1. Regional anatomy of thorax
山东大学医学院 解剖教研室
李振华

2. Parts and regions of the thorax
Boundaries
Superiorly－jugular notch, sternoclavicular joint, superior border of clavicle, acromion, spinous processes of C7
Inferiorly－xiphoid process, costal arch, 12th and 11th ribs, vertebra T12
Regions
Thoracic wall
Thoracic cavity

3. Landmarks of thorax Jugular notch corresponds with
The 2th thoracic vertebra in male, the 3th thoracic vertebra in female
Sternal angle corresponds with
Connects 2nd costal cartilage laterally
The lower border of 4th thoracic vertebra
The bifurcation of trachea in the adult
The beginning of aortic arch which ends posteriorly at the same level
The esophagus is crossed by the left main bronchus

4. Landmarks of thorax
Xiphoid process－xiphisternal synchondrosis lies opposite the body of the 9th thoracic vertebra
Clavicle
Inferior fossa of clavicle
Coracoid process
Ribs and intercostal spaces
Costal arch
Infrasternal angle
Xiphocostal angle
Papillae

5. Thoracic wall Superficial structures Skin Superficial fascia
Superficial aa.
Superficial vv.
Thoracoepigastric v.
Lateral thoracic v.
Superficial nn.
Supraclavicular n.
Anterior and lateral cutaneous branches of intercostal n.

6. Lymphatic drainage of breast
Into pectoral ln. from lateral and central parts of breast
Into apical and supraclavicular ln. from superior part of breast
Into parasternal ln. from medial part of breast
Into interpectoral ln. from deep part of breast
The lymphatic capillaries of breast form an anastomosing network which is continuous across the midline with that of the opposite side and with that of the abdominal wall

7. Thoracic wall Deep structures Deep fascia Muscles of thorax
Superficial layer
Deep layer—clavipectoral fascia
Muscles of thorax
Subclavius
Pectoralis major
Pectoralis minor
Serratus anterior
Intercostales externi
Intercostales interni
Intercostales intimi
Endothoracic fascia 胸内筋膜

8. Intercostal space Posterior intercostal v. Posterior intercostal a.
Intercostal n.
Technique for
thoroacocentesis
(in midaxillary line)
Intercostal nerve block

9. Internal thoracic vessels
Internal thoracic a.&v 胸廓内动脉和静脉
Descends into thorax 1.2cm lateral to edge of sternum
Ends at the sixth costal cartilage by dividing musculophrenic and superior epigastric arteries
Parasternal ln. 胸骨旁淋巴结

10. The Mediastinum 纵隔

11. The Mediastinum 纵隔 Concept
All of organs between the left and right mediastinal pleurae is called mediastinum.
It extends from the sternum in front to the vertebral column behind, and from the thoracic inlet above to the diaphragm below.

12. Subdivisions of mediastinum
Superior mediastinum 上纵隔
Inferior mediastinum下纵隔
Anterior mediastinum 前纵隔
Middle mediastinum 中纵隔
Posterior mediastinum 后纵隔

13. Left side of mediastnum 纵隔左侧面
Left subclavian a.
Thoracic duct
Left vagus n.
Aortic arch
Left recurrent n.
Thoracic aorta
Phrenic n. &
pericardiacophrenic a.
Sympathetic trunk
Root of lung
Pericardium
Greater splanchnic n
Esophagus

14. Right side of mediastnum 纵隔右侧面
Trachea
Right vagus n.
Superior vena cava
Arch of azygos v.
Phrenic n. &
pericardiacophrenic a.
Azygos v.
Root of lung
Sympathetic trunk
Esophagus
Pericardium
Inferior vena cava

15. Superior mediastinum 上纵隔

16. Superior mediastinum 上纵隔
Locating－from inlet of thorax to plane extending from level of sternal angle anteriorly to lower border of T4 vertebra posterioly
Contents
Superficial layer
Thymus
Three veins
Left brachiocephelic v.
Right brachiocephelic v.
Superior vena cava

17. Superior mediastinum 上纵隔
Contents
Middle layer
Aotic arch and its three branches
Phrenic n.
Vagus n.

18. Superior mediastinum 上纵隔
Contents
Posterior layer
Trachea
Esophagus
Thoracic duct

19. Relations of aortic arch
Anteriorly and to the left
Pleura
Lung
Phrenic n.
Pericardiacophrenic vessels
Vagus n.
Posteriorly and to the right
Trachea
Esophagus
Left recurrent n.
Thoracic duct
Deep cardiac plexus

20. Relations of aortic arch
Superiorly
Its three branches
Left brachiocephalic v.
thymus
Inferiorly
Pulmonary a.
Arterial ligament
Left recurrent n.
Left principal bronchus
Superficial cardiac plexus

21. Triangle of ductus arteriosus 动脉导管三角
Boundaries
Phrenic n.
Left vagus n.
Left pulmonary a.
Contents
Arterial ligament
Left recurrent n.
Superficial cardiac plexuses

22. Triangle of ductus arteriosus 动脉导管三角

23. Inferior mediastinum 下纵隔

24. Inferior mediastinum 下纵隔
Anterior mediastinum 前纵隔
Location－posterior to body of sternum and attached costal cartilages, anterior to heart and pericardium
Contents
Fat
Remnants of thymus gland
Anterior mediastinal lymph nodes

25. Inferior mediastinum 下纵隔
Middle mediastinum 中纵隔
Location－between anterior mediastinum and posterior mediastinum
Contents
Heart and pericardium
Beginning or termination of great vessels
Phrenic nerves
Pericardiacophrenic vessels
Lymph nodes

26. Inferior mediastinum 下纵隔
Posterior mediastinum 后纵隔
Location－posterior to heart and pericardium, anterior to vertebrae T5－T12

27. Inferior mediastinum 下纵隔
Posterior mediastinum 后纵隔
Contents:
Esophagus
Vagus n.
Thoracic aorta
Azygos system of veins
Thoracic duct
Thoracic sympathetic trunk
Posterior mediastinal lymph nodes

28. Relations of esophagus
Anteriorly
Trachea
Bifurcation of trachea
Left principal branchus
Left recurrent n.
Right pulmonary a.
Anterior esophageal plexus
Pericardium
Left atrium
Diaphragm

29. Relations of esophagus
Posteriorly
Posterior esophageal plexus
Thoracic aorta
Thoracic duct
Azygos v.
Hemiazygos v.
Accessory hemiazygos v.
Right posterior intercostal v.

30. Relations of esophagus
Left
Left common carotid a.
Left subclavian a.
Aortic arch
Thoracic aorta
Superior part of thoracic duct
Right
Arch of azygos v.

31. Relations of thoracic aorta
Anteriorly
Left root of lung
Pericardium
Esophagus
Posterior
Hemiazygos v.
Accessory hemiazygos v.
Right
Azygos v.
Thoracic duct
Left－mediastinal pleura

32. Mediastinal spaces 纵隔间隙
Retrosternal space 胸骨后间隙 lies beween sternum and endothoracic fascia
Pretracheal space 气管前间隙 lies within superior mediastinum, between trachea, bifurcation of trachea and aortic arch
Retroesophagus space食管后间隙 lies within superior mediastinum, beween esophagus and endothoracic fascia

33. ★You must identify follow structures！
Thoracic wall
Intercostales externi
Intercostales interni
Posterior intercostal a.
Intercostal n.
Internal thoracic a.
Diaphragm
Central tendon
Aortic hiatus
Esophageal hiatus
Vena cava foramen
Costodiaphragmatic recesse
Superior mediastinum
Left brachiocephelic v.
Right brachiocephelic v.
Superior vena cava
Aortic arch
Brachiocephalic trunk
Left common carotid artery
Left subclavian a.
Phrenic n.
Vagus n.
Left recurrent n.
Arterial ligament
Trachea

34. ★You must identify follow structures！
Lung
Apex of lung
Base of lung
Hilum of lung
Root of lung
Cardiac notch
Lingual in left lung
Horizontal and oblique fissures
Superior, middle and inferior lobs of right lung
Superior and inferior lobs of left lung
Middle mediastinum
Pericardium
Phrenic nerves
Posterior mediastinum
Esophagus
Vagus n.
Thoracic aorta
Azygos veins
Thoracic duct
Thoracic sympathetic trunk
Greater splanchnic n