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Osteology

Osteology cont’d
Deformities of the thoracic wall
• Pectus Excavatum:
Sunken Chest (Funnel
chest), deep dent in
the anterior chest
cavity from MRI.
• Pectus Carinatum:
Breast protrudes
outward.
Thoracic Wall
Surface Anatomy and Surface Bony Landmarks

• Bony Landmarks for


Heart Auscultation:
• Aortic Valve
• 2nd right intercostal
spce
• Pulmonary Valve
• 2nd left intercostal
space
• Tricuspid Valve
• 4th left intercostal
space
• L. Sternal border
• Mitral Valve
• 5th left intercostal
space
• mid-clavicular line

LINDA ANN YACONE-MORTON RN, BS, CCRN


Joints of Thoracic Wall
Joint Connection Type Movement
Joints of Thoracic Wall cont’d
Joint Connection Type Movement
Muscles of Thoracic wall
Muscles of Thoracic wall cont’d
Arteries of Thoracic wall
R. Common Carotid a.
R. Brachiocephalic a.
R. Subclavian a.
L. Common Carotid a.
Anastamoses with anterior
Costocervical trunk Superior Intercostal a.
Intercostal aa.

Anterior Intercostal a.
L. Subclavian a. (space 1-6)
Aorta

Anterior Intercostal a.
Musculophrenic a.
Internal Thoracic a. (spaces 7-9)

Supply Serratus
Lateral Thoracic a.
anterior m.
Axillary a.
Supply skin, breast
Superior Thoracic a.
tissue

Thoracic or Posterior Intercostal a. (Space 3-11) Supply Majority of the thoracic muscles.
Descending Aorta
Subcostal a. ("space " 12)
Veins of Thoracic wall

Internal Jugular v.
Superior Vena Cava

Brachialcephalic v.
Anterior Intercostal
Subclavian v. Internal Thoracic v.
v.

Posterior Intercostal v..


(1-11)
Azygous Venous
System
Subcostal v. (12)
Innervation of Thoracic wall
Thoracic Wall
Intercostal Space Structures

Intercostal Space
• From superficial to deep
• External Intercostal
muscle
• Internal Intercostal
muscle
• Neurovascular bundle
(costal groove)
• Intercostal
• Vein
• Artery
• Nerve
• Collaterals
• Innermost Intercostal
muscle
• Endothoracic fascia
• Parietal Pleura
RENDINA & CICCONE, Thorac Surg Clin 17 (2007) 491–501
Trachea
Lung
A A

S S

M
L
L
R L

Primary Bronchus
© Sobotta Atlas
• Blood Supply: Pulmonary + Bronchial a./ v.
• Innervation: Pulmonary Plexus
• Sympathetic: bronchodilation, lung smooth muscle
• Parasympathetic (Vagus n.): bronchoconstriction
Normal Respiration
Pneumothorax
Open Pneumothorax Tension Pneumothorax

© 2008 Thieme Publishers


Content + Borders of Mediastinum

Superior Border: Thoracic inleft, Root of Neck

Anterior Border: Sternum


Superior Mediastinum:
Aorta (Ascending, Arch, Descending aorta), Great Veins,
Trachea, Esophagus, Thoracic Duct (Lymph),
Posterior Border: Vertebral Column

Vagus n., Phrenic n.

Posterior Middle
Mediastinum: Mediastinum:
Esophagus Pericardium
Heart

Inferior Border: Diaphragm


Esophagus
Branches of Aorta

Brachiocephalic a. R. Subclavian a.

L. Common Carotid a. R. Common Carotid a.


Ascending Arch of
Aorta Aorta
L. Subclavian a.
Thoracic (Descending) Abdominal Aorta
Aorta (aortic opening of diaphragm)
Venous Drainage into heart
L. Internal Jugular v.

Left Brachiocephalic v. L. Subclavian v.

(Thoracic Duct)

R. Internal Jugular v.
Right Brachiocephalic v.
Superior Vena Cava R. Subclavian v.

Accessory
Hemiazygos v. 5-8 L. intercostal v.

Azygos v. 9-11 L. Intercostal v.


Hemiazygos v.
12 L. Subcostal v.

2-12 R. Intercostal v. + Subcostal v.


Structures of the Heart
Ductus Arteriosus -
Ligamentum Arteriosum

Foramen Ovale - Fossa Ovalis

© 2008 Thieme Publishers


Left Coronary
Circumflex

Right Coronary

Anterior Interventricular
(Left Anterior Descending - LAD)

Marginal
© Dynamic Human Anatomy LWW
Blood Supply of Heart
Anterior Cardiac V. R. Atrium

Anterior Right
Aortic Coronary Marginal R. Small
Sinus a. Branch Ventricle Cardiac v
R. AV
Groove
R. Posterior
Both Middle Coronary
Asce. Interventricular
Ventricle Cardiac v. sinus
Branch
Aorta

L. Anterior Anterior
Great Coronary
Interventricular aspect of
Left Cardiac V. sinus
Left Branch ventricles
Posterior L. AV
Coronary
Aortic Groove Left
a.
Sinus L. Circumflex Atrium Small Coronary
Branch and Cardiac v. Sinus
Ventricle
Nerve Supply of Heart
Increase HR
Cervical/ Upper Thoracic
Sympathetic Lateral Horn of T1-T6
Ganglia
Increase Contractility

Cardiac Plexus/ Wall of


Parasympathetic Vagus n. Nuclei (NTS) Decrease HR
Heart

Conduction of Heart
Perkinjie
L. Bundle Branches
Fibers
SA node AV node AV Bundle of His
Perkinjie
R. Bundle Branches
Fibers
Clinical Correlation
Disorder Cause Symptom Treatment
Coronary Artery Atherosclerotic plaque build up in Acute Coronary Syndrome Balloon Angioplasty with
Atherosclerosis coronary a. from an early age. Angina Pectoris Endo-luminal Wall stent.
Non-ST segment Elevation MI
(Coronary Heart Rupture of the plaque results in Arrhythmias Aorto-coronary bypass
Disease) thrombus formation and MI. Valve Dysfunction Graft (using internal
Heart Failure thoracic a.)
**Visualize using Tc Nucleotide
Cardiac stress test (Myocardial
Perfusion Imaging)
Fatal Arrhythmia LAD circulation lost due to thrombosis Sudden Cause
results in decreased perfusion and
ischemia of most of the Left Heart
Pulmonary 1. Deep Vein Thrombosis of the  Pulmonary Infarction
Embolism lower extremites  Increased resistance to
2. DVT of pelvis veins Pulmonary blood flow
3. DVT of upper extremites  Right ventricular strain and
4. Hypercoagulable state due to failure.
malignancy, pregnancy, smoking,  Pulmonary vasoconstriction
Factor V Leiden. secondary to serotonin
 HypotensionShock Death
Pleural Effusion Tension Pneumothorax (fluid build up Collapsed Lung
via on-way fluid entrance.

Pneumonia