The respiratory system

- thoracic cavity and respiration

Dr. Mandy R. Liu

School of Biomedical Sciences, LKS Faculty of Medicine, HKU
liurong@hku.hk
Learning Outcomes:
• Describe the anatomy of pleura and pleural cavity.

• Explain the hilum of the lung.

• Outline the anatomical structure of thoracic wall and neurovascular supply.

• Describe the anatomical features of diaphragm and function of phrenic

nerves.

• Explain the muscles of respiration and mechanism of respiration.

• Describe the mediastinum and its contents.

 Pleura and Pleural Cavity
Visceral pleura
Each lung is enclosed in a pleural
Parietal pleura
sac that consists of two continuous
membranes:
◼ visceral pleura(pulmonary pleura)

adherent to surfaces of the lungs

◼ parietal pleura
adherent to the thoracic wall,
mediastinum and diaphragm
Right
pleural The potential space between the
cavity layers of pleura is pleural cavity,
containing serous pleural fluid.
anterolateral view
 Cervical part
Pleura and Pleural Cavity
Parietal pleura can be divided into
four parts:
Costal part ◼ cervical part

◼ costal part
Costomediastinal ◼ mediastinal part
recess
◼ diaphragmatic part

Costodiaphragmatic recesses
The potential space located at
where the diagphragmatic pleura is
mediastinal part
in contact with the lowest parts of
costal pleura.
diaphragmatic part Costomediastinal recesses
Costodiaphragmatic recess anterior view The space located at where the
costal pleura is in contact with the
mediastinal pleura.
 Vagus nerve
Phrenic nerve Hilum of the lung
Vagus nerve
Phrenic nerve The hilum of the lung is the area
where the structures form the root,
Pulmonary artery
which connects the lung with the
heart and trachea.

◼ Pulmonary artery
Pulmonary
veins
◼ Superior and inferior pulmonary
veins
Left main
bronchus ◼ Main bronchus with bronchial
vessels surrounding it

◼ Lymphatic vessels and nerves

anterior view
◼ The bronchial arteries supply the pleura near the
hilum and provide oxygenated blood to lung tissues.
Vagus nerve
Vagus nerve
Phrenic nerve
Phrenic nerve
Pulmonary
artery
Pulmonary Bronchus
artery
Hilum of
the lung Bronchial artery
Bronchial artery

Pulmonary
vein

medial view medial view

Right Left
 Body of T1
Intervertebral discs
Thoracic cage
I
The thoracic skeleton forms the
II
thoracic cage, including:
Sternum
III ◼ 12 pairs of ribs and costal
cartilages
IV
Intercostal space ◼ 12 thoracic vertebrae and
V intervertebral discs
◼ sternum
VI
Costal cartilages
VII XI Functions:
VIII
XII ◼ To protect the heart and lungs
IX
◼ To provide attachment for
X muscles (thorax, back, abdomen
and upper extremities)
anterior view Body of T12
 Body of T1
Ribs and costal cartilages
Intervertebral discs
I
The ribs are curved, flat bones that
II
Sternum form most of the thoracic cage.
III
◼ True ribs (1st to 7th ribs)
IV
Intercostal space
attach directly to the sternum
V
through own costal cartilages
VI
Costal cartilages
◼ False ribs (8th to 10th ribs)
VII XI
VIII connect to the sternum indirectly
XII
IX through costal cartilages
X
◼ Floating ribs (11th and 12th ribs)
anterior view Body of T12
do not connect with the sternum
 Typical and atypical ribs

◼ Typical ribs (3rd-9th)

II
Head: two demifacets
Neck
Tubercle: one articular facet
V Body(shaft): costal angle
costal groove
XI

VI ◼ Atypical ribs (1st, 2nd, and 10th-12th)

1st, 10th-12th: single facet on head
2nd: tuberosities for muscle attachment
11th, 12th: no neck or tubercle
superior view
posterior view
 Sternum
Jugular notch
Clavicular notch
The sternum forms the middle of the
anterior part of the thoracic cage.
Manubrium
Attachment site ◼ Manubrium
for rib I
Sternal angle jugular notch
Articular facets clavicular notch
For rib II
attachment site for the 1st rib
Body
◼ Body

costal notches (2nd to 7th)

◼ xiphoid process
Costal notches

Sternal angle (Angle of Louis)

Xiphoid process
the projection formed by the
anterolateral view
manubrium and body
Superior mediastinum Sternum
The sternal angle marks:
Transverse
◼ The second pair of costal cartilages
thoracic
2nd rib T5 plane
◼ The level of the T4-T5 intervertebral disc

◼ The transverse thoracic plane

- the aortic arch

- the bifurcation of the trachea (carina)

- separate the superior mediastinum from the

inferior mediastinum

lateral view
 Inferior costal facet
Costal facet of Thoracic vertebrae
transverse process
Superior costal facet
The thoracic vertebra forms the middle of
the posterior part of the thoracic cage.
Articulation of
head of rib with ◼ Body
vertebral body - demifacets for the head of ribs
- form costovertebral joints
T8 vertebra 8th rib
◼ Pedicle
lateral view ◼ Lamina
◼ Transverse process
- facet for tubercle of ribs
- form costotransverse joints
Costovertebral joints
◼ Spinous process
Costotransverse joints ◼ Articular processes (superior & inferior)

superior view
 Intercostal space
The intercostal space is the anatomical
space between two ribs, which is
Internal intercostal M. occupied by intercostal muscles, from
outmost to innermost:
External intercostal M. ◼ External intercostal muscle

downward and forward

◼ Internal intercostal muscle

downward and backward

Innermost intercostal M.
◼ Innermost intercostal muscle

downward and backward

 Blood supply of intercostal space
Subclavian A.

◼ Subclavian A. → Internal thoracic A.

Anterior intercostal A.
Posterial intercostal A.
◼ Subclavian A
Thoracic aorta
Posterior intercostal A. (1st, 2nd)

Anastomosis ◼ Thoracic aorta

Posterior intercostal A. (3rd -11th)

Anterior intercostal A.

anterior view
Internal thoracic A.
 Venous drainage of intercostal space

Brachiocephalic V.

Internal thoracic V. ◼Anterior intercostal V.

Anterior intercostal V.
→ Internal thoracic V.
SVC
Posterial intercostal V. → Brachiocephalic V.

◼Posterior intercostal V.
Azygos V.

→ Azygos V./Hemiazygos V
Hemiazygos V.
Superior vena cava (SVC)

anterior view
 Neurovascular bundles in intercostal space
Spinal nerve trunk
Posterior ramus
Innervation
Anterior ramus
◼ the anterior rami of the corresponding
spinal nerves

Costal groove contains neurovascular

structures, from superior to inferior:

Intercostal Vein

Intercostal Artery
anterior view
Intercostal Nerve
 Thoracentesis
to insert a hypodermic needle through an intercostal space into the pleural
cavity to obtain a sample of pleural fluid or to remove blood or pus.
 Diaphragm
The central tendon
The muscular part Diaphragm is a musculotendinous
structure separating the thoracic
and abdominal cavities.
The dome of the diaphragm
the right dome
the left dome
the central aponeurotic part
L2 The crura of the diaphragm
the right crus – arises from L3
L3
the left crus – arises from L2
Median arcuate ligament inferior view
Left crus
Right crus the median arcuate ligament
 Diaphragm
Three openings
◼ Caval opening (T8)

on the central tendon;

transmits IVC and phrenic nerve
◼ Esophageal hiatus (T10)

on the right crus;

transmits esophagus and vagus
nerves
◼ Aortic hiatus (T12)

formed by the right, left crus

lateral view and median arcuate ligament;
transmits aorta, thoracic duct
and azygous vein
 Mechanism of respiration
Quiet inspiration
◼ diaphragm contracts

increase the vertical diameter

◼ external intercostal muscles contract

increase the transverse and AP diameters

develops a negative intrathoracic pressure

lateral view Passive expiration

◼ diaphragm relaxes

decrease the vertical diameter

◼ external intercostal muscles relax

decrease the transverse and AP diameters

Passive recoil of the lungs
 Sternocleidomastoid M. Internal intercostal M. Mechanism of respiration
Anterior and
middle scalene M. Forced(Active) inspiration
◼ anterior and middle scalene muscles
- lift the 1st rib
◼ diaphragm and external intercostal
External intercostal M.
muscles
- increase the diameter
◼ pectoralis and sternocleidomastoid
muscles
- further raise the ribs and sternum
allow additional increase in the AP and
anterior view
transverse diameters

External and internal

abdominal oblique M.
Transvers abdominis
lateral view Rectus abdominis
Sternocleidomastoid M. Internal intercostal M. Mechanism of respiration
Anterior and
middle scalene M. Forced(Active) expiration
◼ abdominal muscles contact

- depress lower ribs

- compress abdominal contents
- push up respiratory diaphragm
◼ Internal and innermost intercostal
muscles contract
- depress ribs
- decrease space in the thoracic cavity
anterior view
allow further increased intrathoracic
External intercostal M. pressure
External and internal
abdominal oblique M.
Transvers abdominis
Rectus abdominis
 Mediastinum
The mediastinum is the central
compartment of the thoracic cavity.
◼ covered by mediastinal pleura

◼ extend from the base of the neck

to the diaphragm

The transverse thoracic plane divides

mediastinum into:
◼ superior mediastinum

◼ inferior mediastinum

- anterior mediastinum
- middle mediastinum (pericardium)
- posterior mediastinum
lateral view
 Mediastinum
Superior mediastinum The mediastinum is the central
Sternal angle compartment of the thoracic cavity.
Transverse ◼ covered by mediastinal pleura
thoracic plane ◼ extend from the base of the neck
to the diaphragm
Inferior
mediastinum
The transverse thoracic plane divides
Posterior mediastinum into:
mediastinum
◼ superior mediastinum

◼ inferior mediastinum

Middle - anterior mediastinum

mediastinum
- middle mediastinum(pericardium)
Anterior mediastinum - posterior mediastinum
lateral view
 Contents of Mediastinum
Superior mediastinum Inferior mediastinum
Thymus Anterior mediastinum Middle mediastinum Posterior mediastinum
Brachiocephalic veins
Superior vena cava
Aortic arch Esophagus
Trachea Descending aorta
Heart
Esophagus Thymus Thoracic duct
Pericardium
Phrenic nerves Sympathetic trunk
Vagus nerves
Thoracic duct

Descending aorta
Sympathetic trunk
Sternum

Thoracic duct

Esophagus
superior view