Anatomy of Thorax

BY
DR. LALNUNMAWII (MPT)
ASSISTANT PROFESSOR
USTM
 Introduction

Thorax (Latin chest) forms the upper part of the

trunk of the body.
The trunk of the body is divided by the diaphragm
into an upper part, called the thorax, and a lower
part,called the abdomen.
The thoracic cavity contains the principal organs of
respiration- the lungs and of circulation-the heart,
both of which are vital for life.
 SURFACE LANDMARKS OF THORAX

Bony Landmarks
1. Suprasternal or jugular notch : It is felt just above
the superior border of the manubrium between the
sternal ends of the clavicles. It lies at the level of
the lower border of the body of the second thoracic
vertebra. The trachea can be palpated in this notch.
2. Sternal angle/angle of Louis: It is felt as a
transverse ridge about 5 cm below the suprasternal
notch.
Sternal angle/angle of Louis
It marks the manubriosternal joint, and lies at the
level of the second costal cartilage anteriorly,
 and the disc between the fourth and fifth thoracic
vertebrae posteriorly. This is an important
landmark for the following reasons.
a) The ribs are counted from this level downwards.
b) The second costal cartilage and second rib lie at
the level of the sternal angle or angle of Louis
c) It marks the plane which separates the superior mediastinum from
the inferior mediastinum.
d) The ascending aorta ends at this level.
e) The arch of the aorta begins and also ends at this level.
f) The descending aorta begins at this level.
g) The trachea divides into two principal bronchi.
h) The azygos vein arches over the root of the right lung and opens into
the superior vena cava.
i) The pulmonary trunk divides into two pulmonary arteries just below
this level.
j) The thoracic duct crosses from the right to the left side at the level of
the fifth thoracic vertebra and reaches the left side at the level of the
sternal angle.
k) It marks the upper limit of the base of the heart.
l) The cardiac plexuses are situated at the same level.
3. Xiphisternal joint: The costal margin on each
side is formed by the seventh to tenth costal
cartilages. Between the two costal margins, there
lies the infrasternal or subcostal angle. The
depression in the angle is also known as the
epigastric fossa.
The xiphoid (Greek sword) process lies in the floor
of the epigastric fossa. At the apex of the angle, the
xiphisternal joint may be felt as a short transverse
ridge. It lies at the level of the upper border of the
ninth thoracic vertebra.
4. Costal cartilages: The second costal (Latin rib)
cartilage is attached to the sternal angle. The
seventh cartilage bounds the upper part of the
infrasternal angle. The lateral border of the rectus
abdominis or the linea semilunaris joins the
costal margin at the tip of the ninth costal
cartilage. The tenth costal cartilage forms the
lower part of the costal margin
5. Ribs: The scapula overlies the second to seventh
ribs on the posterolateral aspect of the chest wall.
The tenth rib is the lowest point, lies at the level
of the third lumbar vertebra. Though the eleventh
rib is longer than the twelfth, both of them are
confined to the back and are not seen from the
front (Fig. 12.2).
6. Thoracic vertebral spines: The first prominent
spine felt at the lower part of the back of the neck
is that of the seventh cervical vertebra or
vertebra prominens. Below this spine, the
thoracic spines can be palpated along the
posterior median line (Fig. 12.3). The third
thoracic spine lies at the level of the roots of the
spines of the scapulae. The seventh thoracic spine
lies at the level of the inferior angles of the
scapulae.
 Soft Tissue Landmarks

1. The nipple: The position of the nipple varies

considerably in females, but in males it usually lies
in the fourth intercostal space about 10 cm from
the midsternal line (Fig. 12.4).
2. Apex beat: It is a visible and palpable cardiac
impulse in the left fifth intercostal space 9 cm from
the midstenal line, or medial to the midclavicular
line.
3. Trachea: It is palpable in the suprasternal notch
midway between the two clavicles.
4. Midclavicular or mammary plane: It is a vertical
plane passing through the midinguinal point, the
tip of the ninth costal cartilage and middle of
clavicle (Fig. 12.5) .
5. Midaxillary line: It passes vertically between the
two folds of the axilla (Fig. 12.5).
6. Scapular line: It passes vertically along the in
ferior angle of the scapula.
 SKELETON OF THORAX

also known as the thoracic cage.

It is an osseocartilaginous elastic cage which is
primarily designed for increasing and decreasing the
intrathoracic pressure, so that air is sucked into the
lungs during inspiration and expelled during
expiration.
 FORMATION

Anteriorly, by the sternum

Posteriorly, by the 12 thoracic vertebrae and the
intervening intcrvertebral discs
On each side, by 12 ribs with their cartilages.
Each rib articulates posteriorly with the vertebral
column.
 Anteriorly, only the upper seven ribs articulate with
the sternum through their cartilages and these are
called True or vertebrosternal ribs.
the next three ribs, i.e. the eighth, ninth and tenth
end by joining the next higher costal cartilage.
These ribs are, therefore, known as
vertebrochondral ribs.
The anterior ends of the eleventh and twelfth ribs
are free: These are called floating or vertebral ribs.
The vertebrochondral and vertebral ribs, i.e. the
last five ribs, are also called false ribs because they
do not articulate with the sternum.
SHAPE:
The thorax resembles a truncated cone which is
narrow above and broad below
The narrow upper end is continuous with the root of
the neck from which it is partly separated by the
suprapleural membrane or Sibson's fascia.
The broad or lower end is almost completely
separated from the abdomen by the diaphragm
which is deeply concave downwards.
In transverse section, the thorax is reniform
(beanshaped,or kidney-shaped). The transverse
diameter is greater than the anteroposterior
diameter. However,in infants below the age of two
years, it is circular. In quadrupeds, the
anteroposterior diameter is greater than the
transverse
 SUPERIOR APERTURE/INLET OF THORAX

The narrow upper end of the thorax, which is continuous

with the neck, is called the inlet of the thorax.
It is kidney-shaped.
 Its transverse diameter is 10-12.5 cm.
The anteroposterior diameter is about 5 cm.
Boundaries:
Anteriorly: Upper border of the manubrium sterni.
Posteriorly: Superior surface of the body of the first
thoracic vertebra.
On each side: First rib with its cartilage.
Partition at the Inlet of Thorax:
The partition is in two halves, right and left, with a
cleft in between.
Each half is covered by a fascia, known as Sibson's
fascia or suprapleural membrane. It partly
separates the thorax from the neck.
The membrane is triangular in shape.
Its apex is attached to the tip of the transverse
process of the seventh cervical vertebra and the base
to the inner border of the first rib and its cartilage.
formed by scalenus minimus and endothoracic fascia.
it provides rigidity to the thoracic inlet
The inferior surface of the membrane is fused to the
cervical pleura, beneath which lies the apex of the
lung. Its superior surface is related to the subclavian
vessels and other structures at the root of the neck.

Structures Passing through the Inlet of

Thorax:

Viscera-
Trachea, oesophagus, apices of the lungs with
pleura, remains of the thymus.
Large Vessels-
Brachiocephalic artery on right side.
Left common carotid artery and the left subclavian
artery on the left side. Right and left
brachiocephalic veins.
Smaller Vessels-
1 Right and left internal thoracic arteries.
2 Right and left superior intercostal arteries.
3 Right and left first posterior intercostal veins.
4 Inferior thyroid veins.
Smaller Vessels-
1 Right and left internal thoracic arteries.
2 Right and left superior intercostal arteries.
3 Right and left first posterior intercostal veins.
4 Inferior thyroid veins.
Nerves-
1 Right and left phrenic nerves.
2 Right and left vagus nerves.
3 Right and left sympathetic trunks.
4 Right and left first thoracic nerves as they ascend cross the
first rib to join the brachial plexus.
Muscles
Sternohyoid, sternothyroid and longus colli.
 INFERIOR APERTURE/OUTLET OF THORAX

The inferior aperture is the broad end of the thorax

which surrounds the upper part of the abdominal
cavity, but is separated from it by the diaphragm.
Boundaries
Anteriorly: Infrasternal angle between the two
costal margins.
Posteriorly: Inferior surface of the body of the
twelfth thoracic vertebra.
On each side: Costal margin formed by the
cartilages of seventh to twelfth ribs.
Diaphragm at the Outlet of Thorax
The outlet is closed by a large musculotendinous
partition, called the diaphragm-the
thoracoabdominal diaphragm- which separates the
thorax from the abdomen.
Structures Passing through the Diaphragm-
There are three large and several small openings in
the diaphragm which allow passage to structures
from thorax to abdomen or vice versa
Large openings:
1. vena caval opening in the central tendon
2. oesophageal opening in the right crus of
diaphragm
3. aortic opening behind the median arcuate
ligament.
Small openings:
1. Superior epigastric artery
2. Musculophrenic artery
3. Lower 5 intercostal vessels and nerves
4. Subcostal vessels and nerves pass
5. Sympathetic trunk
6. Greater and lesser splanchnic nerves