Thoracic cavity

It is the region of the body between the neck and the abdomen.
It is bounded by 12 pairs of ribs, vertebrae and sternum. It
contains trachea, two lungs, heart and great vessels, esophagus
and lymph
nodes. There are two openings of the thorax, the superior thoracic
opening which is also called thoracic inlet and inferior thoracic
opening. Head and neck and upper limbs are attached with the
thoracic cavity through thoracic inlet. Inferior thoracic opening
opens into the abdominal cavity.
Structure of the Thoracic wall
It is covered by skin and muscles. These are attached to
the skeletal part of the thoracic wall.
The thoracic wall is formed posteriorly by the thoracic part
of the vertebral column, anteriorly by the sternum and
costal cartilages, laterally by the ribs and intercostal spaces,
superiorly by the suprapleural membrane and inferiorly by
the diaphragm.
Muscles of the chest wall
Intercostal muscles (External, internal and innermost)
Pectoralis major muscles
Pectoralis minor muscles
Serratus anterior
Rectus abdominis
External oblique
Internal oblique
Transversus thoracis
Transversus abdominus
Latissimus dorsi
Trapezius
Levatores Costarum (12 pairs)
Serratus Posterior Superior Muscle
Serratus Posterior Inferior Muscle
Bones of the thoracic wall

(1) Sternum
(2) Ribs (12 pairs)
(3) Vertebrae (thoracic)
Sternum
It is a flat bone which lies in the midline of anterior chest
wall.
Parts
Manubrium sterni, It Lies opposite T3,T4.
Body, It lies opposite to T5 to T8.
Xiphoid process, T9.
The manubrium has the facet for the first costal cartilages
and a facet for the clavicle. The facet for second costal
cartilage occur at the sternal angle. The remaining costal
cartilages fuses at sternal body.
Rib
It is a long, flattened and twisted bone makes a cage like
structure around the thoracic cavity.
There are 12 pairs of ribs all of which are attached
posteriorly to the thoracic vertebrae and anteriorly to the
sternum through costal cartilages.
Ribs are divided into three categories,
True ribs: Upper 7 pairs, attached directly to sternum
through their costal cartilages.
False ribs: 8th, 9th and 10th pairs, attached to each other and
then to sternum.
Floating ribs: the 11th and 12th pair has no anterior
attachment.
On the basis of structure the ribs are of two types,

(1) Typical rib (ribs no 2-9)

It is a long, twisted, flat bone having a rounded, smooth

superior border and a sharp, thin inferior border. The
inferior border overhangs and forms the costal groove,
which accommodates the intercostal vessels and nerve.

The anterior end of each typical rib is attached to the

corresponding costal cartilage.
It has a head, neck, tubercle, shaft, and angle. The head has
two facets for articulation with the numerically
corresponding vertebral body and that of the vertebra
immediately above.
The neck is a constricted portion situated between the head
and the tubercle. The tubercle is a prominence on the outer
surface of the rib at the junction of the neck with the shaft.
The shaft is thin and flattened and twisted on its long axis. Its
inferior border has the costal groove. The angle is where the
shaft of the rib bends sharply forward.
(2) Atypical ribs (Ribs no 1,10,11,12)
Some ribs varies in structure than the typical ribs which are called atypical
ribs.
The 1st rib is an example of atypical rib. It 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. This rib is small and
flattened from above downward. The scalenus anterior muscle is attached to its
upper surface and inner border. Anterior to the scalenus anterior, the subclavian
vein crosses the rib, posterior to the muscle attachment, the subclavian artery
and the lower trunk of the brachial plexus cross the rib and lie in contact with
the bone.
Costal Cartilages
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.
The cartilages of the 11th and 12th ribs end in the
abdominal musculature.
The costal cartilages contribute significantly to the
elasticity and mobility of the thoracic walls. In old age, the
costal cartilages tend to lose some of their flexibility as the
result of superficial calcification
Thoracic vertebrae
It makes the axial part of the poster chest wall. They are
12 in number. The thoracic vertebrae may be typical and
atypical. The typical thoracic vertebrae has structure of a
common vertebrae while the structure of atypical vertebrae
is somewhat changed from the typical.
Atypical (Non typical ) thoracic vertebrae.
1st, 10th,11th and 12th
T1
Has a complete facet.
One very small inferior demifacet.
Spine nearly horizontal
Has costal facet in transverse process for the tubercle of
first rib.
It has a small body, looks like a cervical vertebra.
T10
One complete facet with the upper border
Small costal facet on transverse process.
T11
One complete circular facet away from upper border.
No costal facet
T12
Broad body & short, oblong spine.
One complete facet midway between upper & lower borders.
No costal facet
Intercostal Spaces
The space between two adjacent ribs is called intercostal space.
There are 9 anterior and 11 posterior intercostal spaces.
Each space contains:
1- Intercostal muscles: External, Internal and innermost.
2- An Intercostal nerve.
3- Intercostal vessels:
a. Intercostal arteries
Anterior & Posterior.
b. Intercostal veins
Anterior & Posterior.
The intercostal nerves, veins and arteries runs near the lower border of the rib in the
following manner from above below,
Vein, Artery and Nerve (VAN). The innermost intercostal muscles are covered by
endothoracic fascia, which is lined internally by the parietal pleura.
Intercostal Muscles

(1) External intercostal muscle

It 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.
The muscle extends forward to the costal cartilage where
it is replaced by an aponeurosis, the anterior (external)
intercostal membrane.
It elevates the rib during inspiration.
(2) Internal intercostal muscle
It forms the intermediate layer.
Its fibers are directed downward and backward from the
subcostal groove of the rib above to the upper border of the
rib below.
The muscle extends backward from the sternum in front
to the angles of the ribs behind, where the muscle is replaced
by an aponeurosis, the posterior (internal) intercostal
membrane.
It depresses the rib downwards during expiration
(3) Innermost intercostal muscle
It forms the deepest layer of the thoracic wall.
It is an incomplete muscle layer and crosses more than one
intercostal space within the ribs.
It is related internally to fascia (endothoracic fascia) and
parietal pleura and externally to the intercostal nerves and
vessels.
It is formed of 3 muscles
1- Innermost Intercostal.
2- Sternocostalis.
3- Subcostalis
Joints of the thoracic wall

Joints of the Sternum

Manubriosternal joint
Between the manubrium and the body of the
sternum.
Xiphisternal joint
Between xiphoid process and the body of the
sternum.

Joints of the Ribs and Costal Cartilages

These joints are cartilaginous joints.
No movement is possible.
Joints of the Costal Cartilages with the Sternum
The 1st costal cartilages articulate with the manubrium
through cartilaginous joints.
The 2nd to 7th costal cartilages articulate with the lateral
border of the sternum by synovial joints.
In addition, the 6th, 7th, 8th, 9th, and 10th costal cartilages
articulate with one another along their borders by small
synovial joints.
The cartilages of the 11th and 12th ribs are embedded in the
abdominal musculature.
Joints of the Heads of the Ribs
The 1st rib and the three lowest ribs have a single
synovial joint with their corresponding vertebral body.
For the 2nd to 9th ribs, the head articulates by means of a
synovial joint with the corresponding vertebral body and
that of the vertebra above it.

Joints of the Tubercles of the Ribs

The tubercle of a rib articulates by means of a synovial joint
with the transverse process of the corresponding vertebra.
This joint is absent on the 11th and 12th ribs.
Intercostal Arteries
Each intercostal space contains a large single posterior intercostal
artery and two small anterior intercostal arteries.
The 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.
The anterior intercostal arteries of the first six spaces are branches of
the internal thoracic artery, which arises from the first part of the
subclavian 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.
 Each intercostal artery gives off branches to the muscles,
skin and parietal pleura.
In the region of the breast in the female, the branches to the
superficial structures are particularly large.
Intercostal Veins
2 in each space.
(1) Posterior intercostal veins
It drain backward into the azygos or hemiazygos veins
and (2) Anterior intercostal veins
It drain forward into the internal thoracic and the
musculophrenic veins.
Intercostal nerves
They are the anterior primary rami of spinal thoracic
nerves fromT1 to T11.
Each nerve runs in the Intercostal space inferior to the
Intercostal vessels.
T3 toT6 are called Typical
T12 is called Subcostal
The remaining nerves are called atypical.
These nerves arises from the vertebrae and runs between
the inner and innermost muscles of the intercostal space.
Branches of intercostal nerves
Rami communicantes
connect the intercostal nerve to a ganglion of the sympathetic trunk.
Gray ramus
It joins the nerve medial at the point at which the white ramus leaves it.
Collateral branch
It runs forward inferiorly to the main nerve on the upper border of the rib
below.
lateral cutaneous branch
It reaches the skin on the side of the chest. It divides into an anterior and a
posterior branch.
Anterior cutaneous branch
It is the terminal portion of the main trunk. It reaches the
skin near the midline.
Muscular branches
These runs to the intercostal muscles.
Pleural sensory branches
these branches goes to the parietal pleura.
Peritoneal sensory branches (7th to 11th intercostal nerves
only) they run to the parietal peritoneum.
Suprapleural Membrane
On either side of the structures passing through the
thoracic outlet, a dense fascial layer called the suprapleural
membrane is present.
It is a fibrous sheet and attached laterally to the medial
border of the 1st rib and costal cartilage.
It is attached at its apex to the tip of the transverse process
of the seventh cervical vertebra and medially to the fascia
investing the structures passing from the thorax into the
neck.
It protects the underlying cervical pleura and resists the
changes in intrathoracic pressure occurring during
respiratory movements.
Thank you