Join the QUB CardioSoc weekly teaching series and delve into thoracic anatomy! This is part two of two lectures that will cover the basics of thoracic anatomy with a clinical correlation to thoracic surgery. This session is aimed at preclinical students embarking on their cardiac studies, and clinical students seeking a refresher. Enhance your anatomical understanding and enrich your medical knowledge base in this peer-to-peer learning platform.
Thoracic Anatomy #2
Summary
The Thoracic Anatomy II teaching session, presented by Donovan Campbell, a student intercalating in Experimental Medicine, offers in-depth knowledge about the complex structures contained within the thoracic cavity. The session breaks down various aspects of thoracic anatomy such as the compartments of the mediastinum, tracheobronchial tree, lungs and pleura as well as delving into the main neurovasculature, lymphatics, and other organs. Attendees will benefit from numerous visual aids, detailed anatomical information such as border descriptors and organ contents, and interactive questions to test comprehension. Importantly, the session also covers clinical relevance, including conditions like Pneumothorax and Barrett's Oesophagus, providing a practical aspect to the theoretical learning.
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Description
Learning objectives
- Understand the anatomical and functional elements of the compartments of the mediastinum, including the superior and anterior mediastinum, and their clinical relevance.
- Gain detailed knowledge of the tracheobronchial tree, lungs and pleura, including their structures, functions and key landmarks.
- Recognize the main neurovasculature of the thoracic region, including their role in thoracic anatomy as well as how they appear and what they indicate in a chest X-Ray.
- Understand lymphatics and other organs in mediastinal compartments in relation to their position, function and clinical significance.
- Develop an ability to answer anatomical questions related to thoracic anatomy, particularly about the borders of the superior mediastinum, the level of the carina, the arterial system supplying the first posterior intercostal artery, segment identification in the lungs, and the naming of mediastinal lymph nodes.
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ThoracicAnatomyII Donovan Campbell Intercalating Experimental MedicineStudent Overview •Compartments of the Mediastinum •Tracheobronchial Tree •Lungs and Pleura •MainNeurovasculature •Lymphatics •OtherOrgansMediastinalCompartments(4-part model) Thieme AtlasofAnatomy SuperiorMediastinum Borders Superior – Thoracic inlet (aperture). Inferior – The transverse plane ofLudwig. Anterior – Manubrium. Posterior – Vertebral bodies ofT1-4. Lateral– Pleurae ofthelungs. SuperiorMediastinum Contents – PrivateLeft Battle PhrenicN. Vagus N. ThoracicDuct Left recurrentlaryngeal N. BrachiocephalicVein Aortic Arch Thymus Trachea Lymphnodes Oesophagus Question1 Whatmarksthesuperiorborderofthesuperior mediastinum? 1. Manubrium 2. AorticArch 3. Left Subclavian 4. ThoracicInlet 5. Cricothyroid Cartlidge Question1 Whatmarksthesuperiorborderofthesuperior mediastinum? 1. Manubrium 2. AorticArch 3. Left Subclavian 4. ThoracicInlet 5. Cricothyroid Cartlidge AnteriorMediastinum Borders Lateral borders- Mediastinalpleurae. Anterior border - Sternal body and transversus thoracis muscles. Posteriorborder - Pericardium. Roof - The transverseplaneofLudwig. Floor - Diaphragm. AnteriorMediastinum Contents • Thymus • Sterno-pericardial ligaments • Lower pole of thyroidgland • Internalthoracic vessels • Para-sternallymph nodes AnteriorMediastinum ClinicalRelevance – All theT's • eratoma • Thymic carcinomas/thymomas • ThyroidCarcinomas • errible Lymphomas PosteriorMediastinum Borders Lateral - Mediastinal pleura. Anterior - Pericardium. Posterior- T5-T12 vertebrae. Roof - The transverseplane ofLudwig. Floor - Diaphragm. PosteriorMediastinum Contents–DATES inVegas Descending Aorta Azygous/hemiazygous veins ThoracicDuct Oesophagus Sympathetic Chain Vagus Nerve– Anterior+PosteriorTrunksUpdatedMediastinalCompartments Shield Classification/International ThymicMalignancy InterestGroupTracheobronchialTree Segmental (tertiary)bronchus –terminal bronchiole. RespiratoryPortion: Respiratory bronchiole – alveoli.TracheobronchialTree Question2 At what vertebral level is the carina? 1.T4/5 2.T5/6 3.T3/4 4.T2/3 5.T7/8 Question2 At what vertebral level is the carina? 1.T4/5 2.T5/6 3.T3/4 4.T2/3 5.T7/8 TracheobronchialTree Ciliated Pseudostratified Columnar EpitheliumTracheobronchialTreeTheLungs The Right Lung 3 Lobes • Upper • Middle • Lower 2 Fissures • Oblique • Horizontal TheLungs TheLeft Lung 2 Lobes • Upper • Lower 1 Fissure • ObliqueSegmentsoftheLungSegmentsoftheLungLungMarkingsLungMarkings ThePleura Pleuralcavity Apotential space. It contains 10-20mlofserous fluid. • It lubricates the surfacesofthe pleurae. • Produces a surface tension, pulling the parietal and visceral pleura together. This ensures that when the thorax expands, the lung also expands,filling with air. Serous membranesfacilitating efficientrespiration. Layer of simple squamousepithelium(mesothelium) Pneumothorax Chest X-Ray Signs: • Radiolucency • Visceral pleuralline • Increased rib separation • MediastinalShift Question3 Whatis thenameof segment 6intherightlung? 1. Medial basal 2. Lateral basal 3. Superior 4. Inferior 5. Apical Question3 Whatis thenameof segment 6intherightlung? 1. Medial basal 2. Lateral basal 3. Superior 4. Inferior 5. ApicalArterialSupply–A9P11 • Subclavian–VIT CD • I–Internalthoracic(anterior intercostals1-6) • Internalthoracic> musculophrenic(7-9) andsuperior epigastricAA • C–Costocervical trunk> supreme intercostalaa (posterior1-2) • Descending thoracicaorta >(3-11)ArterialSupplyIntercostalaaBronchialArtery–T5/6 Question4 What arterialsystem supplies the 1st posterior intercostalartery? 1. Vertebral 2. Internal thoracic 3. Thyrocervical trunk 4. Costocervical trunk 5. Dorsal scapular Question4 What arterialsystem supplies the 1st posterior intercostalartery? 1. Vertebral 2. Internal thoracic 3. Thyrocervical trunk 4. Costocervical trunk 5. Dorsal scapular VenousSystem Anterior intercostalveins> musculophrenic + internalthoracic (all 9) (1) posterior intercostal vein > supreme intercostalvein > brachiocephalic v. (2-3) posterior intercostalveins> superior intercostalvein > L brachiocephalic vein + R azygos v. AzygousandHemiazygous Posterior intercostalveins(11) + subcostalvein > azygos Right 4th-11th > azygos Left 4th-7th > accessoryhemiazygos Left 8th-11th > hemiazygosBronchialvv LymphaticSystem Lungsare drained by 2networks. Peribronchial > drains bronchial andmost ofthelungs. Subpleural > peripheral lungs andvisceral pleura. Clinical Relevance Chylothorax– leakageof chyleintothe thorax. Causes - Iatrogenic, malignancy, trauma, congenital, infection...MediastinalLymphNodesMediastinalLymphNodes Oesophagus Fibromuscular tube 25 cm in length, mucosal layer consisting of non-keratinising stratified squamous epithelium. • Origin – cricoid cartilage (C6) • Insertion – cardiac orifice (T11) 4 Pointsof Constrictions • Cricoid Cartlidge • Aortic Arch • LeftMain Bronchus • Diaphragmatic Hiatus OesophagealLayers Circular muscle layerconstricts behind the food bolus. Longitudinalmusclelayer constricts shortening the length of the O.infrontof the foodbolus. Peristaltic relationship LongitudinalMuscle Layer 1. Superior third–voluntary striatedmuscle 2. Middle third –voluntary striatedand smooth muscle 3. Inferior third – smoothmuscle Neurovasculature Arterial Supply Nerve • Cervical - oesophageal branches of inferior thyroid • Oesophageal plexus. artery (thyrocervical). • Parasympathetic vagal trunks • Thoracic - oesophageal branches of aorta. Right • Sympathetic fibres from intercostal arteries. the cervical and thoracic • Abdominal – left gastric artery (coeliactrunk) sympathetic trunks. Venous • Cervical - inferior thyroid vein. • Thoracic - branches of the azygous veins. • Abdominal – left gastricvein Oesophagus Sphincters Upper - Cricopharyngeus Lower (physiological) - Acute angle - Right crus - Mucosalfolding - Compression (raised intraabdominalpressure) Oesophagus Barrett's Oesophagus Metaplasia> columnarepithelium. (Adenocarcinoma) Squamous cell carcinoma– most prevalent Diaphragm T8 • Inferior VenaCava Caval Hiatus • Right PhrenicN 'VenaCava' T10 • Oesophagus Oesophageal Hiatus • R+LVagus NN • esofLGA/Val branch 'Oesophagus' Aortic Hiatus • ThoracicDuct • Azygous Vein 'Aortic Hiatus' Question5 During an anatomical lung resection for adenocarcinoma, the surgeon resects the station 6 mediastinallymph node. Theyask you the possible name for this node? 1. Descending aortic 2. Ascending aortic 3. Subcarinal 4. Retro-tracheal 5. Pre-vascular Question5 During an anatomical lung resection for adenocarcinoma, the surgeon resects the station 6 mediastinallymph node. Theyask you the possible name for this node? 1. Descending aortic 2. Ascending aortic 3. Subcarinal 4. Retro-tracheal 5. Pre-vascular Resources •Gray's Anatomy for Students •Thieme AtlasofAnatomy •Radiopaedia •TeachMe Anatomy •KenhubRespiratory Physiology Mr.Yong Lim 04/03/25