Intercostal muscles

Function:
-fill in ribcage
-keep from popping
-involved in forced inspi/expiration
2 or 3 muscles depending on who you ask
Named for the Rib ABOVE 11 pairs
Control size of thoracic cavity, elevate and depress ribs, forced breathing
External: run Antero-medially (downward)
Anteriorly near sternum turns into transparent membrane
allowing the internal intercostal to be visible
Internal: run Posterolaterally (perpendicular) (upward)
Innermost: inner layer of internal separated by VAN
Becomes membranous posteriorly near vertebral column

Sternoclavicular Ligament

Intercostal neurovascular bundle

Organized:
Superior-Vein-Artery-Nerve-Inferior
Run in COSTAL GROOVE on INFERIOR part of rib
Posteriorly
Intercostal artery fed by AORTA
Intercostal vein drains into the AZECA vein
Anterior
Intercostal artery fed by ANTERIOR INTERNAL THORACIC A.
Intercostal vein brains into ANTERIOR INTERNAL THORACIC V
ANTERIOR INTERNAL THORACIC aka Internal mammary, Branch off subclavian
held in place by ANTERIOR THORASUS TRANSVERSUS MUSCLE
This muscle make removing the chest wall with anterior internal thoracic artery
intact very difficult

Sternal Notch

Manubrium
Sternal Angle
Angle of Louie

Pulmonary

al

Ve
i
Art n
e
Ne ry
rve

Co
s

ta

lG

Line
Mid C
lavicu
lar

Extern

Mid Axial line

Aortic
l
a
n
r
e
t
In

Left Pulmonary artery IN FRONT of aorta

Right Pulmonary artery BEHIND

Costal Cartillage
Anterior Internal Thoracic
Artery and Vein

An
Ne ter
uro ior
va Int
scu erc
lar ost
bu al
nd
le

Ribs
12 Ribs off of thoracic vertebrae
T1 is where Rib 1 originates
1-6 Ribs articulare with individual COATAL CARTILLAGE
(Hyaline)
7-10 are variable: articulate with catallagenous mass
11-12: floating ribs

Costal Cartillage

CHEST WALL IS REMOVED

Lungs wrap around heart
The Pleura of the lungs do NOT communicate
(this is a good thing, otherwise pneumothorax would be worse)

Tricuspid
ro
ov
e

Phrenic Nerve from C4

-Septum Transversarium originally pulled phrenic nerve down
then...
-It got caught up in PLEUR-PERICARDIAL FOLDS/MEMBRANE
when it grew out from the lateral wall to separate the ANTERIOR HEART
from the POSTERIOR LUNGS

Bicuspid
Mitral

-Musculophrenic ARTERY travels all they way to diaphram

-It literally sits in FIBROUS PERICARDIUM
-Pericardial-phrenic VESSELS travels with phrenic nerve
to the pericardium.
-Pericardium is still living tissue and needs a blood supply
-Locate Phrenic nerve as a ridge in FIBROUS PERICARDIUM, it is exaggerated
by the PERICARDIAL-PHRENIC vein that runs with it
PERICARDIAL PHRENIC IS A SLENDER BRANCH OFF OF THE INTERNAL THORACIC
-Phrenic nerve + Pericardial-phrenic vessels NAV travels the
entire length of the MEDIA STEINUM
PERICARDIUM
Heart was formed in its OWN SPLANCNIC MESODERM
VISCERAL PERICARDIUM that is tightly adhered to heart
-Originated from hearts OWN splancnic mesoderm
-Underneath the VISCERAL PERICARDIUM is where hearts blood supply runs
FIBROUS PERICARDIUM is covered in an amount of fat proportional to body fat
-It originated from PLEURO-PERICARDIAL FOLDS
-Outer FIBROUS LAYER
-Inner SEROUS LAYER: continuous, slimy.
-Extends to proximal portion of great vessels

Rib

CNX
Internal Jugular

V
A
N

Phrenic n.
External Jugular

Inferior Thyroid

Brachiocephalic Vein = Int Jug + subclavian

Lungs

Visceral Plura

Pleural Space

Parietal Plura

Endothoracic Fasia

Right Common Carotid

Innermost Intercostal

Inferior Thyroid
Vertebral
Transvers cervical
Thyrocervical Trunk
Suprascapular

Internal Intercostal

Superficial cervical (dorsal scapular)

External
Intercostal

Scalene anterior (Phrenic n pierces)

Thoracocentesis
CC: for accessing the plural space
Drain fluid or Pus or Blood
-Important to go above a rib to avoid
injuring the intercostal VAN
Structurs passed through
1) External intercostal
2) Internal intercostal
3) Innermost intercostal
4) ENDOTHORACIC FASCIA: fused with parietal pleura but distinct
5) Parietal Plura: somatic mesoderm
5) Enter plural cavity = potential space
DO NOT ENTER visceral plura (somatic mesoderm fused to lung)
DO NOT PUNCTURE LUNG

Rib

3) Left Subclavian
2) Left Common Carotid
1) Brachiocephalic

teriosu
s
ntum A
r
Ligame

Superior
Vena
Cava

Accessory Hemiazygos left posterior intercostal vein drainage, Right Post Intercostal into Azygos
Aortic Arch
Aorta Loops over Pulmonary Artery
Left Pulmonary artery infront of aorta
Vagus Nerve CNX
Right
Pulmonary
artery
behind
Aorta
Phrenic Nerve C4
Vagus nerve generally lies at the bifurcation
of the carotid and the subclavian (on the right side)
Second Intercostal
-CNX dives BEHIND HEART
-Supplies heart then goes into the abdomen
-Gives
off
a
branch
called
the
RECURRENT
LARYNGEAL
Pulmonary Trunk: ligamentum art.
RECURRENT LARYNGEAL
Left Atrium
-On left side CNX passes anterioly to Aortic arch
-Left
CNX
gives
recurrecnt
laryngeal
that
goes
UNDER
Internal Thoracic A
LIGAMENTUM ARTERIOUSUS and then goes UNDER
the AORTIC ARCH and travels back up to larynx

Thymus:
Right beneath
Manubrium
Immunological origin

Spinal Nerve (anterior/vental ramus)

2 Spaces (pericardial reflections)
1) Oblique pericardial sinus: between 5 pulmonary veins
-Reminance of straight tubular heart folding over
-Posterior to heart
2) Transverse pericardial space: space between two outflow tracts
-Surgeons use this space for bypasses
-Posterior to ASCENDING AORTA + Pulmonary Trunk
CC: tamponade
CC: Pericarditis

-Right CNX can be located anteriorly to the bifurcation of

THE COMMON CAROTID AND SUBCLAVIAN
-The Right Recurrent Laryngeal passes posteriorly
UNDER THE SUBCLAVIAN and travels up to larynx
Ductus arteriousus
In fetal circulation blood in the RV travels into the pulmonary artery
with no place to go. The Ductus arteriousus creates a shunt from
the pulmonary artery to the Aorta
-However the ductus arteriosus joins the aorta posteriorly to the
great vessels as to not dilute the blood traveling to the brain.
-Within the first 24hrs BRADYKININ causes ductus areteriousus to
close off and eventually become a fibrous vestigial connection called
the LIGAMETUM ARTERIOUSUS = reminents of ductus arteriousum
-LEFT RECURRENT LARYNGEAL loops under Ligamentum Arteriousus
-If Ductus arteriousus does not close it may need to be stapled.

MEDIA STEINUM: saggital plane through heart

Superior from inferior: Line through
1) Manubrio-sternal joint
2) top of heart
3) 5th thoracic vertabrae
Above this line is Superior Media-Steinum
Below this area is Inferior Media-Steinum
Inferior Media-Steinum is subdivided
1) Posterior: behind heart: Lots of stuff in this space
2) Middle: Heart is in the middle
3) Anterior: nothing but fat and lymphnodes