September 16,
ANATOMY: INTRODUCTION TO THE THORACIC REGION – DR. LAYGO
2013
Thoracic Region cervical/costal pleura pleural covering of apical
Thoracic Cavity – Made up of Thoracic Cage portion of the lungs
- Sternum
- Costal Cartilage – mediates as an indirect Inferior aperture (thoracic outlet)
attachment for sternum and anterior ribs
- Ribs
- Thoracic Vertebra – Where posterior ribs are
attached
- Diaphragm – Lower boundary
- Thoracic Inlet – Superior boundary, level of
thoracic notch, at the level between T2 and T3
Thoracic Cage
Shape: truncated cone
Boundaries:
Anterior wall (Sternum, anterior part of 10 ribs)
Lateral wall (ribs)
Posterior wall (12 thoracic vertebrae and posterior
part of the ribs) Boundary:
Diaphragm
Two major division of the thoracic cavity:
Median partition (mediastinum)
Parts of mediastinum:
1) Anterior mediastinum
2) Middle mediastinum
3) Posterior mediastinum
Laterally (pleurae and lungs)
- Visceral and parietal pleura
- Visceral – pleura attached to lungs
- Parietal – pleura superficial to viscera and close
to thoracic cage
- Pleural cavity – space between parietal and
visceral pleura.
Apertures:
Superior aperture (thoracic inlet)
Measurement: 2 x 4 inches
Boundaries:
Body of 1st thoracic vertebrae
1st rib
1st costal cartilage
Upper border of manubrium sterni
Diaphragm of aperture: Sibson’s fascia
- Extension of deep cervical fascia.
- Encloses 1st part of subclavian artery, internal
thoracic vessels and is also attached to the
“Time changes everything. That’s what people say, it’s not true. Doing things changes things. Not The Anatomy Committee
doing things leaves things exactly as they were.” – Dr. House Batch‘171
September 16,
ANATOMY: INTRODUCTION TO THE THORACIC REGION – DR. LAYGO
2013
Breast (See Miracles In Life Everyday)
Base: 2nd – 6th ribs
Lateral: anterior axillary line
Medially: lateral border of the sternum
BLOOD SUPPLY
1. Axillary artery
-Superior thoracic
-Lateral thoracic: supplies lateral part
-Thoracoacromial: supplies superior portion
2. Internal mammary artery: branch of subclavian artery;
supplies medial part
Stages of development 3. Intercostals artery: perforating branch; supplies
1. Prepubertal posterior portion; branch of aorta
4. Subscapular artery
2. Breast budding
Venous
3. Enlargement
1. Internal thoracic/ mammary vein – eventually drain
4. Secondary mound
at subclavian vein brachiocephalic drainage
5. Single contour of breast
2. Lateral thoracic/ mammary vein – drainage of
Parts:
lateral side eventually draining to axillary vein
1. 15 – 20 lobes
brachiocephalic drainage
2. Lactiferous ducts
Lymphatic drainage
-Ampulla: dilated portion
2 Major groups of lymphatic drainage:
3. Areola
Axillary group of lymph node (LN)
4. Tubercles – alveolar glands
-75% of breast drains on it
Areolar glands of Montgomery: small rounded
Internal mammary group of lymph nodes
elevations
-Lateral part of breast
5. Suspensory ligaments
-25% of breast drains on it
-Separates the fibrous septa
Others:
6. Axillay tail: also called “axillary tail of Spence”
1. External mammary group of LN
-small part
-Average of 1.7 LN
-Extends upward and laterally
-Lying on lateral side pectoralis major muscle
Retromammary space - Space between the mammary gland
-Medial side of axilla
and pectoralis fascia
2. Scapular LN
-Supernumerary breast- Multiple nipples present, usually
-Average of 5.8 LN/ 5-7 LN
located at along the mammary line/ milk line
-Lying together with scapular vessels
-Thoracodorsal branch of scapular vessel
3. Central axillary LN
Breast Quadrants:
-Area where most number of LN are found
-12-15 LN
“Time changes everything. That’s what people say, it’s not true. Doing things changes things. Not The Anatomy Committee
doing things leaves things exactly as they were.” – Dr. House Batch‘172
September 16,
ANATOMY: INTRODUCTION TO THE THORACIC REGION – DR. LAYGO
2013
-Located within axillary fat pad
-Lymph node that is easily palpable
4. Interpectoral/ rotter’s LN
-1.4 LN
-Lying between pectoralis major and minor muscles
5. Axillary vein LN
-Lying on ventral and caudal part of the lateral axillary vein
-Average of 10.7 LN
-Second largest group of LN
6. Subclavian LN/ subclavicular group of LN
-3.5 LN/ 3-5 LN
-Underneath the subclavian vein
7. subareolar plexus of Sappey (Thorek)
Abnormal Findings:
1. Paget’s Disease
2. Breast dimpling
3. Nipple discharges
4. Peau d’ Orange – skin of the
orange
“If you want to change your grade you have to be willing to
be uncomfortable”
Notetakers:
ARANCA, Voltaire
BUCCAT, Noel
YAP, Janel
***Average Lymph Node of 35.3 lymph nodes
3 Parts of Axillary Lymph Node:
a. LEVEL 1
- all axillary nodes lateral to pectralis minor
- axillary vein group
- external mammary
- scapular
b. LEVEL 2
- located underneath pectoralis minor
- central group
- some subclavian
c. LEVEL 3
- axillary lymph node located medial to pectoralis
minor
- apical or subclavicular
“Time changes everything. That’s what people say, it’s not true. Doing things changes things. Not The Anatomy Committee
doing things leaves things exactly as they were.” – Dr. House Batch‘173
