Anatomy of the Thorax

Dr. Ahmed Al-Imam

Dept. of Anatomy, Baghdad
College of Medicine, University of Baghdad
Objectives
• To identify muscles in the thoracic wall

• To define the neurovascular plane

• To discuss the diaphragm

• To describe thoracic movements

Skin:
Above the level of the sternal angle, C4 gives cutaneous innervation, whilst
thoracic nerves T2–T11 provide the dermatomes for the remainder of the
thoracic wall. 1st thoracic nerve innervates some of the skin of upper limb
Blood comes from intercostal & internal thoracic arteries
Lymph goes to the anterior group of axillary nodes
Muscles:
External intercostal muscle: (11 pair)
-Arise from the sharp lower border of the rib to the upper border of the rib below
-Fibers directed antero-iferiorly
-Being along the rib axis its contraction initiates inspiration by elevating the ribs
-Replaced by the external intercostal membrane between costal cartilages
-Supplied by the corresponding intercostal nerves
Internal intercostal muscle: (11 pair)

-Lies deep to external intercostal

-Being perpendicular to the rib axis, their contraction compresses the thorax (expiratory)

-Between the costal angle & neck, they are replaced by the internal intercostal membrane

-Supplied by the corresponding intercostal nerves

Innermost intercostal muscle:
1- Subcostalis:
-Thin flat sheets of muscle fibers lie in the paravertebral gutters
-Characteristically cross more than a space
-Corresponds in direction with the internal intercostal muscle
2- Sternocostalis (Transversus thoracis):
-Arise from the back of the lower 1\2 of the sternum
-Fibers radiate as slips which are inserted into the 2-6 c.c
The neurovascular plane:
-The body wall is trilaminar represented by the three intercostal muscles
-Vessels & nerves of the body wall pass between the inner 2 layers
-The passage plane is the neurovascular plane
Anatomy of the intercostal space:

-The intercostal space contains a

neurovascular bundle (VAN) from
above downwards

-The structures lie within the costal

groove

-The nerve being lowest is

unprotected by the bone

-The intercostal nerve is the anterior

primary ramus of spinal nerves (T1-
T11)
-Each space has an anterior
(double) & posterior (single)
vessels but a single nerve

-Anterior intercostal vessels

arise & terminate in the
internal thoracic system

-Posterior intercostal vessels

arise & terminate in the aortic
& azygos systems
The intercostal nerves:
-The ventral primary rami of the T1-
T11 nerves pass in the intercostal
spaces
-The 12th passes to the posterior
abdominal wall (subcostal nerve)
-T1 is a small nerve & has no
lateral cutaneous br.
-T1-T6 are distributed to the thorax
-T7-T12 are distributed to the
abdomen
-Branches of intercostal nerves:
1- Collateral branch (mainly motor)
2- Lateral cutaneous branch
3- Anterior cutaneous branch
The internal thoracic artery:

-Arises from the 1st part of subclavian artery

-Descends on each side of the sternum giving

the anterior intercostal arteries in the upper
six spaces

-Ends in the 6th intercostal space by dividing

into superior epigastric & musculophrenic
arteries
-The superior epigastric enters the abdominal
wall

-The musculphrenic passes deep to costal

margin & give the remaining anterior intercostal
arteries

-Those of the 2nd, 3rd & 4th spaces supply the

mammary gland by perforating branches
Posterior intercostal arteries:

-The upper 2 arise from the

costo-cervical trunk (2nd part of
subclavian)

-The lower 9 arise from the sides

of the thoracic aorta

-At the rib angle each divides

into posterior & anterior
branches accompany posterior &
anterior rami respectively
Veins:

The only difference from arteries in the posterior

intercostal veins:

-Highest IV (1st PIV) drains to brachiocephalic or

vertebral veins

-Superior IV (2nd + 3rd PIV) drain on the left to

BCV & on the right to azygos veins
Lymphatic drainage of the chest wall:

1- The sternal (internal thoracic) nodes:

-Along internal thoracic artery

-Afferent; medial part of the chest wall,

breast & upper abdominal wall

-Efferent; to the mediastinal lymph trunk

2- The intercostal nodes:

-Near the costal heads in each space

-Afferent; back of the chest wall medially

-Efferent; Upper nodes to the

jugulosubclavian venous confluence,
lower nodes to cisterna chyli
3- The phrenic nodes:

-Anterior, middle & posterior groups

-Afferent; Lower thorax & upper abdomen

-Efferent; Anterior to internal thoracic nodes,

posterior to intercostal nodes & the medial
both ways

4- Axillary nodes:

-Pectoral group; from anterior body wall

above umbilicus & mammary gland

-Scapular group; from posterior body wall

-Both drain to the central axillary nodes

The diaphragm:
A sheet of internal skeletal
muscle that extends across
the bottom of the rib cage.
The diaphragm separates the
thoracic from the abdominal
cavity
Diaphragm performs many
important functions, the most
important is respiration.
Origin:
Trace the ring shaped origin from 5
behind forward:
1-crura: arise from upper three lumbar
vertebrae
4 4
2- Arcuate ligaments:
-Are thickenings in the fascia of
posterior abdominal wall
-Medial AL lies anterior to psoas major
2 2
1 1
while lateral AL lies against quadratus
3 3
lumborum

3- The tip of twelfth rib

4- The inside inside of the costal
margin
5- The xiphisternum
Insertion:
Fibers ascend & then descend in the
direction of the central tendon which looks
like tripple-headed leaf

Openings:
1- Caval: T8 , on the Rt of the central
tendon
2- Oesophageal: T10, in the fibers of the Lt
crus
3- Aortic: T12, in between the 2 crura
Other structures like the azygos veins,
thoracic duct, splanchnic nerves … pass
with these main structures
Blood supply:
1- Pericardiacophrenic a.
2- Superior phrenic branches of thoracic
aorta
3- Inferior phrenic branches of abdominal
aorta

Nerve supply:
Phrenic nerves
Appearance:
-J shape in lateral view
-Kidney shape in superior view
-The diaphragm balloons superiorly, on both
the right and left sides, to form domes. The
right dome is higher (5th rib)
Movements:
-As the diaphragm contracts, the height of the domes decreases and the volume
of the thorax increases.
-The esophagus and IVC penetrate the diaphragm while the aorta passes posterior
to it (accomodates the physiology of respiration)