lecturer: ms ds pillay room 2p24 25 february 2013
TRANSCRIPT
Lecturer: Ms DS Pillay
ROOM 2P24
25 February 2013
Thoracic Wall
Consists of thoracic cage
Muscle
Fascia
Thoracic Cavity
3 Compartments of the Thorax
(Heart)
(Great Vessels)
Superior thoracic aperture
Intercostal space
Intercostal vasculature
Internal thoracic A
Anterior thoracic A Musculophrenic A
Posterior intercostal A
Superior intercostal A Thoracic aorta
Subcostal a.
Veins Internal thoracic vein: internal surface of ribs, lateral
to sternum, drains into brachiocephalic v.
Anterior thoracic vein: anteriorly between ribs to drain into internal thoracic v.
Posterior intercostal veins: travel posteriorly between ribs, 1st 3 join to form superior intercostal v. Drain into brachiocephalic system, remaining drain azygous system
Intercostal Nerves
They are anterior primary rami of spinal thoracic nerves fromT1 to T11
T3 toT6 are Typical
T12 is called Subcostal
The remaining nerves are called atypical
Each nerve runs in Intercostal space inferior to Intercostal vessels
Thieme Cl. 5.200A
Chest Tube Placement
PARIETAL PLEURA VISCERAL PLEURA
PLEURAL CAVITY (SEROUS FLUID)
Pleural Membranes
Parietal Pleura: four parts Cervical
(cupular)
mediastinal
diaphragmatic
costal
Why do you tend to feel pain in the parietal pleura and not the visceral pleura?
Cervical pleura Extends up into neck
Lines undersurface of suprapleural membrane
Reaches level of 2.5-4cm above medial 1/3 of clavicle
Costal pleura Lines inner surface of
Ribs Intercostal spaces
Costal cartilage sides of vertebral bodies
Back of sternum
Diaphragmatic pleura Covers thoracic surface of diaphragm
Costodiaphragmatic Recess Slit-like space between costal & diaphragmatic
parietal pleaura
During inspiration, lower margins of lungs descend into recesses
During expiration, lower margin of lungs ascend so that costal & diaphragmatic pleurae come together
Mediastinal pleura Covers & forms lateral boundary of mediastinum
Continuous with visceral pleura
Lungs lie free except at hilum
Costomediastinal Recesses
Along anterior margins of pleura
Slit-like spaces between costal & mediastinal pleurae
During inspiration & expiration, anterior borders of
lungs slide in & out of recess
Blood, Nerve & Lymphatic drainage of pleura Parietal Pleura Visceral Pleura
Blood Supply
1. post intercostals 2. int thoracic 3. sup intercostals 4. sup phrenic art
1. bronchial art
Nerve Supply
2nd to 12th i/c n sensory fibres only (pain sensitive) phrenic n
symph fibres from T2 to T5
(pain insensitive)
Lymphatic Drainage
drain into adj LN on thoracic wall (axillary nodes)
drain into LN at hilum of lungs
Features of Right & Left Lung
Lobes & fissures : surface anatomy --------------------------------------------------- - Oblique fissure: extends from level of spinous process of T2 vertebra
posteriorly to 6th costal cartilage anteriorly.
- Horizontal fissure: begins from anterior border at level of 4th costal cartilage, runs horizontally to meet oblique fissure at the midaxillary line
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RT lung LT lung
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- Fissures 2 ( oblique & horizontal) 1 (oblique )
- Lobes 3 ( superior, middle & inferior) 2 (superior & inferior )
- Cardiac notch absent present
- Lingula absent present
- Width wider narrower
- Length shorter longer
- Base more concave less concave
- Hilum contains 2 bronchi contains one bronchus
Left Lung Lateral View
Inferior Lobe
Oblique Fissure
Left Lung Medial View
Superior Lobe
Inferior Lobe
Oblique Fissure
Lingula
The Hilum
Pulmonary Artery
Bronchi
Pulmonary Veins
Superior Lobe
Oblique Fissure
Horizontal Fissure
Middle Lobe
Inferior Lobe
Right Lung Lateral View
Right Lung Medial View
Superior Lobe
Middle Lobe Inferior Lobe
The Hilum
Bronchi
Pulmonary Artery
Pulmonary Vein
Pulmonary Ligament
Making an Impression Left Lung Right Lung
Heart Heart
Aortic arch Azygous Vein
Thoracic Aorta Inferior Vena Cava
Esophagus Esophagus
Left Subclavian artery and vein Superior Vena Cava
Right Subclavian artery and vein
Medial Views of the Lungs
groove for azygos vein
right pulmonary arteries
bronchii
diaphragmatic recess
right pulmonary veins
cardiac impression
groove for esophagus
groove for aorta
left pulmonary arteries
left pulmonary veins
Surface Anatomy Lower border of the lung:
Midclavicular line rib 6 Pleura rib 8
Midaxillary line rib 8 Pleura rib 10
• Adjacent to vertebral column rib 10 Pleura rib 12
The anterior borders of lungs lie adjacent to the anterior line of parietal pleura reflection as far as the 4th costal cartilage
The left line of pleural reflection moves laterally & inferiorly at cardiac notch to reach level of 6th costal cartilage
Posterior border of the lung: C7 – T10
The difference between the lower border of the lung and the lower border of the pleura indicates the costodiaphragmatic recess distance
Trachea
R & L principal bronchus
Lobular bronchi (secondary) (2L and 3R)
Segmental bronchi (tertiary) (8L, 10R)
Terminal bronchioles
Respiratory bronchioles
Alveolar ducts
Alveolar sacs
Alveoli
Bronchopulmonary segment
Right main bronchus
R middle lobe bronchus R upper lobe bronchus R lower lobe bronchus
Segmental bronchi Segmental bronchi Segmental bronchi
Apical
Anterior
Posterior
Medial
Lateral
Apical
Anterior
Posterior
Medial
Lateral
Bronchopulmonary segment
Left main bronchus
L upper lobe bronchus L lower lobe bronchus
Upper branch Lower branch
Anterior
Apicoposterior
Superior lingular
Inferior lingular
Segmental
Apical
Anterior
Posterior
Lateral
Arterial supply of lungs Pulmonary arteries
-Give rise to lobar arteries
Bronchial arteries – supply blood for nutrition of structures that comprise the root of the lung
Venous drainage of lungs Pulmonary veins –
-Lobar veins drain into pulmonary veins
Bronchial veins – drain blood in lungs supplied by bronchial arteries
-Left bronchial vein - accessory hemiazygos vein (usually)
-Right bronchial vein - azygos vein
Innervation of lungs Lungs and visceral pleura
-Parasympathetic – from Vagus nerve
-Sympathetic – from sympathetic fibers of sympathetic trunk
Parietal pleura – from intercostal and phrenic nerves
THANKS