Ingrid Hodorová, Assoc. Prof., MD, PhD.,

Zuzana Kováčová MD

THORAX – SKELETON, JOINTS, MUSCLES, ARTERIAL BLOOD SUPPLY, VENOUS AND LYMPHATIC DRAINAGE, INNERVATION, REGIONAL

ANATOMY

THORAX:

- upper part of the trunk - box for vital organs

Boundaries:

external upper: 1/ jugular notch 2/ clavicule

3/ acromion of scapula

4/ spine of C7 (vertebra prominens)

external lower: 1/ xiphoid process

2/ left and right costal arches

3/ vertebra Th12

internal upper: 1/ superior thoracic aperture (made from jugular notch, 1st pair of ribs, vertebra Th1)

internal lower: 1/ inferior thoracic aperture (full filed by diaphragm, which extends

on the right side to the 4th intercostal space (ICS), on the left side

extends to the 5th ICS)

ARTEFICIAL LINES ON THE THORAX:

unpaired: 1/ anterior median line

2/ posterior median line

paired: 1/ sternal line 2/ parasternal line 3/ mid-clavicular line

4/ anterior axillary line

5/ midddle axillary line

6/ posterior axillary line

7/ scapular line

8/ paravertebral line

THORACIC WALL:

1st layer (proper thoracic wall):

1/ osteothorax (ribs, sternum, Th vertebrae + their joints)

2/ proper mm. of thoracic wall (intercostal muscles, transversus thoracis m.,

subcostalis m.)

3/ intrinsic mm. of the back (erector spinae m.)

4/ intercostal neuro-vascular bundle (vein, artery, nerve)

5/ endothoracic fascia

6/ parietal pleura

2nd layer (middle):

1/pectoral fascia

2/ thoracohumeral mm.

3/spinohumeral mm.

4/spinocostal mm.

3rd layer (superficial):

1/ skin

2/ subcutaneous tissue + mammary gland

3/ superficial structures (supraclavicular nn., intercostobrachial nn.,

thoracoepigastric vv.)

OSTEOTHORAX:

Thoracic vertebrae (12): 1/ body - costal facets, 2/ arch - vertebral notches – intervertebral

foramen, vertebral foramen 3/ processes – transverse, sup. and inf. articular,

spinous

Ribs (12 pairs): 1/ head - articular facet of the head

2/ neck

3/ body – tubercle, articular facet, costal crest, costal sulcus

1st rib - groove for subclavian artery, tubercle for scalenus anterior m.,

groove for subclavian vein True ribs: 1st to 7th False ribs: 8th to 10th Floating ribs: 11th to 12th

Sternum: 1/ manubrium ̶ jugular notch, clavicular notch,

costal notch (1st and 2nd ribs) 2/ body (costal notches 2nd to 7th ribs) 3/ xiphoid process sternal angle - attachment the 2nd pair of ribs

JOINTS OF THE RIBS:

Costovertebral joints: 1/ joints of the heads of the ribs (head of the ribs to the body of

the thoracic vertebrae)

2/ costotransverse joints (costal tubercle and transverse process)

Sternocostal joints: 1st to7th ribs to sternum

Interchondral joints: costal arch (cartilages of the 7th to 10th rib)

CONNECTIONS OF THE VERTEBRAL COLUMN:

Syndesmosis:

short ligaments: interspinous, intertransverse, flava

long ligaments: anterior and posterior longitudinal ligaments

Synchondrosis:

Intervertebral discs,

- between vertebral bodies

- nucleus pulposus, anulus fibrosus

- total number 23, 1st between C1-C2, last one between L5-S1

Synostosis:

sacrum

Joints of vertebral column: between superior et inferior articular processes

Curvatures of vertebral column:

in sagittal plane

- lordosis - cervical and lumbar

- kyfosis - thoracic and sacral

in frontal plane

- scoliosis

MUSCLES OF THE THORAX:

Thoracohumeral muscles: 1/ pectoralis major

2/ pectoralis minor

3/ serratus anterior

4/ subclavius

Mm. of proper thoracic wall: 1/ intercostal (external, internal, intimi)

2/ transverse thoracis m.

3/ subcostal mm.

Diaphragm:

muscular portion - sternal part, costal part, lumbar part

oesophageal hiatus (Th10) – esophagus,

vagus nn.,

oesophageal vv.,

phrenocoabdominal br. of left phrenic n.

aortic hiatus (Th12) – aorta

thoracic duct,

central tendon

opening for inferior vena cava (Th8) – inferior vena cava,

phrenocoabdominal br. of right phrenic n.

through crus of lumbar parts pass: azygos v., hemiazygos v., sympathetic trunk,

splanchnic nn. (greater, lesser and least)

innervation - phrenic nerve

MUSCLES OF THE BACK:

Spinohumeral mm.:

1st layer: 1/ trapezius 2/ latissimus dorsi

2nd layer 1/ levator scapulae 2/ rhomboid major 3/ rhomboid minor

Spinocostal mm: 1/ posterior superior serratus

2/ posterior inferior serratus

Intrinsic mm. of the back: 1/ m. erector spinae

ARTERIAL BLOOD SUPPLY OF THE THORAX:

Thoracic aorta:

posterior intercostal aa. (for 3rd to 11th intercostal spaces)

subcostal a.

Subclavian artery :

internal thoracic a.

- anterior intercostal aa.

- musculophrenic a.

- superior epigastric a. (anastomoses with inferior epigastric a.)

costocervical trunk

- supreme intercostal a. (for 1st and 2nd intercostal spaces)

Axillary artery:

thoracoacromial a.

lateral thoracic a.

thoracodorsal a.

VEINOUS DRAINAGE OF THE THORACIC WALL:

Azygos v. - right posterior intercostal vv., right superior intercostal v.,

arch of azygos v.,

drains into superior vena cava

Right supreme intercostal v. - drains into right brachiocephalic v.

Hemiazygos and accessory hemiazygos veins - left posterior intercostal vv.,

drain into azygos v.

Left superior intercostal v. - drains into left brachiocephaliv v.

Left supreme intercostal v. - drains into left brachiocephalic v.

Internal thoracic vv. - left drains into left brachiocephaic v.,

right drains into superior vena cava

Thoracoepigastric vv. - they form lateral thoracic v., it drains into axillary v.

Vertebral venous plexus - external and internal

Veins of the thoracic wall form important cavo-caval and porto-caval anastomoses!

NEUROVASCULAR BUNDLE IN INTERCOSTAL SPACES – VAN:

VAN is made from (in kranio-caudal direction)

posterior intercostal Vein

posterior intercostal Artery

intercostal Nerve

Runs between (in dorso-ventral direction):

endothoracic fascia and internal intercostal membrane

inside internal intercostal mm., separates innermost (intimi) intercostal mm.

between endothoracic fascia and internal intercostal mm.

LYMPHATIC DRAINAGE OF THE THORACIC WALL:

Parietal lymph nodes:

intercostal l. nn.

parasternal l. nn.

phrenic l. nn.

INNERVATION OF THE THORACIC WALL:

Thoracic wall is supplied from nerves of brachial plexus and from intercostal nn.

Sensory: 1/ intercostals nerves

2/ supraclavicular nerves

3/ intercostobrachial nerves

Motor: 1/ phrenic n. (diaphragma)

2/ intercostals nn. (intercostal mm., transverse thoracic m., subcostal m.)

3/ long thoracic n. (serratus anterior m.)

4/ medial and lateral pectoral nn. (pectoralis major and minor)

5/ thoracodorsal n. (latissimus dorsi m.)

6/ dorsal brr. of spinal nerves (intrinsic muscles of the back)

7/ accessory n. (trapezius m.)

8/ subclavian n. (subclavius m.)

MAMMARY GLAND:

Blood supply: 1/ pectoral brr. of thoracoacromial a.

2/ lateral mammary brr. of lateral thoracic a.

3/ medial mammary brr. (perforating brr.) of internal thoracic a.

Innervation: 1/ lateral mammary br., from intercostal nn.

2/ medial mammary br., from intercostal nn.

3/ medial and intermediate supraclavicular nn., from cervical plexus

Lymphatic drainage: 1/ axillary (predominantly pectoral) lymph nodes

(important for metastases)

2/ parasternal lymph nodes

3/ supraclavicular (deep cervical) lymph nodes

4/ superficial inguinal lymph nodes

MEDIASTINUM

- part of the thoracic cavity between two pleural cavities (right and left)

Borders:

ventral: sternum + costal cartilages + transverse thoracis m.

dorsal: thoracic vertebrae (bodies)

caudal: diaphragm

lateral: mediastinal pleura right and left

cranial: superior thoracic aperture

Division:

- horizontal line, which connects sternal angle and intervertebral disc between Th4-5 into:

superior mediastinum

inferior mediastinum – by pericardium is divided into:

- anterior mediastinum

- middle mediastinum

- posterior mediastinum

SUPERIOR MEDIASTINUM:

- communicates with anterior mediastinum and posterior mediastinum

Content:

thymus

right brachiocephalic vein

left brachiocephalic vein + its tributaries

superior vena cava + its tributaries

right and left phrenic nerve – different passage

right and left vagus nerve – different course,

left recurrent laryngeal n.

aortic arch – course, branches: brachiocephalic trunk,

left common carotid a.,

left subclavian artery,

bronchial aa.

trachea (thoracic part)

oesophagus

thoracic duct

superficial cardiac plexus

sympathetic trunk (covered by endothoracic fascia)

anterior mediastinal lymph nodes

ANTERIOR MEDIASTINUM:

- fissure behind the body of sternum and in front of pericardium,

- it communicates with superior mediastinum

Content:

thymus

parasternal lymph nodes

superior et inferior sternopericardiac ligaments

MIDDLE MEDIASTINUM:

- it is separated by pericardium from other parts of mediastinum (from posterior mediastinum is also

separated by bronchopericardiac membrane)

Content:

heart + pulmonary trunk

ascending aorta

left and right pulmonary veins

superior et inferior vena cava

deep cardiac plexus

left and right phrenic nerves + pericardiacophrenic vessels

(between pericardium and mediastinal pleura)

tracheal bifurcation

tracheobronchial lymph nodes

POSTERIOR MEDIASTINUM:

Borders:

anterior - pericardium, bronchopericardiac membrane

posterior - Th5-Th12

inferior - diaphragm

superior - imaginary line: intervertebral disc Th4-5 and sternal angle,

direct communication with superior mediastinum

(important for the spreading of inflammation to the neck and

to the abdominal cavity)

Content:

thoracic aorta

oesophagus

anterior et posterior vagal trunk

thoracic duct

azygos vein

hemiazygos vein

accessory hemiazygos vein

sympathetic trunk (covered by endothoracic fascia!)

greater, lesser et least splanchnic nerve

posterior mediastinal lymph nodes

THE HEART

FUNCTION: it pumps blood throughout the body via the circulatory system

Systemic circulation: LV (left ventricle) → AORTA → Human body → SUPERIOR ET INFERIOR

VENA CAVA → RA (right atrium)

Pulmonary circulation: RV (right ventricle) → PULMONARY TRUNK → Lungs → PULMONARY

VV. → LA (left atrium)

in middle mediastinum

in sac which is called = PERICARDIUM

Pericardium:

fibrous pericardium – fixation through:

- superior and inferior sternopericardial ligg.

- pericardiacophrenic ligg.

- bronchopericardial membrane

- vertebropericardial ligg.

serous pericardium – parietal layer/visceral layer (epicardium)

→ reflexion of serous pericardium creates:

- arterial opening (porta arteriarum) - around ascending aorta and

pulmonary trunk

- venous opening (porta venarum) - around superior vena cava and

inferior vena cava and pulmonary vv.

- transverse pericardial sinus - between porta venarum and

porta arteriarum

- oblique pericardial sinus

Heart wall – layers:

endocardium → endocardial duplications = valves

myocardium → atrial myocardium has 2 layers

ventricular myocardium has 3 layers

epicardium (= visceral layer of serous pericardium)

→ pericardial cavity is between epicardium and pericardium

Cardiac skeleton:

right fibrous ring

left fibrous ring

aortic ring

pulmonary ring

- right fibrous trigone (central fibrous body)

→ between right fibrous ring and left fibrous ring and aortic ring

- left fibrous trigone

→ between left fibrous ring and aortic ring

- tendon of infundibulum (tendo infundibuli)

→ connects pulmonary ring and aortic ring

External features of the heart:

base of the heart

apex of the heart

right auricle/left auricle

sternocostal (anterior)/diaphragmatic (inferior)/pulmonary (left) surface

acute (right) margin - cardiac notch /obtuse (left) margin

coronary sulcus (groove)/ anterior interventricular sulcus (groove)/ posterior

interventricular sulcus (groove)/ terminal sulcus (groove)

Chambers of the heart:

right atrium

right ventricle

left atrium

left ventricle

Right atrium:

true atrium → right auricle - pectinate mm.

interatrial septum - oval fossa (fossa ovalis) with limbus fossae ovalis

opening of superior vena cava (superior vena cava)

opening of inferior vena cava (inferior vena cava) - valve of inferior vena cava

opening of coronary sinus - valve of coronary sinus (on posterior wall)

openings of smallest cardiac veins

Right atrioventricular orifice - right atrioventricular valve (tricuspid):

anterior cusp/ posterior cusp/ septal cusp

Right ventricle:

inflow tract → trabeculae carnae

anterior and posterior papillary m., septal papillary mm.

tendinous cords (chordae tendinae)

supraventricular crest (border between inflow and outflow tract)

outflow tract → septomarginal trabecula (moderator band) - contains right crus of

atrioventricular bundle

conus arteriosus

opening of pulmonary trunk (pulmonary trunk)

with pulmonary valve:

- anterior semilunar cusp(valvula)

- right semilunar cusp (valvula)

- left semilunar cusp (valvula)

Left atrium:

true atrium → left auricle - pectinate mm.

interatrial septum – valvula of foramen ovale (falx septi)

openings of pulmonary veins (superior and inferior pulmonary veins)

openings of smallest cardiac veins

Left atrioventricular orifice - left atrioventricular valve (bicuspid, mitral):

anterior cusp/ posterior cusp

Left ventricle:

inflow tract → trabeculae carnae

anterior and posterior papillary m.

tendinous cords (chordae tendinae)

outflow tract → opening of aorta (ascending aorta) with aortic valve:

- posterior semilunar cusp (valvula)

posterior aortic sinus

- right semilunar cusp (valvula)

right aortic sinus (dilation with beginning of right coronary a.)

- left semilunar cusp (valvula)

left aortic sinus (dilation with beginning of left coronary a.)

Interventricular septum:

membranous part (between inflow part of right ventricle and

outflow part of left ventricle)

muscular part

Arterial blood supply:

- branches of ascending aorta

right coronary a.

- SA nodal br.

- br. for conus arteriosus

- atrial brr.

- right marginal br.

- AV nodal br.

- right, anterior and posterior ventricular brr.

- posterior interventricular br. → septal interventricular brr.

left coronary a.

→ circumflex br.

- left marginal br.

- atrial brr.

- left posterior ventricular br.

→ anterior interventricular br.

- br. for conus arteriosus

- lateral (diagonal) br.

- septal interventricular brr.

- left anterior ventricular brr.

Venous drainage:

coronary sinus (in coronary sulcus, on posterior side of the heart) and its tributaries:

← great cardiac v. (= ant. interventricular v.) - its tributaries:

- left marginal v.

- oblique v. of left atrium

- left posterior ventricular v.

← middle cardiac v. (= posterior interventricular v.)

← small cardiac v.

- right marginal ventricular v.

right anterior ventricular vv.

the smallest cardiac vv.

Innervation of the heart:

cardiac conducting system (heartbeat) – parts:

- sinuatrial node – SA node (in right atrium between opening of superior vena cava

and beginning of right auricle)

- atrioventricular node – AV node (in right atrium; near to opening of coronary sinus)

- atrioventricular bundle – bundle of His

- right and left bundle branches – Tawara branches

- subendocardial branches – Purkynje fibres

→ between SA node and AV node/ SA node and myocardium of left atrium

are connections

autonomic nervous system (influences frequency of rate and force of contractions)

sympathetic fibers - increase heart rate and causes dilatation

of coronary arteries

- cardiac nn. (from cervical and thoracic ganglia)

parasympathetic fibers - decrease heart rate and causes constriction

of coronary arteries

- cardiac brr. (from vagus n.)

→ together create: superficial cardiac plexus - in superior mediastinum,

on aortic arch

deep cardiac plexus - in middle mediastinum,

on the bifurcation of the trachea

Lymphatic drainage:

subendocardial, myocardial, subepicardial lymphatic network →

right collector = right lymphatic trunk of heart (truncus lymphaticus cordis dx.)

left collector = left lymphatic trunk of heart (truncus lymphaticus cordis sin.)

lymph from right collector → praeaortic l. n. → anterior mediastinal l. nn. → thoracis

duct→ left venous angle

lymph from left collector → retroaortic l. n. → inferior tracheobronchial l. nn.→ right

lymphatic duct → right venous angle

Auscultation of heart - Testut´s points:

aortic valve (point A)– right 2nd IC space near the sternum

tricuspid valve (point B) – right 5th IC space near the sternum

bicuspid valve (point C) – left 5th IC space in midclavicular line

pulmonary valve (point D) – left 2nd IC space near the sternum

RESPIRATORY SYSTEM

FUNCTION: transport air into the lungs and to facilitate the diffusion of oxygen into

the blood stream; phonation; thermoregulation

DIVISION:

UPPER RESPIRATORY TRACT

- NASAL CAVITY

- NASAL SINUSES

- NASOPHARYNX, OROPHARYNX (functionally these two parts are

inserted in respiratory system)

LOWER RESPIRATORY TRACT

- LARYNX

- TRACHEA

- BRONCHI

PROPER RESPIRATORY ORGAN

- LUNGS

NASAL SINUSES:

MAXILLARY SINUS

FRONTAL SINUS

ETHMOIDAL SINUS - consists of: anterior air cells

middle air cells

posterior air cells

SPHENOIDAL SINUS

EXTERNAL NOSE:

- pyramid-shaped

External features:

root of nose, dorsum of nose, tip of nose (apex nasi), wings of nose, nares

(nostrils)

Bones of external nose - bony framework:

nasal bones

the frontal processes of the maxillae

nasal part of frontal bone

→ piriform aperture

Cartilages of external nose:

lateral nasal cartilages

major alar cartilages - medial and lateral crus

minor alar cartilages

accesory nasal cartilages

vomeronasal cartilage

NASAL CAVITY:

- is divided by the nasal septum

Parts of the nasal cavity:

nasal vestibule (the border is limen nasi)

proper nasal cavity

Cross-section:

superior nasal concha - part of the ethmoid bone

- superior nasal meatus (sphenoethmoidal recess)

← here is opening of: posterior air cells

sphenoidal sinus

middle nasal concha - part of the ethmoid bone

- middle nasal meatus (ethmoidal bulla, semilunar hiatus,

ethmoidal infundibulum)

← here is opening of: maxillary sinus

frontal sinus

anterior air cells

middle air cells

inferior nasal concha - separate bone

- inferior nasal meatus

← here is opening of: nasolacrimal duct

→ common nasal meatus - near the nasal septum

← interconnects: superior and middle and inferior

nasal meatus

→ nasopharyngeal meatus ← here is common opening of: superior and middle

and inferior nasal meatus

Nasal septum - parts:

bony part - consists of: vomer, perpendicular plate of ethmoidal bone

cartilaginous part - consists of: septal cartilage

membranous part

PHARYNX:

- extends from the base of the cranium to the level of cricoid cartilage (C6 vertebra)

Parts:

Nasal part of pharynx - NASOPHARYNX - functionally this part is inserted in

respiratory system (in the level C1-C2; opens into the nose through two

choanae)

Oral part of pharynx - OROPHARYNX - functionally this part is inserted in

respiratory system (in the level C2-C4; opens into the oral cavity through

isthmus of fauces)

Laryngeal part of pharynx - LARYNGOPHARYNX (in the level C4-C6; opens

into the larynx via laryngeal inlet)

Nasopharynx:

fornix of pharynx - pharyngeal tonsil (adenoids), pharyngeal recess, pharyngeal

opening of auditory (Eustachian) tube, torus tubarius – tubal tonsil, torus

levatorius, salpingopharyngeal fold, salpingopalatine fold

Oropharynx:

isthmus of fauces, median/lateral glossoepiglottic fold, vallecula epiglottica

LARYNX:

Cartilaginous skeleton of larynx:

unpaired cartilages:

- thyroid cartilage (laryngeal prominence, left and right lamina, superior

et inferior thyroid notch, superior and inferior horns, oblique line)

- cricoid cartilage (lamina – arytenoid/thyroid articular surface, arch)

- epiglottis (petiolus, lamina)

paired cartilages:

- arytenoid cartilage (apex, base – muscular and vocal process),

- corniculate cartilage

- cuneiform cartilage

- tritiate cartilage - in lateral thyrohyoid lig.

Connections of larynx:

fibrous joints

- extrinsic ligaments: thyrohyoid membrane – reinforced by median and

lateral thyrohyoid lig.

cricotracheal lig.

- intrinsic ligaments: median cricothyroid lig.- continues laterally as a

conus elasticus

vestibular ligg. (false vocal cords; covered by

mucosa = vestibular folds)

vocal ligg. (true vocal cords; medially are covered

by mucosa membrane = vocal folds,

laterally are surrounded by vocalis m.)

→ fibroelastic membrane :

membrane composed of a dense elastic fibernet which lies below the

mucous membrane of larynx; has 2 parts:

quadrangular membrane and conus elasticus

synovial joints

- cricothyroid joint

- cricoarytenoid joint

Laryngeal cavity - parts:

vestibule of larynx - between aditus laryngis = laryngeal inlet (bounded by

epiglottis, aryepiglotic folds, cuneiform tubercles, corniculate tubercles,

interarytenoid notch) and vestibular folds

ventricle of larynx - a slit between vestibular and vocal folds

infraglottic cavity - between vocal folds and cricoid cartilage

Muscles of larynx:

ventral group - cricothyroideus m. - has straight and oblique part

- stretches the vocal cord

- innervation: superior laryngeal n.

dorsal group - cricoarytaenoideus posterior (posticus) m.

- widens the rima glottidis

- innervation: reccurent laryngeal n.

- arytenoideus m.

- assits in constricting of the rima glottidis

- innervation: reccurent laryngeal n.

- aryepiglotticus m.

- assits in narrowing of laryngel inlet

(aditus laryngis)

- innervation: reccurent laryngeal n.

lateral group - cricoarytaenoideus lateralis m.

- narrows the rima glottidis

- innervation: reccurent laryngeal n.

- thyroarytenoideus m.

- narrows the rima glottidis

- innervation: reccurent laryngeal n.

- thyroepiglotticus m.

- widens the entrance into larynx

(laryngeal inlet/aditus laryngis)

- innervation: reccurent laryngeal n.

Glottis: extended from the rima vestibule (which is between vestibular folds)

to the rima glottidis (which is between vocal folds)

TRACHEA:

- extends from C6 ̶ Th4-5

- in the level Th4-5 – bifurcation of trachea (inside: carina of trachea)

→ around bifurcation of trachea: right/left superior tracheobronchial l. nn.

inferior tracheobronchial l. nn.

- consists of 15 ̶ 20 tracheal cartilages – connected by annular ligg.

- its dorsal wall is membranous = paries membranaceus

Parts:

cervical part

thoracic part – in superius and middle mediastinum

BRONCHI:

- right principal bronchus is shorter, wider and more vertical than left principal bronchus

Right principal bronchus - division:

superior lobar bronchus (is divided into 3 segmental bronchi)

middle lobar bronchus (is divided into 2 segmental bronchi)

inferior lobar bronchus (is divided into 5 segmental bronchi)

Left principal bronchus - division:

superior lobar bronchus (is divided into 5 segmental bronchi)

inferior lobar bronchus (is divided into 5 segmental bronchi)

LUNGS:

External features (common features):

apex, base

costal surface, diaphragmatic surface, medial surface (mediastinal and vertebral

surface)

anterior margin (border), inferior margin (border), posterior margin (border)

root of the lung, hilum of the lung, pulmonary lig. (is a fused triangular-shaped sheet

of parietal and visceral pleura)

oblique fissure, horizontal fissure (right lung!)

Differences between right and left lung:

right lung - 3 lobes: upper lobe, middle lobe, lower lobe

- between upper and middle lobe is horizontal fissure

- in right hilum of the lung: right principal bronchus – epiarterial ↑

right pulmonary a. - caudally

right pulmonary vv. - ventrocaudally

left lung - 2 lobes: upper lobe, lower lobe

- on the anterior margin (border): cardiac notch

- lingula of left lung (structure of upper lobe)

- in left hilum of the lung: left pulmonary a. – superiorly

left principal bronchus – hyparterial ↓

left pulmonary vv. – ventrocaudally

Impressions - right lung:

impression for 1st rib, cardiac impression, sulcus for superior vena cava, sulcus for

subclavian a., sulcus for esophagus, sulcus for azygos v.

Impressions - left lung:

impression for 1st rib, cardiac impression, impression for esophagus, sulcus for left

brachiocephalic v., sulcus for subclavian a., sulcus for aorta

Blood supply - lungs:

functional vessels - pulmonary aa. and pulmonary vv.

nutritive vessels - bronchial br. (thoracic aorta, aortic arch, 3rd and 4th right posterior

intercostal a.)

bronchial vv.

VISCERAL AND PARIETAL PLEURA:

Parietal pleura:

is lining the internal surface of the thoracic wall

innervation: sensitive innervation by intercostal and phrenic n.

costal pleura/ mediastinal pleura/ diaphragmatic pleura

cervical pleura (pleural cupula = dome) - 5 cm above superior thoracic aperture

costodiaphragmatic recess/costomediastinal recess

Visceral pleura:

forms a cover over the lungs

innervation: autonomic innervation by vagus n. and sympathetic trunk

→ between parietal and visceral pleura is pleural cavity