Lecturer: Ms DS Pillay ROOM 2P24 25 February 2013

Transcription

1 Lecturer: Ms DS Pillay ROOM 2P24 25 February 2013

2 Thoracic Wall Consists of thoracic cage Muscle Fascia

3 Thoracic Cavity

4 3 Compartments of the Thorax (Great Vessels) (Heart)

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6 Superior thoracic aperture

7 Intercostal space

8 Intercostal vasculature Internal thoracic A Anterior thoracic A Musculophrenic A Posterior intercostal A Superior intercostal A Thoracic aorta Subcostal a.

9 Veins Internal thoracic vein: internal surface of ribs, lateral to sternum, drains into brachiocephalic v. Anterior thoracic vein: anteriorly between ribs to drain into internal thoracic v. Posterior intercostal veins: travel posteriorly between ribs, 1 st 3 join to form superior intercostal v. Drain into brachiocephalic system, remaining drain azygous system

10 Intercostal Nerves They are anterior primary rami of spinal thoracic nerves fromt1 to T11 T3 tot6 are Typical T12 is called Subcostal The remaining nerves are called atypical Each nerve runs in Intercostal space inferior to Intercostal vessels

11 Chest Tube Placement Thieme Cl A

12 Pleural Membranes VISCERAL PLEURA PARIETAL PLEURA PLEURAL CAVITY (SEROUS FLUID)

13 Parietal Pleura: four parts Cervical (cupular) costal mediastinal diaphragmatic Why do you tend to feel pain in the parietal pleura and not the visceral pleura?

14 Cervical pleura Extends up into neck Lines undersurface of suprapleural membrane Reaches level of 2.5-4cm above medial 1/3 of clavicle Costal pleura Lines inner surface of Ribs Costal cartilage Back of sternum Intercostal spaces sides of vertebral bodies

15 Diaphragmatic pleura Covers thoracic surface of diaphragm Costodiaphragmatic Recess Slit-like space between costal & diaphragmatic parietal pleaura During inspiration, lower margins of lungs descend into recesses During expiration, lower margin of lungs ascend so that costal & diaphragmatic pleurae come together

16 Mediastinal pleura Covers & forms lateral boundary of mediastinum Continuous with visceral pleura Lungs lie free except at hilum

17 Costomediastinal Recesses Along anterior margins of pleura Slit-like spaces between costal & mediastinal pleurae During inspiration & expiration, anterior borders of lungs slide in & out of recess

18 Blood, Nerve & Lymphatic drainage of pleura Blood Supply Nerve Supply Lymphatic Drainage Parietal Pleura 1. post intercostals 2. int thoracic 3. sup intercostals 4. sup phrenic art 2 nd to 12 th i/c n sensory fibres only (pain sensitive) phrenic n drain into adj LN on thoracic wall (axillary nodes) Visceral Pleura 1. bronchial art symph fibres from T2 to T5 (pain insensitive) drain into LN at hilum of lungs

19 Features of Right & Left Lung

20 Lobes & fissures : surface anatomy Oblique fissure: extends from level of spinous process of T2 vertebra posteriorly to 6 th costal cartilage anteriorly. - Horizontal fissure: begins from anterior border at level of 4 th costal cartilage, runs horizontally to meet oblique fissure at the midaxillary line RT lung LT lung Fissures 2 ( oblique & horizontal) 1 (oblique ) - Lobes 3 ( superior, middle & inferior) 2 (superior & inferior ) - Cardiac notch absent present - Lingula absent present - Width wider narrower - Length shorter longer - Base more concave less concave - Hilum contains 2 bronchi contains one bronchus

21 Oblique Fissure Inferior Lobe Left Lung Lateral View

22 Superior Lobe Oblique Fissure Left Lung Medial View Lingula Inferior Lobe

23 Pulmonary Artery Bronchi Pulmonary Veins The Hilum

24 Right Lung Lateral View Superior Lobe Horizontal Fissure Middle Lobe Oblique Fissure Inferior Lobe

25 Right Lung Medial View Superior Lobe Middle Lobe Inferior Lobe

26 The Hilum Bronchi Pulmonary Artery Pulmonary Vein Pulmonary Ligament

27 Making an Impression Left Lung Right Lung Heart Heart Aortic arch Azygous Vein Thoracic Aorta Inferior Vena Cava Esophagus Esophagus Left Subclavian artery and vein Superior Vena Cava Right Subclavian artery and vein

28 Medial Views of the Lungs right pulmonary arteries groove for azygos vein left pulmonary arteries left pulmonary veins right pulmonary veins bronchii diaphragmatic recess groove for esophagus groove for aorta cardiac impression

29 Surface Anatomy Lower border of the lung: Midclavicular line rib 6 Pleura rib 8 Midaxillary line rib 8 Pleura rib 10 Adjacent to vertebral column rib 10 Pleura rib 12 The anterior borders of lungs lie adjacent to the anterior line of parietal pleura reflection as far as the 4 th costal cartilage The left line of pleural reflection moves laterally & inferiorly at cardiac notch to reach level of 6 th costal cartilage Posterior border of the lung: C7 T10 The difference between the lower border of the lung and the lower border of the pleura indicates the costodiaphragmatic recess distance

30 Trachea R & L principal bronchus Lobular bronchi (secondary) (2L and 3R) Segmental bronchi (tertiary) (8L, 10R) Terminal bronchioles Respiratory bronchioles Alveolar ducts Alveolar sacs Alveoli

31 Bronchopulmonary segment Right main bronchus R upper lobe bronchus R middle lobe bronchus R lower lobe bronchus Segmental bronchi Segmental bronchi Segmental bronchi Apical Anterior Posterior Medial Lateral Apical Anterior Posterior Medial Lateral

32 Bronchopulmonary segment Left main bronchus L upper lobe bronchus L lower lobe bronchus Upper branch Lower branch Segmental Anterior Apicoposterior Superior lingular Inferior lingular Apical Anterior Posterior Lateral

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34 Arterial supply of lungs Pulmonary arteries -Give rise to lobar arteries Bronchial arteries supply blood for nutrition of structures that comprise the root of the lung

35 Venous drainage of lungs Pulmonary veins -Lobar veins drain into pulmonary veins Bronchial veins drain blood in lungs supplied by bronchial arteries -Left bronchial vein - accessory hemiazygos vein (usually) -Right bronchial vein - azygos vein

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37 Innervation of lungs Lungs and visceral pleura -Parasympathetic from Vagus nerve -Sympathetic from sympathetic fibers of sympathetic trunk Parietal pleura from intercostal and phrenic nerves

38 THANKS