to identify
• Head, Neck, body/shaft, angle & tubercle
• Put in anatomical position
• Ends
Identify :
(1) Typical ribs (3rd to 9th):
• Head: has two facets, separated by the crest
• Neck: connects the head with the body
• Tubercle: (two parts)
• Body (shaft): thin, flat, and curved, most markedly at the costal angle
• Outer& inner surfaces
• Upper & lower borders
• Costal groove lodges VAN (Intercostal vein, artery and nerve from superior to inferior)
(2) Atypical ribs (1st, 2nd, and 10th-12th)
• 1st rib: broadest, shortest (small head, single facet, superior & inferior surfaces, outer & inner border and
scalene tubercle in superior anterior to is pass the subclavian vein and posterior the subclavian artery
• 2nd rib is a thinner, less curved. Main atypical feature is a rough area on its upper surface, the tuberosity for
serratus anterior.
• 10th-12th ribs have only one facet on their heads
• 11th and 12th ribs are short and has no neck or tubercle
Identify the side of ribs
2 Sternum & Costal Cartilages: observe
• 3 parts:
O Manubrium.
O Body of Sternum.
O Xiphiod process
• Two surfaces (anterior & posterior)
• Borders give articular surfaces to clavicle and costal cartilages
• Jugular notch, angle of Louis and xiphosternal joint
• upper 7 costal cartilages connect upper seven ribs to the lateral edge of the sternum
• 8th, 9th, and 10th ribs to the cartilage immediately above to form costal margin.
3 Discuss the joints between different parts of thoracic cage and movements?
4 Discuss age changes?

5 Count ribs in your chest based on manubriosternal angle?
1a. Head
1b. Neck
1c. Tubercle
1d. Body
1e. Outer surface
1f. inner surface
Upper & lower borders
1g. Costal groove
2a. Manubrium
2b. Body of Sternum
2c. Xiphiod process
2d. Jugular notch
2e. Angle of Louis
2f. Xiphosternal joint
Station 3 Muscles
Observe in Plastic Models
1 Intercostal spaces:- observe
• Intercostal muscles
O External Intercostal (Fibres pass downwards and forwards)
O Internal Intercostal (Fibres pass downwards and backwards)
O Innermost Intercostal (Spanning more than 1 intercostal space)
• Intercostal neurovascular bundle (between internal & innermost)
2 Diaphragm: Observe
Surfaces
• Superior surface faces the thoracic cavity formed right & left domes.
• Inferior surface faces the abdominal cavity
Parts of the diaphragm

• Central tendon.
• Muscular part:
O Sternal part (attach to the posterior aspect of the xiphoid).
O Costal part (Wide muscular slips that attach to the internal surfaces of the lower six ribs)
O Lumbar part: right and left crura
o Medial and lateral arcuate ligaments
Right and left phrenic nerves

Main openings of the diaphragm
• Caval Opening (at the level T8) – what are the contents?
• Esophageal opening (at the T10) – what are the contents?
• Aortic opening (at the level T12) – what are the contents?
What are the structures piercing the diaphragm?
What are the structures passing behind medial and lateral arcuate ligaments?
Discuss vasculatures and innervation?
1a. External Intercostal
1b. Internal Intercostal
2a. Central tendon
2b. Muscular part
2c. Right and left phrenic nerves
2d. Caval Opening (at the level T8)
2e. Esophageal opening (at the T10)
2f. Aortic opening (at the level T12)
What are the structures passing behind medial and lateral

arcuate ligaments?
psoas major & quadratus lamborum respectively
Station 4 Thoracic cavity
Observe in Plastic Models
1 Boundaries
• Sternum anteriorly
• Thoracic vertebrae posteriorly
• Diaphragm inferiorly
• Suprapleural membrane superiorly
Imagine the imaginary line extends between sternal angle and IVD (T4&T5)
Based onthis imaginary line observe the divisions of mediastina (space between lungs) Into:
Superior mediastinum
O Bounded by
• manubrium anteriorly
• T1 to T4 vertebrae posteriorly
• Imaginary line inferiorly
• Thoracic inlet superiorly
• Apices of the lungs laterally
O Contents
• Great vessels
• Vagi and their branches
• Phrenic nerves
• Trachea
• Oesophagus
• Sympathetic trunks
• Thoracic duct
Inferior mediastinum
O Divided into
§ Anterior mediastinum (between pericardium and body of the sternum)
• Contents
o Thymus
o Parasternal lymph nodes
o Sternopericardial ligaments
o Internal thoracic arteries along lateral border of the
sternum
§ Posterior mediastinum (between pericardium and T5 to T12 vertebrae)
• Contents
o Descending aorta
o Oesophagus
o Vagi
o Azygos system
o Sympathetic trunks
o Splanchnic nerves
o Thoracic duct
§ Middle mediastinum
• Contents
o Heart
o Pericardium
o Phrenic nerves
m
o Roots of the great vessels
2 Now after you have seen different parts of the thoracic cavity, please observe structures at the level of angle of
Louis (manubriosternal angle)
• Beginning and termination of the aortic arch
• Superior vena cava pierce the pericardium
• Termination of azygos vein
• Bifurcation of the trachea
• Bifurcation of the pulmonary trunk
• Loop of the recurrent laryngeal nerve
• Cardiac plexuses (may not see)
• Deviation of the thoracic duct to the left side (may not see)
1a. Sternum anteriorly
1b. Thoracic vertebrae posteriorly
1c. Diaphragm inferiorly
Station 5 Trachea, bronchi, lungs and pleura
Observe in Plastic Models / plastinated specimens
1 Observe trachea and bronchi
• Beginning and termination
• Relations
• Structure
• Differences between right and left bronchi
2 Lungs
• Identify: apex, base, surfaces and borders, lobes, fissures, hilum, and impressions.
• Observe the arrangement of structures seen in the hilum and roots.
• Discuss differences between right and left and how to determine side?
• Discuss bronchopulmonary segments and their clinical correlation?
3 Pleura
• Identify parietal and visceral pleurae?
• Identify recesses (costodiaphragmatic and sternocostal)?
• Discuss differences in vasculature, innervation and lymph drainage?
• Discuss clinical correlations?
Station 5
Q1: Differentiate Between the Left and Right Bronchi
Right Left
① Segmented Bronchus 3 ① Segmented Bronchus 2

② More Aligned with Trachea ② Long and Narrow
1: Patient Aspirated A Foreign Object. Where Does It Go?
Right Lung
2: If Patient Is Comatose (Laying Down), 3: It Patient Is Vertical (Sitting Up), Where

Where Does It Go? Does It Go?
Right Inferior Apical (superior) Lobar Bronchus Right Inferior Posterior Basal Lobar Bronchus
Q2/ Identify Borders Fissures, Surfaces of Right and Left Lungs
▪ Anterior Border
• Cardiac Notch
• Lingula
▪ Posterior Border
▪ Inferior Border
1. Horizontal Fissure
2. Oblique Right Fissure
3. Oblique Left Fissure
Q3/ What Are the Main Structures in Helium? (Observe Arrangement)
1. Right superior lobar Bronchus

2. Right Inferior and Middle lobar bronchus
1. Superior Pulmonary Vein (most anterior structures)
2. Inferior Pulmonary Vein
4. Branches Pulmonary Artery (superior structures lying posterior to bronchus)
Q4/ Observe Impressions of The Mediastinal Surface.
1. Apex
2. Groove for Arch of Azygos Vein
3. Groove for Superior Vena Cava
4. Horizontal Fissure
5. Groove for Esophagus
6. Pulmonary Ligament
7. Oblique Fissure
8. Groove for Arch of Aorta
9. Cardiac Impression
10. Groove for Descending Aorta
Q 5/ What Are Pleural Recesses?
Recesses
• Costomediastinal recess: region where the mediastinal and costal pleura
meet
• Costodiaphragmatic recess: region where the costal and diaphragmatic
pleura meet
Provides potential space for the lungs to expand during inspiration and movement
of the diaphragm.
Potential space for air, blood, and/or fluid accumulation (e.g., pleural effusion,
pneumothorax, hemothorax).
3
1. costomediastinal recess
2. cardiac notch
3. costodiaphragmatic recess
1.a Trachea
2.b Bronchi
2.a. apex
2b. base
2c. Costal (costovertebral) surface
2d. Medial (mediastinal) surface
2e. Diaphragmatic (base) surface
2f. anterior border
2g. posterior border
2h. inferior border
2i. right superior lobe
2j. right middle lobe
2k. right inferior lobe
2l. left superior lobe
2m. left inferior lobe
2n. horizontal ssure
2o. oblique ssure
Station 6 Surface and Imaging Anatomy
Station7- Clinical Anatomy
Compression of the Trachea
• In the neck, a unilateral or bilateral enlargement of the thyroid gland can cause gross
displacement or compression of the trachea.
• A dilatation of the aortic arch (aneurysm) can compress the trachea. With each cardiac systole the
pulsating aneurysm may tug at the trachea and left bronchus, a clinical sign that can be felt by
palpating the trachea in the suprasternal notch.
Tracheitis or Bronchitis
• A tracheitis or bronchitis gives rise to a raw, burning sensation felt deep to the sternum instead of
actual pain.
Inhaled Foreign Bodies-
• into the lower respiratory tract is common, especially in children.
• Parts of teeth may be inhaled while a patient is under anesthesia.
• Because the right bronchus is wider and more in line with the trachea, foreign bodies tend to enter
the right instead of the left bronchus. From there, they usually pass into the middle or lower lobe
bronchi.
• Lodgment of a foreign body in the larynx or edema of the mucous membrane of the larynx
secondary to infection or trauma may require immediate relief to prevent asphyxiation.
• A method commonly used to relieve complete obstruction is tracheostomy.
Bronchoscopy
Examining the interior of the trachea, its bifurcation (the carina) and the main bronchi.
Also possible to examine the interior of the lobar bronchi and the beginning of the first segmental
bronchi.
Obtain biopsy specimens of mucous membrane and to remove inhaled foreign bodies (even an
open safety pin).
Tracheostomy
• Site?
o Through the second ring above the isthmus of the thyroid gland;
o through the third, fourth, or fifth ring by first dividing the vascular isthmus of the thyroid
gland; or
o through the lower tracheal rings below the thyroid isthmus.
• The preferred site is through the second ring of the trachea in the midline, with the thyroid
isthmus retracted inferiorly. A vertical tracheal incision is made, and the tracheostomy tube is
inserted.
• At the latter site, the trachea is hiding from the surface of the neck. The pretracheal fascia
contains the inferior thyroid veins and possibly the thyroidea ima artery.
Chronic obstructive pulmonary disease (COPD)
• Two most common cause- Chronic bronchitis and emphysema.

• Emphysema -permanent enlargement of airspaces at and distal to respiratory bronchioles and
destruction of bronchiole walls by inflammation
COR pulmonale by COPD
• Total cross-sectional area of the pulmonary vasculature decreases because of pathologic
destruction and pulmonary vasospasm, which leads to pulmonary hypertension.
• The work of the right ventricle thus increases and may result in hypertrophy and dilation.
Pulmonary tuberculosis
• Primary lesions often occur in distal alveoli of the lower part of the upper lobe or upper
portion of the lower lobe, near the pleura.
• Hilar nodes are commonly affected, with caseation.
• Cavitation may occur with erosion into the airways, which leads to sputum production and
further dissemination.
Bronchogenic carcinoma
• Pancoast syndrome:
• In bronchogenic Ca tumor may spread to involve the sympathetic trunk-Horner's
syndrome (myosis, ptosis, anhydrosis, flushing).
o Neurovascular components passing into the upper limb may be affected, with
resulting paresthesia.
• In superior vena cava (SVC) syndrome, tumor impinges on various structures, which
leads to a sensation of fullness in the head and neck, headache, blurred vision, facial
edema, enlarged neck veins, and dyspnea.
Pneumothorax
Chest trauma (stab wound or fractured rib) may lacerate the chest wall and the parietal and
visceral pleura, which causes a tension pneumothorax that results in a partially or completely
collapsed lung on the affected side
Pneumonia

Lab 1 - Anatomy of Thoracic Walls, Lower Respiratory Tract

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Lab 1 - Anatomy of Thoracic Walls, Lower Respiratory Tract

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Station 1- Bones

Observe in Plastic Models (articulated and/ dismembered)

2 Thoracic vertebrae: pick up vertebra try to identify:

Identify Typical vertebrae(2rd to 9th)

1.f) anterolateral boundary of thoracic inlet

1.g) anterior boundary of thoracic outlet

1.i) anterolateral boundary of thoracic outlet

1.a) posterior boundary of thoracic cage

1.j) posterolateral boundary of thoracic outlet

1.b) lateral boundary of thoracic cage

4 Discuss age changes?

Parts of the diaphragm

Right and left phrenic nerves

What are the structures passing behind medial and lateral

① Segmented Bronchus 3 ① Segmented Bronchus 2

1: Patient Aspirated A Foreign Object. Where Does It Go?

2: If Patient Is Comatose (Laying Down), 3: It Patient Is Vertical (Sitting Up), Where

1. Right superior lobar Bronchus

• Two most common cause- Chronic bronchitis and emphysema.

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