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Lab 1 CARDIO – RESPIRATORY

ANATOMY AND PHYSIOLOGY
Subject Code: RT 53

THORAX AND MEDIASTINUM

• 2nd rib articulate with th sternum
• Aortic arch begins and ends
OUTLINE • Trachea bifurcates into the right and left bronchi at the carina
I Thoracic Wall • Inferior border of the superior mediastinum is demarcted.
II Articulations of the Thorax BODY OF THE STERNUM
III Muscles of the Thorax → Articulates with the 2nd to 7th costal cartilages
IV Nerves and Blood Vessels of the Thoracic Wall → The xiphisternal joint between the body and the xiphoid process lies
V Lymphatic Drainage of the Thorax at the T9 vertebral level
VI Mediastinum XIPHOID PROCESS
→ Flat, cartilaginous process at birth that ossifies slowly from the
central core and unites with the body of the sternum after middle
I. THORACIC WALL age.
A. STERNUM → Ends at the T10 vertebral level which marks the lower limit of the
→ Flat bone in the anterior chest wall thoracic cavity anteriorly, and the level of the esophageal hiatus in
→ Parts: Manubrium, Body, and the Xiphoid Process the diaphragm.
→ Body is more than twice as long as the manubrium in the male and → Palpated in the epigastrium and is attached via its pointed caudal
less than half length of the manubrium in the female. end to the linea alba.
B. RIBS
→ 12 pairs of bones → main part of the bony thoracic wall, extending
from the vertebrae posteriorly to or toward the sternum anteriorly.
→ Increase the anteroposterior and transverse diameter of the thorax
by their movements.
STRUCTURE
→ Typical ribs are 3 through 9 → has head, neck, tubercle, and body
(shaft).
→ Head articulates with the corresponding vertebral bodies and
intervertebral disks and supraadjacent vertebral bodies
→ Shaft or body is thin and flat and turns sharply anteriorly, at the
angle; it has a costal groove that follows, the inferior and internal
surface of the rib and shields the intercostal vessels and nerves
from injury.
→ Tubercle articulates with the transverse process of the
corresponding vertebrae, except ribs 11 and 12.
CLASSIFICATION
MANUBRIUM → True Ribs → Ribs 1 – 7 → attached to the sternum by their costal
cartilages
→ Superior margin contains the jugular notch which can be readily
palpated at the root of the neck → False Ribs → ribs 8 – 12
→ Clavicular notch on each side for articulation with the clavicle → Ribs 8 – 10 → connected to the costal cartilages
→ Articulates with the cartilage of the first rib, the upper half of the → 7th – 10th costal cartilages → form the anterior costal arch of costal
second rib, and the body of the sternum at the manubriosternal joint, margin
or sternal angle. → Floating Ribs → ribs 11 and 12 → connected only to the vertebrae

FIRST RIB
→ Broadest and shortest of the true ribs
→ Single articular facet on its head which articulates with the first
thoracic vertebra
→ Has a scalene tubercle for the insertion of the anterior scalene
muscle and two grooves for the subclavian artery and vein
SECOND RIB
→ Two articular facets on its head, which articulates with the bodies of
the first and second thoracic vertebrae
→ Twice as long as the first
TENTH RIB
→ Has a single articular facet on its had, which articulates with the 10th
STERNAL ANGLE thoracic vertebrae
→ AKA, angle of Louis 11TH AND 12TH RIB
→ Junction between the manubrium and the body of the sternum → Have a single articular facet on their head
→ Is located at the level where: → Have no neck or tubercle

AARON MORA 1
 → Synovial plane joints of heads of the ribs with corresponding and
supraadjacent vertebral bodies.

II. ARTICULATIONS OF THE THORAX

STERNOCLAVICULAR JOINT
→ Saddle – type synovial joint with two separate synovial cavities and
provides the only bony attachment between the appendicular and
axial skeletons

COSTOTRANSVERSE JOINT
→ Synovial plane joint of the rib tubercle with the transverse process
of the corresponding vertebra

STERNOCOSTAL/STERNOCHONDRAL JOINT
→ Articulation of the sternum with the first seven rib cartilages
→ Sternum (manubrium) forms a synchondrosis with the first costal
cartilage
→ 2nd to 7th costal cartilages form synovial plane joints with the sternum

INTERCHONDRAL JOINT
→ Synovial plane joints between the 6th and the 10th costal cartilages
of rib

COSTOCHONDRAL JOINT
→ Synchondroses in which the ribs articulate with their respective
costal cartilages
MANUBRIOSTERNAL JOINT
→ Symphysis (secondary cartilaginous joint) between the manubrium
and the body of the sternum
XIPHISTERNAL JOINT
→ Synchondroses articulation between the xiphoid process and the
body of the sternum
COSTOVERTEBRAL JOINT

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 III. MUSCLES OF THE THORACIC WALL PERICARDIOPHRENIC ARTERIES
→ Accompany the phrenic nerves between the pleura and the
pericardium to the diaphragm
→ Supply the pleura, pericardium, and diaphragm, (upper surface)
ANTERIOR INTERCOSTAL ARTERIES
→ 12 Small arteries, 2 in each of the upper 6 intercostal spaces that
run laterally, one each at the upper and lower borders of each
space.
→ Upper artery in each intercostal space anastomoses with the
posterior intercostal artery and the lower one joins the collateral
branch of the posterior intercostal artery
→ Provide muscular branches to the intercostal serratus anterior, and
pectoral muscles.

V. LYMPAHTIC DRAINAGE OF THE THORAX

STERNAL OR PARASTERNAL INTERNAL THORACIC NODES
→ Located along the internal thoracic cavity
→ Receive lymph from the medial portion of the breast, anterior
intercostal spaces, diaphragm, and supraumbilical region of the
abdominal wall
→ Drain into the junction of the internal jugular and subclavian veins.
INTERCOSTAL NODES
→ Lie near the heads of the ribs on the posterior thoracic wall
→ Receive lymph from the intercostal spaces and the pleura
→ Drain into the cisterna chyli or the thoracic duct
PHRENIC NODES
→ Lie of the thoracic surface of the diaphragm
→ Receive lymph from the pericardium, diaphragm, and liver
→ Drain into the parasternal and posterior mediastinal nodes

IV. NERVES AND BLOOD VESSELS OF THE THORACIC WALL

INTERCOSTAL NERVES
→ Ventral primary rami of the 11th thoracic spinal nerves.
→ Ventral primary ramus of the 12th thoracic spinal nerve is the
subcostal nerve, which runs beneath the 12th rib.
→ Run between the internal and innermost layers of muscles, with
intercostal veins and arteries above.
→ VAN → Vein, Artery, Nerve
→ Reside in the costal grooves on the inferior surface of the ribs
→ Give rise to lateral and anterior cutaneous branches and muscular
branches

INTERNAL THORACIC ARTERY

VI. MEDIASTINUM
→ Aries from the first part of the subclavian artery and descends
directly being the first six costal cartilages, just lateral to the sternum → Interpleural space (area between the pleural cavities and lungs) in
bilaterally. the thorax and is bounded laterally by the pleural cavities, anteriorly
by the sternum and transversus thoracic muscles, and posteriorly
→ Gives rise to two anterior intercostal arteries in each of the upper
by the vertebral column
six intercostal spaces and terminates at the sixth intercostal space
by dividing into the musculophrenic and superior epigastric arteries. → Consists of the superior mediastinum, superior to the pericardium
and three inferior divisions: anterior middle, and posterior.
SUPERIOR MEDIASTINUM
→ Between the 4th and 5th thoracic vertebrae
→ SVC, brachiocephalic veins, each of the aorta, thoracic duct,
trachea, esophagus, vagus nerve, left recurrent laryngeal nerve,
and phrenic nerve.
→ Contains the thymus → lymphoid organ
ANTERIOR MEDIASTINUM
→ Lies anterior to the pericardium and posterior to the sternum and
the transverse thoracic muscles
→ Contains the remnants of the thymus gland, lymph nodes, fat, and
connective tissue
MIDDLE MEDIASTINUM
→ Lies between the right and the left pleural cavities

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→ Contains the heart, pericardium, phrenic nerves, roots of the great
vessels (aorta, pulmonary arteries, and veins and venae cavae),
arch of the azygous vein and main bronchi.
POSTERIOR MEDIASTINUM
→ Lies posterior to the pericardium between the mediastinal pleurae
→ Contains the esophagus, thoracic aorta, azygous, and hemiazygos
veins, sympathetic trunk, and splanchnic nerves

REFERENCES
Content References:
Cardiology Book
Notes from discussion by Sir Mark Kelwin Daguiao
Practice Exam References: