The framework of the walls of the thorax, which is referred to as the thoracic cage, is formed by:

vertebral column behind; the ribs and intercostal spaces on either side;
sternum and costal cartilages in front.

Cavity of the thorax can be divided into a median partition, called the mediastinum, and the laterally placed pleurae and
lungs

The lungs are covered by a thin membrane called the visceral pleura, which passes from each lung at its root (i.e., where
the main air passages and blood vessels enter) to the inner surface of the chest wall, where it is called the parietal
pleura. In this manner, two membranous sacs called the pleural cavities are formed.

Sternum
- Lies in the midline of the anterior chest wall.
It is a flat bone that can be divided into three parts: manubrium sterni, body of the sternum, and xiphoid process
 Manubrium (upper part of the sternum) → MANUBRIOSTERNAL JOINT → body of the sternum
- It articulates with the clavicles and with the 1st costal cartilage and the upper part of the 2nd costal
cartilages on each side. It lies opposite the 3rd and 4th thoracic vertebrae.
 Body of the sternum → XIPHISTERNAL JOINT → xiphoid process
 Xiphoid process (is a thin plate of cartilage that becomes ossified at its proximal end during adult life). No
ribs or costal cartilages are attached to it.

Sternal angle (angle of Louis), formed by the articulation of the manubrium with the body of the sternum.
- Can be recognized by the presence of a transverse ridge on the anterior aspect of the sternum. The
transverse ridge lies at the level of the 2nd costal cartilage, the point from which all costal cartilages and
ribs are counted.
- The sternal angle lies opposite the intervertebral disc between the 4th and 5th thoracic vertebra

Ribs
- 12 pairs of ribs, all of which are attached posteriorly to the thoracic vertebrae
True ribs: upper seven pairs are attached anteriorly to the sternum by their costal cartilages
False ribs: 8th, 9th, and 10th pairs of ribs are attached anteriorly to each other and to the 7th rib by means
of their costal cartilages and small synovial joints.
Floating ribs: 11th and 12th pairs have no anterior attachment

 Typical Rib - typical rib is a long, twisted, flat bone having a rounded, smooth superior border and a sharp, thin
inferior border. (Inferior border overhangs and forms the costal groove, which accommodates the intercostal
vessels and nerve)
 Atypical Rib
The 1st rib is important clinically because of its close relationship to the lower nerves of the brachial plexus
and the main vessels to the arm, namely, the subclavian artery and vein

Costal Cartilages
- are bars of cartilage connecting the upper seven ribs to the lateral edge of the sternum and the 8th, 9th,
and 10th ribs to the cartilage immediately above.
Cartilages of the 11th and 12th ribs end in the abdominal musculature

Joints of the Heads of the Ribs - intraarticular ligament

 1st rib and the three lowest ribs have a single synovial joint
 2nd to 9th ribs, the head articulates by means of a synovial joint
Joints of the Ribs and Costal Cartilages
These joints are cartilaginous joints. No movement is possible

Movements of the Ribs and Costal Cartilages

The 1st ribs and their costal cartilages are fixed to the manubrium and are immobile.

Intercostal Spaces
Spaces between the ribs contain three muscles of respiration: the external intercostal, the internal intercostal, and
The innermost intercostal muscle,
(External intercostal - forms the most superficial layer. Its fibers are directed downward and forward from the
inferior border of the rib above to the superior border of the rib below)

(Innermost intercostal muscle is lined internally by the endothoracic fascia, which is lined internally by the parietal
pleura. Forms the deepest layer and corresponds to the transversus abdominis muscle in the anterior abdominal
wall)

Nerve Supply
The intercostal nerves and blood vessels arranged in the following order from above downward: intercostal
vein, intercostal artery, and intercostal nerve (i.e., VAN)
Intercostal Arteries and Veins:
 Posterior intercostal arteries of the first two spaces are branches from the superior intercostal
artery, a branch of the costocervical trunk of the subclavian artery. The posterior intercostal
arteries of the lower nine spaces are branches of the descending thoracic aorta Diaphragm
 Anterior intercostal arteries of the first six spaces are branches of the internal thoracic artery. The
anterior intercostal arteries of the lower spaces are branches of the musculophrenic artery, one of
the terminal branches of the internal thoracic artery
Intercostal Nerves
- are the anterior rami of the first 11 thoracic spinal nerves

Diaphragm
- thin muscular and tendinous septum that separates the chest cavity above from the abdominal cavity
below
- is the most important muscle of respiration. It is dome shaped and consists of a peripheral muscular part,
which arises from the margins of the thoracic opening, and a centrally placed tendon
Three parts:
A sternal part - arising from the posterior surface of the xiphoid process
A costal part- arising from the deep surfaces of the lower six ribs and their costal cartilages
A vertebral part - arising by vertical columns or crura and from the arcuate ligaments
- Diaphragm curves up into right and left domes, or cupulae. The right dome reaches as high as the upper
border of the 5th rib, and the left dome may reach the lower border of the 5th rib.
 The domes support the right and left lungs, whereas the central tendon supports the heart.
 The diaphragm is lower when a person is sitting or standing; it is higher in the supine position and after a large
meal.
 When seen from the side, the diaphragm has the appearance of an inverted J, the long limb extending up from
the vertebral column and the short limb extending forward to the xiphoid process
Nerve Supply of the Diaphragm
Motor nerve supply: The right and left phrenic nerves (C3, 4, 5).
Sensory nerve supply:

Action of the Diaphragm

On contraction, the diaphragm pulls down its central tendon and increases the vertical diameter of the thorax.
Pleurae
The pleurae and lungs lie on either side of the mediastinum within the chest cavity two parts:
 Parietal layer- lines the thoracic wall, covers the thoracic surface of the diaphragm and the lateral aspect of the
mediastinum and extends into the root of the neck to line the undersurface of the suprapleural membrane at
the thoracic outlet
 Visceral layer - it completely covers the outer surfaces of the lungs and extends into the depths of the interlobar
fissures

 To allow for movement of the pulmonary vessels and large bronchi during respiration, the pleural cuff hangs
down as a loose fold called the pulmonary ligament

 Parietal and visceral layers of pleura are separated from one another by a slitlike space, pleural cavity/ space

 The pleural cavity normally contains a small amount of tissue fluid, the pleural fluid, which covers the surfaces
of the pleura as a thin film and permits the two layers to move on each other with the minimum of friction

Costal pleura - lines the inner surfaces of the ribs, the costal cartilages, the intercostal spaces, the sides of the
vertebral bodies, and the back of the sternum.
Diaphragmatic pleura - covers the thoracic surface of the diaphragm

 In quiet respiration, the costal and diaphragmatic pleurae are in apposition to each other below the lower
border of the lung. In deep inspiration, the margins of the base of the lung descend, and the costal and
diaphragmatic pleurae separate.
 This lower area of the pleural cavity into which the lung expands on inspiration is referred to as the
Costodiaphragmatic recess
- are slitlike spaces between the costal and diaphragmatic parietal pleurae that are separated only by a
capillary layer of pleural fluid.
- In inspiration, the lower margins of the lungs descend into the recesses.
- During expiration, the lower margins of the lungs ascend so that the costal and diaphragmatic pleurae
come together again

Mediastinal pleura - covers and forms the lateral boundary of the mediastinum

 During full inspiration, the lungs expand and fill the pleural cavities. However, during quiet inspiration, the lungs
do not fully occupy the pleural cavities at four sites: the right and left costodiaphragmatic recesses and the right
and left costomediastinal recesses

Nerve Supply of the Pleura

■ The costal pleura is segmentally supplied by the intercostal nerves.
■ The mediastinal pleura is supplied by the phrenic nerve.
■ The diaphragmatic pleura is supplied over the domes by the phrenic nerve and around the periphery by the lower six
intercostal nerves.

Trachea
- is a mobile cartilaginous and membranous tube
- It begins in the neck as a continuation of the larynx at the lower border of the cricoid cartilage at the
level of the 6th cervical vertebra.
- It ends below at the carina by dividing into right and left principal (main)
  Blood Supply of the Trachea
The upper two thirds are supplied by the inferior thyroid arteries and the lower third is supplied by the bronchial
arteries.
 Lymph Drainage of the Trachea
The lymph drains into the pretracheal and paratracheal lymph nodes and the deep cervical nodes.

 Nerve Supply of the Trachea

The sensory nerve supply is from the vagi and the recurrent laryngeal nerves. Sympathetic nerves supply the trachealis
muscle

Bronchi
-The trachea bifurcates behind the arch of the aorta into the right and left principal (primary or main) bronchi
- Bronchi divide dichotomously, giving rise to several million terminal bronchioles that terminate in one or more
respiratory bronchioles.
- Each respiratory bronchiole divides into 2 to 11 alveolar ducts that enter the alveolar sacs.

 Principal Bronchi
Right principal (main) bronchus, is wider, shorter, and more vertical than the left, about 1 in. (2.5 cm) long.
 Before entering the hilum of the right lung, the principal bronchus gives off the superior lobar bronchus.
 On entering the hilum, it divides into a middle and an inferior lobar bronchus

Left principal (main) bronchus is narrower, longer, and more horizontal than the right and is about 2 in. (5 cm) long.
 It passes to the left below the arch of the aorta and in front of the esophagus.
 On entering the hilum of the left lung, the principal bronchus divides into a superior and an inferior lobar
bronchus.

LUNGS
Apex- which projects upward into the neck for about 1 in. (2.5 cm) above the clavicle;
Base- concave that sits on the diaphragm;
Costal surface - a convex which corresponds to the concave chest wall; and a
Mediastinal surface- concave which is molded to the pericardium and other mediastinal structures

At about the middle of this surface is the hilum, a depression in which the bronchi, vessels, and nerves that
form the root enter and leave the lung.
The anterior border is thin and overlaps the heart; it is here on the left
lung that the cardiac notchis found.

 Right Lung
- is slightly larger than the left and is divided by the oblique and
horizontal fissures into three lobes:

Oblique fissure - runs from the inferior border upward and backward
across the medial and costal surfaces until it cuts the posterior border
about 2.5 in. (6.25 cm) below the apex.

Horizontal fissure - runs horizontally across the costal surface at the

level of the 4th costal cartilage to meet the oblique fissure in the
midaxillary line

; Thus middle lobe is small triangular lobe bounded by the horizontal

and oblique fissures
  Left Lung
- is divided by a similar oblique fissure into two lobes: the upper and lower lobes.
- There is no horizontal fissure in the left lung.

Bronchopulmonary Segments
- are the anatomic, functional, and surgical units of the lungs.
Each lobar (secondary) bronchus, which passes to a lobe of the lung, gives off branches called segmental (tertiary)
bronchi.
Each segmental bronchus passes to a structurally and functionally independent unit of a lung lobe called a
bronchopulmonary segment, which is surrounded by connective tissue.
The segmental bronchus is accompanied by a branch of the pulmonary artery, but the tributaries of the pulmonary veins
run in the connective tissue between adjacent bronchopulmonary segments.

As the bronchi become smaller, the U-shaped bars of cartilage found in the trachea are gradually replaced by irregular
plates of cartilage, which become smaller and fewer in number. The smallest bronchi divide and give rise to
bronchioles, which are <1 mm in diameter. (Bronchioles possess no cartilage in their walls and are lined with columnar
ciliated epithelium.)

Respiratory bronchiole - terminal bronchioles, where gaseous exchange between blood and air takes place.
- The diameter of a respiratory bronchiole is about 0.5 mm
- End by branching into alveolar ducts, which lead into tubular passages with numerous thin-walled out
pouchings called alveolar sacs.

The main characteristics of a bronchopulmonary segment may be summarized as follows:

■ ■ It is a subdivision of a lung lobe.
■ ■ It is pyramid shaped, with its apex toward the lung root.
■ ■ It is surrounded by connective tissue.
■ ■ It has a segmental bronchus, a segmental artery, lymph vessels, and autonomic nerves.
■ ■ The segmental vein lies in the connective tissue between adjacent bronchopulmonary segments.
■ ■ Because it is a structural unit, a diseased segment can be removed surgically

The main bronchopulmonary segments are as follows:

■ ■ Right lung
Superior lobe: Apical, posterior, anterior
Middle lobe: Lateral, medial
Inferior lobe: Superior (apical), medial basal, anterior basal, lateral basal, posterior basal
■ ■ Left lung
Superior lobe:Apical, posterior, anterior, superior lingular, inferior lingular
Inferior lobe:Superior (apical), medial basal, anterior basal, lateral basal, posterior basal

Blood Supply of the Lungs

From the bronchial arteries, which are branches of the descending aorta.
The bronchial veins (which communicate with the pulmonary veins) drain into the azygos and hemiazygos veins.

Alveoli receive deoxygenated blood from the terminal branches of the pulmonary arteries.
The oxygenated blood leaving the alveolar capillaries drains into the tributaries of the pulmonary veins, which follow
the intersegmental connective tissue septa to the lung root. Two pulmonary veins leave each lung root to empty into
the left atrium of the heart

Lymph Drainage of the Lungs

-originate in superficial and deep plexuses they are not present in the alveolar walls.
  Superficial (subpleural) plexus - lies beneath the visceral pleura and drains over the surface of the lung toward
the hilum, where the lymph vessels enter the bronchopulmonary nodes.
 Deep plexus - travels along the bronchi and pulmonary vessels toward the hilum of the lung, passing through
pulmonary nodes
All the lymph from the lung leaves the hilum and drains into the tracheobronchial nodes and then into the
bronchomediastinal lymph trunks.

Nerve Supply of the Lungs

- Efferent and afferent autonomic nerve fibers. The plexus is formed from branches of the sympathetic trunk and
receives parasympathetic fibers from the vagus nerve.