Thoracic Wall, Pleural Cavity

• Diaphragm Origin

  Costal part - Inferior border of the ribs (7-12)

  Lumbar part - Vertebral bodies L1-L3, ALL, arcuate

  ligament

  Sternal part - Posterior surface of xiphoid process
• Diaphragm Insertion


  Central Tendon
• Diaphragm Innervation


  Phrenic Nerve (C3-C5) "keeps diaphragm alive"
• Levatores Costarum Origin


  C7-T11 transverse processes
• True Ribs


  1-7, own costal cartilages
• False Ribs

  8-10, indirect sternum attachment
• Floating Ribs

  11-12, no attachment
• Parts of the rib

  head, neck, angle, tubercle

  • Costal Groove - protects intercostal nerve, artery, vein
• Right Lung vs Left Lung

  Both:

  • 3 cm above clavicle in midclavicular line
  • Follow inferior along parasternal line
  • Follow lateral to midclavicular line
  • Continue laterally to 8th rib and posteriorly to 10th rib
  • Follow lateral to midclavicular line

  Left Lung:

  • Follows curvature of the heart to the 6th rib (the heart occupies more space on the left side)
• Costochondral Joint


  Sternal end of rib with lateral end of costal cartilage

  Primary cartilaginous (synchondrosis)joint

  Strengthened by periosteum surrounding bone and cartilage
• Sternocostal Joint

  Costal cartilages with sternum

  Primary cartilaginous joint (1st rib)

  Synovial plane joint (ribs 2

  -7)

  Strengthened by radiate sternocostal ligaments
• Costovertebral Joint Complex


  Costovertebral joint - Head of rib with costal facets of vertebrae

  Costotransverse joint - Tubercle of rib with transverse process of vertebrae

  Plane / gliding joints

  Strengthened by radiate ligament
• "Bucket Handle Movement"

  Middle 1/3 of ribs 7-10 are lower than the sternal or vertebral ends. This allows for movement of the rib shaft laterally.
• "Pump Handle Movement"

  Elevation of ribs 1-6 moves the sternum superiorly and anteriorly.
• Diaphragm Openings

  Caval opening - IVC, Phrenic nerve branch

  Esophageal hiatus - Esophagus, Vagal trunks

  Aortic hiatus - Descending aorta, Thoracic duct
• Interchondral Portion of the internal intercostal muscle contributes to?

  elevation of ribs
• Serratus Posterior-superior


  O: Nuchal ligament, spinous processes of C7-T2

  I: Superior border of ribs 2-5
• Serratus Posterior-inferior


  O: Spinous processes of T11-L2

  I: Inferior border of ribs 9-12
• Muscles of Inspiration

  Quiet breathing - inspiration results from contraction of the

  diaphragm; intercostal muscles increase diameter of thoracic cage
• Muscles of expiration

  Quiet breathing -

  expiration results from passive recoil of lungs and thoracic cage;

  intercostal muscles decrease diameter of thoracic cage
• Thoracic Wall Innervation

  Spinal nerves T1-T12 supply the

  thoracic wall. Ventral (anterior) rami form the

  intercostal nerves.
• Back muscles innervation

  Dorsal (posterior) rami supply joints,

  back muscles and skin in the

  thoracic region
• Rami communicantes

  connect each intercostal nerve to the sympathetic trunk.

  Sympathetic nerve fibers can use spinal

  nerves to reach vessels and glands in thoracic

  wall.
• Shingles

  Herpes zoster infection

  Occurs when the VZV, varicella zoster virus is activated

  dorsal root ganglion
• Anastomoses of the Thoracic Wall

  Posterior and anterior intercostal arteries communicate via

  anastomoses
• What is a branch of the thoracic aorta?

  Intercostal artery of rib 12 or subcostal artery
• An arterial branch from the aorta?

  Posterior intercostal artery
• A branch of the internal thoracic artery (1-6), and musculophrenic (7-9)?

  Anterior intercostal artery
• Intercostal veins run with?

  the arteries in the costal

  space
• Anterior intercostal veins drain into?

  internal thoracic veins
• Posterior intercostals drain into?

  to azygos / hemiazygos vein
• Pleural Space

  Between visceral and parietal layers

  • Filled with serous fluid
• Parietal Pleura is attached to?

  thoracic cage
• visceral pleura is attached to?

  lungs
• Costodiaphragmatic recess


  between ribs 6-12
• Pulmonary artery carries blood to?

  lungs, branches into lobar arteries
• Pulmonary Veins

  R and L superior and inferior pulmonary veins return blood to

  heart
• Bronchial arteries

  Supply root of the lungs, tissue of lungs and visceral pleura

  Branches of the aorta
• Posterior Pulmonary PLexus

  -located posterior to carina

  -main innervation to lung
• What is the insertion of transversus thoracis?

  Inner surface of the costal cartilages of ribs 2-6