1. Chest Surface and Pleura Cavity
Clinical Anatomy
Tony Serino, Ph.D.

2. Chest & Pleura: Topic Objectives
Be able to describe and identify the major muscles, bones and surface anatomy of the chest.
Be able to describe the anatomy of the female breast including its blood and lymphatic supply.
Be able to evaluate the significance of breast lymphatic drainage to metastasis in breast cancer.
Be able to describe and evaluate the role of chest muscles and elasticity in breathing.
Be able to apply lung pressures to the breathing cycle and assess their importance in tension pneumothorax.
Be able to describe and identify all major structures on the lower respiratory tract.
Be able to describe the conditioning of respiratory air.
Be able to describe all lung cell known functions.
Be able to describe the neurological and sensory control of breathing
Be able to apply respiratory regulation to COPD

3. Thoracic Vertebrae

4. Vertebrae and Ribs

5. Rib Types and Sternum

6. Rib Anomalies Cervical ribs Bicipital rib (rib fusion)
Bifid rib (two heads)

7. Ribs 1st rib 2nd rib 11th rib 12th rib Crest of head Head Neck
Tubercle
11th rib
12th rib

8. Clavicle

9. Scapula

10. Scapular Fossa

11. Superficial Muscles
Deltopectoral triangle (contains Cephalic vein)

12. Thoracic Apertures
Superior
Inferior

13. Breast
Male nipple at T4 Dermatome

14. Female Breast Retromammary space Suspensory ligaments Tail of breast
Glandular tissue and stroma

15. Female Breast
Retromammary space

16. Blood supply to the Breast
Lateral thoracic (from axillary a.)
Internal thoracic a. (from subclavian)
Anterior intercostals
Post. Intercostals (from thoracic aorta)
(Venous drainage mostly to axillary v. and internal thoracic v.)

17. Lymphatic Drainage of Breast
Axillary nodes
Parasternal nodes
Pectoral nodes
Subareolar plexus
Inferior phrenic nodes

18. Untreated Breast Cancer

19. Muscles of Thorax

20. Primary muscles of respiration

21. Only used during rapid breathing.

22. Chest Plate

23. Pressures affecting Breathing

25. Inspiration

26. Expiration

27. Pressure changes around lung

28. Lung Volumes

29. Normal Lung Volumes

30. Nerves of thoracic wall

31. Intercostal arteries and nerves
These run along the intercostal groove on inferior rib.

32. Pleura
Cardiac notch
Costodiaphragmatic recess
Costomediastinal recess

33. Surface to Deep Structure Alignment
Bare Pericardium

34. Respiration External Respiration Internal Respiration
The exchange of gas between the blood and external environment (usually includes ventilation)
Internal Respiration
The exchange of gas between the blood and the tissues
Cellular Respiration
Burning of fuel to produce energy within cells
Ventilation (Breathing)
Movement of air in and out of the lungs

35. Respiratory Organs Divided into:
Upper Respiratory Tract
Includes: nostrils (nares), nasal cavity, and nasopharynx
Lower Respiratory Tract
Includes: larynx, trachea, bronchi, and lungs
Conducting Air passages include: nares to terminal bronchioles
Move air to respiratory membrane
Condition the air
Moisten, Warm, Clean

36. Trachea

37. Trachea (x.s.)

38. Mucous Membrane (pseudostratified columnar epithelium)

39. Bronchi Primary bronchi lead to to each lung (left and right)
Secondary (lobar) bronchi lead to each lung lobe (3 on right and 2 on left)

40. Cadaver Lungs

41. Lobes of Right Lung

42. Lobes of Left Lung

43. Bronchi Branches Tertiary Bronchi Primary Bronchi Secondary Bronchi
Tertiary (segmental) bronchi lead to each lung broncho-pulmonary segment
Bronchi continue to divide at least 20 more times.

44. Broncho-pulmonary Segments

45. Lung Blood Supply PA PV
Note: blood supply to respiratory surface; airway blood supplied by bronchial a. (branch of aorta)

46. Blood pathways
Bronchi PA PV

47. Bronchioles Air passages less than 1 mm in diameter are bronchioles.
The terminal bronchioles are the last of the purely conducting air passages.

48. Alveoli highly specialized for Gas Exchange
Lots of Surface Area
Highly vascular
Thin walls

49. Lung Tissue

50. Alveolus

51. P = pressure to collapse
T = surface tension
r = radius
Role of surfactant is to decrease surface tension in alveoli.

52. Partial Pressure Favors Resp. Gas Movement

53. Time to Complete O2 Saturation in Pulmonary Capillaries

54. Oxygen Content of Blood
PO2 = 100 mmHg
Whole Blood
Plasma
Oxygen
Oxyhemoglobin
Total Volume of Oxygen = 0.3ml Plasma + 20 ml whole blood

55. Hemoglobin

56. Oxyhemoglobin Dissociation Curve

57. Hemoglobin Affinity for Oxygen: Effect of Temperature
Affinity decreases with increasing Temperature

58. Hemoglobin Affinity for Oxygen: Effect of pH
Affinity decreases with increasing acidity (i pH)

59. Gas Exchange in Lungs

60. Gas Exchange in Tissues
10%
70%
20%

61. Neural Control of Breathing
Voluntary control located in cerebral cortex and acts through the corticospinal tract. Involuntary located in pons and medulla acting through the spinal cord in the roots of the phrenic nerve (C3-C5) and thoracic cord roots of the external (inspriation(I)) and internal (expiration(E)) intercostal nerves
PRG –pontine resp. group (formerly the apneustic and pneumotaxic centers) –play role in smoothing between insp. and exp., especially during sleep, vocalization and exercise. VRG and DRG – ventral and dorsal resp. group of the medulla. DRG primarily responsible for inspiration; VRG mixture of I and E neurons contains Pre-Botzinger complex which may be pacemaker cells for respiration

62. Neural control of Breathing
PRG
Red is inhibitory
Black is excitatory
DRG
VRG
Hering-Breuer Reflex
I neurons
E neurons
Ext. Intercostals & diaphragm
Int. Intercostals
Lung Stretch
Chemoreceptors

63. CO2 Drive

64. Factors Effecting Respiratory Centers

65. COPD