http://www.triblocal.com/naperville/files/cache/2011/11/gross1108.jpg/460_345_resize.jpg
Mimsa Dissection 2 Session
Konstantinos Choulakis

Thorax
Borders:
•Superiorly: jugular fossa – clavicles – acromion – 7th  cervical vertebra
•Inferiorly: xiphoid process – ribs – spinous process of 12th thoracic vertebra
•
Superior thoracic aperture:  1st thoracic vertebra – first ribs – superior margin of sternum
Inferior thoracic aperture: 12th thoracic vertebra – last ribs – distal costal arches
Regions:
1.Deltoid
2.Inflaclavicular ( =clavipectoral= deltopectoral)
3.Pectoral
4.Presternal
5.Axillary
6.Mammary
7.Inframammary
http://www.atlasofanatomy.com/thorax/slides/Regiones%20Pectorales.jpg
3
1
4
5
2
6
6
7
7
3
http://www.faqs.org/health/images/uchr_02_img0180.jpg
3

Muscles:
M. Pectoralis Major
M. Pectoralis Minor
M. Subclavius
M. Transversus Thoracis
M. Serratus anterior
O:
I:
Inn:
F:
http://medicina.ronnie.cz/img/data/clanky/normal/926_4.jpg
http://medicina.ronnie.cz/img/data/clanky/normal/926_5.jpg
http://medicina.ronnie.cz/img/data/clanky/normal/926_2.jpg
http://medicina.ronnie.cz/img/data/clanky/normal/926_1.jpg
http://classconnection.s3.amazonaws.com/21/flashcards/1004021/png/subclavius1323343136550.png

http://medicina.ronnie.cz/img/data/clanky/normal/926_6.jpg
http://www.albany.k12.or.us/sahs/teacherpages/jdilbone/Anatomy/musc_img/cadaver/antthorax.gif


M. Externus Intercostalis
M. Internus Intercostalis
M. Innermost Intercostal
http://cnx.org/content/m46485/latest/1114_Thorax.jpg
Origin
Insertion
I
O
I
O

Fasciae
•Superficial thoracic fascia: Underneath the skin.
•Pectoral fascia: The pectoral fascia is a thin lamina, covering the surface of the pectoralis
major, and sending numerous prolongations between its fasciculi: it is attached, in the middle
line, to the front of the sternum; above, to the clavicle; laterally and below it is continuous
with the fascia of the shoulder, axilla
•Clavipectoral fascia: It occupies the interval between the pectoralis minor and Subclavius , and
protects the axillary vessels and nerves. Traced upward, it splits to enclose the Subclavius , and
its two layers are attached to the clavicle, one in front of and the other behind the muscle; the
latter layer fuses with the deep cervical fascia and with the sheath of the axillary vessels.
Medially, it blends with the fascia covering the first two intercostal spaces, and is attached also
to the first rib medial to the origin of the Subclavius . Laterally, it is very thick and dense,
and is attached to the coracoid process. The portion extending from the first rib to the coracoid
process is called the costocoracoid ligament.
•Endothoracic fascia: Endothoracic fascia is the layer of loose connective
tissue deep to the intercostal spaces and ribs, separating these structures
 from the underlying pleura
http://www.synthetek.com/Images/Syntherolarticle/autopsy-of-superficial-fascia-pectoral-fascia.jpg
http://202.201.152.9/jpjys/admin/pic/2007530113011.jpg

Arteries
Aorta
•Brachiocephalic Artery
 –  Right Common Carotid. – Right Subclavian.
•Left subclavian artery
•Left common carotid artery
http://www.chw.org/display/displayFile.asp?filename=/Groups/Derm/aortic_arch_diagram.jpg

SUBCLAVIAN ARTERY. Mnemonic for branches VITamin C
It passes ventrocaudally from brachial plexus . Enters the fissure between anterior and middle
scalene muscles. It lies on groove for subclavian artery of first rib passes bellow clavicle and
enter axillary fossa where changes name to Axillary a..
http://drsigonasanatomy.weebly.com/uploads/1/0/3/8/10387966/7267826_orig.gif
Branches
1.Vertebral A. It has intracranial and extracranial branches
2.Internal Thoracic A.. Enters the thoracic cavity through sup. thoracic aperture. It descends on
the internal side of thoracic cage, 1 cm away from the margin of sternum till the level of
6th intercostal fissure where it gives the terminal bracnhes: musculophrenic a., superior
epigastric a.. Branches: a)mediastinal b)pericardiophrenic c)perforating d) anterior intercostal
e)musculophrenic f)superior epigastric
3.Thyrocervical trunk. Arises from subclavian artery by the the medial margin of anterior scalene
muscle. Branches: a)inferior thyroid b)ascending cervical c)superficial cervical d)suprascapular
4.Costocervical trunk. Rises from posterior side of subclavian artery and after a short run towards
1st rib’s neck it divides to a)deep cervical b)supreme intercostal
5.(Transverse cervical)
http://www.dartmouth.edu/%7Ehumananatomy/figures/chapter_50/50-21_files/IMAGE001.PNG

http://www.cicmd.com/images/cicmd/anatomy%20images/subclavian.gif
Branches:
•Vertebral A.
•Internal thoracic A.
a)Pericardial. Supply pericardial sac
b) Pericardiophrenic. Supply pericardium and diaphragm, it is accompanied by phrenic nerve
c)Perforating. Passing through thoracic wall and supply anterior thorax
d)Anterior intercostal enter to the 6 upper intercostal spaces  and anastomose with the posterior
intercostal arteries (<thoracic aorta)
e)Musculophrenic a. . Descend from the 7th rib along the insertion of diaphragm and gives off
intercostal arteries for the 5 caudal intercostal spacies
f)Superior epigastric a. Passes through sternocostal fissure of diaphragm and it descends caudall
on posterior side of rectus abdominis.
•Thyrocervical trunk
a)Inferior thyroid a. passes up at the level C6 it turns medially crosses the big cervical vessels
and nerves and enters thyroid gland. It anastomoses with thyroid superior (< external carotid). It
gives off branches: inf laryngeal, tracheal, oesophageal, and pharyngeal.
b)Ascending cervical a. Ascends to anterior surface of scalenus anterior. It gives off muscular
branches for the surrounding muscles and spinal branches for supply of spinal cord ( these branches
pass through intervertebral foraminae)
c)Superficial cervical a (transverse cervical). Passes over ant. Scalene muscle and supplies
trapezius. Can also arise form transverse cervical
d)Suprascapular a. Passes above transverse scapular ligament and enters to supraspinous fossa then
passes below the acromion and enters infraspinous fossa and supplies the posterior muscles of
scapula. It anastomoses with circumflex scapular a. (<subscapular a. < Axillary a.)
•Costocervical trunk
a)Deep cervical. Ascends between transverse process of C7 and Th1. Supplies surrounding muscles and
vertebral collumn
b)Supreme intercostal. It gives off branches posterior intercostal for the upper two intercostal
spaces
•(Transverse cervical) It is often a branch of thyrocervical trunk. It branches of subclavian
artery after scalene muscles. It gives off ascending branch for levator scapulae and descending
branch for rhomboid and trapezius muscle.

(1) Middle scalene muscle, (2) anterior scalene muscle, (3) dorsal scapular nerve, (4) transverse
cervical artery, (5) phrenic nerve, (6) brachial plexus, (7) descending scapular artery, (8)
suprascapular artery, (9) thyrocervical artery, (10) lung, (11) inferior cervical sympathetic
ganglion, (12) longus colli muscle, (13) vertebral artery, (14) vagus, (15) inferior thyroid
artery, (16) middle cervical sympathetic ganglion, (17) recurrent laryngeal nerve
http://www.bartcop.com/wrong-banana.jpg

Internal thoracic
http://upload.wikimedia.org/wikipedia/commons/5/5c/Gray522.png
http://classconnection.s3.amazonaws.com/33/flashcards/602033/jpg/01_blood_supply_of_thoracic_wall_%
28edit%291312915661716.jpg

http://youknowyoucare.com/wp-content/uploads/2011/01/kim-kardashian-boobs4.jpg



http://classconnection.s3.amazonaws.com/33/flashcards/602033/jpg/lecture_06_-_axillary_nerves_and_v
essels_%28edit%291311552188630.jpg
1. thyrocervical trunk
2. subclavian artery
3. superior thoracic artery
4. thoracoacromial artery
5. lateral thoracic artery
6. thoracodorsal artery
7. brachial artery
8. circumflex scapular artery
9. subscapular artery
10. posterior circumflex humeral artery
11. anterior circumflex humeral artery
12. dorsal scapular artery
13. suprascapular artery
14. transverse cervical artery

http://www.lumen.luc.edu/lumen/MedEd/GrossAnatomy/dissector/labs/ue/post_tri/images/pt3_2.jpg
1 = thyrocervical trunk; 2 = suprascapular artery; 3 = transverse cervical artery( superficial
cervical); 4 = inferior thyroid artery; 5 = phrenic nerve on the anterior scalene muscle.

Axillary artery is a direct continuation of subclavian artery into the axilla. The border between
both arteries is located by the inferior margin of first rib. It descends through the armpit
caudally and at the level of surgical neck of Humerus it passes to brachial artery. It gives off
several branches:
•Branches to subscapular muscle
•Supreme thoracic a. supplies the pectoral and intercostal muscles
•Thoracoacromial a. enters the Clavipectoral triangle and gives several branches as acromial,
deltoidal for the muscle and pectoral for the homonymic muscles.
•Lateral thoracic supplies serratus anerior and gives off lateral mammary branches for the mammary
gland (women)
•Subscapular a. gives early two branches
a)Circumflex scapulae a. which passes from foramen omotricipitale into infraspinous fossa and
supply the muscles on posterior side of scapula, it anastomoses with suprascapular a. (
<thyrocervical a. <subclavian a.)
b) Thoracodorsal a. supply m. latissimus dorsi
•Anterior circumflex humeri supply deltoid muscle and nourishes glenohumeral joint
•Posterior circumflex humeri is bigger than the anterior . It passes from humetricipitale triangle
and supply deltoid and nourishes glenohumeral joint
http://4.bp.blogspot.com/-VZmIp9XnH7Y/Tjr40Dfvm7I/AAAAAAAAIBo/5A81jn6zmyY/s320/Axillary_artery.JPG
1) superior thoracic artery; 2) thoracoacromial; 3) lateral thoracic; 4) subscapular; 5) anterior
humeral circumflex; and 6) posterior humeral circumflex artery.
http://upload.wikimedia.org/wikipedia/commons/4/4c/Axillary_branches.PNG

http://upload.wikimedia.org/wikipedia/commons/d/d5/Axillary_space.png
Humerotricipitale
Circumflex humeri a.
Axillary nerve
Omotricipitale
Circumflex scapulae a.
Suprascapular a.

http://www.topvylet.cz/img/NA32KKIBHV3JO4493661D4Y9Q173I977.jpg



Thoracic Aorta
http://www.netterimages.com/images/vpv/000/000/020/20630-0550x0475.jpg
It begins at the lower border of the fourth thoracic vertebra where it is continuous with the
aortic arch, and ends in front of the lower border of the twelfth thoracic vertebra, at the aortic
hiatus in the diaphragm where it becomes the abdominal aorta.
At its commencement, it is situated on the left of the vertebral column; it approaches the median
line as it descends; and, at its termination, lies directly in front of the column.
It is in relation, anteriorly, from above downward, with the root of the left lung, the
pericardium, the esophagus, and the diaphragm; posteriorly, with the vertebral column and the
azygos vein; on the right side, with the hemiazygos veins and thoracic duct; on the left side, with
the left pleura and lung.
The esophagus, with its accompanying plexus of nerves, lies on the right side of the aorta above;
but at the lower part of the thorax it is placed in front of the aorta, and, close to the
diaphragm, is situated on its left side.

Descending Aorta
The parietal branches
•Posterior intercostal arteries enter the 3rd till 11th intercostal space pass within costal groove
of superior rib. They anastomose with anterior intercostal arteries.
•Subcostal artery passes below 12th rib
•posterior intercostal arteries gives off branches:
a)Dorsal: muscular (back muscles), spinal and cutaneous branches
b)Muscular: for thoracic muscles
c)Collateral: runs on superior margin of caudal rib
d)Lateral cutaneous: supply lateral thoracic wall and mammary gland ( in women- lateral mammary a.
)
•Superior phrenic: supplies the cranial part of diaphragm
The visceral branches
•Bronchial arteries
•Oesophagial arteries
•Pericardial- Mediastinal arteries
http://classconnection.s3.amazonaws.com/14/flashcards/1310014/png/screen_shot_2012-03-24_at_50835_p
m1332634145883.png
http://polyanatomy.files.wordpress.com/2011/10/thoracic-aorta-ascending-descending-aortic-isthmus_m
edical512.jpg
http://classconnection.s3.amazonaws.com/33/flashcards/602033/jpg/05_thoracic_aortic_branches1313383
897898.jpg

Anterior Intercostal Arteries originate from
•Internal thoracic for upper 6 intercostal spaces
•Musculophrenic (terminal branch of internal thoracic) for caudal 5 intercostal spaces
•
Posterior Intercostal Arteries originate from
•    The 1st and 2nd posterior intercostal arteries arise from the supreme intercostal artery, a
branch of the costocervical trunk of the subclavian artery.
•    The lower nine arteries are the aortic intercostals, so called because they arise from the
back of the thoracic aorta.
•
File:Gray530.png
http://web.uni-plovdiv.bg/stu1104541018/docs/res/skandalakis%27%20surgical%20anatomy%20-%202004/Cha
pter%2004_%20Mediastinum_fichiers/loadBinaryCAAZAO30.jpg
http://classconnection.s3.amazonaws.com/1022/flashcards/884731/jpg/intintcost.jpg
http://wberesford.hsc.wvu.edu/PC1010010labelled1.jpg

Veins
V. SUBCLAVIA
v. transversa colli
v. suprascapularis

V. AXILLARIS
vv. thoracoepigastricae – vv. subcutaneae abdominis
v. thoracica lat.
vv. costoaxillares
v. cephalica
http://upload.wikimedia.org/wikipedia/commons/e/e9/Gray576.png
http://classconnection.s3.amazonaws.com/33/flashcards/602033/jpg/lecture_06_-_axillary_veins_%28edi
t%291311552833018.jpg

Vena cava
It is formed by the union of the ascending lumbar veins with the right subcostal veins at the level
of the 12th thoracic vertebra. A major tributary is the hemiazygos vein, a similar structure on the
opposite side of the vertebral column. Other tributaries include the bronchial veins, pericardial
veins, and posterior right intercostal veins. It communicates with the vertebral venous plexuses.
The hemiazygos vein and the accessory hemiazygos vein, when taken together, essentially serve as
the left-sided equivalent of the azygos vein. That is, the azygos vein serves to drain most of the
posterior intercostal veins on the right side of the body, and the hemiazygos vein and the
accessory hemiazygos vein drain most of the posterior intercostal veins on the left side of the
body. Specifically, the hemiazygos vein mirrors the bottom part of the azygos vein. It usually
begins in the left ascending lumbar vein or renal vein, and passes upward through the left crus of
the diaphragm to enter the thorax. It continues ascending on the left side of the vertebral column,
and around the level of the ninth thoracic vertebra, it passes rightward across the column, behind
the aorta, esophagus, and thoracic duct, to end in the azygos vein.
The accessory hemiazygos vein is a vein on the left side of the vertebral column that generally
drains the fifth through eighth intercostal spaces on the left side of the body.
File:Gray480.png

Nerves
http://www.proprofs.com/quiz-school/upload/24595.gif
http://classconnection.s3.amazonaws.com/694/flashcards/597694/jpg/brachial_plexus21310948706257.jpg

Intercostal Nerves arise from spinal nerves they contain sensory (cutaneous) and motor fibers
http://anesthesiology.unm.edu/_Docs/Resources/IntercostalNerves.jpg


http://www.grunex.com/data/Marty/random_pics/world-of-tanks-logo1.png



Dissection
http://ect.downstate.edu/courseware/haonline/imgs/00000/0000/600/629.jpg
1st Step
Incisions
Skin layer

Step 2
Subcutaneous Layer
Supraclavicular Nerves
Cephalic vein
(Thoracoacromial Artery)
https://www.proceduresconsult.jp/UploadedImages/pcj_0122_00001349_100000_large_27102010113717.jpg
http://o.quizlet.com/i/1RyQ8gq-KRaEZ_ShA-2iDw_m.jpg
http://now24.gr/wp-content/uploads/2012/05/mparmparousis.jpg

Step 3
1.Clean The surface of pectoralis major and deltoid muscle
2.Cut the pectoralis major 4 cm from the arm and reflect it. Take care to preserve the pectoral
nerves and vessels.
3.Find and clean the pectoralis minor m. and subclavious and clean the Clavipectoral fascia
4.Cut the Pectoralis minor m.
5.Find and clean axillary artery and its branches at the lateral thoracic wall (Lateral thoracic
and Subcapular arteries)
6.Identify and clean axillary vein and its tributaries at the lateral thoracic wall (vv.
Thoracoepigastricae, vv.costoaxillares, v. thoracica lat.)
7.Identify and clean Long thoracic nerve
http://upload.wikimedia.org/wikipedia/commons/4/4c/Axillary_branches.PNG
http://upload.wikimedia.org/wikipedia/commons/e/e9/Gray576.png
http://www.med.mun.ca/anatomy/media/ul_innervation/Long%20Thoracic%20Image083.jpg

Step 4
Identify and clean the brachial Plexus
http://ect.downstate.edu/courseware/haonline/imgs/00000/0000/600/654.jpg
Lateral cord
http://ect.downstate.edu/courseware/haonline/imgs/00000/0000/600/655.jpg
Medial cord
Branches:
1.Musculocutaneous
2.Lateral Pectoral
3.Lateral root of Median nerve
Branches:
1.Ulnar
2.Medial Pectoral
3.Medial root of Median nerve
4.Medial cutaneous of arm
5.Medial cutaneous of forearm
Intercostobrachial nerve

Posterior cord
Click for Full Screen
Branches:
Upper and lower Subscapular
Thoracodorsal
Axillary
Radial

Step 5
Find and clean the vessels and nerves that pass from the
1.Omotricipitale
2.Humerotricipitale
http://upload.wikimedia.org/wikipedia/commons/d/d5/Axillary_space.png
Humerotricipitale
Circumflex humeri a.
Axillary nerve
Omotricipitale
Circumflex scapulae a.
Suprascapular a.

Step 6
Intercostal spaces
http://anesthesiology.unm.edu/_Docs/Resources/IntercostalNerves.jpg

Step 7
Open the rib cage by cutting the ribs and removing the anterior thoracic wall
Find and clean the Internal Thoracic vessels and the Transversus thoracis muscle
http://jiepou.shmu.edu.cn/gjjp/jjkt/jxkj/2.xiongbu.files/slide0023_image013.jpg

Internal Organs
Structures within the thoracic cavity include
•    structures of the cardiovascular system, including the heart and great vessels, which include
the thoracic aorta, the pulmonary artery and all its branches, the superior and inferior vena cava,
the pulmonary veins, and the azygos vein
•    structures of the respiratory system, including the trachea, bronchi and lungs
•    structures of the digestive system, including the esophagus,
•    endocrine glands, including the thymus gland,
•    structures of the nervous system including the paired vagus nerves, and the paired sympathetic
chains,
    lymphatics including the thoracic duct.
It contains three potential spaces lined with mesothelium: the paired pleural cavities and the
pericardial cavity. The mediastinum comprises those organs which lie in the center of the chest
between the lungs.
http://medical-neuroscience.medicine.dal.ca/Correlations_Medical_Imaging/pic3.JPG
http://image1.masterfile.com/getImage/861-03339611em-Human-cadaver-dissection-of-the-left-lung--Lun
gs-are-the-light--spongy.jpg File:Slide11gggg.JPG

The mediastinum lies between the right and left pleura in and near the median sagittal plane of the
chest. It extends from the sternum in front to the vertebral column behind, and contains all the
thoracic viscera except the lungs. It may be divided for purposes of description into two parts:
•    an upper portion, above the upper level of the pericardium, which is named the superior
mediastinum with its superior limit at the superior thoracic aperture and its inferior limit at the
plane from the sternal angle to the disc of T4-T5 (Plane of Ludwig at Angle of Louis);
•    and a lower portion, below the upper level of the pericardium. This lower portion is
subdivided into three parts:
1.        that in front of the pericardium, the anterior mediastinum;
2.        that containing the pericardium and its contents, the middle mediastinum;
3.        and that behind the pericardium, the posterior mediastinum.
It is surrounded by the chest wall anteriorly, the lungs laterally and the spine posteriorly. It is
continuous with the loose connective tissue of the neck, and extends inferiorly onto the diaphragm.
http://4.bp.blogspot.com/-s8fnD-lqw0U/TevdapTzYPI/AAAAAAAAAHI/LsShgwAD-QM/s640/mediastinum.jpg

•aortic arch
•brachiocephalic artery
•thoracic portions of the left common carotid and the left subclavian
•brachiocephalic veins and
•upper half of the superior vena cava
•left highest intercostal vein
•vagus nerve
•cardiac nerve
•superficial and deep cardiac plexuses
•phrenic nerve
•left recurrent laryngeal nerve
•trachea
•esophagus
•thoracic duct
•remains of the thymus
Contents of Superior Mediastinum
http://home.comcast.net/%7Ewnor/thxsectt2.jpg
Cross section through the thorax at vertebra T2 This section cuts through the superior mediastinum
above the aortic arch.
Cross section through the thorax at vertebra T3. This section is also through the superior
mediastinum but a little lower than the one above. You are looking up and into the aortic arch
http://home.comcast.net/%7Ewnor/thxsectt3.jpg

Contents of Anterior Mediastinum
•A quantity of loose areolar tissue
•Dome lymphatic vessels which ascend from the convex surface of the liver
•Two or three anterior mediastinal lymph nodes
•The small mediastinal branches of the internal thoracic artery
•Thymus (involuted in adults)
Cross section through the thorax at vertebra T5. This section cuts through the anterior, middle and
posterior mediastina.
You now see the ascending and descending aortae as well as the pulmonary trunk.
http://home.comcast.net/%7Ewnor/thxsectt5.jpg
Contents of Middle Mediastinum
•the heart enclosed in the pericardium
•the ascending aorta
•the lower half of the superior vena cava with the azygos vein opening into it
•the bifurcation of the trachea and the two bronchi
•the pulmonary artery dividing into its two branches
•the right and left pulmonary veins
•the phrenic nerves
•pericardiocophrenic vessels
Contents of posterior Mediastinum
•    thoracic part of the descending aorta
•    azygos vein
•    the hemiazygos vein and the accessory hemiazygos vein
•    vagus nerve
•    splanchnic nerves
•    esophagus
•    thoracic duct
•    Sympathetic ganglia
Cross section through the thorax at vertebra T5.
http://home.comcast.net/%7Ewnor/thxsectt8.jpg
Cross section through the thorax at vertebra T8

Trachea
The trachea connects to the larynx at the C6 vertebral level. It continues caudally and enters the
mediastinum through superior thoracic aperture. At the Th4-Th5 vertebral level it divides (tracheal
bifurcation) into two principal bronchi ( at this point there is located sagitally a structure
called carina). By the passing through the superior thoracic aperture, the trachea is
topographically divided into pars cervicalis and pars thoracica. The underlay of the tracheal wall
is created with 15-20 C-shaped, hyaline cartilages, which are connected to each other by fibrous
connective tissue (annular ligaments). The posterior cartilaginous portion is substituted by
fibrous connective tissue and smooth muscle tissue (pars membranaceus). The whole set of smooth
muscle is called m.trachealis. The mucosa of trachea is consists of pseuodostratified cilated
collumnr epithelium and in the submucosa there are numerous seromucous glands, the tracheal
glands
http://da5wf380ybs7x.cloudfront.net/var/ezwebin_site/storage/images/media/images/e-anatomy/chest-an
atomy-illustrations/trachea-and-bronchial-tree-en/4510309-1-eng-GB/trachea-and-bronchial-tree-en_im
agelarge.jpg http://www.pinknews.co.uk/images/2013/07/Adonis-Georgiadis-CREDIT-Twitter.jpg

http://image.masterfile-illustrations.com/em_w/02/10/10/671-02101088w.jpg
The right principal bronchus is shorter wider and it runs more steeply in comparison to the left
which is longer, narrower and passes more horizontally .
http://www.somso.de/img/hs21_1.jpg

http://ect.downstate.edu/courseware/haonline/imgs/00000/2000/900/2955.jpg
Left lung
•upper lobe
•lingula
•lower lobe
•oblique fissure
Right lung
1.upper lobe
2.lower lobe
3.middle lobe
4.oblique fissure
5.horizontal fissure
Each lung is surrounded by a pleural cavity, which consists of two pleurae. The parietal pleura
lies against the rib cage, and the visceral pleura lies on the surface of the lungs. In between the
pleura is pleural fluid. The pleural cavity helps to lubricate the lungs, as well as providing
surface tension to keep the lung surface in contact with the rib cage.

The lungs
http://classconnection.s3.amazonaws.com/600/flashcards/821600/jpg/hilum1319690907459.jpg
Left lung- Mnemonic :LABV
HilumàLeft
1.(pulmonary) Artery
2.Bronchus
3.(pulmonary) Veins
Pulmonary ligament
Impressions of organs on the left lung:
http://www.med.umich.edu/lrc/coursepages/m1/anatomy2010/html/images/left_hilum.gif

http://www.med.umich.edu/lrc/coursepages/m1/anatomy2010/html/images/right_hilum.gif
Right lung-mnemonic: RBAV
1.Bronchus
2.(pulmonary) artery
3.(pulmonary) vein
http://o.quizlet.com/i/rSKliUNWhp5Y_Hy1TMf9LA_m.jpg
Heart
impression
Impressions of organs on the right lung:
The Right Lung has an oblique and a horizontal fissure

http://ect.downstate.edu/courseware/haonline/imgs/00000/3000/100/3126.jpg
http://ect.downstate.edu/courseware/haonline/imgs/00000/3000/100/3123.jpg
Left Vagus N.: Recurrent Laryngial, Cardiac branches
Phrenic nerve
http://www.keeptalkinggreece.com/wp-content/uploads/2013/09/health-minister.jpg?f9d891

There are two layers to the pericardial sac: the outermost fibrous pericardium and the inner serous
pericardium. The serous pericardium, in turn, is divided into two layers, the parietal pericardium,
which is fused to and inseparable from the fibrous pericardium, and the visceral pericardium, which
is part of the epicardium. The epicardium is the layer immediately outside of the heart muscle
proper (the myocardium)
Pericardium
http://bjr.birjournals.org/content/83/987/194/F1.large.jpg
The lines of reflection between visceral and parietal pericardium form two pericardial sinuses, the
transverse pericardial sinus and the oblique pericardial sinus. The transverse pericardial sinus
lies anterior to the superior vena cava and posterior to the ascending aorta and pulmonary trunk.
Place your finger in the transverse pericardial sinus and examine the relationships of the
structures.

The human heart has four chambers, two superior atria and two inferior ventricles. The atria are
the receiving chambers and the ventricles are the discharging chambers. Deoxygenated blood from the
body flows via the venae cavae into the right atrium, which pumps it through the tricuspid valve
into the right ventricle, whose subsequent contraction forces it out through the pulmonary valve
into the pulmonary arteries leading to the lungs. Meanwhile, oxygenated blood returns from the
lungs through the pulmonary veins into the left atrium, which pumps it through the mitral valve
into the left ventricle, whose subsequent strong contraction forces it out through the aortic valve
to the aorta leading to the systemic circulation.
The heart
http://www.rkm.com.au/anatomy/anatomical-illustrations/human-heart-anatomy-label.png
http://www.texasheartinstitute.org/HIC/Anatomy/images/fig1_crosslg.jpg

Special features
•Atrioventricular valves
•Papillary muscles
•Chordae tendinae
•Semilunar valves
•Fossa Ovale
•Anterior Interventricular sulcus
•Posterior Interventricular sulcus
•Atrioventricular groove
•Conduction system of the heart
http://2.bp.blogspot.com/-QIc6Z1Yy9hM/TZNDFvH-HOI/AAAAAAAAABU/_xutGdzP9U0/s1600/F3.large.jpg
http://upload.wikimedia.org/wikipedia/commons/4/46/Gray492.png
http://upload.wikimedia.org/wikipedia/commons/5/5f/Gray491.png

Arterial Blood supply of the heart
http://ect.downstate.edu/courseware/haonline/imgs/00000/3000/100/3170.jpg
http://ect.downstate.edu/courseware/haonline/imgs/00000/3000/100/3171.jpg
http://ect.downstate.edu/courseware/haonline/imgs/00000/3000/100/3172.jpg
http://ect.downstate.edu/courseware/haonline/imgs/00000/3000/100/3102.jpg
Left Coronary artery                                           Anterior Interventricular
artery                  Left circumflex artery
Left Marginal artery

http://ect.downstate.edu/courseware/haonline/imgs/00000/3000/100/3173.jpg
http://ect.downstate.edu/courseware/haonline/imgs/00000/3000/100/3174.jpg
http://ect.downstate.edu/courseware/haonline/imgs/00000/3000/100/3177.jpg
Right coronary artery                            Right Marginal
artery                                           Posterior Interventricular vein

http://ect.downstate.edu/courseware/haonline/imgs/00000/3000/100/3179.jpg
http://ect.downstate.edu/courseware/haonline/imgs/00000/3000/000/3090.jpg Click for Full Screen
http://ect.downstate.edu/courseware/haonline/imgs/00000/3000/100/3178.jpg Click for Full Screen
Small cardiac vein
(with Right marginal artery)
Anterior cardiac vein
Empty to right atrium
Coronary sinus
Great cardiac vein
(with ant. Interventricular artery)
Middle cardiac vein
( with post.Interventricular artery)

Heart
http://web.gccaz.edu/~rbowker/cadaver/%206696GPlastHeart.jpg
http://web.gccaz.edu/~rbowker/cadaver/%206698GPlastHeartPost.jpg
http://web.gccaz.edu/~rbowker/cadaver/%206700GPlastHeartPost.jpg

Oesophagus
The oesophagus is 23 till 28 cm long tube , which connects the pharynx (C6 level) to stomach. It
enters the thorax through superior thoracic aperture and it passes into the abdominal cavity
through the hiatus for oesophagus of diaphragm and on the left side of T11-T12 it joins the
stomach. The place that Oesophagus joins the stomach is called Cardia. The beginning of oesophagus
is 15 cm away from the anterior teeth and the cardia is 40 cm away ( important for oesophagoscopy
and gastroscopy). The diameter of oesophagus is 1,5 cm but during swallowing its diameter can be
double.
In the course of oesophagus we observe three short physiological constrictions
I.The Upper constriction (15 cm away from incisors) is located in the pharyngo-oesophageal
junction. The constriction is due to arrangement of the circular muscles of the lower pharyngeal
constrictor and also the submucosal venous plexus participates in it.
II.The middle constriction (24 cm away from incisors )is in the plane of tracheal bifurcation. At
this plane the oesophagus is located between the aorta, the trachea and the left bronchus.
III.The lower contriction (40cm way form incisors) is positioned in the place where oesophagus
passes through the diaphragm
1.
http://d3j7fudf8o8iuo.cloudfront.net/var/ezwebin_site/storage/images/media/images/e-anatomy/mediast
inum-anatomy-illustrations/oesophagus-cardia-anatomy-diagram-imaios/5904334-1-eng-GB/oesophagus-car
dia-anatomy-diagram-imaios_medical512.jpg

1.The Cervical Portion (pars cervicalis) is approximately 6 cm long and comes up to the lower
margin sternum. It lies in front of the vertebral column and it is movable against it . In front of
oesophagus the trachea passes . Inside the groove between the oesophagus and the trachea the
recurrent laryngeal nerve imbedded.
2.The Thoracic Portion (pars thoracicis) is 16 till 20 cm long . At the beginning (retro-tracheal
part) it lies in front of vertebral column and caudally it draws apart from the spine . In front of
the oesophagus at the beginning the trachea is situated and at the level T4-T5 the trachea
bifurcates.  Below this level (retro-pericardiac part) the oesophagus passes behind the heart
stored in pericardial sac. At the level of T3 the beginning of thoracic aorta attaches to
oesophagus. Caudally the thoracic aorta passes in the midsagittal plane and behind oesophagus. On
the oesophagus is lying the anterior and posterior vagal trunk which is formed by the Left and
Right Vagus Nerves respectively.
3.The Abdominal Portion (pars abdominalis)  is 1 till 2 cm long and passes below the diaphragm
towards  the cardia. In front of it the left hepatic lobe is located . This part of oesophagus is
covered by the peritoneum.
http://etc.usf.edu/clipart/56700/56715/56715_esophagus_lg.gif

http://www.dewereldmorgen.be/sites/default/files/imagecache/slideshow_1680x1050/2011/11/19/georgiad
is.jpg http://www.koolnews.gr/wp-content/uploads/2013/08/Adonis-Georgiadis-382x600.jpg