THORAX prof.

Ezz Eldin USIM

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

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).

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 cartilage anterior, 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 .

Intercostal muscles

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 the rib posterior. Then it is replaced by internal (posterior) intercostal membrane . Direction: Down backward (lateral) Action: Depress the ribs (expiratory muscle). Nerve supply: intercostal nerves.

Transversus thoraces
Of

three parts : 1) sternocostalis muscle . 2) inner most intercostal (intimis ). 3) subcostalis muscle .

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

2)Innermost intercostal m.
Origin: from the inner surface of the rib above 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 the intercostal space.

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).

INTERCOSTAL NERVES

Definition: they are the ventral rami of the thoracic 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 the thoracic Wall supplying muscles at the same space and skin over it they are 3-4-5-6 thoracic ventral rami nerves.

Intercostal nerves 2

2) Atypical intercostal nerves: that supply any area out side their Corresponding space as follow : a) 1st thoracic nerve is atypical since its Lateral 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 (called Intercostbrachial nerve).

Intercostal nerves 3
c)

The lower five intercostal and the subcostal are atypical since they Descend into the anterior abdominal wall supply the abdominal wall .

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.

Intercostal nerve

6) Then it pierces: internal intercostal muscle, anterior intercostal membrane and lastly the pectoralis major muscle to end as anterior cutaneous branches. End: Terminal anterior cutaneous branch that divides into 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.

Intercostal nerve

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.

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 are double (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.

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 intercostal artery of the subclavian artery. b) From the third till the eleventh intercostal arteries arises from the 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 costal groove from above downward).

INTERCOSTAL VEINS
Also two groups (sets) anterior and posterior: a) The anterior intercostal veins: At the upper six spaces drain at internal 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.

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 to the right side to end at Azygos vein).

THE

PLEURA

Definition : Is a serous membrane formed of two layers

1) Parietal layer: outer layer lines the inner surface of the chest wall. 2) Visceral layer: inner layer adherent to the lung tissues and dips at the fissures of the lung. 3) Pleural sac (cavity): is the sac between the two layers .

Parts of the pleura

Parts

: 1) costal pleura 2)mediastinal. 3)Diaphragmatic 4)Cervical pleura ( Apex)

SURFACES OF THE PLEURA

1) Apex: extend above the clavicle covered by suprapleural membrane from Transverse process of 7th cervical vertebra to inner border of first rib. 2) Base (diaphragmatic surface): related to the diaphragm that separates 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.

Pleura
Parts

of the pleura

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 the sternoclavicular 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).

Surface anatomy of the pleura 2

3) Inferior border: common for both sides from 6th costal cartilage to 8th rib at midclavicular line then to the 10th rib at midaxillary line then to the 12th rib (12th vertebral spine).

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.

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.

Pleural recesses

Are spaces OR parts of the pleural sac that occupied by the lung only in deep inspiration they are two (reserve space): 1) Costodiaphragmatic recess: along the inferior border 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.

Pleural recesses 2
2) Costomediastinal recess: is present along the anterior border of the lung. It is not important clinically for pleural tapping ( parasenthesis) .

Nerve supply of the pleura

1) visceral layer is non sensitive for Pain and supplied by 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.

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 at midclavicular 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.

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

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 .

lungs
Right

lung

Left lung

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 the mediastinum and contain The hilum.

Lung 4
Right lung Left lung Shorter and wider . loner Has three lobes (600-700gm) . 500 gm of No cardiac notch . two lobes has notch
Has

two fissures .

only one

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.

Lung 6

2) BELOW THE HILUM: groove for Inferior vena cava . 3) POSTERIOR TO THE HILUM: esophagus and Azygos vein posterior to the right border of the esophagus 4) ABOVE THE HILUM: groove for arch of Azygos vein, above this groove there is impression for trachea right vagus and esophagus.

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

Right lung

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 thoracic aorta . 3) ABOVE THE HILUM: groove for arch of aorta above it there are Two grooves for left common carotid and left subclavian arteries. Esophagus, thoracic duct and left recurrent laryngeal nerve posterior to the Grooves related to the branches of the aortic arch .

4) Below the hilum : groove for esophagus .

Left lung

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

Hilum of right Lung 2

2) Minor contents: a) Bronchopulmonary lymph nodes . b) Bronchial artery from the 3rd posterior intercostal artery (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 and parasympathetic (vagus).

Hilum of the right lung

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.

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. .

Hilum of the left lung

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.

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 both pleura and lung. Function of fibrous pericardium: 1) Prevent over distention of the heart. 2) Fix the heart to diaphragm and back of sternum.

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.

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.

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.

Pericardium 6

Blood supply of pericardium: a) The fibrous and parietal are adherent together and Supplied by branches from internal thoracic artery as Pericardiophrenic and musculophrenic arteries also Supplied by branches from descending aorta b) Visceral layer of serous supplied with by blood from the heart by diffusion. 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 HEART

UPPER BORDER: ============== from point A to B it is formed by both atria POINT: A) Start from the lower border of left 2nd costal cartilage 1.5 inch From midline to point B. POINT: B) At the upper border of the right 3rd costal cartilage 1 inch from Midline.

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 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 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 left atrium).

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 while its 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.

ANATOMY OF THR RIGHT ATRIUM

1) External feature: a) the right atrium 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 the opening Of superior vena cava to the front of the opening of inferior vena cava.

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 divides The atrium into smooth posterior part, and rough anterior part.

2) Rough anterior wall: containing muscular ridges called MUSCULAE PECINATI 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.

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

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.

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

Conducting system

ANATOMY OF THE LEFT ATRIUM

The left atrium: form most of the base of the heart opposite 5-6-7-8th Vertebrae and descend one vertebra at supine position. The interior of left atrium: is completely smooth except 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.

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 in shape due to convexity of the interventricular septum to the right side e) The thickness of the wall: 1 cm

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 muscular irregularities . They are few in number but large in size if compared To that of the left ventricle.

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 .

Interior of right ventricle

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 or septal).

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

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 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 those at the right side . @ No moderator band . B) smooth part : called vestibule of aorta at the base of ascending aorta.

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 semilunar cusps one anterior And two posterior

CROOS SECTION OF THE HEART

1)Cavity of left ventricle 2)Cavity of right ventricle 3)Walls of left ventricle 4)Walls of right ventricle 5)Interventricular septum 6)Papillary muscles 7)Posterior interventricular sulcus

Heart valves

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.

Origin of coronary arteries

Blood supply of the heart 2

1) RIGHT CORONARY ARTERY: Arises from the anterior aortic sinus. Passes to the right between pulmonary trunk (posterior) and the right auricle (anterior) at the atrioventricular groove. To reach inferior border of the heart. then It continue at the posterior part of the atrioventricular groove to anastmose With the circumflex branch of the left coronary artery.

Branches of the right coronary 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

3) Posterior interventricular artery: descend at the diaphragmatic surface At the posterior interventricular groove, to supply the diaphragmatic Surface of both ventricles and the posterior 1/3 of the interventricular Septum.

4) Nodal branch: that supplies the sinatorial node and the atrioventricular Node at 10%. 5) Conus artery: that supplies the pulmonary trunk ascending aorta (vasa Vasorum).

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

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 interventricular groove 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 the heart.

Branches of Left coronary 2

4) Circumflex branch: winds around the left margin of the heart and passes At the posterior part of atrioventricular sulcus to anastmose with right Coronary artery and give branches to atrioventricular node (AVN). 5) Small left conal artery: supply the pulmonary trunk and ascending aorta.

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 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.

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.

<>

Venous drainage 3
2)

Anterior cardiac veins: are 3 to 4 veins drain 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
DEFINITION:

The part of the thorax beteen the medial surfaces of both pleura and lung .

Subdivision of mediastinum as seen on sagittal section superior mediastinum (1) anterior mediastinum (2) medial mediastinum (3) posterior mediastinum (4)

Subdivision of mediastinum
1)

anterior 2) middle 3)posterior

Superior mediastinum 2
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

Superior mediastinum 3
The contents of superior mediastinum in planes from anterior to posterior: glandular plane venous plane arterial-nervous plane visceral plane lymphatic plane

Sup. Mediastinum 4
Thymus

gland

Sup. Mediastinum 5
VENOUS COTENTS

Superior mediastinum 6
Arterial

contents

Superior mediastinum 6

Superior mediastinum 7
Trachea

Sup. Mediastinum 8
Esophagus

Superior mediastinum 9
Thoracic

duct

Anterior mediastinum
Anterior

mediastinum bounadries: anterior : body and xiphoid of sternum posterior : pericardium lateral : mediastinal pleura superior : plane of Sternal angle inferior : diaphragm

Anterior mediastinum 2
Contents

: 1)Remains of thymus gland . 2)Superior and inferior Sternopericardial ligaments

Middle mediastinum
Boundaries : anterior : pericardium posterior : pericardium lateral :mediastinal pleura superior :plane of Sternal angle inferior : diaphragm

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
Boundaries anterior : pericardium posterior : bodies of thoracic vertebrae 5 12 lateral : mediastinal pleura superior : plane of Sternal angle inferior : diaphragm

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
Begin

End

: Tributaries :