Thorax lectures for first year Medical students, El Minia University. 18-10-2011. By Dr. Noura El Tahawy .....

1. The Thoracic wall (Bones) By Dr. Noura El Tahawy MD. Ph. D

4. The Bony Thorax

6. The Bony Thorax

9. Sternum.

10. Sternocostal joints.

12. Clinical Notes Sternum and Marrow Biopsy Since the sternum possesses red hematopoietic marrow throughout life, it is a common site for marrow biopsy . Under a local anesthetic, a wide - bore needle is introduced into the marrow cavity through the anterior surface of the bone . The sternum may also be split at operation to allow the surgeon to gain easy access to the heart, great vessels, and thymus .

19. Fifth right rib, as seen from the posterior aspect .

20. A typical rib. A. Anterior view. B. Posterior view of proximal end of rib.

22. Atypical ribs.

23. Thoracic vertebrae Dr, Noura El Tahawy

24. Typical thoracic vertebra.

25. Atypical thoracic vertebrae.

26. Thoracic vertebra . A . Superior surface . B . Lateral surface .

28. also also Fifth right rib as it articulates with the vertebral column posteriorly and the sternum anteriorly. Note that the rib head articulates with the vertebral body of its own number and that of the vertebra immediately above. Note also the presence of the costal groove along the inferior border of the rib .

30. Joints of the Chest Wall Dr. Noura El Tahawy

32. Sternocostal joints.

33. Joints between ribs and vertebreae

34. Costovertebral joints.

35. Chest radiographs. A. Standard posterior-anterior view of the chest. B. Standard lateral view of the heart.

36. Openings of the Thorax Dr. Noura El Tahawy

38. Thoracic outlet showing the cervical dome of pleura on the left side of the body and its relationship to the inner border of the first rib. Note also the presence of brachial plexus and subclavian vessels. (Anatomists often refer to the thoracic outlet as the thoracic inlet .

39. Superior thoracic aperture. components, contents, passages and relationships Superior thoracic aperture: vertebra TI, rib I, costal cartilage I, manubrium of sternum Contents: Apices of right and left lung; brachiocephalic, subclavian arteries and veins; trachea, esaphagus; vagus nerves; sympathetic trunc; phrenic nerves

40. Contents: Apices of right and left lung; brachiocephalic, subclavian arteries and veins; trachea, esaphagus; vagus nerves; sympathetic trunc; phrenic nerves

41. The Thoracic Outlet Syndrome The brachial plexus of nerves (C5, 6, 7, and 8 and T1) and the subclavian artery and vein are closely related to the upper surface of the first rib and the clavicle as they enter the upper limb . It is here that the nerves or blood vessels may be compressed between the bones. Most of the symptoms are caused by pressure on the lower trunk of the plexus producing pain down the medial side of the forearm and hand and wasting of the small muscles of the hand. Pressure on the blood vessels may compromise the circulation of the upper limb .

43. Thoracic outlet as seen from above. Note the presence of the cervical ribs ( black ) on both sides. On the right side of the thorax, the rib is almost complete and articulates anteriorly with the first rib. On the left side of the thorax, the rib is rudimentary but is continued forward as a fibrous band that is attached to the first costal cartilage. Note that the cervical rib may exert pressure on the lower trunk of the brachial plexus and may kink the subclavian artery .

45. A. Inferior thoracic aperture. B. Diaphragm.

46. Flexible thoracic wall and inferior thoracic aperture.

47. Major structures passing between abdomen and thorax.

48. Diaphragm as seen from below. The anterior portion of the right side has been removed. Note the sternal, costal, and vertebral origins of the muscle and the important structures that pass through it .

49. References 1- Richard Snell; Clinical Anatomy by regions; Eighth Edition; 2008

50. Thank you