Transcript Thorax - 山东大学医学院人体解剖学教研室

Thorax
山东大学医学院 解剖教研室
李振华
The muscles of thorax
Extrinsic muscles
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Pectoralis major
Pectoralis minor
Serratus anterior
Intrinsic muscles
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Intercostales externi 肋间外肌
Intercostales interni 肋间内肌
Intercostales intimi 肋间最内肌
Transverses thoracis 胸横肌
Intercostales externi
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Origin: lower border of riⅡ)
Insertion: upper border of rib
below origin
Action: elevate ribs adding in
forced inspiration
Replaced anteriorly by external
intercostals membrane.
Intercostales interni
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Origin: upper border of rib
Insertion: lower border of rib
above origin
Action: depress ribs for forced
expiration
Replaced posteriorly by
internal intercostals membrane.
Diaphragm膈
Shape and position:
dome-shaped between thorax and
abdomen, consists of a peripheral
muscular part and a central tendon
Origin
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Sternal part: xiphoid process
Costal part: lower six and costal
cartilages
Lumbar part: arises by two crura from
upper 2-3 lumbar vertebrae
Insertion: central tendon
Weak areas: triangular spaces without
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muscular tissue
Lumbocostal triangle: between
costal and lumbar parts.
Sternocostal triangle: between
costal and sternal parts.
Openings in the diaphragm
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Aortic hiatus主动脉裂孔－lies anterior to the body of the
12th thoracic vertebra between the crura. It transmits the
aorta, thoracic duct
Esophageal hiatus 食管裂孔－for esophagus and vagus
nerves at level of T10.
Vena cava foramen 腔静脉孔－for inferior vena cava,
through central tendon at T8 level
T8
T10
T12
Action:
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Contraction: the dome
moving downward,
increases the volume of
thoracic cavity which
results in inspiration, at
the same time the intraabdominal pressure is
increased assists in
defecation, vomiting or
child birth.
Relaxation: the dome
returns to the former
position, reduces the
volume to the thoracic
cavity, resulting in
expiration.
Arteries of thorax
Pulmonary trunk
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Arises from right ventricle
Runs up, back ,and to the left
Bifurcates inferior to aortic arch
into right and left pulmonary
arteries, one for each lung
Pulmonary arteries
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Right pulmonary artery－passes
posterior to ascending aorta and
superior vena cava to hilum of
right lung
Left pulmonary artery－passes
anterior to descending aorta and
left main bronchus to hilum of left
lung
Arterial ligament 动脉韧带－ remnant of ductus arteriosus, connects
bifurcation of pulmonary trunk to inferior border of aortic arch
Triangule of ductus arteriosus 动脉导管三角
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Bounded by phrenic n., left vagus n. and left pulmonary a.
Contents－ arterial ligament , left recurrent n. and superficial
cardiac plexuses
Ascending aorta 升主动脉
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Runs upward, forward
and to the right,
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Extends to level of
second right sternocostal
joint
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Branches: right and left
coronary arteries
Aortic arch 主动脉弓
Continuation of ascending aorta
Curves upward, to the left and
posteriorly, then downward, arching
over left principal bronchus and
pulmonary trunk to lower border of
T4 level, to become descending
aorta
Branches (from right to left )
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Brachiocephalic trunk－extends to
right sternoclavicular joint, bifurcates
into right subclavian and right
common carotid arteries
Left common carotid artery
Left subclavian artery
Aortic isthmus－baroreceptor
Aortic glomera－chemoreceptor
Thoracic aorta 胸主动脉
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Continuation of aortic arch at lower border of T4
Courses downward on left side of, then in front of
vertebral column
Passes through aortic hiatus of diaphragm at level
of T12 vertebra to enter abdominal cavity
Main branches
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Parietal branches
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Nine pairs posterior intercostals arteries
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One pair subcostal artery
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For lower nine intercostals spaces and
upper part of abdominal wall; superior
phrenic arteries supply the superior
surface of the diaphragm.
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Visceral branches
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Bronchial branches: one or two for each
lung
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Esophageal branches
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Pericardial branches
Internal thoracic artery 胸
廓内动脉－descends into
thorax 1.2cm lateral to
edge of sternum, and
ends at the sixth costal
cartilage by dividing
musculophrenic and
superior epigastric
arteries
Veins of thorax
Brachiocephalic veins
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Formed by union of internal jugular and
subclavian veins posterior to the
sternoclavicular joint
Angle of union is termed venous angle
Superior vena cava
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Formed by union of right and left
brachiocephalic veins behind the right
sternocostal synchorndrosis of first rib
Runs vertically down on right of ascending
aorta
Joined by azygos vein at level of sternal
angle
Enters right atrium at lever of lower border
of third right sternocostal joint
Collects blood from veins of upper half of
body
Azygos vein 奇静脉
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Begins as continuation of right
ascending lumbar vein
Ascending along the right side of
vertebral column
Joins superior vena cava by aching
above right lung root at level of T4 to
T5
Receives right posterior intercostals
and subcostal veins plus some of
bronchial, esophageal and pericardial
veins, and hemiazygos vein
Tributaries－hemiazygosv.半奇静脉
and accessory hemiazygos v. 副半奇
静脉, which receive most left posterior
intercostals vein and left bronchial
veins
Veins of vertebral column
Consists of
 External vertebral
venous plexus
 Internal vertebral
venous plexus
The lymphatic drainage of thorax
The lymphatic drainage
of thoracic wall
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To axillary lymph nodes
To parasternal lymph nodes
(along internal thoracic
vessels)
To intercostals lymph nodes
from deeper structures
lymph nodes of the thoracic contents
lymph nodes of trachea,
bronchi and lungs
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Pulmonary lymph nodes肺淋巴结
lie in the angles of bifurcation of
branching lobar bronchi
Bronchopulmonary hilar lymph
nodes支气管肺门淋巴结－lie in the
hilus of the lung
Tracheobronchial lymph nodes
气管支气管淋巴结－situated above or
below the bifurcation of trachea
Paratracheal lymph nodes
气管旁淋巴结－along each side of
the trachea
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Anterior mediastinal
lymph node纵隔前淋巴结
lies anterior to the large blood
vessels of thoracic cavity and
pericardium; the efferents unite
with those of paratracheal lymph
nodes, to form the right and left
bronchomediastinal trunks 支
气管纵隔干. The left
bronchomediastinal trunk
terminates in thoracic duct, and
right in the right lymphtic duct
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Posterior mediastinal
lymph nodes纵隔后淋巴
结 lie along the esophagus and
thoracic aorta
Thoracic duct 胸导管
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Begins in front of L1 as a dilated sac, the
cisterna chyli乳糜池, which formed by
joining of left and right lumbar trunks and
intestinal trunk
Enter thoracic cavity by passing through
the aortic hiatus of the diaphragm and
ascends along on the front of the vertebral
column, between thoracic aorta and
azygos vein
Travels upward, veering to the left at the
level of T5
At the roof of the neck, it turns laterally
and arches forwards and descends to
enter the left venous angle
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Just before termination, it receives the
left jugular, subclavian and
bronchomediastinal trunks
Drains lymph from lower limbs, pelvic
cavity, abdominal cavity, left side of
thorax, and left side of the head, neck
and left upper limb
Right lymphatic duct 右淋巴导管
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Formed by union of right jugular,
subclavian, and bronchomediastinal
trunks
Ends by entering the right venous
angle
Receives lymph from right half of head,
neck, thorax and right upper limb
Anterior branches of thoracic nerves
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Intercostal nerves 肋间神经 (anterior
rami of T1- T11): runs forward inferiorly
to intercostals vessels in costal groove
of corresponding rib, between
intercostals externi and intercostals
interni; first six nerves are distributed
within their intercostals space, lower
five intercostals nerves leave anterior
ends of their intercostals spaces to
enter abdominal wall
Subcostal nerve 肋下神经 (anterior
ramus of T12): follows inferior border
of T12 rib and passes into abdominal
wall
Distribution: distributed to intercostales
and anterolateral abdominal muscles,
skin of thoracic and abdominal wall,
parietal pleura and peritoneum
The segmental innervation of anterior
surface of trunk
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T2－sternal angle
T4－ nipple
T6－xiphoid process
T8－costal arch
T10－umbilicus
T12－midpoint between
umbilicus and symphysis
pubis
Phrenic nerve 膈神经
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Descends over scalenus
anterior to enter thorax
Accompanied by
pericardiophrenic vessels and
passes anterior to lung roots
between mediastinal pleura
and pericardium to supply
motor and sensory
innervation to diaphragm
Sensory fibers supply to
pleurae, pericardium and
peritoneum of diaphragm;
usually right phrenic nerve
may be distributed on live,
gallbladder and biliary system.
Left vagus nerve 左迷走神经
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Enter thoracic inlet between left
common carotid and left subclavian
arteries, posterior to left
brachiocephalic vein
Crosses aortic arch where left
recurrent laryngeal nerve branches
off
Passes posterior to left lung root
Forms anterior esophageal plexus
Forms anterior vagal trunk at
esophageal hiatus where it leaves
thorax and passes into abdominal
cavity , then divides into anterior
gastric and hepatic branches
Right vagus nerve 右迷走神经
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Enter thoracic inlet on right side
of trachea
Travels downward posterior to
right brachiocephalic vein and
superior vena cava
Passes posterior to right lung
root
Forms posterior esophageal
plexus
Forms posterior vagal trunk at
esophageal hiatus where it
leaves thorax and passes into
abdominal cavity, then divides
into posterior gastric and celiac
branches
Recurrent laryngeal nerves
喉返神经
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Right one hooks around right
subclavian artery, left one hooks
aortic arch
Both ascend in tracheo-esophageal
groove
Nerves enter larynx posterior to
cricothyroid joint, the nerve is now
called inferior laryngeal nerve
Innervations: laryngeal mucosa
below fissure of glottis , all
laryngeal laryngeal muscles except
cricothyroid
Bronchial and esophageal
branches
Thoracic sympathetic trunk
胸交感干
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Branches of sympathetic trunk to
thoracic plexuses
Greater splanchnic nerve 内脏大神经
formed by preganglionic fibers from
T5~T9 ganglia, and relay in celiac
ganglion.
Lesser splanchnic nerve 内脏小神经
formed by preganglionic fibers from
T10~T12 ganglia, and relay in
aorticorenal ganglion.
The postganglionic fibers supply the liver,
spleen, kidney and alimentary tract as far
as the left colic flexure.
Regional anatomy of thorax
山东大学医学院 解剖教研室
李振华
Parts and regions of the thorax
Boundaries
 Superior－jugular notch,
sternoclavicular joint,
superior border of clavicle,
acromion, spinous
processes of C7
 Inferior－xiphoid process,
costal arch, 12th and 11th
ribs, vertebra T12
Regions
 Thoracic wall
 Thoracic cavity
Landmarks
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Jugular notch corresponds with
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The 2th thoracic vertebra in male,
the 3th thoracic vertebra in female
Sternal angle connects 2nd
costal cartilage laterally，
corresponds with
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The lower border of 4th thoracic
vertebra
The bifurcation of trachea in the
adult
The beginning of aortic arch which
ends posteriorly at the same level
The esophagus is crossed by the
left main bronchus
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Xiphoid process－phisternal
junction lies opposite the
body of the 9th thoracic
vertebra
Clavicle
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Ribs and intercostal spaces
Costal arch
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Inferior fossa of clavicle
Coracoid process
Infrasternal angle
Xiphocostal angle
Papillae
Thoracic wall
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Skin
Superficial fascia
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Thoracoepigastric v.
Supraclavicular n.
Anterior and lateral
cutaneous branches of
intercostal n.
Deep fascia
Intercostal space
Posterior intercostal v.
Posterior intercostal a.
Intercostal n.
Lymphatic drainage of breast
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Into pectoral ln. from lateral and
central parts of breast
Into apical and supraclavicular ln.
from superior part of breast
Into parasternal ln. from medial
part of breast
Into interpectoral ln. from deep
part of breast
The lymphatic capillaries of breast
form an anastomosing network
which is continuous across the
midline with that of the opposite
side and with that of the abdominal
wall
Internal thoracic vessels
 Internal thoracic a.&v.
胸廓内动脉和静脉
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Parasternal ln.
胸骨旁淋巴结
Endothoracic fascia
胸内筋膜
The Mediastinum 纵隔
Concept－all of organs
between the left and
right mediastinal
pleurae is called
mediastinum. It extends
from the sternum in
front to the vertebral
column behind, and
from the thoracic inlet
above to the diaphragm
below.
Subdivisions of mediastinum
Superior mediastinum
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上纵隔
Inferior mediastinum
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下纵隔
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Anterior mediastinum
前纵隔
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Middle mediastinum
中纵隔
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Posterior mediastinum
后纵隔
Left side of mediastnum
Left subclavian a.
Thoracic duct
Left vagus n.
Left recurrent n.
Phrenic n. &
pericardiacophrenic a.
Aortic arch
Thoracic aorta
Sympathetic trunk
Root of lung
Pericardium
Esophagus
Greater splanchnic n
Right side of mediastnum
Trachea
Left vagus n.
Arch of azygos v.
Azygos v.
Sympathetic trunk
Esophagus
Inferior vena cava
Superior vena cava
Phrenic n. &
pericardiacophrenic a.
Root of lung
Pericardium
Superior mediastinum 上纵隔
Locating－from inlet of
thorax to plane extending
from level of sternal angle
anteriorly to lower border of
T4 vertebra posterioly
Contents
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Superficial layer
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Thymus
Three veins
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Left brachiocephelic v.
Right brachiocephelic v.
Superior vena cava
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Middle layer
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Aotic arch and its three
branches
Phrenic n.
Vagus n.
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Posterior layer
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Trachea
Esophagus
Thoracic duct
Relations of aortic arch
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Anteriorly and to the left －
pleura, lung，phrenic n.,
pericardiacophrenic vessels and
vagus n.
Posteriorly and to the right－
trachea, esophagus, left
recurrent n., thoracic duct, deep
cardiac plexus
Superiorly－its three branches,
left brachiocephalic v. and
thymus
Inferiorly－pulmonary a., arterial
ligament, left recurrent n., left
principal bronchus and superficial
cardiac plexus
Triangule of ductus arteriosus
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动脉导管三角
Bounded by phrenic n., left vagus n.
and left pulmonary a.
Contents－ arterial ligament , left
recurrent n. and superficial cardiac
plexuses
Inferior mediastinum 下纵隔
Anterior mediastinum
前纵隔
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Location－posterior to body of
sternum and attached costal
cartilages, anterior to heart and
pericardium
Contents－fat, remnants of
thymus gland, anterior
mediastinal lymph nodes
Middle mediastinum
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中纵隔
Location－between
anterior mediastinum and
posterior mediastinum
Contents: hart and
pericardium, beginning or
termination of great
vessels, phrenic nerves,
pericardiacophrenic
vessels , lymph nodes,
Posterior mediastinum
后纵隔
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Location－posterior to heart
and pericardium, anterior to
vertebrae T5－T12
Contents: esophagus, vagus n.,
thoracic aorta, azygos system
of veins, thoracic duct, thoracic
sympathetic trunk, posterior
mediastinal lymph nodes
Relations of esophagus
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Anteriorly－trachea,
bifurcation of trachea, left
principal branchus, left
recurrent n., right pulmonary
a., anterior esophageal
plexus, pericardium, left
atrium, diaphragm
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Posteriorly－posterior
esophageal plexus,
thoracic aorta, thoracic
duct, azygos v.,
hemiazygos
v.,accessory
hemiazygos v., right
posterior intercostal v.
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Left－left common carotid a., left subclavian a., aortic arch,
thoracic aorta, superior part of thoracic duct
Right－arch of azygos v.
Relations of thoracic aorta
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Anteriorly－left root of lung,
pericardium and esophagus
Posterior－ hemiazygos v.,
accessory hemiazygos v.,
Right－azygos v. and thoracic
duct
Left－mediastinal pleura
Mediastinal spaces 纵隔间隙
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Retrosternal space 胸骨后间隙－
lies beween sternum and
endothoracic fascia
Pretracheal space 气管前间隙－
lies within superior mediastinum,
between trachea, bifurcation of
trachea and aortic arch
Retroesophagus space
食管
后间隙－ lies within superior
mediastinum, beween
esophagus and endothoracic
fascia