胸部(课前介绍)(李峰)解剖学.ppt

,REGIONAL ANATOMY OF THORAX,Professor Li Feng,* The thorax lies between neck and abdomen. * The thorax includes thoracic wall and thoracic cavity. * The thoracic wall consists of skin, fascia, muscles and bones. * The thoracic cavity contains heart, lungs, trachea, esophagus and so on.,Boundaries of the thorax Superiorly: jugular notch, sternoclavicular joint, superior border of clavicle, acromion, spinous process of C7 vertebra Inferiorly: xiphoid process, costal arch, 11th and 12th ribs, T12 vertebra,1. Skeleton of thoracic wall 12 pairs of ribs 12 pairs of costal cartilages (true, false, floating ribs) 12 thoracic vertebrae and intervertebral discs 1 sternum (manubrium, body, xiphoid process),Inlet of thorax: upper border of manubrium, first rib， vertebra T1 Outlet of thorax: T12 vertebra, 11th and 12th ribs, costal arch， xiphoid process,2. Thoracic wall Skin Superficial fascia Deep fascia Pectoral m. Bony thorax Intercostal spaces and contents Endothoracic fascia,Pectoral muscles 1th layer: pectoralis major external oblique abdominal m. rectus abdominal m. 2th layer: pectoralis minor subclavicular m. serratus anterior 3th layer: intercostal m. 4th layer: transverse thoracis,4th layer: transverse thoracis,Serratus anterior,Intercostal m. External intercostal m.:The muscular fibers run downward and forward. The fleshy m. are replaced by external intercostal membranes anteriorly. Internal intercostal m. Innermost intercostal m.,Internal intercostal m. The muscular fibers run upward and forward. The fleshy m. are replaced by internal intercostal membranes posteriorly.,Intercostal spaces and contents Intercostal vessels: intercostal a. thoracic aorta intercostal v. azygos v. hemiazygos v. accessory hemiazygos v. Intercostal nerves: spinal cord,Near angles of ribs: intercostal a. collateral a. intercostal v. collateral v. intercostal n. collateral n.,Thoracocentesis The needle is inserted into pleural cavity. Posteriorly: superior to rib Anteriorly: between two ribs,3. The diaphragm Location: separates thoracic cavity from abdominal cavity 3 Parts: costal part sternal part lumbar part 3 hiatus:,3 hiatus: aortic hiatus: thoracic aorta, thoracic duct esophageal hiatus: esophagus, vagus n. vena caval foramen: inferior vena cava, right phrenic n.,4. Pleura and pleural cavity Thoracic cavity: three compartments 2 pulmonary cavities 1 mediastinum pulmonary cavity lungs pleura mediastinum heart trachea esophagus,Pleura Visceral pleura: invests lungs, continuous with parietal pleura at root of lung Parietal pleura: lines pulmonary cavity Pleural cavity *lies between visceral and parietal pleurae; *contains a small amount of pleural fluid;,lung,Division of parietal pleura Pleural cupula: encloses apex of lungs Costal pleura: lines inner surface of thoracic wall Mediastinal pleura: covers lateral aspects of mediastinum Diaphragmatic pleura: lines over diaphragm on each side of mediastinum,Pleural recess The lungs do not completely occupy pleural cavity during expiration. Costodiaphragmatic recess The diaphrgmatic pleura is in contact with the lowermost part of costal pleura. Costomediastinal recess The costal pleura is in contact with mediastinal pleura.,5. The lungs Shape of lungs: Apex: extends into root of neck Base: rests on diaphragm Three surfaces: *costal: related to thoracic wall *mediastinal: related to mediastinum *diaphragmatic: rest on the diaphragm Three borders: anterior (cardiac notch) posterior border inferior border,Fissures and lobes Oblique fissure: divides lungs into sup. and inf. lobes. Horizontal fissure: divides right lung into sup. and mid. and inf. lobes.,Hilum of lung area where structures enter and leave lungs. Root of lung primary bronchus pulmonary artery and vein lymphatic vessels nerves,Bronchial tree trachea primary bronchi lobar bronchi segmental bronchi (bronchopulmonary segment),6. The mediastinum *extends from sup. thoracic aperture to diaphragm. *extends from sternum to thoracic vertebrae. *contains all structures between the left and right mediastinal pleurae,Division of mediastinum transverse thoracic plane: from sternal angle to lower margin of 4th thoracic vertebra superior mediastimun inferior mediastinum anterior mediastinum middle mediastinum posterior mediastinum,Superior mediastinum extends from sup. thoracic aperture to transverse thoracic plane. Contents superficial layer, middle layer, the deepest layer,Structures in superficial layer: thymus brachiocephalic vein sup. vena cava,Structures in middle layer: arch of aorta and its three branches (brachiocephalic trunk, common carotid a., subclavian a.) phrenic n. vagus n.,Structures in the deepest layer: recurrent laryngeal n. (vagus n.) trachea esophagus thoracic duct (chyle cistern),Inferior mediastinum It is subdivided by pericardium into: Anterior mediastinum bounded by post. surface of sternum and costal cartilages and ant. surface pericardium. thymus connective tissue Middle mediastinum Posterior mediastinum,Middle mediastinum It is bounded by pericardium. pericardium heart great vessels arch of azygos v. primary bronchi phrenic nerves,right,right,left,Posterior mediastinum esophagus thoracic aorta vagus n. azygos v. hemiazygos v. accessory hemiazygos v. thoracic duct thoracic sympathetic trunk lymph nodes,Azygos system of veins azygos v. hemiazygos v. accessory hemiazygos v.,Thoracic duct *begins at chyle cis