thorax .ppt
TRANSCRIPT
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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
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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
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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
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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
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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.
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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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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
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Superior mediastinum 3
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
Superior mediastinum 6
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Superior mediastinum 6
Arterial contents
Superior mediastinum 6
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Superior mediastinum 6
Superior mediastinum 7
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Superior mediastinum 7
Trachea
Sup Mediastinum 8
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Sup. Mediastinum 8
Esophagus
Superior mediastinum 9
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Superior mediastinum 9
Thoracic duct
Anterior mediastinum
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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
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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
inferior : diaphragm
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
lateral : mediastinal pleura
superior : plane of Sternal angle
inferior : diaphragm
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 :