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Thorax

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187 views27 pages

Thorax

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Abinash
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| (QE) __ THORAX MUSCLES Facial Nerve’. i. @ Asillary Nerve B tang the awe" teng thevac te Nerve ANTERIOR AXIO- APPENDICULA Acckssory Nerve.” SUPERFICIAL Subclawi tater costal rece + Platyema. , + Deltoidl + Pectoralis Major + Serratus Anterior beer + Sternocleide mastoid +» Subclavius |. Pectoralis Minor 1, Eaternal intercostal Muscle + teternal intereortal Musele @ Dorsal scapular Nerve ‘ APPENDICULAR SUPERFICIAL B Tharacodersal Nerve + Deltold Im Supraseapular Nerve 7. + Trapezius . w lower subscapular Nerve | 2 5 +Rhomboid Major «Rhormboid Minor seer sLatissimus dorsi DEEP “+ Supraspinatus + Infra spinatus +Teres minor “Teres major ° . evator- scapulae SDT NBOS LECTURES = *2 PLEURAL SAC, 1 ON EITHER SIDE OF THE MEDIASTINUM. OUTER LAYER IS PARTETAL PLEURA SINNER LAYER IS VISCERAL OR PULMONARY PLEURA. "2 PLEURA CONTINUE WITH EACH OTHER AROUND HILIUM OF LUNGS BETWEEN PLEURAL CAVITY COMPARISON OF VISCERAL & PARIETAL PLEURA | DEVELOPMENT SPLANOPLEURIC MESODERM — SOMATOPLEURIC MESODERM | POSITION LINES SURFACE OF LUNG LINE THORACIC WALL, INCLUDING TISSUES MEDIASTINUM & DIAPHRAM. NERVE SUPPLY | SYMPATHETIC NERVES FROM | THORACIC NERVES & PHRENIC T2-T5 GANGLIA, NERVES PARASYMPATHETIC FROM VAGUS NERVE _ SENSITIVITY | INSENSITIVE TO PAIN SENSITIVE TO PAIN BLOOD SUPPLY | BRONCHIAL VESSELS INTERCOASTAL & PERICARDIACOPHRENIC L VESSELS | LYMPHATIC | TRACHEOBRONCHIAL LYMPH | INTERCOASTAL LYMPH NODE DRAINAGE NobE - (SEERA «— cover SURFACE & FISSURES OF LUNGS EXCEPT HILUM WHERE IT CONTINUE WITH PARIETAL PLEURA. -FIRMLY ADHERENT TO THE LUNGS CAN NOT BE SEPARATED. BARTETADIBUEUBA :- THICKER THAN VISERAL PLEURA SUB DIVIDED INTO 4 PARTS - 1.COSTAL, 2.DIAPHRAGMATIC, 3.MEDIASTINAL, 4.CERVICAL 1.CERVICAL PLEURA - REPRESENT BY CURVED LINE. - ABOUT 2.5CM ABOVE CLAVICLE. 2.ANTERIOR MARGIN OF COSTOMEDIASTINAL ~ — RIGHT SIDE - EXTEND - STERNOCLAVICULAR JOINT TO STERNUM ANGLE. = VERTICALLY DOWNWARD TO XIPHISTERNAL POINT ~ LEFT SIDE - FOLLOW THE SAME COURSE UP TO 47 COSTOCARTILAGE LEVEL. ~ THEN ARCH DOWN TO 6™ COSTOCARTILAGE. 3,POSTERIOR MARGIN - PASS 2CM LATERAL TO 12 THORACIC SPINE TO 2CM LATERAL TO 4™ CERVICLE SPINE. A-INFERTOR MARGIN - CROSS 8"™ RIB IN MID CLAVICULAR LINE - 10™ RIB IN MID AXILLARY LINE - JOHAR MBBS LECTURES ea YouTube “APEX - 2.5CM ABOVE MEDIAL 2/3 CLAVICLE 1. ANTERIOR BORDE OF VISCERAL PLEURA - -RIGHT SIDE :- CORRESPOUND CLOSELY WITH COASTO MEDIASTINAL LINE -OBTAIN BY JOINING - STERNOCLAVICULO JOINT & STERNAL ANGLE -MEDIAL PLANE JUST ABOVE XIPHISTERNAL JOINT. -LEFT SIDE :- CORRESPOUND TO COASTOMEDIASTINAL LINE UP TO LEVEL OF 4" COSTOCARTILAGE - LOWER PART REPRESENT A CARDIAC NOTCH - FROM 4™ COASTOCARTILAGE IT PASS - LATERAL 3.5CM FROM STERNAL MARGIN - THEN CURVE DOWN MEDIALLY TO REACH 6™ COASTOCATILAGE - AREA OF CARDIAC NOTCH IS DULL ON PERCUSSION CALLED AREA OF SUPERFICIAL CARDIAC DULLNESS. 2.LOWER BORDER- CROSS 6™ RIB IN MIDCLAVICULAR LINE, 8™ RIB IN MID AXILLARY LINE. 2.5 em above the medial 3rd of the clavicle _Junction of medial and middle 3rd of the clavicle Midpoint of sternal angle Level of 4th costal cartilage 6th costal cartilage ‘Sth rib in the midelavicular line 10th rib in the midaxillary line 12th rib ac the lateral -~.~er Posterior end 2 em from midline of erector spinae muscle atthe level of T12 spine ‘JOHAR! MBBS LECTURES. “THERE ARE 2 RECESSES OF PARIETAL PLEURA ACT RESERVE SPACE FOR LUNGS TO EXPAND DURING INSPIRATION “LIE ANTERIORLY ,BEHIND STERNUM AND COSTAL CARTILAGE "BETWEEN COSTAL AMD MEDIASTINAL PLEURA “PARTICULARLY IN RELATION CARDIAC NOTCH OF LEFT LUNG “FILLED UP BY ->ANTERIOR MARGIN OF LUNGS EVEN DURING QUIET BREATHING “ONLY OBVIOUS--REGION OF CARDIAC NOTCH OF LUNG “LIE INFERTORLY BETWEEN COSTAL AND DIAPHRAGMATIC PLEURA “VERTICALLY 5CM AND EXTEND FROM 8™ >TO 10™ RIB IN MIDAXILLARY LINE “FILLED BY ->LUNGS EXPEND INTO RECESSES DURING INSPIRATION *SO THIS RECESS ARE OBVIOUS ONLY IN ->EXPIRATION Right ung Ribs 70 °0 26) SCAN OR WITH Lo PP Costodiaphragmatic recess (pleural cavity) {MPARETEADIBUEURA- suRROUND ROOT OF LUNGS->EXTEND DOWNWARD BEYOUND ROOT AS FOLD CALLED PULMONARY LIGAMENT --THIN LAYER OF LOOSE AREOLAR TISSUE WITH FEW LYMPHATICS ~ DEAD SPACE-->INTO PULMONARY VEIN EXPAND DURING -->INCREASE IN VENOUS RETURN IN EXCERCISE Bronchus the ung i Eater Pulmonary Hoament "JOHAR! MBBS LECTURES @ayoulube }-> DIVIDED INTO 3 LOBES - UPPER, MIDDLE, & LOWER BY OBLIQUE FISSURE AND HORTONTAL FISSURE tend AUEPRIDUNGE> orvrpeD INTO 2 LOBES - UPPER & LOWER LOBE BY OBLIQUE FISSURE ~ CUT INTO WHOLE THICKNESS OF LUNGS, EXPECT AT HILUM -DUE TO OBLIQUE PLANE OF FISSURE -->LOWER LOBE IS MORE POSTERIOR SUPPER & MIDDLE LOBE MORE ANTERIOR FHORTZONTADIFISSURE - Passes FROM ANTERIOR BORDER UP TO OBLIQUE FISSURE -SEPARATE WEDGE SHAPED MIDDLE LOBE FROM UPPER LOBE -RUN HORIZONTALLY AT LEVEL OF FOURTH COSTAL CARTILAGE -TONGUE SHAPE PROJECTION OF LEFT LING BELOW CARDIAC NOTCH CALLED LINGULA A,RIGHT LUNGS - OESOPHAGUS - TRACHEA - RIGHT VAGUS NERVE ~ RIGHT PHRENIC NERVE ~ SUPERIOR VENA CAVA_-> ARCH OF AZYGOS VEIN - RIGHT BRACHIOCEPHALIC VEIN - INFERIOR VENA CANA - HIULM - IMPRESSION OF RIGHT ATRIUM 2.LEFT LUNGS - OESPHAGUS - THORACIC DUCT -TRACHEA a - LEFT PHRENIC NERVE ~ LEFT VAGUS MERVE ~ PULMONARY TRUNK pane sone ~ HILUM - IMPRESSION OF LEFT VENTICLE Right Vagus nenve — esophagus RighY brachiocephalic —Terechon vein ‘Anch of; azyqes ven Ascencling aasdto. Supetian vena caver Tmpnessien of sight edsdum Left subclavian coteny left common canctid Left secunnent Jonyngeos nenve. Left vagus nenvee Left supenion intencostal vein Hilum Impnession of left verdside "FROM BY STRUCTURE WHICH EITHER ENTER OR COME OUT OF LUNGS AT HILUM “LIE OPPOSITE THE BODY OF 5™ 6™ & 7™ THOARCIC VERTEBRAE EONTENTS - pRINCIPAL BRONCHUS ON LEFT SIDE ~ EPARTERIAL & HYPARTERIAL BRONCHI ON RIGHT SIDE ~ 1 PULMONARY ARTERY 2 PULOMONARY VEIN - SUPERIOR & INFERIOR BRONCHIAL ATERIES BRONCHIAL VEINS ANTERIOR & POSTERIOR PULMONARY PLEXUSES OF NERVE - LYMPHATICS OF LUNGS ANT. TO POST. - SIMILAR IN BOTH SIDES - SUPERIOR PULMONARY VEIN = PULMONARY ARTERY - BRONCHUS “ABOVE DOWNWARD - DIFFERENT IN 2 SIDES 1) RIGHT SIDE - EPARTERIAL BRONCHUS. -PULMONARY ARTERY -HYPARTERTAL BRONCHUS INFERIOR PULMONARY VEIN 2) LEFT SIDE - PULMONARY ARTERY ~ BRONCHUS - INFERIOR PULMONARY VEIN (SREDATONSE- antertor - COMMON ON 2 SIDES - PHRENIC NERVE - PERICARDIACOPHRENIC VESSELS. - ON RIGHT SIDE - SUPERIOR VENA CAVA POSTERIOR - COMMON ON 2 SIDES - VAGUS NERVE - ON LEFT SIDE - DESCENDING THORACIC AORTA SUPERIOR - ON RIGHT SIDE - TERMINAL PART OF AZYGOS VEIN - ON LEFT SIDE- ARCH OF AORTA ‘JOHAR! MBBS LECTURES terial EPBemcha Bronchial fvterles vial ele wesc i inferior pulmonary oo superior pulmonary Vein - Left principal Anferter_ptmon Nee van sererior supertor pulmonary Nigerent Anterior ferior focterior viene [QGRGINGIRGN URC IN ROOT OF LUNGS Postexiart 1 TRACHEA DIVIDES INTO 2 PRIMARY PRINCIPAL BRONCHI -->RIGHT & LFT BRONCHUS 2.EACH PRINCIPAL BRONCHUS ENTER LUNGS ->THROUGH HILIUM 3.DIVIDES INTO SECONDARY LOBAR BRONCH--ONE FOR EACH LOEBS -> 3 LOBAR BRONCHI - RIGHT SIDE 2 LOBAR BRONCHI - LEFT SIDE 4.EACH LOBAR BRONCHUS DIVIDE INTO TERTIARY -> 1 FOR EACH BRONCHOPULMONARY SEGMENTS ---> WHICH ARE 10 ON RIGHT AND LEFT SIDE 5.SMALLER BRANCHES ARE CALLED RESPIRATORY BRONCHIOLES: "10 SEGEMNTS IN RIGHT SIDE AND 10 ON LEFT SIDE 1. WELL DEFINED ANATOMIC , FUNCTIONAL AND SURGICAL SECTOR OF LUNGS 2. EACH ONE IS AERATED BY TERTIARY BRONCHUS 3. EACH SEGMENTS IS PYRAMIDAL IN SPACE -->APEX ->TOWARD ROOT OF LUNGS 4, EACH SEGMENTS HAS SEGMENTAL BRONCHUS & ARTERY AND AUTONOMIC NERVE 5. SEGMENTAL VENULES LIE->IN CONNECTIVE TISSUE BETWEEN ADJACENT PULMONARY UNITS: 6.DURING SEGMENTAL RESCENTION, THE SURGEON WORK ALONG SEGMENTAL VEIN TO ISOLATE A PARTICULAR SEGMEMT (HUSUNI - BRANCHES OF PULMONARY ARTERY ACCOMPANY ‘THE BRONCHI DEWiso rode PULMONARY VEIN DO NOT ACCOMPANY THE BRONCHI NOR PULMONARY ARTERIES -RUN IN THE INTERSEGMENTAL PLANES, 1.USUALLY, THE INFECTION OF A BRONCHOPULMONARY SEGMENT REMAINS RESTRICTED TO IT, ALTHOUGH TUBERCULOSIS & BRONCHOGENIC CARCINOMA MAY SPREAD FROM ONE ‘SEGMENT TO ANOTHER. 2.KNOWLEDGE OF THE DETAILED ANATOMYOF THE BRONCHIAL TREE HELPS CONSIDERABLY IN :- SEGMENTARY RESECTION. i | | JOHAR! MBBS LECTURES — Borenchiole Buronchial i Segmerdel 8 o egmerdal venule Tnder segmerdal plane, Adveals BRONCHOPULMONARY SEGMENTS Vertebral Colums Superior Mediastinum sternal plane '* Anterior (nediattinum eriddle mediaakinurn 4 « Posterior ZL mediastinum Nediaitnum Diaphragm JOHAR] MBBS LECTURES Boule a __ SUPERIOR MEDIASTINUM *MOST IMP CONTENT IS HEART ENCLOSE IN PERCARDIUM DIVISION :-SUPERTOR & INFERTOR MEDIASTINUM (SSURERIGRIMEDIASTINUM - separateD FROM INFERTORLY BY IMAGINARY PLANE PASSING THROUGH STERNAL ANGLE ANTERIORLY & THORACIC VERTEBRAE POSTERIORLY SBOUNBARTESE - ANTERTORLY - MANUBRIUM STERNT ~ POSTERIORLY - UPPER THORACIC 4 VERTEBRAE ~ SUPERIORLY - PLANE OF THORACIC INLET ~ INFERIORLY - AN IMAGINARY LINE - ON EACH SIDE - MEDIASTINAL PLEURA FEONTENTS :- 1.TRACHEA & OESOPHAGUS 2.MUSCLE - STERNOHYOID & STERNOTHYROID 3 ARTERIES - ARCH OF AORTA ~ BRACHIOCEPHALIC ARTERY - LEFT COMMON CAROTID ARTERY & SUBCLAVIAN ARTERY 4.VEIN - LETF & RIGHT BRACHIOCEPHALIC VEIN 5 NERVE - VAGUS . PHRENIC & CARDIAC NERVE OF BOTH SIDE 6. THORACIC DUCT & LYMPH NODES: [BNrerror meprastzNUM “DIVIDED INTO - ANTERIOR, MIDDLE , POSTERTOR MEDIASTINUM, "ANTERIOR MEDIASTINUM - VERY NARROW SPACE INFRONT OF PERICARDIUM. SBOUNDBAREES :- 1. ANTERIORLY - BODY OF STERNUM 2.POSTERIORLY - PERCARDIUM 3. SUPERIORLY - IMAGINARY LINE 4.0N EACH SIDE - MEDIASTINAL PLEURA SONTENTSIE 1. sTERNOPERICARDIAL LIGAMENT 2.LYMPH NODE 3.LOWEST PART OF THYMUS 4, AREOLAR TISSUE "JOHAR! MBBS LECTURES \ Cad a 1 ANTERIORLY - STERNOPERICARDIAL LIGAMENT 2.POSTERIORLY - OESOPHAGUS =DESCENDING THORACIC AORTA. 3.0N EACH SIDE - MEDIASTINAL PLEURA FGONTENT :- 1 HEART ENCLOSED IN PERICARDIUM 2.ASCENDING AORTA 3.PULMONARY TRUNK 4.2 PULMONARY ARTERIES 5.VEINS - LOWER PART OF SUPERIOR VENACAVA ~ TERMINAL PART OF AZYGUS VEIN - RIGHT AND LEFT PULMONARY VEIN 6 NERVES - PHRENIC - DEEP CARDIAC PLEXUS 7.LYMPH NODES 8.BIFURCATION OF TRACHEA *POSTERTOR MEDIASTINUM $= SBOUNDARTESIES ANTERTORLY - PERICARDIUM - BIFURCATION OF TRACHEA - PULMONARY VESSELS ~ POSTERIOR PART OF THE UPPER SURFACE O THE DIAPHRAM. POSTERIORLY - LOWER 8 THORACIC VERTEBRAE & INTERVENING brscs. -ON EACH SIDE - MEDIASTINAL PLEURA. REONTENT :- 1. OFSOPHAGUS 2. ARTERIES - DESCENDING THORACIC AORTA & ITS BRANCHES 3.VEINS - 1.AZY6OS VEIN 2.HEMIAZYGOS VEIN 3.ACCESSORY HEMIAZYGOS VEIN 4.NERVES - 1.VAGT 2 SPLANCHNIC NERVES ( GREATER. LESSER ) 3.8 THORACIC GANGLIA OF THE SYMPATHETIC CHAIN 5.LYMPH NODE ‘JOHAR! MBBS LECTURES Outline of Sternum 4 supenot rch Of fo venacava pulmonasy Avleny _—— pulmonary vein | card’ Fitwous stegame pevicavelium piaphragm Inferior venacava ___— Arteria) tube of Agcendin Bora 'S Pesicardium mona’ Superior Pune venacava Apu Intransvers | ‘oinuS Lert Right Pulmonary . veins Pulmonary vel Inferior venacava Anpw in ‘oblique Sinus. Ascencling aorta —— Pulmonary trunk Superior vena cava Right ouricte Right pulmonary artery Right pulmonary veine ~ Musculi pectinat? limbus fossa ovalis Interertvial septin | Crista terminalis Fossa ovalis Right cchouentricube orifice and vole Opening of Value of inferior vena cava cm eoronary Sinus | ‘PUMP INTO RIGHT VENTRICLE THROUGH TRICUSPID VALVE 1. CHAMNER IS ELONGATED VERTICALLY, RECEIVING HE SUP. VENA CAVA AT THE UPPER END & INF. VENA CAVA AT THE LOWER END. 2. ALONG RIGHT BORDER OF ATRIUM-> SHALLOW VENTRICAL GROOVE WHICH PASSES FROM ---> SUPERIOR VENA CAVA TO INFERIOR VENA CAVA IS CALLED SULCUS TERMINALIS 3. IT PRODUCED BY INTERNAL MUSCULAR RIDGE CALLE CRISTA TERMINALIS 4. UPPER PART OF SULCUS CONTAINED S.A NODE 5. ANTRIOVENTRICULAR GROOVE SEPARATED RIGHT ATRIUM FROM RIGHT VENTRICLE INLET OF RIGHT ATRIUM - 1. SUPERIOR VENA CAVA 2, INFERIOR VENA CAVA 3. CORONARY SINUS 4. ANTERIOR CARDIAC VEINS INTERNAL FEATURES :- DIVIDED INTO 3 PARTS (EMOGTHIPART - DEVELOPMENT - DRIVED FROM RIGHT HORN SINUS VENOSUS - MOST OF TRIBUTARIES EXCEPT ANT. CARDIAC VEINS OPEN INTO IT 1.SUPERIOR VENA CAVA 2.INFERIOR VENA CAVA - EUSTACHTAN VALVE 3.CORONARY SINUS - THEBESIAN VALVE 4. VENAE CORDIS MINIMAE @EROUGHIANITIPART - DEVELOPMENT - DERIVED FROM PRIMITIVE ATRIAL CHAMBER - IT PRESENT A SERIES OF MUSCULAR RIDGE CALLED MUSCULT PECTINATI SUERITERATIEAUISERTUM - DEVELOPMENT - DRIVED FROM PRIMITIVE ATRIAL CHAMBER ~ IT PRESENT THE FOSSA OVALIS A SHALLOW DEPRESSION IN LOWER PART = ANNULUS OVALTS & FOSSA OVALIS THE PROMINENT MARGIN FOSSA OVALIS NOTE :- DIAGRAM OF RIGHT ATRIUM - PAGE NO.65 | JOHAR! MBBS LECTURES zi Ne ——————— RTERY| OSETION - SMALLER THAN LEFT CORONARY ARTERY ~ ARISE FROM ANT. AORTIC SINUS GOURSE - FIRST PASS FORWARD BETWEEN ROOT OF PULMONARY TRUNK & RIGHT AURICLE - THEN RUN DOWNWARD - RIGHT ANTERIOR CORONARY SULCUS - WINDS AROUND THE INFERTOR BORDER TO REACH - DIAPHRAGMATIC SURFACE OF HEART - TERMINATE BY ANASTOMOSIS WITH LEFT CORONARY ARTERY BRANCHES :— 1. ARTERTAL BRANCH - ANT., POST. & LATERAL 2.RIGHT CONUS ARTERY - FROM CIRCLE AROUND PULMONARY TRUNK CALLED ANNULUS OF VIEUSSENS' 3.VENTRICLAR BRANCH- ANT. & POST GROUP 4, RIGHT MARGINAL ARTERY 5.POSTERIOR INTERVENTRICULAR BRANCH - LIE IN POST. INTERVENTRICULAR GROOVE RIGHT ATRIUM VENTRICLE - GREAT PART OF RIGHT VENTRICLE - EXCEPT AREA ADJOING INTERVENTRICULAR GROOVE SMALL PART OF LEFT VENTRICLE WHOLE CONDUCTING SYSTEM OF HEART EXCEPT A PART OF LEFT BRANCH OF AV BUNDLE EFT CORONARY ARTERY} #POSETEON - ArIse FROM LEFT AORTIC SINUS #EGURSE - FrRsT RUN FORWARD TO LEFT END EMERGE BETWEEN PULMONARY TRUNK -HERE IT GIVE THE INTERVENTRICULAR BRANCH WHICH RUN DOWNWARD IN GROOVE OF SAME NAME -FUTHER CONTINUATION OF LCA IS CALLED CIRCUMFLEX ARTERY “IT WIND AROUND LEFT BORDER OF HEART & CONTINUE IN LEFT CORONARY SULCUS TERMINATE BY ANASTOMOSIS WITH RCA a Ar MEDS LECTURES = 4 iz 1 ANT. INTERVENTRICULAR BRANCH - LARGEST BRANCH 2 CIRCUMFLEX BRANCH IS TERMINATE PART OF LCA 3.ANT.POST VENTRICULAR BRANCH 4. ARTERIAL BRANCH - ANT.POST. LAT, GROOVE (MBEADORIBISTREBUTION © 1 Lerr arrrum 2. VENTRICLE - GREATER PART OF LEFT VENTRICLE EXCEPT ‘AREA ADJOINING POSTERIOR INTERVENTRICULAR GROOVE & SMALL PART OF RIGHT VENTRICLE OR ANT.PART OF INTERVENTRICULAR SEPTUM. 3.ANT.PART OF INTERVENTRICULAR SEPTUM. 4_LEFT BRANCH OF AV BUNDLE: CARDIAC DOMINANCE :~ 1.ARTERY GIVING POSTERIOR INTERVENTRICULAR BRANCH IS DOMINANT ARTERY 2.IN 90% RIGHT CORONARY ARTERY GIVE POSTERIOR INTERVENTRICULAR ARTERY -3SUCH HEART CALLED RIGHT DOMINANCE 3.IN 10% OF CIRCUMFLEX ARTERY CONTINUATION OF LEFT CORONARY ARTERY 4.PROVIDE POSTERIOR INTERVENTRICULAR BRANCH SUCH HEART CALLED LEFT DOMINANCE HEART. “ALL VEIN EXCEPT ---->ANT.CARDIAC VEIN OPEN INTO -2CORONARY SINUS CORONARY SINUS OPENS INTO --2RIGHT ATRIUM. “SITUATED INTO LEFT POSTERIOR CORONARY SULCUS END INTO RIGHT ATRIUM 1.GREAT CARDIAC VEIN - ACCOMPANY FIRST ANT.VENTRICULAR ARTERY THAN. LEFT CORONARY ARTERY : 2.MIDDLE CARDIAC VEIN - ACCOMPANY - POSTERIOR INTERVENTRICULAR ARTERY 3.SMALL CARDIAC VEIN - ACCOMPANY ~ RIGHT CORONARY ARTERY ‘A-RIGHT MARGINAL VEIN - ACCOMPANY - MARGINAL BRANCH OF RIGHT CORONARY ARTERY 5.POST.VEIN OF LEFT VENTRICLE - RUN ON DIAPHRAGMATIC SURFACE ON LEFT VENTRICLE 6.OBLTQUE VEIN OF LEFT ATRIUM - RUNNING OF POST.SURFACE LEFT ATRIUM 3 TO 4 SMALL VEIN WHICH RUN PARALLEL TO EACH OTHER ON THE ANT.WALL OF RIGHT VENTRICLE. OPEN DIRECTLY INTO RIGHT ATRIUM. MOHAR] MBBS LECTURES canoe ASLO ESETINOETS :- NUMEROUS SMALL VALVE LESS VEIN PRESENT IN ALL FOUR CHAMBER OF HEART --->DIRECTLY OPEN RIGHT ATRIUM Nein of LeFt ventricle Oblique vein of Right atu: left atyium Coronary sinus Anteriar Cardiac vein Smo\ cardiac vein Nein Posteriow vein of Left venbicle Ascending aorta Left coronary avtew CiveumPlex branch Byonchto SA mode Diageo sane) Rai ‘agonel. branch Coronary artery = terior Margino| | - interventviculay branch. Fostevioy intervenhi lov byanch’ *THE AZYGOS TERM MEANS UNPAIR *AZYGOS VEIN DRAIN THORACIC WALL & THE UPPER LUMBAR REGION. *FROM IMPORTANT CHANNEL CONNECTING IVC. “VEIN OCCUPIES UPPER PART OF POST. WALL OF ABDOMINAL WALL & THE POST. MEDIASTINUM. - FORM BY UNION OF LUMBAR AZYGOS - RIGHT SUB COASTAL ~ ASCENDING LUMBAR VEIN. aed 1.RIGHT SUPERTOR INTERCOASTAL VEIN-> FORM BY UNION OF 28°, 38,47 POST. INTERCOASTAL VEIN. 2.5™ TO 8™ POST .INTERCOASTAL VEIN. 3.HEMIAZYGOS--->AT LEVEL OF LOWER BORDER OF 8 THORACIC VERTEBRAE. 4. ACCESSORY HEMIAZYGOS VEIN - AT THE LEVEL OF UPPER BORDER OF 8™ THORACIC VERTEBRA 5.RIGHT BRONCHIAL VEIN, NEAR THE TERMINAL END OF AZYGOS VEIN. 6.SEVERAL OESOPHAGEAL, MEDIASTINAL, PERICARDIAL VEINS. "CONTINUATION OF ASCENDING AORTA *SITUATED IN MEDIASTINUM. 1.BEGIN BEHIND THE UPPER BORDER OF THE 2“° RIGHT STERNOCHONDRAL JOINT. 2.RUN UPWARD, BACKWARD & BIFURACTION OF TRACHEA. 3.IT THUS ARCHES OVER ROOT OF LUNG. 4.ENDS AT LOWER BORDER OF BODY OF 4" THORACIC VERTEBRAE. SBRANCHES :- ~ BRACHIOCEPHALIC ARTERY ---->DIVIDES RIGHT COMMON CAROTID RIGHT SUBCLAVIAN ARTERIES - LEFT COMMON CAROTID ARTERY - LEFT SUBCLAVIAN ARTERY "vem LEFT BRACHTOCEPHALDE VELM LEFT SUPERTOR INTERCOSTAL ‘SUPERT-OR om 7 RD VENA CAVA: : Azya0S Vern THER | HemrAzyoos RIGHT Supe 1 : weve i OSTAL N Rosterrog TNTERCOS TAD very, Ran sy ‘eee LEFT SuseosTAL VEIN LmbAR poye, LEFT ASCEADINN LUMBAR Vern ° FERTOR VENA CAVA. Rony p ore ” ow LEFT commen! CAROTED ARTER' P29 me y CAROTID ARTERY LEFT SUBCLAVEAN Renter actA ferery ee ARCH® OF AORTA 0) EPH pT my iene SPESCEND IN AORTA AORTA, RIOHT "EXTEND FROM UPPER PART OF ABDOMEN TO LOWER PART OF NECK “CROSS POST.BORDER SUP.PART OF MEDIASTINUM 1.BEGINS AS A CONTINUATION OF THE UPPER END OF THE CISTERNA CHYLI NEAR LOWER BORDER -12 THORACIC VERTEBRAE | 2.ENTER THORAX THROUGH AORTIC OPENING OF DIAPHRAM 3. THEN ASCEND THROUGH POST.MEDIASTINUM FROM LEVEL OF 12™ - 5™ THORACIC VERTEBRAE. 4.THEN IT COURSE THROUGH SUP. MEDIASTINUM 5.IN NECK - ARCH LAT. AT LEVEL OF 7" CERVICAL VERTEBRAE 6.AND BY OPENING INTO ANGLE OF JUNCTION BETWEEN LEFT SUBCLAVIAN & LEFT INTERNAL JUGULAR VEIN. | -AT AORTIC OPENING OF DIAPHRAM - ANTERIORLY-DIAPHRAM -POSTERIORLY-VERTEBRAL COLUMN -TO THE RIGHT - AZYGOS VEIN -TO THE LEFT - AORTA -IN THE POST.MEDIASTINUM - ANTERIORLY - DIAPHRAGM -OESOPHAGUS -RIGHT PLEURAL RECESS POSTERIORLY - VERTEBRAL COLUMN -RIGHT POST.INTERCOASTAL ARTERIES TO THE RIGHT - AZYGOS VEIN TO THE LEFT - DESCENDING AORTA IN SUP. MEDIASTINUM - ANTERIORLY - ARCH OF AORTA POSTERIORLY - VERTEBRAL COLUMN -TO THE RIGHT - OESOPHAGUS -TO THE LEFT - PLEURA IN THE NECK - THE THORACIC DUCT FORMS AN ARCH RISING ABOUT 3-4CM ABOVE THE CLAVICLE -ANTERTORLY - LEFT COMMON CAROTID ARTERY - LEFT VAGUS ~ INTERNAL JUGULAR VEIN -POSTERIORLY - VERTEBRAL ARTERY = SYMPATHETIC TRUNK - LEFT PHRENIC NERVE $n ee ae (SPREBUTARIESI® THorActc DUCT RECEIVE LYMPH FROM BOTH HALF OF BODY BELOW DIAPHRAM & LEFT HALF ABOVE ABDOMEN. ~ IN THORAX THORACIC DUCT RECEIVE - LYMPH VESSEL FROM POST.MEDIASTINAL NODE & SMALL INTERCOASTAL NODE. ~ LEFT JUGULAR TRUNK, LEFT SUBCLAVIAN TRUNK END IN THORACIC bucT ~ LEFT BRONCHOMEDIASTINAL TRUNK - DRAIN LYMPH FROM LEFT HALF OF THORAX & END IN THORACIC DUCT . -RIGHT SIDE THERE IS RIGHT LYMPHATIC DUCT. ->INTO WHICH RIGHT BRONCHIOMEDIASTINAL, RIGHT JUGULAR, RIGHT SUBCLAVIAN LYMPH DRAIN -RIGHT LYMPHATIC TRUNK END IN RIGHT BRONCHIOCEPHALIC VEIN. NOTE :~ DIAGRAM OF THORACIC DUCT - PAGE NO.74 “ALL INTERCOSTAL NERVE - SUPPLY INTERCOSTAL MUSCLE INTERCOASTAL NERVE ARE ANT.PRIMARY RAMI OF THORACIC 1-12 SPINAL NERVE ~THE ANT PRIMARY RAMI OF 12 THORACIC NERVE - FORM SUBCOASTAL NERVE. IN ADDITIONAL TO SUPPLY INTERCOASTAL SPACE - -UPPER 2 INTERCOASTAL NERVE - ALSO SUPPLY UPPER LIMB MUSCLE -LOWER 5 - SUPPLY ABDOMINAL WALL ALSO CALLED THORACO ABDOMINAL NERVE -3-6 SUPPLY ONLY THORACIC WALL THEY ARE CALLED TYPICAL INTERCOASTAL NERVE. BEGURBE :- INTERCOASTAL NERVE RUN IN COASTAL GROOVE->END NEAR STERNUM (BAREIS = uscuLar BRANCH - NUMEROUS MUSCULAR BRANCH SUPPLY INTERCOASTAL MUSCLE - TRANSVERSUS THORACTS ~SENSORY BRANCH - MAIN BRANCH & COLLATERAL BRANCH ALSO SUPPLY PARIETIAL PLEURA & PERIOSTEUM OF RIB -LAT.CUTANEOUS BRANCH ARISE-NEAR ANGLE OF RIB WHERE IT PAIR INTERCOASTAL MUSCLE & DISTRIBUTED TO THE SKIN -ANT.CUTANEOUS BRANCH - EMERGE ON THE SIDE OF STERNUM SUPPLY OVERLYING SKIN -COMMUNICATING BRANCH - EACH NERVE IS CONNECTED TO THORACIC SYMPATHETIC GANGLION BY A DISTAL PLACE WHITE & PROXIMAL GREY RAMUS COMMUNICANS. ‘JOHAR! MBBS LECTURES. Teslerer (wlorcertal Lateral Cutancoms brand Anterior interceitad rembrane, Anterior cskuncoes Branch ‘Internal thoracic. ves Right lymphatic. duct Right jugular lymph trum Right cubclavin Lege subdavian Iyenphy frank Tymph trunk = orga [Set eee ia —Thorade Duct Intercastal ty z vessel’ — pesceding thoracic hyaph AUN Cisterna enyli 7 Anfestingl lymph run LeF tumbar iymmph Ara, Internal ilfac lymph trunk mr iN ‘external Wace lymph trunk "JOHAR! MBBS LECTURES "9-INTERCOASTAL SPACE - ANTERTORLY "11 INTERCOASTAL SPACE POSTERIORLY SRTEREOASTADIMUSAIE — 1 exreanaL INTERCOASTAL MUSCLE 2. INTERNAL INTERCOASTAL MUSCLE 3. TRANSVERSUS THORACIS - DIVIDED INTO 3 PARTS- SUBCOSTALTS, INTERCOSTALIS INTIMI, STERNOCOSTALIS _ ~ POST. - TUBERCLE OF RIB - ANT. - COSTOCHONDRAL JUNCTION “ANTERTORLY - BETWEEN COSTOCHONDRAL JUNCTION AND STERNUM REPLACED BY EXTERNAL INTERCOASTAL MEMBRANE “POSTERIORLY - END OF MUSCLE IS CONTINUOUS WITH POSTERIOR FIBRES SUPERIOR COSTO TRANSVERSE LIGAMENT DIRECTION OF FIBRE - DOWNWARD, FORWARD & MEDIALLY IN FRONT (@UENITERNADIENTERCOASTAL - ANT. - LATERAL BORDER OF STERNUM-->CONTINOUS ---SUPERIOR COSTO LIGAMENT - POST. - ANGLE OF RIB BEYOND POSTERTOR INTERCOASTAL MEMBRANE DIRECTION OF FIBRE - DOWNWARD, BACKWARD, LATERALLY - POSTERIOR PART OF LOWER INTERCOASTAL SPACE - MIDDLE 2/4 OF ALL INTERCOSTAL SPACE - ANTERIOR PART OF UPPER INTERCOSTAL SPACE Rib Neurovascular Bundle Intercostal Vein Intercostal Artery Intercostal Nerve Intercostal Muscles External intercostal Internal intercostal Innermost Internal Intercostal Rib SSS EEaEnaeaaEE ‘JOHAR! MBBS LECTURES: rz YouTube Saneaeen SBOUNDARTES - ANT. - UPPER BORDER OF MANUBRIUM STERNI -POST. - SUPERIOR SURFACE OF 15° THORACIC VERTEBRA -EACH SIDE ON 15° RIB “PLANE OF INLET IS DIRECTED DOWNWARDS AND FORWARD WITH AN OBLIQUITY OF 45 DEGREE. "PARTITION AT INLET OF THORAX :~ 1PARTITION IN 2 HALVES----RIGHT & LEFT -->WITH CLEFT BETWEEN 2.EACH HALF IS COVERED BY FASCIA - SIBSON FASCIA OR SUPRAPLEURAL MEMBRANE 3.MEMBRANE - TRIANGULAR IN SHAPE -APEX ----->ATTACHED TO TIP OF TRANSVERSE PROCESS OF 7™ CERVICAL VERTEBRA ~BASE ---->INNER BORDER OF 1°7 RIB 4.SIBSON FASCIA-->IS FLATTENED TENDON OF SCALENUS MINIMUS 1.VISCERA - TRACHEA - OESOPHAGUS - APICES OF LUNGS WITH PLEURA - THYMUS 2.LARGE VESSELS - BRACHIOCEPHALIC ARTERY ON RIGHT SIDE - LEFT COMMON CAROTID ARTERY ->ON LEFT SIDE - LEFT SUBCLAVIAN ARTERY--ON LEFT SIDE ~ RIGHT & LEFT BROCHIOCEPHALIC VEIN 3.SMALLER VESSELS - RIGHT & LEFT INTERNAL THARACIC ARTERY ~ RIGHT & LEFT SUPERIOR INTERCOSTAL ARTERIES - RIGHT & LEFT FIRST POSTERIOR INTERCOSTAL VEINS - INFERIOR THYROID VEINS 4 NERVES - RIGHT 4 LEFT PHRENIC NERVE, VAGUS NERVE, SYMPATHETIC TRUNKS 5.MUSCLES - STERNOHYOID - STERNOTHYROID - LONGUS COLLT "JOHAR! MBBS LECTURES: ree YouTube — Lonpus cervices(alli ) Fil Hhoradc nerve “Trachea Aperg lug Intercathd vier SympatheHe frunt Ser eet Lac ymyea Academe Lek utbaavian ew hery Let phrenic nerve IRiqn Brachi ocephate Lejk common carck artery vin Lek Brachiocephalic View Raqht luternel Lek internal phoraede Heoraic artery Skevwothy roid aed Bracki ocephuic 1 shemmomyoid artery | Sterna part | Cotte part Soperior

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