THE THORACIC WALL (D)

2014
THORACIC WALL
AN OVERVIEW
Assoc Prof dr Hamiadji
Tanuseputro
LECTURES ON THE THORAX
 WALLS OF THE THORAX
IDENTIFY THE NUMBERS
1. clavicle
2. superficial fascia
3. glandular tissue
4. lactiferous duct
5. lactiferous sinus
6. areola
7. nipple
8. rib
9. intercostals
muscles
10. pleura
11. pleural cavity

The mammary gland is made up of superficial

fascia, gland lobules, lactiferous ducts and
lactiferous sinuses. There are 15 to 20 lobules,
each with its own duct which empties through the
nipple.
MORE ELABORATION

The bones of the thorax. Note

that the upper two and a half and
the lower two and a half thoracic
vertebrae are visible.
MORE ELABORATION
 WALLS OF THE THORAX
STUDYTHERIBSANDITSMOVEMENTS
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The superior surface of the first rib,

The right seventh rib from inferior
and posterior.
showing grooves for vessels as well
as muscular and ligamentous
attachments. The scalenus minimus
(not shown) is also inserted into the
first rib.
 WALLS OF THE THORAX
STUDYTHERIBSANDITSMOVEMENTS
 WALLS OF THE THORAX
STUDYTHERIBSANDITSMOVEMENTS
The ribsand
diaphragmmovein
suchawaythatthree
dimensionsofthe
thoraciccavityare
increased
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Diagram of certain movements of the ribs. In A,

when the upper ribs are elevated, the
anteroposterior diameter of the thorax is
increased ("pump-handle" movement). In B, the
lower ribs move laterally when they are
elevated, and the transverse diameter of the
thorax is increased ("bucket-handle"
movement).
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The sternum and its muscular attachments.

 WALLS OF THE THORAX
(INTRINSIC MUSCLES)
The intercostalmuscles are arranged as three layers (external layer, internal layer and an incomplete
innermost layer) between the ribs.
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The nerves, arteries, and muscles of the thoracic wall. Note

that the intercostal vessels pass behind the longitudinally
disposed structures of the posterior mediastinum. The
thickness of the intercostal muscles is exaggerated
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Intercostal vessels and nerve. A part of the

sympathetic trunk is shown, including some rami
communicantes.
WALLS OF THE THORAX
(INTRINSIC MUSCLES)
The diaphragm closes
the thoracic outlet and
separates the thoracic
cavity from the
abdominal cavity.

The diaphragm is the most

important muscle of the
thoracic wall. During normal
respiration, this muscle is the
primary component.
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The intercostal muscles. A shows the direction of fibers of

the external and internal intercostal muscles. B shows a
vertical section through an intercostal space. The white
arrow represents the path of a needle in pleural aspiration,
avoiding the intercostal vessels and nerve.
WALLS OF THE THORAX
(EXTRINSIC MUSCLES)

Name all the

Extrinsic
muscles of the
thorax.
Why are these
muscles called
EXTRINSIC?
 WALLS OF THE THORAX
(EXTRINSIC MUSCLES)

Identify the numbered muscles!

Use an atlas!!
WALLS OF THE THORAX
(EXTRINSIC MUSCLES)

The muscles of the back

can be broken down
into three groups:
superficial - muscles
that act on the upper
limb
intermediate - muscles
of thorax
deep - muscles of
vertebral column
MEDIASTINUM & HEART

The heart and its

pericardium make up the
contents of the middle
mediastinum. The left and
right phrenic nerves and
their adjacent arteries
(pericardiacophrenic) lie to
the left and right of the
pericardium and anterior
to the roots of the lungs.
 MEDIASTINUM & HEART
WHAT ARE THE IMPORTANCE
OF THE STERNAL ANGLE
 MEDIASTINUM & HEART
DRAW THE PARTS
OF THE HEART
 MEDIASTINUM & HEART
DRAW THE PARTS
OF THE HEART
 MEDIASTINUM & HEART
STUDY THE PERICARDIAL
SINUSES
 MEDIASTINUM & HEART
Musculi pectinati (rough part) Infundibulum

Sinus venarum (smooth part)

Trabeculae carniae
 MEDIASTINUM & HEART
STUDY THE PERICARDIAL
SINUSES
Within the pericardial
cavity, at the points
where the visceral
and parietal
pericardia are
continuous with one
another, small
chambers or sinuses
are located.

The pericardial
sinuses:
transverse pericardial
sinus
oblique pericardial
sinus
 MEDIASTINUM & HEART
GIVE THE INNERVATION
OF THE HEART

The heart also has an internal

nervous system made up of
the SA (sinuatrial node) and
the AV (atrioventricular)
node. The AV bundle (His)
leaves the AV node near the
lower part of the interatrial
septum and splits over the
upper part of the
The strength and frequency of the heart beat is controlled by interventricular septum into a
the autonomic nervous system. Both parasympathetic and left bundle branch (LBB) and a
sympathetic parts of the autonomic nervous system are right bundle branch (RBB).
involved in the control of the heart.
 MEDIASTINUM & HEART
GIVE THE INNERVATION
OF THE HEART

The strength and frequency of the heart beat is controlled by the

autonomic nervous system. Both parasympathetic and
sympathetic parts of the autonomic nervous system are involved
in the control of the heart.
MEDIASTINUM & HEART
GIVE THE PROJECTIONS
OF THE VALVES

Heart Valve
Positions
This diagram is a
special
dissection that
shows the four
heart valves and
their
relationship to
one another.
THANK YOU
FOR YOUR PATIENCE