Thorax

@avishekbadal @theMBBSvibes @suryanshvaibhav

 Thorax

mediastinum
1
↓
Supo Telf
> fibrous pericardium
⑭ 'n
AM MM PM
↓ ↓
Behind the

# Sternal Angle (Angle of Louis) # space b/w Mediastinum

*
2
mngs:
Lat the lower border ofTr)
1) Origin & end of
AOA

*
2) Division ofTrachea Kadaveric Levez) (living T/ Ta)

3) so as
Pulmonary trunk.

1) Attachment of2nd costal

cartilage.
5) under the IPA) -

Left Recurrent
laryngeal
nv.
Loops.

6) Azygous vein drains in SVC.

7) presence ofCardiac Plexus -

superficial
Deep
8) Thoracic duct deviates to left.
(largest lymphatic
duct)
9) Jun of
Sup. 8 Inf. Mediastinum.

Lower border
#
of1 pt. Recurrent
Laryngeal ur.

TranspyPoric plane
↓
smaller
↓
LoopS SCA

#aphragm

Fascia
Condensation of

3 the muscle which

of
are present deep
to it.

from: costal
originating Intire
margin
(xiphoid process costal
+
cart. +12th rib+12th
vertebrae)

converging to: central tendon (Non contractile part)

#
MOpeningsdiaph.

2.2. in
 ④ ⑦
IVC

17
Vena Caval
1.
opening
Rt. Phrenic no
(m(T) (Ts) ->

Oesophagus
2.
Oesophageal Opening Rt. & It.
Vagus
NV.

(In Right crus) (Tio) OesophagealGastric br. of Lt.

Aorta

3. Aortic Thoracic duct

Opening
(bIw crus) (T.2) vein
(sometime
hemiazygos vein also out.)
Azygos

BF
#
I Post Ganglionic

whitesame
NV.

ramus
Grey ramus
communicans
communicans

sympathetic chain

# So,

s
preganglionic sym.nr.

↳
->
④ (without relaying)
L splanchnic
visceral
no

uv.& -
=

Isplanchnic * Diaphragm
⑧
nV.

S
Coeliac Ganglion
They only use white ramus

communicans.

of supplied by both & phrenic

# Right crus
diaphragm no

# attach.
RiDs: 3 part
1 vest. -
&Body
1
Trans. process

stegnum
①RACIC
WALL

i
1/2
(lower border
1. 2xt. m (E) of upper rib)
2. Into 1/c i (I)
Neurovascular
3. Innermost 1/2 in (Im)
bundle
subcostalis
->

Intercostalic
->
Intimi
Lupper border

lower rib
of
Sternocostalis
->
(InBDC) -
(Trans. Thoracic)

↳ (NAVC

In Mid Axillary
line
↓

Str. Pierced are 8

1. Skin

x(z
2. Fascia
-> E
I, in downward, forward, medial
3. Serratus Ant.
(908)
in I
4. Ext. 12 ->
I/m: downward, backward, lateral
Int. m &
5. 1/c
intimi
=> In Its in downward, backward, lateral
6. Intercostalis
7. Indothoracic fascia

8. Parietal Pleura

Arcostae Nv.

Typical Ita UVs.: supply Is & else.

nothing
⑰ · Brachial plexus

⑫ · Intercostobrachial nv.

3
Tz
Tk Typical II no: 4, (sometime 3, T3 -1/c
brachial

:
nv.1

-> Thoraco-abdominal no

⑰ 2 -> subcostal nVo

Course:
 Aerial supply

-
Stermum

->
coronary bypass graft
-> Breast (main

of
artery)
Ic space
->

Angle
m pleura

w
->

rib
-> pericardium (indirectly
->
Diaphragm
-> Abdominal wall

(bro SCA)
of
(*VI T ( D)

Despite of
#
being histologically
small ,
it acts like a
resizeartery
↓
Elastic a -> Tunica media: lots of elastic fibres
& almost will smooth in
#small size/median size
artery
or

↓
Muscular : lots of
smooth in in
·. Best candidate for CABG.
their tunica media

#Fernal
Thoracic
Artery -

1st SCA (VIT(D)

part of (scalenus auto

F(ct
I
4
>sternal (5%
-

Ant - c angle

&

A
16th/cs

*
-

↓v
1
/

*
Musculophrenic a

↓
↑
*
Ant. I/c superior epigastric
* ↓ ↓

7 n
gth 1C5 Fo
of Morgagni
+

to

Content ofRectus sheath

Branches:

Superior epigastric
) Terminal
1. a

2. Musculophrenic
3. Ant 1/ca (In 1st to 6th (cs)

4. Mediastinal by (Remains of
Thymus)
5. Periophrenic
I
Runs a phrenic nr.

&

supplies

diaphragm,
mediastinal pleura &
fibrous
peri carcin
8: perforating mammary
6. In

bro (2nd 84th (cs)

↓1

#east
 Ezyges & emiazyges in

"unpaired
-> on post. abdominal wall
vein'
->
posto mediastinum on either side of
U.C.

④ Brachiocephallic vein
⑫ Brachiocephallic vein

goo
1/vein

oS pin
isIs

7
⑫

vein in e
⑦ superior 1/c
·
velc
⑫ superior
"vein ↓...... lower border of Tr

IS
Osternal Angle)
5

i
=
5
=
↳ VC
x
->
->
Acc.
Hemiazygos vein
s
85 -

Azygos vein <-

·
vein
Hemiazygos
9=
>

⑫ subcostal vein" -= ↑ #Asubcostal vein

⑭
# ↑ ② Lumbar

Azygos vein

↑↑
⑫ Lumbar
② vein ③
Ascending
l
↑
"Formative Tributaries
of vein"
Azygos

Parietal: 4
types
~
Body
wall
developmentallyis Mr. Supply & Blood supply
Pleura ↓ derived from same.
visceral organs
~
Viscera: Runs fissure
along
->
of leng
1
-> forms
monary tale
d

Divides in
the
lung
BPS

①
* -keura:
parietal

1) Cervical
↓

*
*
clavicle
2) Costal

:P Diphragmatic
Mediastinal
@ ->
<- HiLum
·-

·
pp
-
Vp
&

-
-

↳ costomediastinal
-
-
Recess
-

↑ pieciral
↓ ③
I
large
just cavity
recess
costodiaphragmatic
 CDR
*
Preferred site of
pleural tap
↓ ↓
most dependent >th -
gth(1cS)
in
Mid-axillary Line

Rt. Principal Bronchus

*
shorter i. infection chances .
*wider

more
* in the line with trachea

2581Ta5

IROOTS LUNG1
OF

⑫ ①
Arch ofAzygos Arch of Aorta
↓
↓

5
# x
·oipfanerial *
Epaterial bronchus
·D
-
PA

principal
bromams bronchus
*

Pulm. Vein (Ant & inferiorly)

Pulm.veins

Apulmonaryligamentsee
->

(space for expansion ofPU)

Impressionon Lung:

Arch of Aorta

-> Left SCA

-> left CLA

-> Brachiocephalic
 IBronchial Artery
-> supplies tracheobronchial tree.
# P. Vein
->
supplies till
respiratory bronchiole.
↓

3rd Oxy blood Bronchial vein ka

+

>R -
Rt. BA-1 - Rt. post. It
deoxy blood
from
~1 -

Lt.BA-2 ->
coming directly
descending aorta /Thoracic Aorta

Bonchopulmonarysegment
part
*
of lung bytertiary bronchus/
aerated

segmental bronchus/3id gen.

bronchus

Pyramidal
* in
shape & their apex is towards

the hilum.
↓

"Principle for Postural

drainage"
BPS
* are separated by visceral
pleura/pulmonary
septae.
*
surgically resectable.

*
Pulmonaryvein is
Intersegmental.

Upper lobe
1 ·TB ↑↑

Middle
lobe
[

1
cower

lobe
to provide space
for ef

pericardium

1) Fibrous pericardium
> Parietal layer
2) serous pericardium
> Visceral layer
(epicardium)

: Transverse
pericardial
* sinus

oblique
~
 >Arterial Tube (covered a serous visceral
pericardium)
merged
sinusonbehind **** vent
->
so PT
ligature ofAA& can

ii. be done
using this sinus

- behind LA & b/w PV.

Isinusl - Allows expansion ofLA cont

compressing
oesophagus
Heart
Sup. as subar
border
-

①ii) / Diaphragmatic surface

(In Newnatal) * Auricle

I
"Medial to
MCL'
everyI wall
Rough

* Rt. Atrium > Rough ant wall SA Node: upper part of

smooth post, wal Crista Terminalis

Musculus Pectinati
Limbus ofFossa Ovalis
comb-letme
->

Einstein
can
RA)

1
Coronary sinus

Venous

Crista termonalis(fromonsolse ee
drainage ofheart

Rt. Ventricle
(Trabecular
->
Rough inflowing part part)
(infundibulum)
smooth outflowing part
->

(inverted funnel shaped)

 ! PT
-

j
supra ventricular <
1 >
Infundibulum

sureand
***
> Trabacular carnae
↓ ↓

Rough heart

of
value
Bridge
↓

Ridge pillar -> also ala

⑭. .., .
Papillary in.

chirdae Tendonae
->

Septo Marginal Trabaculae

careone

inAont
(Moderator Band
Papillary
Giving passage to Rto Bundle br

ofBundle of
His.

Coronary Circulation
AA

*
↓
the heart
crowning
# Teens <0ld/Mature
In heart attacks,
chances survival
of is more in mature
be anastomosis is better in matures.
guys

① Ant. Aortic sinus

Ascending,Aorta ② ④
Posterior sinus

00
Now
Coronary posterior sinus
Aortic sinus
x
=
LCA
↓
.....
Produces bulge in
LCA (sometimes)
interatrial septum ↓
RCA
& sudden

is cardiac death
that bulge cla
Torus Aorticus

Nodal
br." RCA c65:

1st

I
supran
PIVA

supply
AV
FT
Node
soumtgracoon >
Diagonal

LLADA)
br.
Re

⑫ iarginalarea) <Atrio -
ventricular
groove
sulcus)
coronary
=
 RCA:
Right coronary
LCA:left a a

PIVA:Post. Interventricular
99
AIVA = AUt. 99

LADA Left Ant.

Descending
=

Cardiac dominance

NI, Rs br. circumflaet

5
*Nsa
of

ofR
*3br.
co-dominance
#

② cardiac dominance
#
Advantage (Rare)
*
90%
*
population 10% population
*
Advantage.

supply SAN

....... ↑

Ant. Coronary
C
sulcus

Post. Coronary
>
sulcus

# Interventricular septum

Ant. 2yrdc AIVA (RAD)

Post. Yrd<PIVA

v. of Marshall

>Oblique V. Of LA

sigmatary
cabin
> Accompanying a
↓

2. circumflex a

↓ Middle cardiac Vo

small cardiac vo
↓
↓
PIVA
1. RCA

2. Rt.
Marginal
Nv Supply Of Heart

Symt para sym

sep: superficial cardiac plexis
# SCP
DCP: Deep Cardiac Plexus
chain
Cervical cardiac br.
sym: Sup. Cervical Ganglion of sym,
SCCB: Sup.
ICCB: Into a e 99
Parasym: Into cervical cardiac br. of vagus nr.

RIN: Resurrent Laryngeal Nr.

Br. of Descending Aorta .

Rt. Bronchial ā - 1
1st & 2nd I/C ā - SCA
Coarctation Of Aorta
Localized narrowing
Thoracic Duct of blood vessels may
Largest lymphatic duct be at the level of
ductus arteriosus

⑫
Lymphatic
he
-
 Oesophagus
• 25cm long
Relations
Ant - Trachea & Oblique Sinus & LA (OS behing the LA)
Post - Thoracic Duct, Vertebral Column (just behind TD)
, Descending Aorta (in lower part) & Rt. Post I/C ā
Right - Azygos Vein
Left - Descending Thoracic Aorta

Ino

Vein

Nerve Supply
&
Parasym &motorm
Secret

ot*
or

yin! 1
-

Oesophageal
plexus
T,

Tz

Is
Ts

Phrenic Nerve

1
# b/w Scalenus Med & Ant. Brachial
(z
-

25 Plexus come out anteriorly

descends onto to scalenus ant.

B/w SCA&SCV Supply

↓

BehindInto Thoracic Art.

Motor:
Diaphragm
sens; mediastinal & central part
↓

within pericardiophrenic of diaph. pleura

↓
&
Runs to
advent fibrous pericardium
Fibrous pericardium

2 >
&to phrenic NV Lt. Phaenic NV.
* ↓

veno-caval
opening diaphragm
pierces dome of

supply age from its under surface

 Typical Thoracic Vertebrae

Heart shaped - body

Vert. Foramen - narrow & circular
Long Transverse process

*
⑧x
cro
Rib is attached twice

Nerve Supply Of Pleura

↑
Bodywall
Blood Supply
• All Parietal layers - Develop from Somatopleuric LPM
Parietal Pleura
• All Visceral layers - Develop from Splanchnopleuric LPM • Internal Thoracic Art.
↳ viscera • Musculophrenic Art.
Parietal Pleura • I/C Art.
Visceral Pleura
• Pulmonary Art & Bronchial Art

Venous Drainage
• Int Thoracic Vein
• Azygos Vein

Visceral Pleura
• Somatic Nv - Phrenic Nv
ANS (T2-T5) (from Sym. chain)
• Autonomic - Parasym Vagus Nv
• Insensitive to PAIN

Pericardium
• Fibrous Pericardium
• Serous Pericardium Parietal layer
- Visceral layer (Epicardium)
Blood Supply
Fibrous & Parietal Pericardium • Int Thoracic Art
• Descending Thoracic Aorta
• Musculophrenic Art
Visceral Pleura
• RCA & LCA

Nerve Supply
• Fibrous & Parietal SP - Phrenic Nv
Sensitive to PAIN
• Visceral Pericardium - ANS
Mediastinum Superior Mediastinum
• Ant - Manubrium
• Post - T1-T4 Vertebrae
• Roof - Suprapleural Memb (Sibson’s Fascia)
• Inf - Imaginary line connecting sternal
angle to lower border of T4
• Each side - Pleura

Posterior Mediastinum
• Above - Sternal Angle
• Below/Inf - Diaphragm
• Ant - Post wall of fibrous pericardium
• Post - T5-T12 Vertebrae
• Each side - Pleura

Thoracic Sympathetic Chain

SCG%
MCG
① >Post
Ganglionic
sym. NV.

Lateral
↑
④ > Limb

- medial
⑪
->
midline
↓
pierces the

crus of diaph.

Renalnv./

DH (sens. Dorsal Root

DR Ganglia

·
Post
Ganglionic sym. Neuron

Autonomic
v

↓
(T -

Lc sacrum 2,3,4)
+

1
VR communicans

V +1 Ramus
Grey
(motor) communicans

&Intermedo-later
be v

Nr.
Pre-Ganglionic sym

->core part act as

sym station
&

ganglion
↓
post
ganglion nv.

# phrenic nu: Middle Mediastinum.

no post. "
vagus
0
Branches
>T. -TsGanglion -> Post Ganglionic nv.

↓
medial bro
1. Cardiac plx.
2. OesO 99
> T5 -

T12 Ganglion 3. Aortic 99

d 4. Palmo ef

Pre-ganglionic sym
nr.

↓
Pierces the crus
diaphagu
of
↓
in abdomen
Ganglion

lat.br -> supply limbs &

body wall
-> gland
pilomotor, Vasomotor, sweat

Aorta

Ascending Aorta
• 5cm long
• Enclosed in fibrous pericardium
Relations
• Ant - Sternum, Rt Auricle, Infundibulum of RV
• Post - Transverse Sinus
• Rt - SVC
• Lt - PT

RCA
->

A.S.
Non
->

Coronary
LLA
->

Arch Of Aorta
• +nt in Sup Mediastinum
• Begins at Sternal Angle
• Goes upward, backward, towards left and then downward
• Ends at the left side of lower border of T4

Relations (TS č inf view)

8 open
Svc <
caravan

epcardiac
py.

⑦
⑫ ⑦ RLN <
--
Thoracic <
duct ② & Ant. to AOA

⑫ & Post to AOA

 Keep Hustling
Keep Grinding

You’re already living the dream..

#BetterYourself

@avishekbadal @theMBBSvibes @suryanshvaibhav