thorax .ppt

7/27/2019 thorax .ppt

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THORAX

prof. Ezz EldinUSIM


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Inlet and outlet

Inlet of thorax : 1) first thoracic vertebra

2) inner border of 1st rib

3) upper border of manubrium sterni .

Outlet of thorax : 1) lower 6 ribs lateral

2) xiphoid process . 3) last thoracic vertebra


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THE INTERCOSTAL MUSCLES

The intercostal muscles 11 on each Side they are

present between the ribs at three groups from

superficial to Deep :

1)External intercostals muscle

2) Internal intercostal muscle

3) Transverses thoraces

(sternocostalis).


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External intercostal muscles

Origin: From the lower border and outer

surface of the rib above.

Insertion: Upper border of the rib below

Extension: From the tubercle of the rib posterior

to the level of the costal cartilageanterior, then continue as external

(anterior) intercostal membrane till the

edge of the sternum .

Direction of fibres :downward medially.

Action : inspiratory muscle elevate the ribs . Nerve supply : intercostal nerves .


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Intercostal muscles
http://upload.wikimedia.org/wikipedia/commons/b/b1/Gray819.png


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Internal intercostal muscle

Origin: from the floor of the costal groove of the rib above

Insertion: Upper border of the rib below.

Extension: from Sternal margin anterior to the angle of therib posterior. Then it is replaced by internal (posterior)

intercostal membrane .

Direction: Down backward (lateral)

Action: Depress the ribs (expiratory muscle).

Nerve supply: intercostal nerves.


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Transversus thoraces

Of three parts :

1) sternocostalis muscle .

2) inner most intercostal (intimis ). 3) subcostalis muscle .


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1)Sternocostalis m.

Origin : back of sternum and xiphoid process .

Insertion : at inner surface of costal

Cartilages from 2 to 5 or 6 .

Nerve supply and action : similar to

inter nal intercostal
http://en.wikipedia.org/wiki/Image:Transversus_thoracis.png


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2)Innermost intercostal m.

Origin: from the inner surface of the ribabove the costal groove.

Insertion: Upper border of the rib below. It

has same direction of internal intercostal.Action and nerve supply: As internal

intercostal depress the ribs (expiratory).

Site: It presents at the middle 2/4 of theintercostal space.


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3)Subcostales muscle

Present at lower three or four Spaces, it

extends from the front of the neck and

angle of the ribs to the same area of the rib

above (at the posterior part of the spaces).


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INTERCOSTAL NERVES

Definition: they are the ventral rami of thethoracic nerves, they are 11 pair

(From 1 to 11 thoracic spinal nerves).

N.B.: The 12th thoraciccalled subcostal nerve. Types of intercostal nerves:

1) Typical intercostal nerves: that present in thethoracic Wall supplying muscles at the same

space and skin over it they are 3-4-5-6 thoracicventral rami nerves.


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Intercostal nerves 2

2) Atypical intercostal nerves: that supply anyarea out side their Corresponding space asfollow :

a) 1st thoracic nerve is atypical since itsLateral branch share in the formation of the

brachial plexus.

b) 2nd thoracic is atypical: it gives lateral branch

to supply skin at The floor of the axilla (calledIntercostbrachial nerve).


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Intercostal nerves 3

c) The lower five intercostal and the

subcostal are atypical since they

Descend into the anterior abdominalwall supply the abdominal wall .


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ANATOMY OF THE TYPICAL


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ANATOMY OF THE TYPICAL

INTERCOSTAL NERVES 4

Definition: They are the ventral rami of the 3-4-5-6 thoracic nerves.

Course: 1) Comes from intervertebral foramen passes deep to the

Thoracic sympathetic chain.

2) Then passes between posterior intercostal membrane and the pleura.

3) Then between internal intercostal muscle and inner most intercostal m.

4) Then passes between internal intercostal muscle and the pleura

5) Then between internal intercostal and the sternocostalis muscles here

It crosses in front of internal mammary (thoracic) vessels.


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Intercostal nerve 5

6) Then it pierces: internal intercostal muscle, anteriorintercostal membrane and lastly the pectoralis major

muscle to end as anterior cutaneous branches.

End: Terminal anterior cutaneous branch that dividesinto medial and lateral Cutaneous branches supplying

the skin at front of the chest wall.

N.B: The nerves accompanied by intercostal vessels as

they pass at the Costal groove and arranged ( V .A.N.)from above downward.


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Intercostal nerve 6

Branches of the typical intercostal nerves:

================================

1)It gives White ramus communicant to sympathetic ganglia.

And receive grey ramus communicant from the ganglion.

2) Lateral cutaneous branch: sensory to skin at lateral side of chest wall.

3) Muscular branches: supply intercostal muscles.

4) Sensory branches: to the parietal pleura.

5) collateral branch: pass along upper border of rib below supply

muscular branches to intercostal muscles.

6) End as (terminal branch): Anterior cutaneous that divides into: Medial and lateral cutaneous to supply skin in front of the chest.


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INTERCOSTAL ARTERIES

They are two groups (sets): Anterior and Posterior sets (group).

A) Anterior intercostal arteries: They are nine arteries at the upper

---------------------------------- nine Intercostal spaces, all of them aredouble (two) in each space :

. 1) in the upper six spaces arises from the internal mammary

(thoracic) artery.

2) The next 7th -8th -9th arises from the musculophrenic artery.


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Intercostal arteries 2

B) Posterior intercostal artery: They are eleven single arteries

----------------------------------

(one in Each space) they arise as follow:a) 1st and 2nd posterior intercostal arises from Superior intercostalartery of the subclavian artery.

b) From the third till the eleventh intercostal arteries arises fromthe descending thoracic aorta .

Course: The arteries accompany the intercostal veins and nerves

at the same muscular plane (between internal and inner most

Intercostal muscles) with arrangement VAN at the costalgroove from above downward).


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INTERCOSTAL VEINS

Also two groups (sets) anterior and posterior:

a) The anterior intercostal veins: At the upper six spaces drain atinternal mammary vein . At the spaces 7-8-9 they end at

. at musculophrenic vein.

b) Posterior intercostal veins: they end as follow.

1) The first posterior intercostal end at: Brachiocephalic vein (Rt.or Lt.)

2) Second to fourth join to form superior intercostal vein: at

left side it ends at left Brachiocephalic vein while at the

right Side it ends at the arch of the Azygos vein.


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Intercostal veins 2

3) From 5 to 11 right posterior intercostal

vein end at Azygos vein.

4) On the left side from 5 to 8th form

accessory Hemiazygos vein. while

From 9th to 11th join the Hemiazygos

vein (both Hemiazygos Cross from left tothe right side to end at Azygos vein).


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THE PLEURA

Definition : Is a serous membrane formed of twolayers

1) Parietal layer: outer layer lines the innersurface of the chest wall.

2) Visceral layer: inner layer adherent to the lungtissues and dips at the fissures of the lung.

3) Pleural sac (cavity): is the sac between the twolayers .


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Parts of the pleura

Parts :

1) costal pleura

2)mediastinal.3)Diaphragmatic

4)Cervical pleura

( Apex)


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SURFACES OF THE PLEURA

1) Apex: extend above the clavicle covered by suprapleuralmembrane from Transverse process of 7th cervical vertebra

to inner border of first rib.

2) Base (diaphragmatic surface): related to the diaphragm thatseparates it From the abdominal organs (stomach fundus,

spleen and left lobe of The liver at left side and the right lobe

of the liver at right side).

3) Medial surface (mediastinal): related to mediastinum contents.

4) Sternocostal surface: related to sternum, ribs and intercostal

muscles.


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Pleura

Parts of the pleura


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SRFACE ANATOMY OF THE

PLEURA 1) Apex (cervical pleura): present 1inch (2.5cm) above

the medial 1/3 of The clavicle (it is covered by

suprapleural membrane).

2) Anterior border: from the apex descend behind thesternoclavicular Joint then :

A) at left side descend to 2 costal cartilage then to 4 C.C.

Then makes curve to the left 1 inch forming cardiac

notch to reach 6th costal cartilage .

B) At the right side: descend direct from 2 costal Cartilage to the 6th costal cartilage (no cardiac notch).


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Surface anatomy of the pleura 2

3) Inferior border: common for both sides from 6th costalcartilage to 8th rib at midclavicular line then to the 10thrib at midaxillary line then to the 12th rib (12th vertebralspine).

4)Posterior border: for both lungs from 12th rib

to the apex it ascend along the vertebral column

(vertebral border).

N.B: The only difference at the anterior border.


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Pleural reflections

Are places where the pleura reflected

(changes)

From visceral into parietal layer, it occurs

at two sites:

1) Around the hilum of the lung.

2)At the pulmonary ligament extend from

below the hilum to Diaphragm.


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Pleural recesses

Are spaces OR parts of the pleural sac thatoccupied by the lung only in deep inspiration

they are two (reserve space):

1) Costodiaphragmatic recess: along the inferiorborder of the pleura here the lung separated

from the pleura by two spaces at the

midaxillary line. This recesses used clinically for

drainage of the Pleural effusion as water in hydrothorax or excess air as in Pneumothorax.


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Pleural recesses 2

2) Costomediastinal recess: is present

along the anterior border of the lung.

It is not important clinically for pleural

tapping ( parasenthesis) .


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Nerve supply of the pleura

1) visceral layer is non sensitive for Pain and suppliedby autonomic (sympathetic nerves and vagus parasymp.).

2) Parietal layer : is sensitive for pain supplied by

a) phrenic nerve That supplies the medial surface

and the central part of the base.

b) Intercostal nerves: supply the sternocostal surface

and the Peripheral part of the base diaphragmatic

surface).

Blood supply: intercostal arteries.


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THE LUNG

Pyramidal shape and has the following: A) BORDERS: (surface anatomy)

a) Apex: same as the pleura.b) Anterior border: same as the pleura

c) Inferior border: Begin at 6th costal cartilage, and crosses 6th rib atmidclavicular line then cross the

8th rib at midaxillary line to end at 10th rib posterior

(10th thoracic spine) two ribs above the pleura.

d) Posterior border: from 10th rib ascend to the apex.


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lung

1)Lung

2)Horizontal fissure of right lung

3)Heart

4)Acute margin

5)Obtuse margin

6)Brachiocephalic trunk

7)Trachea

8)Left common carotid artery

9)Left subclavian artery


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Lung 2

FISSURES:

Surface anatomy of the fissures: 1) oblique fissure for both lungs start

at 3rd thoracic spine (at the level of spine of scapula) then cross the 5th

rib at midaxillary line and descend to 6th costal cartilage along medial

border of the laterally rotated scapula ..

2)Horizontal fissure for the right lung only : start at 4th costal cartilage

Then pass posterior to meet the oblique fissure at midaxillary

Line .


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lungs

Right lung Left lung


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Lung 3

B) SURFACES OF THE LUNG:a) Costal Surface: related to chest wall.b) Base (diaphragmatic surface): related to

the diaphragm separate it from stomach , spleen ,left

lobe of liver at left side , and the right lobe of liver

at right side .

c) Medial (mediastinal) surface related to themediastinum and contain The hilum.


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Lung 4

Right lung Left lung

Shorter and wider . loner

Has three lobes (600-700gm) . 500 gm ofNo cardiac notch . two lobes

has notch

Has two fissures . only one


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RELATION OF THE MEDIASTNAL

(MEDIAL) SURFACE lung 5

A) RIGHT LUNG :

1`) ANTERIOR TO THE HILUM:

cardiac impression for right atrium,

Right phrenic nerve and pericardium. Then

superior vena cava and Right

brachiocephalic vein above the cardiac

impression.


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Lung 6

2) BELOW THE HILUM: groove for Inferior vena cava .

3) POSTERIOR TO THE HILUM: esophagus and Azygos veinposterior to the right border of the esophagus

4) ABOVE THE HILUM: groove for arch of Azygos vein, above thisgroove there is impression for trachea right vagus and esophagus.

N.B: The arch of Azygos separates the trachea and esophagusfrom the lung


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Right lung

f f f
http://www.bartleby.com/107/240.html


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Relation to medial surface of left

lung 7 1) ANTERIOR TO THE HILUM: cardiac impression for left ventricle,

Left auricle, phrenic nerve and pericardium.

2) POSTERIOR TO THE HILUM: groove for descending thoracicaorta .

3) ABOVE THE HILUM: groove for arch of aorta above it there areTwo grooves for left common carotid and left subclavian arteries.

Esophagus, thoracic duct and left recurrent laryngeal nerve posteriorto the Grooves related to the branches of the aortic arch .

4) Below the hilum : groove for esophagus .


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Left lung
http://www.bartleby.com/107/240.html


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HILUM OF THE LUNG . 8

A) THE HILUM OF THE RIGHT LUNG CONTAINS:

1) Major structures: a) Eparterial and Hyparterial

--------------------------- bronchus.

b) Pulmonary artery in between and in

front of the bronchi.

c) Superior and inferior pulmonary veins

below the artery

Hil f i ht L 2


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Hilum of right Lung 2

2) Minor contents: a) Bronchopulmonary lymph nodes .

b) Bronchial artery from the 3rd posterior intercostalartery (First aortic posterior intercostal) or from upper

the left bronchial A.Bronchial veins that end at Azygos vein.

c) Pulmonary nerve plexuses: Anterior and posterior

plexus to the bronchi formed of sympathetic andparasympathetic (vagus).

Hil f th i ht l


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Hilum of the right lung

THE HILUM OF THE LEFT LUNG


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THE HILUM OF THE LEFT LUNG

1) Major contents: a) left bronchus(0ne).

------------------------

b) Pulmonary artery above the bronchus.

c) Superior and inferior pulmonary vein below the artery.


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Hilum of the left lung 2

Minor contents: a) lymph nodes (bronchopulmonary) ---------------------

b) Pulmonary nerve plexuses: One anterior and

one posterior to the Main bronchus

.

c) Bronchial arteries are two arise from the descending aorta (they are superior and

inferior)

d) The bronchial Veins end at Hemiazygos veins in

the left side.

.

Hil f th l ft l


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Hilum of the left lung


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THE PERICARDIUM

Is divided into two types: fibrous and serous type.

1) FIBROUS PERICARDIUM--------------------------------------------

Definition: is a fibrous sac surrounding the heart.

Shape: conical shape with a) Base: below and adherent to the

central Tendon of the diaphragm.

b) Apex: superior and surround the big vessels

ascending aorta ,pulmonary artery and superior vena

cava.


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Pericardium 2

Relation: a) anterior surface: attach to the back of the Sternum by Sternopericardial ligaments

From the pericardium to the back of upper

and lower of the body of sternum.

b) Posterior surface: related to the posterior Mediastinum and its content.

c) Laterally related to phrenic nerves and medial surface of bothpleura and lung.

Function of fibrous pericardium:

1) Prevent over distention of the heart.

2) Fix the heart to diaphragm and back of sternum.


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Pericardium 3

2) SEROUS PERICARDIUM

----------------------------------------------

Definition: Is a serous sac that surrounds the heart

Structure: formed of inner visceral layer adherent to

The heart and outer layer lining the inner the

Surface of the fibrous pericardium.

The two layers are separated by pericardial

Cavity.


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Pericardium 4

The pericardial sinuses: Are recesses of the pericardial

Cavity they are two.

A) Transverse sinus: is a recess of pericardium behind

The ascending aorta and pulmonary trunk. Relation: a) anteriorly related to ascending aorta and

Pulmonary trunk

b) Posterior: two atria and superior vena cava

c) Superior: right pulmonary artery.


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PERICARDIUM 5

B) Oblique sinus: Is pericardial recess behind left atrium .

Boundaries: a) anterior: back of left atrium.

b) Posterior: the content of posterior mediastinum (esophagus

descending aorta).

c) Inferior: connected with general pericardial Cavity between

i.v.c. and inferior left pulmonary vein.

d) Superior: is reflection of the visceral layer Into parietal on the

back of left atrium at the Level of the superior pulmonary veins.

e) At the sides : pulmonary veins .

.

N.B: THE LEFT ATRIUM INTERVENE (SEPARATES)BETWEEN THE

TWO SINUSES.


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Pericardium 6

Blood supply of pericardium: a) The fibrous and parietal are adherent together and

Supplied by branches from internal thoracic artery asPericardiophrenic and musculophrenic arteries also

Supplied by branches from descending aorta

b) Visceral layer of serous supplied with by blood from the heart bydiffusion.

Nerve supply: Visceral layer by sympathetic and

Parasympathetic (autonomic) as heart.

The fibrous and parietal layer by phrenic

Nerves being sensitive to pain.

SURFACE ANATOMY OF THE


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SURFACE ANATOMY OF THE

HEART UPPER BORDER: ==============

from point A to B it is formed by both atria

POINT: A) Start from the lower border of left 2ndcostal cartilage 1.5 inch From midline to point B.

POINT: B) At the upper border of the right 3rdcostal cartilage 1 inch from Midline.


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Surface anatomy of heart 2

POINT: C) Present at the right 6 costal cartilage 1 inch from the midline .

POINT: D) Present at the left 5th intercostal space 3.5 inch (9cm

from the Median plane where the apex of the heart.

RIGHT BORDER: from point B to C formed by the right atrium. -------------------------

LOWER BORDER: From point C to point D at the left fifth space

------------------------- 3.5 inch from the median plane( 9.5 cm) it is

formed by both Ventricles

LEFT BODER: from point D to point A formed by left ventricle and

-------------------- left auricle .

SURFACE ANATOMY OF HEART


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SURFACE ANATOMY OF HEART

VALVES :

P 1) PULMONARY VALVE: AT THE LEVEL OF 3RD LEFT

COTSTAL CARTILAGE (STERNOCOSTAL JUNCTION).

A 2) AORTIC VALVE: AT THE LEVEL OF 3RD LEFT

INTERCOSTAL SPACE CLOSE TO STRENAL MARGIN.

M 3) MITRAL VALVE: AT THE LEVEL OF 4TH COSTAL

CARTILAGE CLOSE TO STERNAL MARGIN

T 4) TRICUSPED VALVE: AT THE LEVEL OF 4TH INTERCOSTAL SPACE AT THE MEDIAN PLANE.

SURFACES AND BORDERS OF


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SURFACES AND BORDERS OF

THE HEART BORDERS: ----------------

a) Right border: formed totally by the right atrium.

b) Lower border: formed by the two ventricles (mainly

right ventricle). c) Apex of the heart: formed by the left ventricle at the

left 5th intercostal space.

d) Left border: formed by left ventricle and left auricle.

e) Upper border: formed by two atria (mainly by the leftatrium).


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SURFACES OF THE HEART

1)THE BASE OF THE HEART: Formed mainly by the left atrium and Small part of right atrium. It is related posteriorly to the oblique sinus

Of the pericardium that separate it from the contents of the posterior mediastinum.The back of left atrium receives four pulmonary veins.

While the s.v.c and I.v.c. terminate at the right atrium.

2)INFERIOR (DIAPHRAGMATIC) SURFACE: it's right 1/3 formed by the

right ventricle, while its left 2/3 formed by left ventricle This surface contains posterior interventricular groove.

3) STERNOCOSTAL SURFACE: it's right 2/3 formed by the right ventricle whileits left 1/3 formed by left ventricle Such variation,

is due to the convexity of the interventricular septum to The right side.

This surface contains anterior interventricular groove.


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ANATOMY OF THR RIGHT


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ANATOMY OF THR RIGHT

ATRIUM 1) External feature:

a) the rightatrium forms the right border of the heart

extending from 3rd to 6th right costal cartilage parallel

To the Sternal margin.

b) The right auricle: project from the atrium upward to the right side.

c) Groove called sulcus terminalis extend from the front of theopening Of superior vena cava to the front of

the opening of inferior vena cava.


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Right atrium 2

2) Internal feature (Interior of right atrium): contains-----------------------------------------------------

1) CRISTA TERMINALIS: muscular ridge extend from the front of

the Opening of s.v.c. To the front of the opening of i.v.c. this ridge dividesThe atrium into smooth posterior part, and rough anterior part.

2) Rough anterior wall: containing muscular ridges called MUSCULAEPECINATI radiating from the crita terminalis at anterior wall.

3) Smooth posterior wall: named sinus venarum since it receives the

Openings of the big veins as I.V.C, I.V.C. and coronary sinus.


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1)Sinus venarum

2)Cresta terminalis

3)Fossa ovalis

4)Rim or limbus of the fossa ovalis

5)Musculi pectinati

6)Valve of the inferior vena cava


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Right atrium 3

4) THE INTERATRIAL SEPTUM: From the right side only there is Oval fossa (fossa ovales) represented remains of septum primum.

Limbus fossa ovales (annulus ovale) that surround the fossa from

Above, anterior and posterior but not inferior. This annulus ovale is

The remains of septum secumdum of the original growing heart.

5) Openings of right atrium: 1) S.V.C.: At lev of 3rd right costal cartilage.

2) I.V.C.: At level of 6th right costal cartilage.

3) Coronary sinus: to the left of S.V.C.

4) Tricuspid valve: At 4th space at midline.

5) Vinae cordis minimi: at cavity of atrium.


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Right atrium 4

C) Conducting system:1)S.A.NODE: at the lateral wall at the site

of crita Terminalis between the opening of

I.V.C.and S.V.C.

2)A.V.NODE: at the lower part of

interatrial septum


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Conducting system

ANATOMY OF THE LEFT


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ANATOMY OF THE LEFT

ATRIUM

The left atrium: form most of the base of theheart opposite 5-6-7-8th Vertebrae and

descend one vertebra at supine position.

The interior of left atrium: is completely smoothexcept its auricle .the wall Of left atrium has no

crista terminalis, no musculae Pectinati.

The interatrial septum has no fossa ovales

and no annulus ovalis.

C S


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VENTRICLES

ANATOMY OF RIGHT VENTRICLES:

EXTERNAL FEATURE: a) Sternocostal Surface: it forms

the right 2/3

b) Diaphragmatic surface: the ventricle forms right 1/3 of

it.

c) Lower border: the right ventricle form most of the

lower border

d) Cross section of the right ventricle is semilunar inshape due to convexity of the interventricular

septum to the right side

e) The thickness of the wall: 1 cm

2) INTERNAL FEATURE


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2) INTERNAL FEATURE

A) Rough part: vent.2 @ THREE PAPILLARY muscles(anterior, posterior and medial or septal one ) they are

muscular projections. The apex of each one gives

fine threads called corda Tendinae that attach to the

lower surface of the cusps Of tricuspid valve.

@ TRABECULAE CARNAE: are rough muscularirregularities . They are few in number but large in size if

compared To that of the left ventricle.

R h t t 3


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Rough part vent . 3

@ MODERATOR BAND: It is right bundle

branch of Purkinje extend from the

septum to the base of Anterior papillary

muscle (it prevent over distention Of the

right ventricle, and it is a conducting

system .

I t i f i ht t i l


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Interior of right ventricle

Ri ht t i l 4


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Right ventricle 4

B)The Smooth part: called Infundibulum of the right ventricle at the base of Origin of the pulmonary trunk (artery).

C) The septum: the interventricular septum is convex to the right

side.

D) Orifices of the right ventricle :

@ Tricuspid valve: Has three cusps (anterior Posterior and medial orseptal).

@ Pulmonary valve: Has three semilunar cusps Two anterior and one

posterior .

ANATOMY OF THE LEFT


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ANATOMY OF THE LEFT

VENTRICLE A)EXTERNAL FEATURE:

a) Sternocostal Surface: it forms only left 1/3.

b) Diaphragmatic surface: It forms left 2/3 of that surface.

c) Lower border: forms small part of that border.

d) Cross section: nearly circular due to concavity of the septum

e) Thickness: 3times thicker than the right (about 3 cm.).

INTERNAL FEATURE


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INTERNAL FEATURE

of left ventricle 2

A)ROUGH PART CONTAINS: @Two papillary muscles only : one

anterior and one posterior no medial.

@ Trabeculae carnae : muscular small ridges

smaller in size and more numerous than thoseat the right side .

@ No moderator band .

B) smooth part : called vestibule of aorta

at the base of ascending aorta.

L ft t i l 3


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Left ventricle 3

C) THE SEPTUM: is convex towards the

left ventricle.

D) Orifices of left ventricle :

@ Mitral valve: has an anterior and

posterior cusp only.

@ Aortic valve: has three semilunarcusps one anterior And two posterior


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CROOS SECTION OF THE


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CROOS SECTION OF THE

HEART1)Cavity of left ventricle2)Cavity of right ventricle

3)Walls of left ventricle

4)Walls of right ventricle

5)Interventricular septum

6)Papillary muscles7)Posterior interventricular sulcus

Heart al es


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Heart valves

BLOOD SUPPLY OF THE HEART


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BLOOD SUPPLY OF THE HEART

A) ARTERIAL SUPPLY:two coronary arteries from the ascending

aorta Are the only source of the blood

supply of the Heart.

O i i f t i


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Origin of coronary arteries

Blood s ppl of the heart 2


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Blood supply of the heart 2

1) RIGHT CORONARY ARTERY: Arises fromthe anterior aortic sinus.

Passes to the right between pulmonary trunk(posterior) and the right auricle (anterior)

at the atrioventricular groove. To reach inferiorborder of the heart.

then It continue at the posterior part of theatrioventricular groove to anastmose

With the circumflex branch of the left coronaryartery.


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Branches of the right coronary


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g y

artery

1) Marginal artery: runs along the Lower

----------------------- borer of the costal

surface to supply the right ventricle with

other ventricular branches.

.

2) Atrial branches: supplies the right

atrium.

Branches of right coronary 2


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Branches of right coronary 2

3) Posterior interventricular artery: descend at the diaphragmaticsurface At the posterior interventricular

groove, to supply the diaphragmatic Surface of both ventricles andthe posterior 1/3 of the interventricular

Septum.

4) Nodal branch: that supplies the sinatorial node and theatrioventricular Node at 10%.

5) Conusartery: that supplies the pulmonary trunk ascending aorta (vasaVasorum).

LEFT CORONARY ARTERY


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LEFT CORONARY ARTERY

Arises from the left posterior aortic sinus

Passes to the left between the pulmonary

trunk (post.) and the left auricle (ant.) at

the atrio-ventricular groove.

Then it divides into anterior interventricular

and Circumflex branch.

Branches of the left coronary artery


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Branches of the left coronary artery

1) Left marginal branches to the left ventricle

2) Atrial branches: supply the left atrium.

3) Anterior interventricular branch: descend at

the sternocostal surface at Anterior interventriculargroove supplying the anterior

surface of both Ventricles and the anterior 2/3

of the interventricular septum ,it anastmose

With the posterior interventricular at the apex of theheart.

Branches of Left coronary 2


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Branches of Left coronary 2

4) Circumflex branch: winds around theleft margin of the heart and passes

At the posterior part of atrioventricular

sulcus to anastmose with rightCoronary artery and give branches to

atrioventricular node (AVN).

5) Small left conal artery: supply the pulmonary

trunk and ascending aorta.

APPLIED ANATOMY


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APPLIED ANATOMY

the coronary arteries are end arteries where the

Anastmosis between them is not enough to

Maintain the blood supply if a branch is

occluded by thrombus that is Why they called END ARTERIES. Block of a large branch

results in Myocardial infarction and chest pain

(angina pectoris).

VENOUS DRAINAGE OF THE


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HEART

1) Coronary sinus: venous tube about 5

cm in length present at the Posterior

part of the atrioventricular groove

(coronary Sulcus).

It ends at the right atrium to the left of the

opening of IVC .

And its opening guarded by small

rudimentary valve.


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Venous drainage of the heart 2


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Venous drainage of the heart 2

Tributaries of the coronary sinus:a) great cardiac : vein drain sternocostal Surface of both ventricles.

b) Middle cardiac vein: at the posterior interventricular surface drain

The diaphragmatic surface of both ventricles.

c) Small cardiac vein: accompany marginal artery at the inferior

border Of the costal surface and it drains the right ventricle

d) Oblique vein of the left atrium drain the back of left atrium.

e) Posterior cardiac vein: at the back of left ventricle, it ascend to end at the coronary sinus or great cardiac vein.


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Venous drainage 3


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Venous drainage 3

2) Anterior cardiac veins: are 3 to 4 veinsdrain the costal surface of the Right

ventricle to the right atrium directly.

3) Vinae cordis minimi: they drain the

myocardium directly into the

Corresponding chamber directly.

THE MEDIASTINUM


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THE MEDIASTINUM

DEFINITION:

The part of the thorax

beteen the medial

surfaces of both pleura

and lung .


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Subdivision of mediastinumas seen on sagittal section

superior mediastinum (1)

anterior mediastinum (2)

medial mediastinum (3)

posterior mediastinum (4)

Subdivision of mediastinum


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Subdivision of mediastinum

1) anterior

2) middle

3)posterior

Superior mediastinum 2


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Boundaries of the superior mediastinum

anterior : manubrium of the sternum

posterior : anterior surface of bodies of

vertebrae T1 through T4

superior : plane of the thoracic inlet

inferior : plane of the Sternal angle

lateral : mediastinal pleura



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The contents of superior mediastinum inplanes from anterior to posterior:

glandular plane

venous plane

arterial-nervous plane

visceral plane

lymphatic plane

Sup Mediastinum 4


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Sup. Mediastinum 4

Thymus gland

Sup Mediastinum 5


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Sup. Mediastinum 5

VENOUS COTENTS



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Arterial contents



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Trachea

Sup Mediastinum 8


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Sup. Mediastinum 8

Esophagus



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Thoracic duct

Anterior mediastinum


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Anterior mediastinum

Anterior mediastinum bounadries:

anterior : body and xiphoid of sternum

posterior : pericardium


superior : plane of Sternal angle

inferior : diaphragm

Anterior mediastinum 2


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Anterior mediastinum 2

Contents :

1)Remains of thymus

gland .

2)Superior and inferior

Sternopericardial ligaments

Middle mediastinum


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Middle mediastinum

Boundaries :

anterior : pericardium

posterior : pericardium

lateral :mediastinal pleura

superior :plane of Sternal

angle


Middle mediastinum 2


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Middle mediastinum 2

Contents : 1) heart and its surrounding pericardium

2) lower of s.v.c.

3) four pulmonary veins . 4) ascending aorta .

5) pulmonary trunk .

6) two phrenic nerves at sides of heart . 7) tracheal bifurcation and two bronchi .

Posterior mediastinum


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Posterior mediastinum

Boundaries anterior : pericardium

posterior : bodies of thoracic vertebrae 5 -

12


superior : plane of Sternal angle


Posterior mediastinum 2


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Posterior mediastinum 2

Contents : 1) Aorta descending .2) Thoracic duct.

3) Azygos and hemiazygos veins

4) Oesophagus and oesophageal

nerve plexus around it .

5) sympathetic chain and greater

and lesser splanchnic nerves .

Thoracic duct


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Thoracic duct

Begin : End :

Tributaries :

thorax .ppt

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