ADDIS ABABA UNIVERSTIY

COLLEGE OF HEALTH SCIENCES

SCHOOL OF MEDICINE
DEPARTMENT OF MEDICAL RADIOLOGIC
TECHNOLOGY (MRT)

Cross-sectional Anatomy of the

Thorax
Prepared by: Blein Mulugeta
NOVEMBER, 2022

12/11/22 1
 THORAX- Outline

• Boundaries of the thorax

• Thoracic Wall:
– Bones of the thorax
– Muscles of the thorax
– Arteries and nerves of the thoracic wall
– Breasts
• Thoracic Cavity
– Thoracic Visceral Structures
12/11/22 2
 Points for Practice
• What are the basic regions of the thorax?
• What are the bones that make up the
thoracic cage?
• What are the boundaries of the thorax?
• Muscle of the thoracic wall?
• Arterial supply of the thoracic wall and how
do they arise?
• Venous drainage of the thoracic wall?
• Major innervation of the thoracic wall?
• Functions of the thorax?
12/11/22 3
 The Thorax
• The thoracic cavity, surrounded by
the thoracic wall, contains the heart,
lungs, thymus, distal part of the
trachea, and most of the esophagus.

• The thoracic wall consists of skin,

fascia, nerves, vessels, muscles, and
bones.

12/11/22 4
 The Thorax
Functions of the thoracic wall include:
• protecting of thoracic & abdominal internal organs;
• Resisting negative internal pressures generated by
elastic recoil of the lungs & inspiratory movements;
• providing attachment for and supporting the weight
of the upper limbs.
• It provides attachment for muscles of upper limbs,
neck, abdomen & back, & muscles of respiration.

12/11/22 5
 Thorax
Thorax:
• primary function : respiration.
ribs & diaphragm move thoracic cavity
increases and decreases in size during
inspiration & expiration of respiration.

• It also may aid in returning venous blood back

to the heart because of the negative pressure
produced with respiratory movements.

• Secondarily, it protects organs located within its

cavity plus some organs of the abdominal cavity.

12/11/22 6
 Thorax
1. major thoracic organs of the thorax are:
• lungs
• heart

2. The other structures include:

• aorta and its branches
• superior cava & inferior vena cava
• trachea and primary bronchi; esophagus
• Nerves: sympathetic trunks & their
associations; vagus & phrenic nn
• azygos and hemiazygos venous systems
• Thoracic duct
12/11/22 7
 The Thorax: Bones
BONES OF THE THORAX:
•Thoracic vertabrae
•Ribs
•Sternum

THORACIC VERTABRAE:
•All thoracic vertabrae form
joints with the ribs.
•The first thoracic vertabra
contains a facet for first rib
and upper part of the second
rib.

12/11/22 8
 Skeleton of Thoracic Wall
• thoracic skeleton forms osteocartilaginous thoracic
cage .
• thoracic skeleton (bony thorax) includes;
-12 pairs of ribs and costal cartilages,
-12 thoracic vertebrae & intervertebral discs
- sternum.
• Costal cartilages form the anterior continuation of
the ribs, providing a flexible attachment at their
articulation with the sternum .
• Ribs & their cartilages are separated by intercostal
spaces, containing intercostal muscles, vessels,
and nerves.

12/11/22 9
 Skeleton of Thoracic Wall
Ribs:
• The ribs are curved, flat bones that form most of the thoracic
cage .
• They are remarkably light in weight yet highly resilient.
• There are three types of ribs:
1. True (vertebrocostal) ribs (1st- 7th ribs) attach directly to
the sternum through their own costal cartilages.
2.False (vertebrochondral) ribs (8th -10th ) ribs) have cartilages
that are joined to the rib just superior to them; thus,
their connection with the sternum is indirect.
3.Floating (free) ribs (11th- 12th ribs) have rudimentary
cartilages that do not connect even indirectly with the
sternum;  instead, they end in the posterior abdominal
musculature.

12/11/22 10
• True ribs have direct
attachment b/n
vertebrae & the
sternum.
• Each rib attaches to
sternum by its own
costal cartilage

• False ribs attach to

the sternum by way
of costal cartilage
above it.

• Floating ribs do not

have an anterior
attachment

11
 Skeleton of Thoracic Wall
Ribs:
• Typical ribs (3rd - 9th) have a:
• Head: that is wedge-shaped and two facets that are separated by the
crest of the head . One facet is for articulation with the numerically
corresponding vertebra, and one facet is for the vertebra superior to it.
• Neck: that connects the head with the body at the level of the tubercle.
• Tubercle: at the junction of the neck and body. The tubercle has a smooth
articular part for articulating with the corresponding transverse process of
the vertebra
• Body (shaft): that is thin, flat, and curved, most markedly at the angle
where the rib turns anterolaterally.
• The concave internal surface has a costal groove that protects the
intercostal nerve and vessels .

12/11/22 12
12/11/22 13
12/11/22 14
 Typical & Atypical ribs
Atypical ribs (1st, 2nd, & 10th - 12th) :
• The 1st rib: is the broadest (its body is widest & nearly
horizontal), shortest, & most sharply curved of the seven true
ribs;
• it has two grooves crossing its superior surface for the
subclavian vessels.
• The 1st rib has single facet.
• The 2nd rib: is thinner, less curved & much longer than 1st rib.
• It has two facets on its head for articulation with the bodies of
the T1 and T2 vertebrae.
• The 10th -12th ribs, like the 1st rib, have only one facet on their
heads.

• The 11th and 12th ribs are short and have no necks or tubercles.

12/11/22 15
 Typical & Atypical Ribs

12/11/22 16
 Typical & Atypical Ribs

12/11/22 17
 Skeleton of Thoracic Wall
Costal cartilages:
•prolong the ribs anteriorly and contribute to the elasticity of
the thoracic wall.
Intercostal spaces:
•separate the ribs and their costal cartilages from one
another.
•spaces and neurovascular structures are named according
to the rib forming the superior border of the space.
•there are 11 intercostal spaces and 11 intercostal nerves.
•The subcostal space is below the 12th rib and the anterior
ramus of spinal nerve T12 is the subcostal nerve.

12/11/22 18
 Skeleton of Thoracic Wall
Thoracic Vertebrae:
• There are 12 thoracic
vertebrae:
1st & 12th are called atypical
and the rest are typical.
All of the typical vertebrae
have same characteristics.
The 1st and 12th vertebrae
have slightly different
characteristics than the
typical ones.

12/11/22 19
 Skeleton of Thoracic Wall
Characteristics of a typical thoracic
vertebra include:
• body (1)
• superior & inferior demifacets (2,3)
• pedicle (4)
• superior & inferior articular processes
(5, 6)
• transverse process (with an articular
process) (7,10)
• lamina (8)
• spinous process (9)
• superior and inferior notches (13,12)
• vertebral canal(14)
• intervertebral disk (11)  is not a bone
but an integral part of vertebral column

12/11/22 20
 Skeleton of Thoracic Wall
Thoracic Vertebrae:
•are typical vertebrae in that: they are independent, they have bodies,
vertebral arches & seven processes for muscular & articular
connections .
Characteristic features of thoracic vertebrae include:
•All thoracic vertabrae form joints with the ribs
•Thoracic vertabrae from 2-8 have similar characterstics (contain superior
& inferior costal demifacets on posterolateral aspect of their bodies for the
articulations with head of ribs) : Thus, they are typical thoracic vertabrae.

•The first and the 9th-12th contain single costal facet.

•The 11th and12th thoracic vertebrae contain one costal facet& no
transverse costal facet for the 11 th and12th ribs respectively.

12/11/22 21
12/11/22 Blein M. 22
12/11/22 Blein M. 23
 Skeleton of Thoracic Wall
Thoracic Vertebrae:
Other important features of thoracic vertebrae
are the following:
•Their bodies are shorter venterally than dorsally
•Their articular processes are more or less vertical.
•The spinous process are curved downward
•They contain circular vertebral foramina
•Their transverse processes bear costal facets for
the articulation with the tubercles of the ribs.

12/11/22 24
 Skeleton of Thoracic Wall
Sternum:
•The sternum is the flat,
vertically elongated bone
that forms the middle of the
anterior part of the thoracic
cage.
•The sternum consists of
three parts: manubrium,
body, and xiphoid
process

12/11/22 25
 Bones of the Thorax
Sternum:
•jugular notch (1)

•manubrium (2)
•facet for head of first rib
•facet for head of second rib

•manubriosternal joint (sternal

angle) (3)

•body (made up of several fused

sternabrae) (4)

•xiphoid process (5)

12/11/22 26
 Surface Anatomy of the Thorax:
Sternum-
• lies subcutaneously in the anterior median line and is palpable
through out its length.
Jugular notch (superasternal notch)
• easily palpated concave center of superior border of manbrium.
• The notch lies at level of inferior border of body of T2 vertebra
Manubrium: -
• upper part of sternum, approximately 4cm long,
• lies at level of bodies of T3 & T4 vertebrae.
• left side of manubrium is anterior to arch of aorta,
• its right side directly over lies margin of brachiocephalic vein to form
superior vena cava.

12/11/22 27
 Surface Anatomy of the Thorax…
Strenal angle (angle of luois) –

• lies at level of T4 – T5 Intervertebral disc & space b/n 3rd & 4th
thoracic spinous processes.
• Marks level of 2nd pair of costal cartilage at manubrostrnal joint.
• trachea bifurcates into the main (primary) bronchi at this angle
• arch of aorta (begins posterior to 2 nd right sternocostal joint) and
thoracic aorta begin at level of sternal angle.
Body of sternum: -
• aproximately10 cm long;
• lies anterior to right border of the heart & vertebrae T5 - T9.

12/11/22 28
 Surface Anatomy of the Thorax…
Xiphoid process:-

• lies at the level of T10 vertebra.

• It is an important landmark in the median plain
because:
– Its junction with sternal body at xiphisternal joint (at
level of inferior border of T9 vertebra) indicates the
inferior limit of central part of thoracic cavity.
– A midline marker for superior limit of liver, central
tendon of diaphragm & inferior border of the heart.

 
12/11/22 29
 Bony Boundaries of the Thorax
1. Sternum:
•manubrium (1)
•sternal angle (2)
•body (3)
•xiphoid process (4)
2. 12 pairs of ribs:
•6 or 7 pairs of true ribs (5)
•3 or 4 pairs of false ribs (6)
•2 pairs of floating ribs (7)
3.thoracic inlet (superiorly)(8)
4.thoracic outlet (inferiorly) (9)
5. thoracic vertebrae,
posteriorly
30
 Reconstructed CT image of the thorax –Sagittal plane depicting
the measurement of second rib inclination at manubriosternal
joint (T – thoracic vertebra, MSJT – manubriosternal joint)

12/11/22 31
 Reconstructed CT image of the thorax –Sagittal Plane showing
complete destruction of the xihphoid process

12/11/22 32
 CT 3-D bone reconstructed images of thorax

12/11/22 33
CT chest- Bone Window- Axial Plane
12/11/22 34
CT chest- all 3 planes
High-resolution CT of a normal thorax
12/11/22 35
 The Thoracic Wall
• Thoracic wall is made up of sternum, ribs plus three
layers of intercostal muscles, diaphragm &
intercostal vessels and nerves.

• Inside, the thoracic wall is lined by Endothoracic

Fascia.
• Muscles of the thorax consist of the intercostals and
diaphragm.
• Intercostal muscles are arranged as three layers
(external layer, internal layer and an incomplete
innermost layer) b/n the ribs.
• Diaphragm closes the thoracic outlet and separates the
thoracic cavity from the abdominal cavity.

12/11/22 36
 Muscles of the Thoracic Wall
The three layers of the intercostal muscles are:

– external layer -- external intercostal

– internal layer -- internal intercostal
– innermost layer –
• transversus thoracic (anterior),
• innermost (lateral) and
• subcostal (posterior);these make up the
deepest layer of muscles from anterior to
posterior, respectively.

•The diaphragm is the most important muscle of the

thoracic wall: primary component of normal/silent
respiration.
12/11/22 37
 Muscles of the Thoracic Wall
• external
intercostal
• internal
intercostal
• innermost
intercostal:
• transversus
thoracis (anterior)
• Innermost (lateral)
• subcostal
(posteriorly)

12/11/22 38
 Muscles of the Thoracic Wall

12/11/22 39
 Muscles of the Thoracic Wall
• The serratus posterior muscles: serratus
posterior superior and serratus posterior
inferior, have traditionally been described
as inspiratory muscles

• recent studies have suggested that they

may have a proprioceptive function

12/11/22 40
 Muscles of the Thoracic Wall
• Serratus posterior superior was said to
elevate the superior four ribs, thus
increasing the AP diameter of the thorax
and raising the sternum.
• Serratus posterior inferior was said to
depress the inferior ribs, preventing them
from being pulled superiorly by the
diaphragm

12/11/22 41
12/11/22 42
 Muscles of the Thoracic Wall
• The levatores costarum muscles are 12
fan-shaped muscles that elevate the ribs,
but their role, if any, in normal inspiration
is uncertain.
• They may play a role in vertebral
movement and/or proprioception.

12/11/22 43
 Muscles of Thoracic Wall: Diaphragm
Diaphragm:
• a dome-shaped, thin musculotendious partition b/n thoracic &
abdominal cavity.
• central part of the diaphragm is tendinous.
• peripheral part is muscular & arises from the whole circumference of
the thorax.

– Diaphragm has three parts,

• (1) Sternal part:
• (2) Costal part
• (3) Lumbar part

12/11/22 44
Attachments, disposition, and features of the abdominal aspect of the diaphragm.
A. The thoracic wall and cage have been removed to demonstrate the attachments and
convexity of the right dome of the diaphragm.
B. The fleshy sternal, costal, and lumbar parts of the diaphragm (outlined with broken
lines) attach centrally to the trefoil-shaped central tendon, the aponeurotic insertion of the
diaphragmatic muscle fibers.

12/11/22 45
 The crura of the diaphragm
• are musculotendinous bands that arise
from the anterior surfaces of the bodies of
the superior three lumbar vertebrae, the
anterior longitudinal ligament, and the IV
discs.
• the right crus, larger and longer than the
left crus, arises from the first three or four
lumbar vertebrae. The left crus arises from
the first two or three
12/11/22 46
 Muscles of Thoracic Wall: Diaphragm
Diaphragm:
• Central Tendon: is approximately in the center of the dome
 Heart and pericardium rest on it.
Openings of the Diaphragm: has 3 large openings:
1. Opening for inferior vena cava:
• at level of T8 vertabra; in central tendon part
• Inferior vena cava & Rt. Phrenic n. transmitted.
2. Esophageal hiatus:
• at T10 vertebra; in muscular part
• Esopahgus, Rt. & Lt. vagus nerves, Lt Gastric vessels
(esophageal branches) & lymphatic vessels transmitted.
3. Aortic hiatus:
• At level of T12 vertebra; in muscular part: b/n the crura
• Aorta, Thoracic duct & Azygus vein transmitted
12/11/22 47
12/11/22 48
 Muscles of Thoracic Wall: Diaphragm
Diaphragm:
• Innervation: Motor supply : phrenic nerves, C4 with
contributions from C3 and C5. Sensory supply: centrally by
phrenic nerves (C3-C5), peripherally by intercostal nerves (T5-
T11) and subcostal nerves (T12)

• Blood Supply:, musculophrenic arteries. Veins drain into internal

thoracic veins

• Function:
1. It is the principal muscle of inspiration, and may be the sole
moving muscle of quiet inspiration.
2. the diaphragm takes active part in all expulsive acts.

12/11/22 49
12/11/22 50
 Arterial Blood Supply to the
Thoracic Wall

The thoracic wall is supplied by three

sources of blood supply:
Axillary:
•supreme thoracic (2)
•lateral thoracic (3)
Subclavian:
•internal thoracic (or
mammary) artery (1): anterior
intercostal branches
Aorta:
•Posterior intercostal arteries (4)
12/11/22 51
 Arterial Blood Supply to the
Thoracic Wall
• Each typical intercostal space contains
three arteries:
– One posterior and
– Two anterior intercostal arteries
1. The posterior artery originates from the
aorta (thoracic part)
2. The anterior arteries from the internal
thoracic arteries which inturn arise from
the subclavian arteries in the root of the
neck
12/11/22 52
 Arterial Blood Supply to the
Thoracic Wall
• Together, the intercostal arteries form a
basket-like pattern of vascular supply
around the thoracic wall

12/11/22 53
 Arterial Blood Supply to the
Thoracic Wall

12/11/22 54
 Arterial Blood Supply:Posterior
intercostal arteries
• Are 11 pairs
• The upper two posterior intercostal
arteries on each side are derived from
the supreme (superior )intercostal
artery, a branch of the costocervical
trunk in the neck.
• Costocervical trunk is a posterior branch
of subclavian artery

12/11/22 55
 Arterial Blood Supply: Posterior
intercostal arteries
• The remaining 9 pairs of posterior
intercostal arteries arise from the posterior
surface of the thoracic aorta

• The sub costal arteries the last pair arising

from the thoracic aorta run below the lower
border of the 12th ribs

12/11/22 56
 Arterial Blood Supply: Anterior
intercostal arteries
• Originate directly or indirectly as lateral
branches from the internal thoracic
arteries
• Each internal thoracic artery arises as
a major branch of subclavian artery in
the neck

12/11/22 57
 Arterial Blood Supply: Anterior
intercostal arteries

• At the level of the sixth intercostal space, it

divides into two terminal branches:
• The superior epigastric artery, which
continues inferiorly into the anterior abdominal
wall
• The musculophrenic artery, which passes
along the costal margin, goes through the
diaphragm

12/11/22 58
12/11/22 59
12/11/22 60
 Veins of Thoracic Wall
• Veins: most of the veins join the azygos system of veins.
• Some of the upper veins join the brachiocephalic veins.
• Venous drainage parallels pattern of arterial supply
• Centrally, the intercostal veins ultimately drain into
 Azygos system of veins-drains posteriorly
 Brachiocephalic veins--drains posteriorly
 Internal thoracic veins- -drain anteriorly
Posteriorly
• The 1st intercostal space drain by the 1st posterior intercostal
veins on both sides and join the brachiocephalic veins
• The 2nd,3rd , 4th left intercostal spaces drain by the superior
intercostal veins utercostal veins superior intercostal veins

12/11/22 61
 Veins of Thoracic Wall
 On the left side, they
form the left superior
intercostal vein,
which empties into
the left
brachiocephalic vein
 On the right side,
they form the right
superior intercostal
vein, but empties
into the azygos vein

12/11/22 62
 Veins of Thoracic Wall
• From the 5th & below, posterior
intercostal veins
 On the right side, drain into
the azygos vein directly
 On the left side, the middle &
lower four posterior intercostal
veins form the superior
hemiazygos vein & inferior
hemiazygos vein respectively
 Both hemiazygos flow into azygos
by crossing the midline at T8 & T9
level respectively

12/11/22 63
 Veins of Thoracic Wall
Anteriorly
• The anterior intercostal veins drain into
 Internal thoracic veins --- directly from the first six
intercostal spaces
 Musculophrenic veins --- from 7-9 spaces
 The musculophrenic veins finally joins the
internal thoracic veins

12/11/22 64
12/11/22 65
12/11/22 66
 Nerves of Thoracic Wall
Innervation of Thoracic Wall:
• There are 12 thoracic spinal nerves.
• After leaving the intervertebral
foramen, each divides into a
posterior/dorsal & anterior/ventral
ramus.
• The anterior rami do not form
plexuses (except part of T1).
 They are distributed to the
corresponding intercostals spaces
where they lie in the costal groove
below the artery.
  At the anterior end of the spaces
they pierce the muscles and become
cutaneous.
12/11/22 67
 Nerves of Thoracic Wall
Innervation of Thoracic Wall:
• The 7-12th intercostal nerves pass
thru the intercostals spaces, but
continue into the abdominal wall:
 They are called thoraco-
abdominal nerves.

• The 12th intercostal nerve is called

the sub costal nerve It is
posteriorly related to the kidneys.

12/11/22 68
12/11/22 69
 Dissection of anterior aspect of anterior thoracic wall.
The external intercostal muscles are replaced by membranes between costal
cartilages. The H-shaped cuts through the perichondrium of the 3rd and 4th
costal cartilages are used to shell out pieces of cartilage, as was done with the
4th costal cartilage. It is not uncommon for the 8th rib to attach to the sternum,
as in this specimen. The internal thoracic vessels and parasternal lymph nodes
(green) lie inside the thoracic cage lateral to the sternum.
12/11/22 70
Posterior aspect of anterior thoracic wall.
The internal thoracic arteries arise from the subclavian arteries and have paired
accompanying veins (L. venae comitantes) inferiorly. Superior to the 2nd costal cartilage,
there is only a single internal thoracic vein on each side, which drains into the
brachiocephalic vein. The continuity of the transversus thoracis muscle with the
transversus abdominis muscle becomes apparent when the diaphragm is removed, as
has been done here on the right side.
12/11/22 71
 Breasts
• The breasts are the most prominent
superficial structures in the anterior
thoracic wall, especially in women.
• The breasts consist of glandular and
supporting fibrous tissue embedded within
a fatty matrix, together with blood vessels,
lymphatics, and nerves

12/11/22 72
• The mammary glands are in the
subcutaneous tissue overlying the
pectoralis major and minor muscles.
• At the greatest prominence of the breast is
the nipple, surrounded by a circular
pigmented area of skin, the areola

12/11/22 73
 FEMALE BREASTS

• The roughly circular body of the female

breast rests on a bed that extends
transversely from the lateral border of the
sternum to the midaxillary line and
vertically from the 2nd through 6th ribs

12/11/22 74
12/11/22 75
• Between the breast and the pectoral fascia
is a loose connective tissue plane or
potential space—the retromammary space
(bursa).
• This plane, containing a small amount of
fat, allows the breast some degree of
movement on the pectoral fascia.

12/11/22 76
• A small part of the mammary gland may
extend toward the axillary fossa (armpit),
forming an axillary process or tail (of
Spence).
• Some women discover this especially when
it may enlarge during a menstrual cycle and
become concerned that it may be a lump
(tumor) or enlarged lymph nodes.

12/11/22 77
12/11/22 78
12/11/22 79
.The mammary gland is firmly attached to the dermis
of the overlying skin, especially by substantial skin
ligaments , the suspensory ligaments (of Cooper),
which help support the mammary gland lobules.
. During puberty (ages 8-15 years), the breasts
normally enlarge, owing in part to glandular
development but primarily from increased fat
deposition
. In most women, the breasts enlarge slightly during
the menstrual period from increased release of the
gonadotropic hormones - FSH & LH - on the
glandular tissue.
• The lactiferous ducts give rise to buds that form 15-20
lobules of glandular tissue, which constitute the
parenchyma of the mammary gland.
. Each lobule is drained by a lactiferous duct, which
usually opens independently on the nipple.
. The ducts converge toward the nipple.
. Deep to the areola, each duct has a dilated portion, the
lactiferous sinus, in which a small droplet of milk
accumulates or remains in the nursing mother.
. The mother’s milk is secreted into lactiferous sinus
from where it's sucked by the baby’s mouth, not
directly from the gland.
 Vasculature of the Breast

. The arterial supply of the breast derives from the:

 Medial mammary branches of perforating
branches & anterior intercostal branches of the
internal thoracic artery, originating from the
subclavian artery.
 Lateral thoracic & thoracoacromial arteries,
branches of the axillary artery.
 Posterior intercostal arteries, branches of the
thoracic aorta in the 2nd, 3rd, & 4th intercostal
spaces.
• The venous drainage of the breast is mainly to
the axillary vein, but there is some drainage to the
internal thoracic vein.
• The lymphatic drainage of the breast is important
• because of its role in the metastasis of cancer cells.
• Lymph passes from the nipple, areola, & lobules of the gland to the
subareolar lymphatic plexus.
 From this plexus:
 Most lymph (> 75%), especially from the lateral breast quadrants, drains
to the axillary lymph nodes, initially to the anterior or pectoral nodes for
the most part.
 Some lymph may drain directly to other axillary nodes or even to
interpectoral, deltopectoral, supraclavicular, or inferior deep cervical
nodes.
 Most of the remaining lymph, particularly from the medial breast
quadrants, drains to the parasternal lymph nodes or to the opposite
breast,
 Lymph from the inferior quadrants may pass deeply to abdominal
lymph nodes (subdiaphragmatic inferior phrenic lymph nodes).
• Lymph from the skin of the breast, except the
nipple & areola, drains into the ipsilateral axillary,
inferior deep cervical, & infraclavicular lymph
nodes & also into the parasternal lymph nodes of
both sides.
. Lymph from the axillary nodes drains into clavicular
(infraclavicular& supraclavicular) lymph nodes &
from them into the subclavian lymphatic trunk,
which also drains lymph from the UL.
. Lymph from the parasternal lymph nodes enters
the bronchomediastinal lymphatic trunk, which
also drains lymph from the thoracic viscera.
12/11/22 88
• The termination of these lymphatic trunks
varies; traditionally, these trunks are
described as merging with each other and
with the jugular lymphatic trunk, draining
the head and neck to form a short right
lymphatic duct on the right side or entering
the termination at the thoracic duct on the
left side.
• However, in many (perhaps most) cases,
the trunks open independently into the
junction of the internal jugular and
subclavian vein, the venous angle, to form
the brachiocephalic veins . In some cases,
they open into both of these veins.
 Nerves of the Breast

. The nerves of the breast derive from anterior

& lateral cutaneous branches of the 4th-6th
intercostal nerves.
. Rami communicantes connect each anterior
ramus to a sympathetic trunk.
. The branches of the intercostal nerves thus
convey sensory fibers to the skin of the
breast & sympathetic fibers to the blood
vessels in the breasts & smooth muscle in
the overlying skin & nipple.
12/11/22 92
12/11/22 93
 Small Cell Lung Cancer with Metastasis to
the Breast

12/11/22 94
 Thoracic Cavity

• Transverse
section
through the
thorax:
• the thorax in cross
section: is kidney
shaped.
• You can also see the
anterior, posterior and
lateral boundaries.

12/11/22 95
 Subdivisions of Thoracic Cavity
Subdivisions of the thorax:

1.left and right lateral

cavities &

2. mediastinum (as seen

on cross section)

•the left and right lateral

cavities are occupied by the
Lungs & Pleura.

12/11/22 96
 The Pleura

• Each lung is enclosed in a serous sac, the pleura.

• In common with serous sacs in the body, each sac
consists of a parietal and a visceral layer separated by
a potential space known as pleural cavity.

• The pleura that covers the lung surface (attached to the

surface of the lung) is called the visceral pleura.
• The remainder of the pleura that lines the inside of the
thoracic wall is called the parietal pleura.

12/11/22 97
12/11/22 98
• Pleura produces a small amount of fluid that fills
the gap b/n the parietal & visceral layers of
pleura  Pleural Cavity.
• This fluid reduces friction b/n the two layers.
therefore,the surface of the lung, which is covered
by visceral pleura, directly opposes and freely slides
over the parietal pleura attached to the wall

12/11/22

99
Pleural recesses: are those parts of the
pleural cavity which the lung occupies in
forced inspiration only.
The largest recess is the
costodiaphragmatic recess (one on each
side).

12/11/22 100
 The Pleura

• a cross section thru the

thorax showing various parts of
the parietal pleura.

•Notice that the visceral and

parietal pleura are continuous
at the root of the lung
•Parts of the parietal pleura
(parietal pleura in blue; visceral
pleura in purple) in a cross
section

12/11/22 101
 The Pleura
•This is a frontal or (coronal)
section through the thorax
showing the various parts of the
parietal pleura.

• visceral & parietal pleurae are

continuous at the root of the lung.

•Parts of the parietal pleura

(parietal pleura in blue; visceral
pleura in purple):
1. costal
2. mediastinal
3. cervical (cupular)
4. diaphragmatic
12/11/22 102
 The Pleura
• The visceral or pulmonary pleura are inseparably attached to
the lung tissue:
  thus, it is supplied by bronchial vessels and by
sympathetic & parasympathetic nerves from pulmonary
plexus (autonomic nervous system).

• The parietal pleura lines the inside of the thoracic wall

 the Endothoracic Fascia: separates parietal pleura from the inside of
the thoracic wall)
  thus, parietal pleura is supplied by intercostals vessels.
Innervation: is by intercostal & phrenic nerves: (costal
pleura by intercostal nerves; mediastinal pleura by phrenic
nerve; & diaphragmatic pleura by phrenic nerve & lower five
intercostal nerves).

12/11/22 103
 The Pleura Cavity
• At the level of vertebrae TV to TVII, the mediastinal
pleura reflects off as a tubular, sleeve-like covering
 It serves as a passage way of structures that pass between
the lung and mediastinum (i.e. airway, vessels, nerves,
lymphatics)
• This sleeve-like covering, and the structures it
contains, forms the root of the lung
• The root joins the medial surface of the lung at an
area referred to as the hilum of lung

12/11/22 104
 The Pleura Cavity
 A thin fold of pleura projects inferiorly from the root which
extends from the hilum to the mediastinum pulmonary
ligament
• It accommodates the down-and-up translocation of
structures in the root during breathing
• Structures within each root and located in the hilum are:
- Pulmonary artery - Pulmonary plexuses of nerves
- Two pulmonary veins - Lymphatic vessels
- Bronchus (two on the right) - Bronchial lymph nodes
- Bronchial vessels - Areolar tissue

12/11/22 105
 Root and Hilum

12/11/22 106
 The Lungs
The Lungs:

• The lungs are the essential organs of respiration.

• They are highly elastic structures.

 It is this elasticity which is responsible for
the ordinary expiration force.
• Each lung lies free in its own pleural cavity.

12/11/22 107
 The Lungs
• Its only attachment is at its root.
• By “root of the lung” we mean all
structures entering and leaving the lung at
the hilus.
• They connect the lung with trachea (by
Bronchii) and heart (by pulmonary
vessels).

12/11/22 108
 The Lungs
• The lungs present an apex, a base, 3
borders and 3 surfaces:

• The apex projects above the thoracic

inlet into the root of the neck.
  It is related to subclavian, common
carotid, brachiocephalic arteries,
brachiocephalic veins, scalenus
medius, sympathetic trunk, 1st thoracic
spinal nerve and superior intercostal
arteries.

• The base or diaphragmatic surface is

related to the diaphragm.

12/11/22 109
 Lobes & Surface of the Lungs
• The lungs fill
lateral thoracic
cavities & are
divided into lobes:
 Left lung has 2
lobes & Right
lung has 3 lobes.

• bulk of the lung

surface is against
the ribs & is called
costal surface.

• Other surfaces
include the:
diaphragmatic &
mediastinal.
12/11/22 110
 Lobes & Surface of the Lungs

• Each lung also

has 3 borders:
anterior,
posterior &
inferior.

• Anterior border
of the left lung is
pushed out by the
heart & this
notch is called the
cardiac notch.
 inferior to the
notch is a small
lingular lobe.
12/11/22 111
 Lobes & Surface of the Lungs
• In both lungs, the
superior and
inferior lobes are
separated by the
oblique fissure.

• In the right
lung, the
superior lobe is
divided into
superior &
middle lobes,
by the
horizontal
fissure.
12/11/22 112
 Surface Anatomy of the Thorax…
Fissures of the lungs :
• The oblique fissure: extends from the level of
spinous process of T2 vertebra (posteriorly), to
6th costal cartilage (anteriorly).

• The horizontal fissure of the right lung extends

from the oblique fissure along the 4th rib & costal
cartilage anteriorly.

12/11/22 113
 CT Appearances of the Major Fissures

• The major fissure is an important anatomic

landmark in the interpretation of chest
radiographs and CT images
• Major fissures appearance:
– radiography .........................hairlines of soft
tissue density
– conventional CT .................lucent,
hypovascular bands
– high-resolution CT ..............most often appear
as sharp lines

12/11/22 114
Rt Lung Lt Lung

12/11/22 115
Minor fissure

• On CT the minor fissure position is represented

by an oval area of reduced vascularity at the level
of the bronchus intermedius

12/11/22 116
 Minor fissure is rarely seen as line but its position can be identified by large
triangular or oval shape deficiency of vessel extending from major fissure to
chest wall at the level of bronchus intermedius
12/11/22 117
 The minor fissure is apparent as an area of avascularity anterior to
the major fissure
12/11/22 118
 Other Relations of Root of the Lung

•On the mediastinal surface of

the right lung, you will find:
1.azygos vein and its arch
(over the root of the lung)
2.Groove for the superior vena
cava.

3.depression for the right

atrium.
4. Phrenic nerve anterior to
the root of the lung
5. Rt. vagus nerve posterior
to the root of the lung
6.Esophagus

12/11/22 119
 Root of the Right Lung

12/11/22 120
 Other Relationships With the
Root of the Lung
•On the mediastinal surface
of the left lung, you will find
these structures:
1. descending aorta
2.arch of the aorta over root
of the lung
3.Left Ventricle
4. Lt. common carotid a.
5. Lt. subclavian artery
6. phrenic nerve anterior to
the root of the lung
7. vagus nerve posterior to
the root of the lung
12/11/22 121
 Other Relationships With the
Root of the Lung

12/11/22 122
 Vessels of the LUNGS
Blood Supply to the lungs:
1. Pulmonary arteries
2. Bronchial vessels:
• Right bronchial artery usually arises from the 3rd right posterior
intercostal artery.
• Left bronchial arteries (two) originate from the thoracic aorta.

Veins:
• Deep bronchial veins
• Superficial bronchial veins
 They terminate in the azygos system mainly.

12/11/22 123
 Nerves of the Lungs
The nerve supply:
• The bronchial constrictors are innervated by the
vagus:
bronchial constriction & vasodilation; &
increase glandular secretion
(parasympathetic by vagus nerve).
• bronchial dilators are innervated by sympathetic
nerves.
bronchial dilation & vaso constriction
(sympathetic).

12/11/22 124
 CT-Windows of the Lung

12/11/22 125
 CT normal Lung scan-without
contrast

12/11/22 126
Contrast enhanced CT scan of chest displayed on soft tissue windows.
Fat, muscle and bone are easily distinguished by their different levels
of grey

12/11/22 127
The Trachea & Bronchial Tree
The Trachea: commences in the neck at lower border of
cricoid cartilage at the level of the 6th cervical vertebra,
and ends below by dividing into a right and left primary
bronchus at the level of the sternal angle (b/n 4th & 5th
thoracic vertebral).
• The trachea is held open by 'C-shaped' transverse
cartilage rings embedded in its wall-
open part of the 'C' faces posteriorly.
The posterior wall of the trachea is composed mainly of
smooth muscle.
• It lies in the midline except at its bifurcation where it
slightly deviates to the right.
12/11/22 128
12/11/22 129
12/11/22 130
The Trachea & Bronchial Tree
The Trachea:
• A ridge b/n the two principal
bronchi, at their point of origin is
called the carina.
• right primary bronchus is shorter,
wider & more straight (more in line
with the trachea) thus, foreign
bodies have a great tendency to
go to the right primary bronchus.

12/11/22 131
 TRACHEA

12/11/22 132
 TRACHEA

12/11/22 133
 The Trachea & Bronchial Tree
Trachea, Bronchial Tree and
Bronchopulmonary Segments:

• The lung has an organized

system of airways which we call
the bronchial tree.
• The primary bronchus divides
into lobar (secondary) bronchi,
two on the left and three on the
right side.
• The lobar bronchi give origin to
and terminate in segmental
(tertiary) bronchi.
– each segmental bronchus then
enters Broncho pulmonary
segment
– There are ten segmental bronchi on
the right side & eight on left side.
12/11/22 134
• Each segmental bronchus, together with
the part of the lobe it supplies, is called a
bronchopulmonary segment.

• A bronchopulmonary segment is the

zone of distribution of a segmental
bronchus & is a functional, anatomical &
surgical unit of lung tissue.
12/11/22 135
 The Trachea & Bronchial Tree
Trachea, Bronchial Tree and
Bronchopulmonary
Segments:

• Respiratory bronchioles,
alveolar ducts, alveolar sac
& alveoli constitute
respiratory tissue proper.
•

12/11/22 136
 The Trachea & Bronchial Tree

12/11/22 137
Bronchopulmonary segment: Right Lung

12/11/22 138
 Bronchopulmonary segment: Left Lung

12/11/22 139
 Bronchopulmonary segment
• Normal bronchi may be seen in the central areas
of the lung on high-resolution CT (HRCT) and
usually are about the same size as the adjacent
pulmonary artery

• Normal bronchi are not visible in the most

peripheral areas of the lung, i.e., within 5 to 10
mm of the pleural surface

• Sub-segmental bronchi can routinely be identified

with thin-section CT
12/11/22 140
12/11/22 141
12/11/22 142
12/11/22 143
 Right to Left

Level of tracheal carina

12/11/22 144
 • right main bronchus (RM)
• right upper lobe bronchus (ru)
• right upper lobe anterior
segmental bronchi (3)
• right upper lobe posterior
segmental bronchi (2)
• right superior pulmonary vein (rv)
• left main bronchus (LM)
• left apicoposterior segmental
bronchus (1+2)
• left superior pulmonary vein (lv)

Level of right upper lobe bronchus

12/11/22 145
 • bronchus intermedius (BI)
• left main bronchus (LM)
• right superior pulmonary vein
(rv)
• superior division of left upper
lobe bronchus (small arrows)
• left upper lobe anterior
segmental bronchi(3)
• left upper lobe apicoposterior
segmental bronchi (1+2)
• left descending pulmonary
artery (Ld)

Level of left upper lobe bronchus, superior division

12/11/22 146
 • bronchus intermedius (BI)
• right descending pulmonary
artery (Rd)
• lingular bronchus (4+5)
• left lower lobe bronchus (LL)
• left lower lobe superior
segmental bronchus (6)
• left descending pulmonary
artery (Ld)

Level of left upper lobe bronchus, inferior (lingular) division

12/11/22 147
 • Middle lobe bronchus (4+5)
• right lower lobe bronchus (RL)
• right descending pulmonary artery (Rd)
• lingular superior segmental bronchus (4)
• left lower lobe basal trunk (BT)
• left lower lobe segmental arteries (a)

12/11/22 Level of middle lobe bronchus 148

 • lateral segmental bronchi of the middle
lobe (4)
• medial segmental bronchi of the middle
lobe (5)
• right lower lobe basal trunk (BT);
• right lower lobe basal segmental arteries
(a, on right)
• lingular segmental bronchus (5)
• left lower lobe anteromedial segmental
bronchus (7+8)
• left lower lobe lateral and posterior basal
segmental bronchi (9+10)
• left lower lobe basal segmental arteries (a,
on left)

Level of lower lobe basal trunks.

12/11/22 149
 • right lower lobe medial (7, on right),
anterior (8, on right), lateral (9, on
right), and posterior (10, on right) basal
segmental bronchi;
• right inferior pulmonary vein (v, on
right);
• left lower lobe medial (7, on left),
anterior (8, on left), lateral (9, on left),
and posterior (10, on left) basal
segmental bronchi
• left inferior pulmonary vein (v, on left)

Level of basal segmental bronchi

12/11/22 150
 Clinical correlation

• Broncholithiasis

– the presence of calcified material within the tracheobronchial

tree, develops from erosion of a calcified peribronchial
lymph node into the bronchial lumen
– most calcified lymph nodes result from granulomatous
lymph node inflammation caused by histoplasmosis or TB

12/11/22 151
• Broncholithiasis...

• Broncholiths may occlude the airway and lead to

bronchiectasis, obstructive atelectasis, or pneumonia.
• Patients are often asymptomatic but may have cough
productive of stones or calcified material (lithoptysis).
• Hemoptysis may develop from erosion of the broncholith
into a bronchial vessel.

12/11/22 152
Broncholithiasis

Targeted reconstruction of the right lung from a CT in a 33-year-old woman with hemoptysis at the
level of the middle lobe bronchus (A) and proximal basal segmental right lower lobe bronchi (B)
show calcified lymph nodes (arrows) in the right hilum and azygoesophageal recess (arrows in A)
with a calcified node within the anterior basal segmental bronchus (arrow in B).
12/11/22 153
 Bronchiectasis

– Bronchiectasis is defined as an abnormal permanent

dilatation of bronchi.
– Morphologically, bronchiectasis is divided into three group

cylindric

varicose

saccular (cystic)

12/11/22 154
• Bronchiectasis...

– The CT appearance of bronchiectasis depends on the site of

involvement and the type of bronchiectasis.
– In the upper and lower lobes, all bronchi are imaged in
cross section, and their luminal diameter can be directly
compared to that of the accompanying pulmonary arteries.

12/11/22 155
• Bronchiectasis ...

– Cystic bronchiectasis in any region is easily recognized as

clusters of rounded lucencies, often containing air-fluid
levels; this appearance has been likened to a cluster of
grapes

12/11/22 156
 Cystic Bronchiectasis

CT scan through the lower lobes in a 12-year-old boy with severe postinfectious bronchiectasis shows
clustered thin-walled cysts representing dilated bronchi in cross section. Note the presence of dependent
fluid within several left lower lobe bronchi (arrows).
12/11/22 157
 Divisions of the Thoracic Cavity

Subdivisions of thorax:

•left and right lateral

cavities
•mediastinum

12/11/22 158
 Subdivision of mediastinum
Subdivision of
mediastinum
as seen on sagittal
section:

•superior mediastinum (1)

•anterior mediastinum (2)
•medial mediastinum (3)
•posterior mediastinum (4)

 2, 3 & 4 are parts of

inferior mediastinum
12/11/22 159
 Superior Mediastinum

Boundaries of superior
mediastinum(1):

anterior - manubrium of the

sternum
posterior - anterior surface of
bodies of vertebrae T1 thru T4
superior - plane of the thoracic
inlet
inferior - plane of the sternal
angle
lateral - mediastinal pleura
12/11/22 160
 Contents of the Superior
Mediastinum
From anterior to posterior you
see:
•glandular plane
•venous plane
•arterial-nervous plane
•visceral plane
•lymphatic plane

•This image shows structures of

the superior mediastinum.

starting from anterior boundary,

work your way thru the superior
mediastinum from anterior to
posterior.
12/11/22 161
 Superior Mediastinum

•With the thorax

intact, the first thing
you see is the
manubrium of the
sternum and the
cartilage of the first
rib.

•These structures
make up the anterior
boundary.
12/11/22 162
 Superior Mediastinum
1. The first plane is the
glandular plane.

• The gland is what is

left of the thymus.

It consists of two

lobes and is mainly
fat in the adult with
small islets of active
thymic cells scattered
throughout.
12/11/22 163
Thymus on CT

• In infants and young children, usually under 5 years of age

– the thymus appears quadrilateral on CT

• In older children

– the thymus gradually assumes a triangular or arrowhead

configuration

• The margins of the thymus are

– smooth and convex in infants and younger children

– straight or concave in older children

12/11/22 164
 Superior Mediastinum-Thymus

Thick arrow
aorta
Arrowhead
SVC
Thin arrows
thymus

12/11/22 165
 Superior Mediastinum- Adult Thymus

12/11/22 166
 Superior Mediastinum
2. The second plane
is the venous
plane & consists of
the:

• left
brachiocephalic
vein
• right
brachiocephalic
vein
• superior vena
cava
• arch of the
12/11/22 167
 Superior Mediastinum
3. The third plane is
the arterial-nervous plane
and consists of the:
•aortic arch and its
branches
•brachiocephalic
artery
•left common carotid
artery
•left subclavian artery
nerves include the:
•left and right vagus
nerves
•left and right phrenic
nerves
12/11/22 168
 Superior Mediastinum
4. The fourth
plane is the visceral
plane & includes
the:
•trachea
•esophagus
•left recurrent
laryngeal nerve

Trachea: is shown
in the picture
12/11/22 169
 Superior Mediastinum

Visceral Plane :

•Esophagus

12/11/22 170
 Superior Mediastinum

5. The fifth plane is

the lymphatic
plane and consists
of the:

•thoracic duct

12/11/22 171
 Superior Mediastinum

12/11/22 172
Chest CT scan demonstrates an anterior mediastinal mass. The anterior junction line is
obliterated, whereas the lung interfaces with the hilar vessels (arrow) and aorta
(arrowhead) are preserved
12/11/22 173
 Coronal CT Chest
with Mediastinal
Window

12/11/22 174
 Contrast-enhanced chest CT scan (a, axial view with
mediastinal window; b, reformatted coronal
reconstruction). Multiple, confluent lymphadenopathies
12/11/22 175
 CT angiography with reconstruction showing tumor invasion
into right atrium. a Axial view. b Sagittal view. c Coronal view;
arrow noting transcardiac hepatic feeding vessel. d Coronal
3-D reconstruction; red denotes tumor mass. 
12/11/22 176
 Subdivision of the Inferior
Mediastinum

Subdivision of inferior
mediastinum as seen on
cross section:

•anterior mediastinum (1)

•middle mediastinum (2)

•posterior mediastinum (3)

12/11/22 177
 Boundaries of the mediastinum
inferior mediastinum (2):
• anterior mediastinum:
– anterior -- body and xiphoid of sternum
– posterior -- pericardium
– lateral -- mediastinal pleura
– superior -- plane of sternal angle
– inferior -- diaphragm
• middle mediastinum:
– anterior -- pericardium
– posterior -- pericardium
– lateral -- mediastinal pleura
– superior -- plane of sternal angle
– inferior -- diaphragm
• posterior mediastinum:
– anterior -- pericardium
– posterior -- bodies of thoracic vertebrae 5 -
12
– lateral -- mediastinal pleura
– superior -- plane of sternal angle
-- inferior -- diaphragm
12/11/22 178
 Anterior Mediastinum

Anterior Mediastinum contains:

• connective tissue & fat

• a few blood vessels, one or two lymph
nodes.
• lower end of what used to be the thymus.
• It also contains the anterior folds of the
pleura, the costomediastinal folds.
12/11/22 179
Middle Mediastinum: Pericardium
•Pericardium: composed
of outer fibrous
pericardium & an inner
smooth, serous
pericardium.
•serous pericardium has an
inner visceral(epicardium) &
outer parietal parts which are
continuous at roots of the Great
Vessels.

• potential space b/n

visceral & parietal serous
pericardium is the
pericardial cavity  there
is only a thin layer of fluid
12/11/22 180
b/n the two layers.
 The Pericardium

12/11/22 181
 The Pericardium
Fibrous Pericardium:
• is very strong & adherent
to parietal layer of serous
pericardium.
• it is a cone-shaped bag
with its base/inferiorly on
central tendon of
diaphragm & its
apex/superiorly
continuous with
adventitia of the great
vessels.
12/11/22 182
 The Pericardium
Fibrous Pericardium:
• Anteriorly, it is attached to
posterior surface of sternum by
sternopericardial ligaments:
 These attachments help to
keep heart in its position.
 The sac also limits cardiac
distention.

• phrenic nerves, (C3 to C5), &

pericardiacophrenic vessels
are located within/pass thru
fibrous pericardium & supply it.

12/11/22 183
 Pericardium: Vessels & Nerves
• pericardium is supplied by pericardiacophrenic,
musculophrenic, & inferior phrenic arteries (branches
from internal thoracic a.), and thoracic aorta.
• Veins from pericardium enter azygos system of veins
and internal thoracic & inferior phrenic veins.
• Nerves supplying pericardium: vagus nerve [X],
sympathetic trunks(vasomotor), & phrenic nerves.
*** source of somatic sensation (pain) from parietal
pericardium is carried in phrenic nerves:
 For this reason, 'pain' related to a pericardial problem
may be referred to supraclavicular region of shoulder.

12/11/22 184
 The Pericardium
Relations of Pericardium/Heart:
• Inferior – rests on diaphragm
(separated from liver & stomach)
• Right side- Rt phrenic nerve,
Rt lung & pleura
• Left side – Lt phrenic nerve, Lt
lung & pleura
• Posterior – posterior
mediastinum containing
esophagus & descending aorta,
anterior to T5 - T8 vertebrae
• Superior – great vessels
• Anterior – anterior mediastinum
& contents; lungs & pleura/
cardiac notch; sternum &
adjoining ribs
12/11/22 185
 The Pericardium

12/11/22 186
 The Pericardium
•Pneumopericardium: when air is introduced into
pericardial cavity.
This might occur in penetrating wounds to thorax.

•Hemopericardium: When blood fills pericardial

cavity
the heart can no longer work & the condition is fatal
if not recognized & treated.

•cardiac tamponade:  happens after long term

cardiac pathology when walls become very thin & weak.
 heart virtually blows out & enters pericardial cavity.

12/11/22 187
 Surface Anatomy of the Heart
•For radiologic evaluations,
a thorough understanding of
structures defining cardiac
borders is critical.
•Rt Border: (posterior-
anterior view) consists of:
SVC, Rt atrium, & IVC.
•Lt Border: consists of arch
of aorta, pulmonary
artery, & Lt ventricle.
• Inferior Border: consists
of: Rt ventricle & Lt
ventricle at the apex.

12/11/22 188
 The Heart
• The anterior surface of the heart
or sternocostal surface:
• Notice the ruffled edges of the left
(LA) & right (RA) atria =>used for
orientation=>can only be seen
when we are looking at the anterior
surface of the heart.
• Note the four chambers of the
heart:
1. right atrium (RA)
2. left atrium (LA)
3. right ventricle (RV)
4. left ventricle (LV)

12/11/22 189
 The Heart
• Anterior surface of the heart
or sternocostal surface:

• Also note the three borders of

the heart:
right border (1) made up of
the right atrium,
inferior border (2) made up of
right atrium, right ventricle &
left ventricle
left border (3) made up of the
left ventricle.

12/11/22 190
Surfaces of the heart:
1. Anterior surface: consists mostly of Rt ventricle
with some of Rt atrium & some of Lt ventricle.
• Anterior surface faces anteriorly.
2. Diaphragmatic surface:
• consists of Lt ventricle & a small portion of Rt
ventricle
• heart in the anatomic position rests on
diaphragmatic surface
• diaphragmatic surface rests on the diaphragm,
• is separated from base by coronary sinus,
(atrioventricular groove).
3. Left pulmonary surface:
• consists of Lt ventricle & a portion of Lt atrium &
faces Lt lung.
4. Right pulmonary surface:
• consists of Rt atrium & faces Rt lung.
5. Apex – formed by Lt ventricle: is directed
12/11/22 191
downward, forward & to the left.
 The Heart: Surfaces

12/11/22 192
 The Heart: Surfaces

12/11/22 193
 The Heart: Surfaces
6. Base of the Heart:
-is quadrilateral & directed
posteriorly.
- formed mainly by Lt atrium,
partly by Rt atrium & proximal
parts of great veins (SVC &
IVC; & pulmonary veins)
Upper boundary of the base
is bifurcation of pulmonary
trunk & Lower boundary – is
coronary sulcus.
• the base is fixed posteriorly
to pericardial wall, opposite
bodies of vertebrae T5 to T8
(T6 to T9 when standing).
• Esophagus lies
immediately posterior to the
base.
12/11/22 194
 The Heart: anterior aspect
•Note the great vessels of the
heart & their relationships to
one another:
•superior and inferior venae
cavae (SVC & IVC)

•pulmonary trunk and left &

right branches (LPA & RPA)

•pulmonary veins (LPV &

RPV): usually 4 in number

•ascending aorta
12/11/22 195
Coronary Arteries & Cardiac Veins
•The heart muscle is supplied by the
coronary arteries which are direct
branches of the ascending aorta.
 arise from Lt & Rt aortic sinus
of ascending aorta
•Heart muscle is drained by the
cardiac veins.
• Most of the venous blood drainage is
by way of coronary sinus  into the
right atrium.
 A small amount of blood drains
directly into the right atrium by way of
the anterior cardiac veins & vena
cordis minimae (smallest cardiac veins).
12/11/22 196
 Coronary Arteries
•The heart is supplied
by two major coronary
arteries, the right & left
coronary aa.
• Lt coronary a divides
into: 1. anterior
interventricular &
2. circumflex branches
immediately after it
arises from left side of
the ascending aorta.
12/11/22 197
 Coronary Arteries
•The anterior
interventricular a.
(AIVA) lies in the anterior
interventricular sulcus
& is also known as the Lt
anterior descending a.

• AIVA supplies wall of

right & left ventricles,
interventricular septum
& apex of the heart.

12/11/22 198
 Coronary Arteries

•The circumflex branch (CCA)

lies in the coronary sulcus:
Supplies walls of LA & LV &
forms an anastomosis with the
right coronary a.

12/11/22 199
 Coronary Arteries
•Right coronary a. lies in the coronary
sulcus & immediately after leaving
ascending aorta gives rise to anterior
right atrial: which gives rise to the
important nodal artery.

 nodal artery supplies the

sinoatrial node (SA node) or
pacemaker of the heart.

•When the nodal artery fails to supply

the node, an artificial pace maker,
placed in the thoracic wall, is required.

12/11/22 200
 Coronary Arteries
•Right Coronary Artery
supplies Rt atrium & Rt
ventricle, sinu-atrial &
atrioventricular nodes,
interatrial- septum, a
portion of Lt atrium

12/11/22 201
 Coronary Arteries
• Rt coronary a. supplies Rt. Atrium
& parts of Rt. & Lt ventricles

 in the coronary sulcus, Rt

coronary a giving a branch along the
right inferior border of the heart called
marginal artery:  supplies the Rt
ventricle .

•Finally, the right coronary gives rise to

the posterior interventricular artery
(post. Descending a.) branch, & then
anastomoses with the circumflex
artery from the left coronary a.
12/11/22 202
 The Heart
• The heart functionally consists of two pumps: Lt & Rt Pumps:
 Rt pump receives deoxygenated blood from the body & sends it to
the lungs.
 Lt. pump receives oxygenated blood from the lungs and sends it to
the body.
 Each pump consists of an atrium & a ventricle separated by a valve.
 The thin-walled atria receive blood coming into heart, whereas thick-
walled ventricles pump blood out of the heart:
 More force is required to pump blood thru the body than thru lungs,
so muscular wall of Lt ventricle is thicker than the Rt.
 Interatrial, interventricular, and atrioventricular septa separate the
four chambers of the heart .
 The internal anatomy of each chamber is critical to its function.

12/11/22 203
 The Heart: Internal Structures
Right atrium:
• Blood returning to the right atrium enters thru: the
superior & inferior venae cavae, (which together
deliver blood to the heart from the body); & coronary
sinus, (which returns blood from walls of the heart itself).
• SVC enters upper posterior portion of Rt atrium.
• IVC & coronary sinus enter the lower posterior portion
of Rt atrium.
• From Rt atrium, blood passes into Rt ventricle thru Rt
atrioventricular orifice.
• Rt atrioventricular orifice is closed during ventricular
contraction by tricuspid valve.

12/11/22 204
The Heart: Internal Structures
Right ventricle: Internal-
Structures:.
1. Papillary muscles
2. chordae tendineae:
3. tricuspid valve (right
atrioventricular valve): closes Rt
atrioventricular orifice during
ventricular contraction
• it usually consists of three cusps or
leaflets.naming of cusps as
anterior, posterior & septal cusps

12/11/22 205
 Internal Structure of Heart…
Left atrium (LA):

•LA communicates with

left ventricle thru the
mitral or bicuspid- valve.

•As in the right ventricle

(RV), the valve cusps
connect to the papillary
muscles (PM) by way of
chordae tendineae.

12/11/22 206
 The Heart:Internal Structures
Left ventricle:
• Blood enters ventricle thru the left
atrioventricular orifice.
• is longer than Rt ventricle, & has
the thickest layer of myocardium.
.
• Papillary muscles & chordae
tendineae, are similar to that of Rt
ventricle.
• Two papillary muscles, anterior &
posterior papillary muscles, are
usually found in Lt ventricle & are
larger than those of Rt ventricle.

12/11/22 207
 The Heart: Conduction
Cardiac conduction system:
• musculature of atria & ventricles is capable of contracting
spontaneously.
• The Cardiac Conduction System initiates & coordinates
contraction.
• The conduction system consists of nodes and networks of
specialized myocardial cells organized into four basic components:
1. sinu-atrial node;
2. atrioventricular node;
3. atrioventricular bundle with its right & left bundle branches;
4. The Purkinje fibers
• Blood supply of conducting system – may be from right or
left coronary arteries.

12/11/22 208
 Innervation of the Heart

•Autonomic nervous system (ANS)

is directly responsible for regulating:
heart rate; force of each
contraction; cardiac output:
Strength & frequency of heart beat.
•Both parasympathetic &
sympathetic parts are involved.
•Sympathetic fibers arise from
segments T2-T4 of the spinal cord &
increase the rate of conduction

12/11/22 209
 Innervation of the Heart

• Parasympathetic stimulation: 
decreases heart rate; reduces force
of contraction; constricts the
coronary arteries:
Effect of vagus n. at the SA node is
the opposite of sympathetic nerves 
decreases the heart rate.

12/11/22 210
12/11/22 211
12/11/22 212
Right side:
– SVC
– RA
Anterior aspect:
– RV
Cardiac apex:
– LV
Left side:
– LV
Left atrial appendage
– Pulmonary trunk
– Aortic arch.
12/11/22 213
12/11/22 214
12/11/22 215
 Heart Size • Normal is <50% on PA
upright radiograph

12/11/22 216
 CT- Heart Chambers

12/11/22 217
 RT. VENTRICLE SEPTUM

DOME OF
DIAPHRAGM

LT. VENTRICLE

DESCENDING
AORTA

12/11/22 218
• Right Atrium

– most superior

• Right Ventricle

– most anterior

• Left Atrium

– most posterior

• Left ventricle 33. Right Ventricle

– most inferior 34. Right Atrium

35. Left Atrium
36. Left Ventricle

12/11/22 219
 33. Right Ventricle
34. Right Atrium

12/11/22 220
 Right ventricle

Right atrium Left ventricle

R inferior
pulmonary vein

Serratus
anterior
Bronchi to left
lower lobe
Thoracic
(descending) aorta
Latissimus dorsi Left atrium
12/11/22 221
12/11/22 222
Interventricular Septum
–  This is the muscle between the left and right ventricles.

12/11/22 223
12/11/22 224
 Right ventricle

Right atrium Interventricular

septum

Left ventricle

Left atrium

Esophagus Thoracic (descending)

aorta

12/11/22 225
 CT of the Great Vessels of the
Heart

12/11/22 226
 Right Pulmonary Vein

• delivers oxygen rich blood from the lungs to the left atrium

•  It is found inferior to the level of the pulmonary arteries. 

• There are usually a superior and inferior set of pulmonary

arteries
•  The right pulmonary veins are found anterior to the right
pulmonary arteries in the right hilum

12/11/22 227
 Left Pulmonary Vein

• The left pulmonary veins are usually superior to the right

pulmonary veins.

12/11/22 228
12/11/22 229
 Ascending aorta
Right ventricle
Right atrium

R superior
pulmonary vein L inferior
pulmonary vein

Left atrium Thoracic

(descending) aorta
Esophagus
12/11/22 230
 Right ventricle
Atrioventricular sulcus
Inter ventricular septum

Right atrium Left ventricle

Coronary sinus

Thoracic
(descending) aorta

12/11/22 231
 Right ventricle

Left ventricle

Inferior vena cava

Coronary sinus

Esophagus Spinal cord

12/11/22 232
 A coronary MRA image obtained using 2-D gradient echo and fat suppression

LAD

LM
LCx

MRI Image: In the image on the left, the left main coronary artery (LM) branches into
12/11/22
the left anterior descending (LAD) and left circumflex (LCx) arteries. 233
 A coronary MRA image obtained using 2-D gradient echo and fat suppression

RCA

MRI Image: The right coronary artery (RCA) can be seen originating from the aortic
12/11/22 234
root. Proper cardiac gating is crucial to resolve this level of detail
12/11/22 235
12/11/22 236
12/11/22 237
 Just above Aortic Arch

12/11/22 238
12/11/22 239
 Ascending aorta

Bifurcation of trachea

Azygous vein Thoracic (descending)

aorta

12/11/22 240
 Arch of aorta
Serratus anterior

Trachea

Arch of azygous vein

12/11/22 241
The red line represents the plane
through which the aortic image on the
right is obtained.

MRI Image: AA = Ascending Aorta, AAR = Aortic Arch, DA = Descending Aorta, LA =

Left Atrium, RV = Right Ventricle
12/11/22 242
12/11/22 243
 Aortic Branches

The three important branches of the ascending aorta/aortic arch

– brachiocephalic artery/trunk

– left common carotid artery

– left subclavian artery

12/11/22 244
12/11/22 245
12/11/22 246
12/11/22 247
 Brachiocephalic Trunk

• Is the largest branch of the aorta

• it gives rise to:

– the right subclavian artery

– right common carotid artery

12/11/22 248
12/11/22 249
 R Brachiocephalic vein
Brachiocephalic trunk

L Common carotid artery

L Subclavian artery

Trachea

Esophagus

12/11/22 250
 Common Carotid Artery
Left Common Carotid Artery
•originates directly from the arch of the aorta.

•divides into the external carotid and internal carotid at the superior border of the thyroid cartilage

Right Common Carotid Artery

•arises from the brachiocephalic trunk

•It is one of the two branches of the brachiocephalic trunk, the other being the right subclavian artery

•The carotid body is found at the bifurcation of the internal and external carotid vessels

12/11/22 251
12/11/22 252
 13. Left Subclavian Artery
13a. Right Subclavian Artery
14. Left Common Carotid Artery
14* Right Common Carotid Artery
12/11/22 253
 Subclavian Artery
• Right artery arises from - Brachiocephalic Trunk .

• Left artery arises from - Arch of Aorta.

• The vessel enter the upper limb.

• The vessel is related to the anterior scalene muscle anteriorly.

• This muscle divides the subclavian artery into three parts which are
medial, lateral, and deep to the muscle. 
• The subclavian artery forms branches: internal thoracic artery, vertebral
artery, thyrocervical artery, costocervical trunk, and dorsal scapular artery.

12/11/22 254
12/11/22 255
12/11/22 256
 Internal thoracic artery

Arch of aorta
Serratus anterior

Superior vena cava

Trachea

Arch of azygous vein

Fourth Rib

12/11/22 257
 Distal Subclavian Artery

• It becomes the Axillary artery at the Lateral Border of the first rib.

• The axillary artery then becomes the brachial artery after it

crosses the inferior border of the teres major muscles
• It is the Source of the arterial supply of the U.L
– axillary.
– brachial.
– radial.
– ulnar.
– palmar arches (superficial & deep)

12/11/22 258
 Internal Jugular Vein

• drains the blood supply of the face and the brain

•  The vein starts at the jugular foramen as a continuation of the

sigmoid sinus. 
• It is found lateral to the common carotid artery and anterior to
the vagus nerve  
• The vessel joins with the subclavian vein to form the
brachiocephalic vein which then enters the superior vena cava.

12/11/22 259
12/11/22 260
 Cont...

12/11/22 261
 Right Brachiocephalic Vein

• formed by the right internal jugular vein and the right

subclavian vein
• the junction is located behind the medial end of the right
clavicle
• it is a short vein and is only half the length of the left
brachiocephalic vein

12/11/22 262
 Left Brachiocephalic Vein

• a vein that is formed by the union of the left internal jugular and
left subclavian vein
• this vein travels to the right and unites with the right
brachiocephalic vein behind the manubrium of the sternum
• the thymus is located anterior to this vein

• the thoracic duct also empties into the left brachiocephalic vein

12/11/22 263
 13. Left Subclavian Artery
14. Left Common Carotid Artery
16. Scapula
21. Right Brachiocephalic Vein
21*. Left Brachiocephalic Vein
12/11/22 264
 L Brachiocephalic vein

Sternoclavicular joint Brachiocephalic trunk

L Common carotid artery
R Brachiocephalic vein L Subclavian artery

Trachea

Teres
major
Infraspinatus Esophagus Scapula

12/11/22 Subscapularis 265

12/11/22 266
 Rt. CCA Lt. CCA

Rt. IJV Lt. IJV

Rt. EJV Lt. EJV

12/11/22 267
 Rt.
CCA
Rt. SCV
joining Rt. Rt. Lt.
BCV CCA Lt.
BCV SCV

Rt.
SCA Lt.
SCA

12/11/22 268
• Arterial Phase
– Aortic arch

Brachiocephalic a.

14* R Common carotid

a.

13a. R Subclavian a.
14. L Common carotid
a.
13. L Subclavian a.

12/11/22 269
• Arterial Phase
19. Aortic Arch

19 *Ascending Aorta

19+Descending Aorta

12/11/22 270
 Superior Vena Cava

• Formed by the junction of the right and left brachiocephalic

veins
• Is a tributary that drains blood from the head and upper
extremity
• Diameter of superior vena cava

– At level of aortic arch: 1.4 cm ± 0.4 cm

– At level of pulmonary trunk bifurcation: 2 cm ± 0.4 cm

12/11/22 271
12/11/22 272
 Cont.......

SVC Aortic Arch

1
2
2

12/11/22 273
12/11/22 274
 Arch of aorta

Superior vena cava

Trachea

Esophagus

12/11/22 275
 Ascending aorta

Superior vena cava

Thoracic
(descending)
aorta
L main bronchus
R main bronchus
Esophagus
12/11/22 276
 7

1 2 Image 9

3
4 6

1. Superior vena cava

2. Arch of the aorta
3. Trachea
4. Esophagus
5. Body of the Rt scapula
6. Spinal cord
7. Body of the sternum

12/11/22 277
 SVC
AAR
T
E

MRI Axial: AAR = Aortic Arch, E = Esophagus, SVC = Superior Vena Cava, T = Trachea
12/11/22 278
 Inferior Vena Cava

• drain into the right atrium

• a tributary for the iliac veins, mesenteric veins, pelvic veins,

hepatic and left renal veins 
• Formed by the union of the right and left iliac veins

• travels to the right of the abdominal aorta as it ascends into the

abdomen

• pierces the diaphragm at its hiatus at the level of (T8) to enter the
thorax
12/11/22 279
 R
V LV

IVC

DA

12/11/22 280
 Inferior vena cava
Esophagus

Thoracic (descending)
aorta

12/11/22 281
 RV

RA
LV
IVC

DA

MRI Axial: DA = Descending Aorta, IVC = Inferior Vena Cava, LA = Left Atrium, RA =
12/11/22
Right Atrium, RV = Right Ventricle 282
 Pulmonary Trunk

• This is the outlet of the right ventricle

• It originate from the right ventricle.

• It is a structure that is about 5 cm in length

• It carries deoxygenated blood to the lungs

• It is the origin of the right and left pulmonary arteries.

12/11/22 283
 Ascending aorta
Main pulmonary artery
SVC

L pulmonary artery

R pulmonary artery

Descending aorta

Esophagus

Azygous vein
What is this
12/11/22 duct? 284
 Pulmonary Phase
– Pulmonary trunk/artery

30. R Pulmonary Artery

12/11/22 30 *L Pulmonary Artery 285

 Right ventricle
Diaphragm
Apex of heart

Left ventricle

Inferior vena cava

Esophagus

Azygous vein Thoracic (descending)

Posterior intercostal artery
aorta

12/11/22 286
 20. Azygous Vein
22. Superior Vena Cava
24. Teres Major Muscle
29. Pulmonary Trunk
12/11/22 287
 Right Pulmonary Artery

• It supplies the lungs with deoxygenated blood that has returned from
the body. 
• It has relationships with both the ascending aorta and the superior
vena cava.
• It travels inferior to the arch of the aorta.

• It is found posterior to the superior vena cava.

12/11/22 288
 Right...

•  It is also found posterior to the right pulmonary vein in the right
hilum.
• The right pulmonary artery passes in front of the right main
bronchus and behind the ascending aorta.
• Anteriorly, the right superior pulmonary vein crosses the right main
artery
• The right main pulmonary artery passes in front of the right main
bronchus

12/11/22 289
12/11/22 290
 Cont.....

Left pulmonary artery

1
5
Right pulmonary 4
artery

3
Oesophagus
2

Azygos vein

12/11/22 291
 Body of sternum
Ascending aorta Pulmonary trunk

Superior vena cava

R pulmonary artery

Body of T6

Esophagus Spine of T5

12/11/22 292
12/11/22 293
 Left Pulmonary Artery

•  It is found anterior to the descending aorta.

• It arches over the left main bronchus

12/11/22 294
 Ascending aorta
Pulmonary trunk

Superior vena cava

L pulmonary ar

Thoracic
(descending
aorta
L main bronchus
R main bronchus
Esophagus
12/11/22 295
 29. Pulmonary Trunk
30. Right Pulmonary Artery
30*. Left Pulmonary Artery
12/11/22 296
 Ascending aorta
Pulmonary trunk

Superior vena cava

L pulmonary
R pulmonary artery
artery
Thoracic
(descending
aorta
L main bronchus
R intermedius
bronchus Esophagus
12/11/22 297
 Posterior Mediastinum
• Anterior boundary of the posterior
mediastinum is the posterior pericardial
wall.
• The posterior boundary is the anterior
surfaces of the bodies of thoracic
vertebrae T5-T12.

12/11/22 298
 Posterior Mediastinum
• Major structures in the posterior mediastinum
include:
• esophagus and its associated nerve plexus,
• thoracic aorta and its branches,
• azygos system of veins,
• thoracic duct and associated lymph nodes,
• sympathetic trunks, and
• thoracic splanchnic nerves.

12/11/22 299
 Posterior Mediastinum: Esophagus
Esophagus:
• it is a muscular tube, b/n pharynx in the neck & stomach
in the abdomen.
• It begins at the inferior border of the cricoid cartilage,
opposite vertebra CVI, and ends at the cardiac opening
of the stomach, opposite vertebra TXI.
• descends on anterior aspect of bodies of vertebrae, (in a
midline position in the thorax).
• Near the diaphragm, it moves anteriorly & to the left,
crossing from right side of thoracic aorta to anterior to it.
• It then passes thru esophageal hiatus, an opening in the
muscular part of the diaphragm, at vertebral level TX.

12/11/22 300
 Posterior Mediastinum: Esophagus
Esophagus:
Relationships in the posterior mediastinum:
• The right side is covered by mediastinal part of parietal
pleura
• Anterior to esophagus, are the right pulmonary artery and
the left main bronchus
• It passes posteriorly to left atrium, separated from it only by
pericardium.
• Inferior to left atrium, it is related to the diaphragm
• Structures posterior to the esophagus include: thoracic
duct, portions of hemiazygos veins, right posterior
intercostal vessels, and, near the diaphragm, thoracic
aorta.
12/11/22 301
Sites of Esophageal-
Constrictions:
• it is compressed by
surrounding structures at four
locations:
• Junction with pharynx
• At the arch of aorta
• Left main stem
bronchus
• Esophageal Hiatus

12/11/22 302
These constrictions have important clinical
consequences:
• a swallowed object is most likely to lodge at a
constricted area.
• ingested corrosive substance would move more
slowly, causing more damage at these sites
•constrictions present problems during passage of
instruments.

12/11/22 303
 Esophagus: Vessels & Nerves
Arterial supply & venous in posterior mediastinum include:
• Esophageal arteries & bronchial arteries (arise from the
thoracic aorta), and ascending branches of left gastric artery in
the abdomen.
• Venous drainage involves small vessels returning to the
azygos vein, hemiazygos vein, & esophageal branches to left
gastric vein in the abdomen.

Innervation of the esophagus:

• Esophageal branches from vagus nerves & sympathetic trunks

12/11/22 304
 Posterior Mediastinum
Thoracic aorta:
Branches:

1.Visceral Branches:
•esophageal
•Broncheal
•Pericardial
•mediastinal

2.Parietal Branches:
•Post. Intercostal
•Sup. Phrenic
•subcostal

12/11/22 305
 Thoracic duct
Thoracic duct:
• is the principal channel through which lymph from
most of the body is returned to the venous
system.
• It begins as a confluence of lymph trunks in the
abdomen, (a saccular dilation referred to as the
cisterna chyli), which drains the abdominal
viscera and walls, pelvis, perineum, and lower
limbs.
• thoracic duct extends from vertebra LII to the root
of the neck.

12/11/22 306
• Enters thorax, posterior to the aorta, thru aortic
hiatus of diaphragm,
• It lies posterior to diaphragm & esophagus &
anterior to bodies of vertebra; b/n aorta (on the
Left) & Azygos v (on the Right)
• at level of TV, it moves to the left of the midline
& enters superior mediastinum & then into the
neck

12/11/22 307
• Near its termination, the thoracic duct often receives the
jugular, subclavian, and bronchomediastinal lymphatic
trunks
• The thoracic duct usually empties into the venous
system near the union of the left internal jugular and
subclavian vein(the left venous angle or origin of the left
brachiocephalic vein)

12/11/22 308
12/11/22 309
 Azygos vein
Azygos vein:
• arises opposite vertebra LI or LII
•azygos vein enters thorax thru aortic hiatus of the
diaphragm,
•It ascends thru posterior mediastinum, to the right
of thoracic duct.
•At about TIV level, it arches anteriorly, over the
root of the right lung, to join the superior vena.

12/11/22 310
Tributaries of the azygos vein include:
• right superior intercostal vein (a single vessel formed
by the junction of the second, third, and fourth intercostal
veins),
• fifth to eleventh right posterior intercostal veins,
• the hemiazygos vein,
• the accessory hemiazygos vein,
• esophageal veins,
• mediastinal veins,
• pericardial veins, and right bronchial veins.

12/11/22 311
 Posterior Mediastinum: Azygos Vein

12/11/22 312
 Azygos vein
Tributaries joining the hemiazygos vein include:
• lowest four or five left posterior intercostal veins,
• esophageal veins, and
• mediastinal veins.

Tributaries of accessory hemiazygos vein

include:
• the fourth to eighth left posterior intercostal
veins;
• sometimes, the left bronchial veins.

12/11/22 313
 Representative Levels of Cross
Sections of the Thorax
• These cross sections are arranged so that the
right side of the body is on your left.
This is how you will examine CAT scans and
MRI's.
assume that you are looking at a person,
patient or a cadaver lying on a bed.

12/11/22 314
 Cross Sections of the Thorax

•Cross section
through the
thorax at
vertebra T2.

•This section
cuts thru the
superior
mediastinum,
above the aortic
arch.

12/11/22 315
 Cross Sections of the Thorax
•Cross section thru the
thorax at vertebra T3.

•This section is also at

level of the superior
mediastinum but a
little lower than the one
above.
•And also at level of
the aortic arch.

•identify openings of
the brachiocephalic,
left common carotid
&d left subclavian
arteries.
12/11/22 316
 Cross Sections of the Thorax

•Cross section thru

the thorax at
vertebra T5.
•This section is cut at
level of anterior,
middle and
posterior
mediastina.
•You now see the
ascending &
descending aortae
and the pulmonary
trunk.
12/11/22 317
 Cross Sections of the Thorax
•Cross section thru
the thorax at
vertebra T8:

•This section cuts

thru the heart in
such a way that all
four chambers of
the heart are seen.

•also identify the

anterior, middle
and posterior
parts of the inferior
mediastinum.

12/11/22 318
 Cross Sections of the Thorax
•Cross section through
the thorax at vertebra:
T9.
•This section is taken
just below the one above
except that you are now
beginning to cut into the
abdomen.
•On the right side, you
can see a piece of the
liver which is just
beneath the diaphragm.
•The dome of the right
diaphragm is usually
higher because of the
massive liver below it.
12/11/22 319
 Imaging the Thorax- CT and
MRI Scans

12/11/22 320
The important structures of the thoracic cavity can be identified at
certain key points within the chest as identified on the chest radiograph.
CT scans depicting anatomy at the level of the great vessels
CT scans depicting anatomy at the levels of the aortic arch
and carina.
CT scans depicting the
anatomy at the level of the
atria and ventricles.
12/11/22 326
12/11/22 327
12/11/22 328
12/11/22 329
12/11/22 330
12/11/22 331
12/11/22 332
12/11/22 333
12/11/22 334
12/11/22 335
12/11/22 336
12/11/22 337
12/11/22 338
12/11/22 339
12/11/22 340
12/11/22 341
12/11/22 342
12/11/22 343
12/11/22 344
12/11/22 345
12/11/22 346
12/11/22 347
12/11/22 348
12/11/22 349
12/11/22 350
12/11/22 351
12/11/22 352
12/11/22 353
 References
• Standring, Susan. Gray’s anatomy-Anatomical
Basis of Clinical Practice
• Drake l. Richard . Vogle. Wayne. Mitchel. M.W.
Adam. Gray’s anatomy-for students
• Keith L. Moore Ph.D Arthur F. Dalley II Ph.D.
Anne M. R. Agur B.Sc. (OT), M.Sc., Ph.D.
Clinically Oriented Anatomy -Moore

12/11/22 354
 Thank You!!!

12/11/22 355