Thoracic cavity

 Thoracic cavity is cone

shaped
 The thorax cavity has
two major
openings(Apertures):
A. Superior thoracic
aperture (Thoracic
Inlet)
B. Inferior thoracic
aperture (Thoracic
Outlet)

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A. Superior thoracic aperture
(Thoracic Inlet)
 Opens towards the neck.
 Boundaries:
 Posteriorly
- body of T1 vertebra
 Laterally
- medial margin of rib1
 Anteriorly
- manubrium I
 B. Inferior thoracic aperture(outlet)
large and
expandable
Boundaries:
Posteriorly
- body of T12
vertebra
Posterolaterally
- 12th rib and distal
end of 11th rib
Anterolaterally
- distal cartilaginous
ends of 7th -10th ribs
Anteriorly
- xiphoid process
 Diaphragm
Diaphragm
 Closes the inferior thoracic
aperture
 Is not flat but has a dome
shape: right dome ( reach up to
5th rib ) and higher than the left
During its contraction, there
is a decrease on the height of the
dome and an increase on the
volume of the thorax
 Openings in the diaphragm
Aortic hiatus
－ lies anterior to the body of
the 12th thoracic vertebra
between the crura.It transmits
the aorta,thoracic duct
Esophageal hiatus
－ for esophagus and vagus
nerves at level of T10.
Vena cava foramen
－ for inferior vena cava,
through central tendon at T8
level
 Parts of the thoracic cavity
Thoracic cavity is divided
into 3 divisions
1. Two pleural cavities(2) -
occupy lateral part and contain
the lungs
2. Mediastinum
 the space between lungs and
pleurae extends vertically from
the superior thoracic aperture to
the diaphragm.
 Contains the pericardium &
the heart and associated great
vessels trachea, esophagus,
vagus nerves, phrenic nerves,
thoracic duct, azygos veins,
thymus, sympathetic trunk, etc
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 Pleura
The lung's outer surface and the internal wall of the
thoracic cavity are covered by a serous membrane called the
pleura
 The membrane attached to lung tissue is called the
visceral pleura and the membrane lining the thoracic walls
is the parietal pleura
 Both layers are composed of simple squamous
mesothelial cells on a thin connective tissue layer
containing collagen and elastic fibers
The narrow pleural cavity between the parietal and
visceral layers is entirely lined with mesothelial cells that
normally produce a thin film of serous fluid that acts as a
lubricant,
8 facilitating the smooth sliding of one surface over
 Pleura

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 Innervation and blood supply of the pleura
Parietal pleura
 Cervical, costal and peripheral diaphragmatic portion -
intercostal nerves and vessels
 Central portion of diaphragmatic and mediastinal - phrenic
nerve and internal thoracic & musculophrenic vessels
Sensitive to pain
Lymphatics - intercostal, internal mammary, diaphragmatic &
posterior mediastinal lymph nodes
Visceral pleura
 Innervation - sympathetic nerves derived from T4 & T5
insensitive to pain
Vasculature and lymphatics are similar to lung
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 The Lung
 Itis a pink or grey, spongy structure, Pyramidal in shape
similar to the thoracic cavity.
 The Right lung is shorter because the liver is pushing the
diaphragm underneath. It is also Wider and Heavier than the
left lung.
 The surfaces of the lung are covered by visceral pleura.
 Each lung has an Apex, three Surfaces and three Borders.
 The apex: extends into the base of the neck, above the first
rib and clavicle (2-4cm) anteriorly, and as far as the neck of
the first rib posteriorly. Sympathetic trunk and lower trunk of
the brachial plexus are related to it.
 Both apices are grooved anteriorly by the subclavian
arteries, & below that by first rib.
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The Lung
 Surfaces and borders of the lung
 Anterior surfaces
 Lateral surfaces
 Costal surface
 The inferior surface
 diaphragmatic
surface
 The posterior surface
 The mediastinal
surface consists of
the hilum

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 Lobes and Fissures of the Lung
 The right lung has three lobes:
Upper, Middle,and Lower
Lobes
 The left Lung has two lobes
Upper And Lower Lobes
 Each lobe is an anatomical
entity divided into a number of
segments.
 Oblique fissure, on the right
lung, separates the upper and
middle lobes from the lower
lobe.On the left side it separates
the upper from the lower lobes.
 Horizontal fissure, separates
the upper lobe from the middle
lobe, on the right lung.

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 Tr a c h e a a n d B r o n c h u s
Tr a c h e a
5 inches long, 1 inch in diameter
 Fibroelastic wall, embedded by U- shaped bars of HYALINE
cartilage
 Begins at the neck (below the cricoid cartilage of the larynx) at
the level of the body of the sixth cervical vertebra.
 Ends below in the thorax at the level of the sternal angle.
Principal Bronchi
Right Main Bronchus – wider, shorter, more vertical than the left,
1 inch long, gives off the superior lobar bronchus before it enters
the right lung. On entering the hilum of the lung it divides into a
middle and inferior lobe bronchus
 Left Main Bronchus
– narr ower, lo nger, more
hori zontal , 2 i nch es
l ong. Passes to t he left
bel ow t he arch of t he
aor ta and i n front of t he
esophagus. Upon
ent eri ng the hi lum, it
di vides in to a superior
and i nferi or lobar
br onchi
 Vessels of the Lungs
 Each lung has a pulmonary artery supplying blood to it,
and two pulmonary veins draining blood from it.
 The right and left pulmonary arteries arise from the
pulmonary trunk, at the level of sternal angle and carry
venous blood to the lungs for oxygenation. Each
pulmonary artery becomes part of the root of the lung
and gives off its first branch to superior lobe before
entering the hilum.
 Bronchial arteries supply blood to the lung tissues. Left
bronchial arteries arises from thoracic aorta, the right
may arise from thoracic aorta or superior posterior
intercostal artery or from left superior bronchial artery.
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 Nerves of the lungs
 Right and left pulmonary plexuses, anterior and
posterior to the roots of lungs, innervate the lung and
visceral pleurae.
 Pulmonary plexuses receive contribution from: right
and left sympathetic trunks, and parasympathetic from
right and left vagus nerves.
 Lymphatic drainage: There are , subpleural plexus and
deep plexus. The subpleural plexus drains lymph from
the surface to the hilum. The deep plexus drainage
follows the bronchi and pulmonary vessels to the root of
the lung. All lymph from the lung leaves along the root
of the lung and enter the bronchial lymph nodes and
superior tracheobronchial lymph nodes.

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 The Mediastinum
 All of organs between the left
and right mediastinal pleurae is
called mediastinum.
 It extends from the sternum in
front to the vertebral column
behind, and from the thoracic
inlet above to the diaphragm
below.
 Subdivisions of Mediastinum
A. Superior Mediastinum
B. Inferior Mediastinum
C. Anterior Mediastinum
D. Middle Mediastinum
E. Posterior Mediastinum
 Superior mediastinum
Locating
 － from inlet of thorax to plane
extending from level of sternal angle
anteriorly to lower border of T4
vertebra posterioly
Contents
 Thymus, Left & Right
brachiocephelic vein,Superior vena
cava ,Aotic arch and its three
branches,Phrenic n.,Vagus n,
Trachea, Esophagus,Thoracic duct
 Anterior mediastinum
Location
 posterior to body of
sternum and attached
costal cartilages,
anterior to heart and
pericardium
Contents
 fat, remnants of
 Middle mediastinum

Location –between anterior

mediastinum and posterior
mediastinum
Contents:
 Heart and pericardium,
 Beginning or termination of
great vessels,
 Phrenic
nerves,pericardiacophrenic
vessels , lymph nodes,
 Posterior mediastinum
Location
 posterior to heart And
pericardium, anterior to
vertebrae T5 － T12
Contents:
 esophagus, vagus nerve,
thoracic aorta, azygos
system of veins, thoracic
duct, thoracic sympathetic
trunk, posterior mediastinal
lymph nodes
 PERICARDIUM
I. FIBROUS PERICARDIUM
- Is a tough connective tissue outer layer that defines
the boundaries of the middle mediastinum
 Is a cone-shaped bag with its base on the diaphragm
and its apex continuous with the adventitia of the great
vessels
Attachments:
Base – attached to the central tendon of the diaphragm
and to a muscular area of the diaphragm on the left side
Anteriorly – attached to the posterior surface of the
sternum by sternopericardial ligaments
phrenic nerves and pericardiacophrenic vessels
 PERICARDIUM
II. Serous Pericardium- Is thin and consists of:
Parietal layer- Lines the inner surface of the fibrous
pericardium
Visceral layer- Adheres to the heart and forms its outer
covering
Pericardial Cavity – a narrow space that contains a
small amount of fluid between the two layers of serous
pericardium allows the uninhibited movement of the heart
 THE HEART
Location:
 lies obliquely in the thorax
between the two lungs in
the middle mediastinum
Position:
 downward, forward and
then laterally
 About ⅔ of the heart is on
the left and ⅓ is on the right
Size: is approximately equals
to individual’s tightly
clenched fist
Shape: rounded cone –
shaped,
The Heart has:
 An apex, a base, four
surfaces, four borders,
grooves, externally
 Four chambers - Right
Atria,Left Atria,Right
Ventricle, Left
Ventricle
 Four valves- Tricuspid
,Bicuspid ,Aortic ,
Pulmonic
 Conducting system,
internally
 External Anatomy
 Auricles
 Major veins
 Superior vena cava
 Inferior vena cava
 Pulmonary veins
 Major arteries
 Aorta
 Pulmonary trunk

Fig. 22.5
The apex of the heart:
 Is formed by the left ventricle.
Lies posterior to the left 5th IC
space in adults. underlies the site
where the heartbeat may be
auscultated ,the apex beat
The base of the heart
 Is the heart's posterior aspect
(opposite the apex).
 Is formed mainly by the left
atrium. Faces posteriorly toward
T6 - T9 vertebrae
 is separated from the body of
vertebrae by: the pericardium
& esophagus, and aorta.
Surfaces of the heart
→four surfaces
 Anterior (sternocostal) surface-
formed mainly by the right
ventricle.
 Diaphragmatic (inferior)
surface- formed mainly by the
left ventricle and partly by the
right ventricle.
 Right pulmonary surface-
formed mainly by the right
atrium
 Left pulmonary surface-
formed mainly by the left
ventricle. forms the cardiac
impression of the left lung
 Internal anatomy of the heart
 Heart has - 4 chambers: The 2 Atria and the 2 Ventricles
- 4 valves :- Atrioventricular( Tricuspid & mitral)
- Semilunar (aotric & pulmonary) valves
Right Atrium-
 Receives venous blood from the SVC, IVC, and coronary sinus.
 The interior of the right atrium has a: Smooth, thin-walled, posterior
part on which the venae cavae (SVC and IVC) and coronary sinus
open, bringing poorly oxygenated blood into the heart.
Right Ventricle
 Forms the largest part of the anterior surface of the heart.
 Superiorly it tapers into an arterial cone, which leads into the
pulmonary trunk
 The right AV orifice is surrounded by one of the fibrous rings of the
fibrous skeleton of the heart
Left Atrium
 Forms most of the base of the heart. The valveless pairs of right and left
pulmonary veins enter the smooth-walled atrium .
 A semilunar depression in the interatrial septum indicates the floor of the
foramen ovale.
 The interior of the left atrium has: Four pulmonary veins (two superior
and two inferior) entering its smooth posterior wall
 Has slightly thicker wall than that of the right atrium. Has a left AV
orifice(Mitral Valve).
Left Ventricle
 Forms the apex of the heart.
 The interior of the left ventricle has: The Wall is two to three times as
thick as that of the right ventricle.
 A conical cavity that is longer than that of the right ventricle
 Anterior and posterior papillary muscles that are larger than those in the
right ventricle.
 Heart Valves
 Atrioventricular
 Tricuspid
 Bicuspid or mitral
 Semilunar
 Aortic
 Pulmonary
 Chordae tendineae
 Papillary muscles

Fig. 22.6

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The tricuspid valve:
 Guards the right AV orifice.The bases of the valve cusps are attached
to the fibrous ring around the orifice
 Chordae tendineae attach to the free edges and ventricular surfaces of
the anterior, posterior, and septal cusps.
The mitral valve
 A double-leaflet mitral valve that guards the left AV orifice
 is located posterior to the sternum at the level of the 4th costal
cartilage
 The mitral valve has: two cusps, anterior and posterior.
The Semilunar Valves
- Pulmonic Valves
 Each of three semilunar cusps of the pulmonary valve (anterior,
right, and left) is concave when viewed superiorly
 Semilunar cusps do not have tendinous cords to support them

Aortic Valve:
 is also located posterior to the left side of the sternum at the level of
the 3rd intercostal space
 semilunar cusps of the aortic valve (posterior, right, and left), are
also concave when viewed superiorly
 located between the left ventricle and the ascending aorta
 the ascending aorta begins at the aortic orifice
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 External location of the heart valves: 3, 3.5, 4, 4.5 rules
 This is not the best place to hear the valves but simply where they are
located
• 3rd costal cartilage: location of pulmonary valve
• 3rd intercostal space : location of aortic valve
• 4th costal cartilage: location of mitral valve
• 4th intercostal space: location of tricuspid valve
 Best site to auscultation the valve sound
 Blood supply of the Heart
 Comprise the coronary arteries and cardiac veins, which carry blood
to and from most of the myocardium
 The endocardium and some subendocardial tissue located immediately
external to the endocardium receive oxygen and nutrients by diffusion.
Arterial Supply of the Heart
 The coronary arteries: the first branches of the aorta. supply the
myocardium and epicardium
 The right and left coronary arteries- arise from the proximal part of
the ascending aorta, just superior to the aortic valve.
 Supply both the atria and the ventricles
Coronary
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arteries
Venous Drainage of the Heart
 The heart is drained mainly by veins that empty into the coronary
sinus and partly by small veins that empty into the right atrium
 The coronary sinus, the main vein of the heart, is a wide venous
channel that runs from left to right in the posterior part of the
coronary groove
Lymphatic Drainage of the Heart
 Lymphatic vessels in the myocardium and subendocardial
connective tissue pass to the subepicardial lymphatic plexus
 Vessels from this plexus pass to the coronary groove and follow the
coronary arteries
 Intermediate structures
The Ascending Aorta:
 Is about 6cm long, and approximately 2.5 cm in diameter
 Begins at the Aortic Orifice
 Its only branches are the coronary arteries.
 The ascending aorta is intrapericardial as a result,it is considered a
content of the middle mediastinum (part of the inferior mediastinum).
The arch of the aorta (aortic arch):
 Is the curved continuation of the ascending aorta
 begins posterior to the 2nd right sternocostal (SC) joint at the level of
the sternal angle
 arches superiorly, posteriorly and to the left, and then inferiorly
 The arch of the aorta ends by becoming the thoracic aorta posterior to
the 2nd left sternocostal joint
Branches of the aortic arch: 1. Brachiocephalic trunk
2. Left common carotid artery
3. Left subclavian artery
Thoracic Aorta
 Is the continuation of the arch of the aorta
 Begins at T4 vertebra and descends in the posterior mediastinum on
the left sides of the T5 - T12 vertebrae
 The thoracic aortic plexus , an autonomic nerve network, surrounds
it.
 Lies posterior to the root of the left lung,pericardium,and
esophagus.
 Terminates (with a name change to abdominal aorta) anterior to the
inferior border of the T12 vertebra
 Enters the abdomen through the aortic hiatus in the diaphragm
 The thoracic duct and azygos vein ascend on its right side and
accompany it through this hiatus.
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 Individual Assignment -I
1- Discuss Coronary artery disease or coronary heart disease?
2- Describe Myocardial Infarction?
3- Describe Nerve Supply to The Heart
3-Conducting System of the Heart-SA Node,AV Node,AV
Bundle and bundle branchs