The Department of Human anatomyThe Department of Human anatomy

Lecture Lecture ANATOMY OF ANATOMY OF

BLOODBLOODVESSELS ANDVESSELS AND

NERVES OF NERVES OF PECTORALPECTORAL

CAVITYCAVITY

PLANPLAN I. PARTS AND BRANCHES OF AN AORTAI. PARTS AND BRANCHES OF AN AORTA a) THE DESCENDING AORTAa) THE DESCENDING AORTA b) THE VEINS SYSTEM OF THE THORAXb) THE VEINS SYSTEM OF THE THORAX c) THE LYMPHATICS OF THE THORAXc) THE LYMPHATICS OF THE THORAX II.II.THE NERVOUS SYSTEM OF THE THORAXTHE NERVOUS SYSTEM OF THE THORAX a) anterior and posterior branches of the thoracic a) anterior and posterior branches of the thoracic

nervesnerves b) the phrenic nerveb) the phrenic nerve c) the thoracic part of the sympathetic trunkc) the thoracic part of the sympathetic trunk d) the thoracic part of the vagusd) the thoracic part of the vagus (10(10thth) nerve) nerve

Topicality: normal functioning of the walls and the chest cavity depends on their correct blood supply and innervation.

PARTS AND BRANCHES PARTS AND BRANCHES OF AN OF AN AORTAAORTA

Aorta Aorta isis contents of:contents of: 1. ASCENDING PART OF 1. ASCENDING PART OF

AN AORTAAN AORTA 22. . ARCH OR ARCH OR

AORTIC ARCHAORTIC ARCH 3. DESCENDING PART OF 3. DESCENDING PART OF

AN AORTAAN AORTAAll of them have own branches.All of them have own branches.

The arch of aorta, arcus aortae begins at the level of sternal angle. It arches superiorly, posteriorly and to the left, and then inferiorly. On passing over the left main bronchus, the arch of aorta descends to the posterior mediastinum and reaches the body of Th4 on the left. Here it becomes continuous with the descending part of thoracic aorta.

1. 1. AN ASCENDING AORTAAN ASCENDING AORTA The ascending aorta The ascending aorta begins begins

between the left atrium and the between the left atrium and the infundibulum. This the first part of infundibulum. This the first part of the aorta. The ascendinq aorta the aorta. The ascendinq aorta has three aortic sinuseshas three aortic sinuses and and bulb.bulb. It contains of two branches:It contains of two branches:

a) the left coronary artery (arteria a) the left coronary artery (arteria coronaria cordis sinistra)coronaria cordis sinistra)

b) the right coronary artery (arteria b) the right coronary artery (arteria coronaria cordis dextra).coronaria cordis dextra).

Branches of arch of Branches of arch of aorta aorta

1) 1) BrachiocephalicBrachiocephalic trunc (artery) trunc (artery) ::

Right subclavianRight subclavian Right common carotidRight common carotid

2) 2) Left common Left common carotidcarotid

External carotidExternal carotid Internal carotidInternal carotid

3) 3) Left subclavianLeft subclavian  

TheThe descending aortadescending aorta TheThe descending aorta descending aorta,, pars pars

descendens aortae runs along descendens aortae runs along the vertebral column on the left. the vertebral column on the left. Its upper portion resides within Its upper portion resides within the posterior mediastinum (thethe posterior mediastinum (the thoracic aorta),thoracic aorta), on passing the on passing the aortic hiatus,aortic hiatus, the thoracic aorta the thoracic aorta becomes continuous with the becomes continuous with the abdominal aorta.abdominal aorta. The abdominal The abdominal aorta aorta ends by splitting into ends by splitting into common iliac arteries at the common iliac arteries at the level oflevel of L4 L4 (the (the aortic aortic bifurcation,bifurcation, bifurcatio aortae). bifurcatio aortae).

THE THORACIC AORTA THE THORACIC AORTA (PARS THORACICA AORTAE)(PARS THORACICA AORTAE)is a continuation of the aortic arch. It resides is a continuation of the aortic arch. It resides

within the posterior mediastinum next to the within the posterior mediastinum next to the vertebral column. The aorta resides to the left vertebral column. The aorta resides to the left and then posteriorly from the esophagus. The and then posteriorly from the esophagus. The thoracic aorta passes through the aortic hiatus thoracic aorta passes through the aortic hiatus to become continuous with the abdominal to become continuous with the abdominal aorta. Other neighboring organs are the aorta. Other neighboring organs are the thoracic duct (found on the left) the azygos thoracic duct (found on the left) the azygos and hemiazygos veins and the left sympathetic and hemiazygos veins and the left sympathetic trunk. The branches of thoracic aorta are trunk. The branches of thoracic aorta are subdivided into the parietal and the visceral. subdivided into the parietal and the visceral.

The parietal branches are only the posterior intercostal and the superior phrenic arteries: - the posterior intercostal arteries, arteriae intercostales posteriores (10 pairs) run along intercostal spaces 3 through 11. The branches running below the 12 rib are the subcostal arteries (arteriae subcostales). - the superior phrenic arteries, arteriae phrenicae arise from the lower portion of the thoracic aorta. They supply the lumbar part of diaphragm.

The visceral branches The visceral branches supply supply the thoracic viscera:the thoracic viscera:

- - thethe bronchial branches, bronchial branches, rami rami bronchiales accompany the bronchiales accompany the bronchi on their way to the lungsbronchi on their way to the lungs

- the- the esophageal branches, esophageal branches, rami oesophagcalcs arise from rami oesophagcalcs arise from the anterior surface of the the anterior surface of the thoracic aorta. The upper thoracic aorta. The upper esophageal branches esophageal branches anastomose with the inferior anastomose with the inferior thyroid artery and the lower with thyroid artery and the lower with the left gastric artery;the left gastric artery;

- the- the pericardial branches pericardial branches,, rami rami pericardiac are the small pericardiac are the small branches that reach the posterior branches that reach the posterior surface of pericardium;surface of pericardium;

- the- the mediastinal branches, mediastinal branches, rami rami mediastinals are the small mediastinals are the small branches that supply mediastinal branches that supply mediastinal fat.fat.

  

THE VEINS SYSTEM OF THE THORAXTHE VEINS SYSTEM OF THE THORAXThe superior vena cava The superior vena cava the the

great vein draining blood great vein draining blood from the head and neck is from the head and neck is located in the superior located in the superior mediastinum. About 7cm mediastinum. About 7cm long, this large vessel enters long, this large vessel enters the right atrium of the heart the right atrium of the heart vertically from its superior vertically from its superior aspect.aspect.

The brachiocephalic veins The brachiocephalic veins are located in the superior are located in the superior mediastinum. mediastinum.

a)a) THE THE INTERNAL JUGULAR VEININTERNAL JUGULAR VEIN b) THE b) THE SUBCLAVIAN VEINSUBCLAVIAN VEIN

The thoracic wall and The thoracic wall and upper lumbar region upper lumbar region are drained by the are drained by the posterior intercostal posterior intercostal and lumbar veins into and lumbar veins into the the azygous veinazygous vein. . These consist of These consist of longitudinal trunks on longitudinal trunks on right and left sides. right and left sides. There is a single trunk There is a single trunk on the right. On the on the right. On the left side the left side the hemiazygous veinhemiazygous vein..

The lymphatic glandsThe lymphatic glands ( (nodulesnodules)) of the of the viscera of the thorax are:viscera of the thorax are:

1)The bronchial lymphatic glands-are situated 1)The bronchial lymphatic glands-are situated round the bifurcation of the trachea and roots of round the bifurcation of the trachea and roots of the lungs. They are ten or twelve in number, the lungs. They are ten or twelve in number, the largest being placed opposite the the largest being placed opposite the bifurcation of the trachea. The smallest round bifurcation of the trachea. The smallest round the bronchi and their primary divisions for some the bronchi and their primary divisions for some little distance within the substance of the lungs.little distance within the substance of the lungs.

2) The superior mediastinal or cardiac glands - 2) The superior mediastinal or cardiac glands - lie in front of the transverse aorta and left lie in front of the transverse aorta and left innominate vein. innominate vein.

:

The lymphatic glands of the The lymphatic glands of the thoracic wall are:thoracic wall are:

The intercostal lymphatic glands - The intercostal lymphatic glands - are small, and situated on each are small, and situated on each side of the spine near the costo-side of the spine near the costo-vertebral articulations. They vary vertebral articulations. They vary from one to three in each space.from one to three in each space.

The sternal or internal mammary The sternal or internal mammary lymphatic glands - are placed at the lymphatic glands - are placed at the anterior extremity of each anterior extremity of each intercostal space, by the side of the intercostal space, by the side of the internal mammary vessels.internal mammary vessels.

The SUPERFICiAl LYMPHATIC VESSELS The SUPERFICiAl LYMPHATIC VESSELS - - of the of the front of the thorax run across the great front of the thorax run across the great pectoral muscle, and those on the back pectoral muscle, and those on the back part of this cavity lie upon the trapezius part of this cavity lie upon the trapezius and latissimus dorsi. and latissimus dorsi.

THE DEEP LYMPHATIC VESSELS OF THE THORACIC THE DEEP LYMPHATIC VESSELS OF THE THORACIC WALL WALL are are

I) The intercostal lymphatic vessels I) The intercostal lymphatic vessels 2) Tne internal mammary lymphatic 2) Tne internal mammary lymphatic

vessels vessels 3)The lymphatic vessels of the diaphragm3)The lymphatic vessels of the diaphragmLYMPHATIC VESSELS OF THE THORAX LYMPHATIC VESSELS OF THE THORAX areare 1)The lymphatic vessels of the lung1)The lymphatic vessels of the lung 2) 2) The cardiac lymphatic vesselsThe cardiac lymphatic vessels 3)3) The thymic lymphatic vessels The thymic lymphatic vessels 4)4) The lymphatic vessels of the The lymphatic vessels of the

oesophagus oesophagus

THE INNERVATION OF THE WALLS OF THORATIC THE INNERVATION OF THE WALLS OF THORATIC CAVITYCAVITY

The anterior branchesThe anterior branches (rami (rami ventrales)ventrales) of the spinal nerves of the spinal nerves innervate the skin and muscles innervate the skin and muscles of the ventral wall of the body of the ventral wall of the body and both pairs of limbs. The and both pairs of limbs. The anterior branches of the spinal anterior branches of the spinal nerves preserve their original nerves preserve their original metameric structure only in the metameric structure only in the thoracic segment (nn. thoracic segment (nn. intercostales). In the other intercostales). In the other segments connected with the segments connected with the limbs in whose development the limbs in whose development the segmentary character is lost, the segmentary character is lost, the nerves arising from the anterior nerves arising from the anterior spinal branches intertwine. spinal branches intertwine.

THE POSTERIOR THE POSTERIOR BRANCHESBRANCHES (rami dorsales) (rami dorsales) of the thoracic of the thoracic nerves divide into medial nerves divide into medial and lateral / branches and lateral / branches giving rise to branches giving rise to branches running to the running to the autochthonous muscles; autochthonous muscles; the skin branches of the the skin branches of the superior thoracic nerves superior thoracic nerves originate only from rami originate only from rami mediales, while those of mediales, while those of the inferior thoracic nerves, the inferior thoracic nerves, from rami laterales.from rami laterales.

TheThe phrenic nervephrenic nerve TheThe phrenic nerve phrenic nerve is the is the

mixed branches of the mixed branches of the cervical plexus- its motor cervical plexus- its motor branches innervate the branches innervate the diaphragm. It sends diaphragm. It sends sensory nerves to the pleura sensory nerves to the pleura and pericardium. and pericardium.

Some of the terminal branches Some of the terminal branches of the nerve pass through of the nerve pass through the diaphragm into the the diaphragm into the abdominal caviti abdominal caviti (NN.PHRENICOABDOMINALES(NN.PHRENICOABDOMINALES))

The thoracic part of the sympathetic trunkThe thoracic part of the sympathetic trunkThe thoracic part of the sympathetic trunk The thoracic part of the sympathetic trunk consists of 10 to consists of 10 to

12 ganglia of a more or less triangular shape. The thoracic 12 ganglia of a more or less triangular shape. The thoracic part is characterized by the presence ofpart is characterized by the presence of white white communicating branches (rami communicantes albicommunicating branches (rami communicantes albi) which ) which connect the anterior roots of the spinal nerves with the connect the anterior roots of the spinal nerves with the sympathetic trunk ganglia. sympathetic trunk ganglia.

The branches of the thoracic part are as follows: The branches of the thoracic part are as follows: - the cardiac branches- the cardiac branches (nervi cardiaci thoracici); (nervi cardiaci thoracici);- - the grey communicating branchesthe grey communicating branches (rami communicantes grisei (rami communicantes grisei));;- - the pulmonar branchesthe pulmonar branches (rami pulmonales); (rami pulmonales);- the aortic branches- the aortic branches (rami aorlici) (rami aorlici) form a thoracic aortic plexus form a thoracic aortic plexus (plexus (plexus

aorticus thoracicus), aorticus thoracicus), partly on the oesophagus - oesophageal plexuspartly on the oesophagus - oesophageal plexus (plexus esophageus(plexus esophageus), and on the thoracic duct (the vagus nerve also ), and on the thoracic duct (the vagus nerve also contributes to the formation of these plexuses);contributes to the formation of these plexuses);

- the greater and lesser splanchnic nerves- the greater and lesser splanchnic nerves (nervi splanchnici major (nervi splanchnici major andand minor).minor).

The thoracic part of the sympathetic trunkThe thoracic part of the sympathetic trunk

The thoracic part of the The thoracic part of the vagus nerve: vagus nerve: 1. The recurrent laryngeal nerve (n. laryngeus recurrens) 2.Cardiac branches (lower) (ramus cardiaci cervicales inferiores)3.Pulmonary and tracheal branches (rami bronchiales and tracheales)4.Thoracic cardiac branches (rami cardiaci thoracici)5.Oesophageal branches (rami esophagei)

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