Fundamental Philosophy Surgery Series
Thorax
Topographic Anatomy | Thorax
Serratus anterior muscle
Cephalic vein
Nipple
Body of sternum
Deltoid muscle
Jugular notch
Clavicle
Clavicular head
Sternal head
Sternocleidomastoid muscle
Biceps brachii muscle
Triceps brachii muscle
Axilla Anterior axillary fold
Posterior axillary fold
Clavicular head of Pectoralis major muscle
Sternal head of Pectoralis major muscle
Latissimus dorsi muscle
Xiphoid process of sternum
Serratus anterior muscle
Linea alba
Rectus abdominis muscle
Tendinous intersection
External oblique muscle
Mammary Gland | Mammary Gland
Anterolateral dissection
Pectoralis major muscle (deep to pectoral fascia)
Axillary tail (of Spence)
Serratus anterior muscle
External oblique muscle
Gland lobules
Fat
Lactiferous sinus
Lactiferous ducts
Nipple
Areola
Areolar glands
Suspensory ligaments of breast (Cooper’s)
Sagittal section
Clavicle
2nd rib
Pectoralis major muscle
Pectoral fascia
Intercostal muscles
Intercostal vessels and nerve
Lung
6th rib
Suspensory ligaments of breast (Cooper’s)
Lactiferous duct
Lactiferous sinus
Gland lobules
Fat (subcutaneous tissue layer)
Mammary Gland | Arteries of Mammary Gland
Subclavian artery
Internal thoracic artery and its perforating branches
Medial mammary branches
Axillary artery
Brachial plexus
Brachial artery
Lateral thoracic artery
Lateral mammary branches
Axillary tail (of Spence)
Lateral mammary branches of lateral cutaneous branches of posterior intercostal arteries
Mammary Gland | Lymph Vessels and Nodes of Mammary Gland
Parasternal nodes
Apical (subclavian) nodes
Interpectoral (Rotter’s) nodes
Central axillary nodes
Lateral axillary (humeral) nodes
Posterior axillary (subscapular) nodes
Anterior axillary (pectoral) nodes
Pathway to anterior mediastinal nodes
Pathways to opposite breast
Pathways to inferior phrenic (subdiaphragmatic) nodes and liver
Body Wall | Bony Framework of Thorax
Anterior view
Jugular notch of Sternum
Manubrium of Sternum
Angle of Sternum
Body of Sternum
Xiphoid process of Sternum
Acromion of Scapula
Coracoid process of Scapula
Glenoid of Scapula
Neck of Scapula
Scapular notch of Scapula
Subscapular fossa of Scapula
Clavicle
True ribs (1-7)
Costal cartilages
False ribs (8-12)
Floating ribs (11-12)
Posterior view
Head of rib
Neck of rib
Tubercle of rib
Angle of rib
Body of rib
Floating ribs (11-12)
Clavicle
Acromion of Scapula
Supraspinous of Scapula
Spine of Scapula
Infraspinous fossa of Scapula
True ribs (1-7)
False ribs (8-12)
Body Wall | Ribs and Sternocostal Joints
1st left rib: superior view
Subclavius muscle
Grooves for subclavian vein and artery
Anterior scalene muscle
Serratus anterior muscle (1st digitation)
Middle scalene muscle
Head
Neck
Tubercle (no angle)
2nd left rib: superior view
Serratus anterior muscle (1st digitation)
Posterior scalene muscle
Head
Neck
Tubercle
Angle
Middle rib: posterior view
Head
Neck
Tubercle
Angle
Articular facet for transverse process of vertebra
Superior Articular facets for vertebral body
Inferior Articular facets for vertebral body
Costal groove
Sternocostal articulations: anterior view
Clavicle
Manubrium
Interclavicular ligament
Articular disc
Costoclavicular ligament
Articular cavity
Intraarticular sternocostal ligament
Articular cavities
Costochondral joints
Costal cartilages
Interchondral joints
Xiphoid process
Costoxiphoid ligament
Rib 1
Rib 2
Costal cartilages
Rib 3
Rib 4
Radiate sternocostal ligaments
Rib 5
Rib 6
Rib 7
Rib 8
Note: The head of a typical rib articulates with the superior costal facet of the thoracic vertebra of the same number (by its inferior articular facet), the inferior costal facet of the vertebra above (by its superior articular facet), and the intervertebral disc between the two vertebrae. The costal tubercle articulates with the transverse process of the vertebra of the same number.
Body Wall | Costovertebral Joints
Left lateral view
Anterior longitudinal ligament
Inferior costal facet (for head of rib one number greater)
Interarticular ligament of head of rib
Superior costal facet (for head of rib of same number)
Radiate ligament of head of rib
Transverse costal facet (for tubercle of rib of same number as vertebra)
Lateral costotransverse ligament
Intertransverse ligament
Superior costotransverse ligament
Transverse section: superior view
Costotransverse ligament
Lateral costotransverse ligament
Superior costotransverse ligament (cut)
Radiate ligament of head of rib
Superior articular facet of rib head
Intraarticular ligament
Synovial cavities
Right posterolateral view
Transverse process (cut off)
Superior costal facet (for head of rib of same number)
Radiate ligament of head of rib
Costotransverse ligament
Lateral costotransverse ligament
Superior costotransverse ligament
Intertransverse ligament
Body Wall | Anterior Thoracic Wall
Sternocleidomastoid muscle
Posterior triangle of neck
Trapezius muscle
Perforating branches of internal thoracic arter and anterior cutaneous branches of intercostal nerves
Pectoralis major muscle
Cephalic vein
Acromion
Deltoid muscle
Long thoracic nerve and lateral thoracic artery
Latissimus dorsi muscle
Digitations of serratus anterior muscle
Lateral cutaneous branches of intercostal nerves and posterior intercostal arteries
External oblique muscle
Anterior layer of rectus sheath
Sternalis muscle (inconstant)
Linea alba
Sternohyroid muscle Invested by cervical fascia
Sternohyoid muscle Invested by cervical fascia
Omohyoid muscle Invested by fascia
Clavicle
Subclavius muscle invested by clavipectoral fascia
Thoracoacromial artery (pectoral branch) and lateral pectoral nerve
Costocoracoid ligament
Coracoid process
Medial pectoral nerve
Pectoralis minor muscle by Clavipectoral fascia
Clavipectoral fascia
Digitations of serratus anterior muscle
External intercostal membranes anterior to internal intercostal muscles
External intercostal muscles
Body and xiphoid process of sternum
Internal oblique muscle
Rectus abdominis muscle
Cutaneous branches of thoracoabdominal (abdominal portions of intercostal) nerves and superior epigastric artery
Body Wall | Anterior Thoracic Wall (continued)
Omohyoid, sternohyroid and sternohyoid muscles
Clavicle
Subclavius muscle
Trapezius muscle
Thoracoacromial artery
Coracoid process
Cephalic vein
Pectoralis major muscle (cut)
Deltoid muscle
Intercostobrachial nerve
Long thoracic nerve and lateral thoracic artery
Pectoralis minor muscle
Digitations of serratus anterior muscle
Lateral cutaneous branches of intercostal nerves and posterior intercostal arteries
External intercostal muscles
External intercostal membranes anterior to internal intercostal muscles
Internal oblique muscle
Rectus abdominis muscle and sheath (cut)
Internal jugular vein
Levator scapulae muscle
Anterior Scalene muscles
Middle Scalene muscles
Posterior Scalene muscles
Phrenic nerve
Brachial plexus
Thoracic duct
Subclavian artery and vein
Axillary artery and vein
Superior thoracic artery
Internal thoracic artery and veins
External intercostal muscle
Internal intercostal muscle (cut)
Transversus thoracis muscle
Anterior intercostal branches of internal thoracic artery
Intercostal nerve
Musculophrenic artery and vein
Transversus abdominis muscle
Superior epigastric arteries and veins
Body Wall | Chest Drainage Tube Placement
Preferred sites
For pneumothorax (2nd or 3rd interspace at midclavicular line)
For hemothorax (5th interspace at midaxillary line)
Trocar and cannula pushed through intercostal space
Trocar withdrawn; tube passed into chest through cannula
Cannula withdrawn; tube connected to underwater seal (with suction if indicated)
Intercostal space is pierced above rib to avoid damage to neurovascular bundle lying in costal groove
Thoracocentesis and tube drainage with underwater seal drainage usually suffices
Body Wall | Anterior Thoracic Wall: Internal View
Sternothyroid muscle
Sternohyoid muscle
Internal jugular vein
Anterior scalene muscle
Subclavian artery and vein
Clavicle (cut)
Brachiocephalic vein
Phrenic nerve and pericardiacophrenic artery and vein
Internal thoracic artery and vein
Anterior intercostal arteries and veins and intercostal nerve
Perforating branches of internal thoracic artery and vein and anterior cutaneous branch of intercostal nerve
Collateral branches of intercostal artery and vein
Body of sternum
Sternocostal triangle
Diaphragm
Slips of costal origin of diaphragm
Transversus abdominis muscle
Manubrium of sternum
Common carotid artery
Inferior thyroid artery
Vertebral artery
Brachiocephalic trunk
Subclavian artery and vein
Brachiocephalic vein
Internal thoracic artery and vein
Anterior intercostal arteries and veins and intercostal nerve
Internal intercostal muscles
Innermost intercostal muscles
Transversus thoracis muscle
Musculophrenic artery and vein
Transversus abdominis muscle
Internal thoracic artery and veins
Superior epigastric artery and veins
Body Wall | Intercostal Nerves and Arteries
External oblique muscle
Lateral cutaneous branch of posterior intercostal artery
External intercostal membrane
Anterior intercostal arteries
Rectus abdominis muscle
Superior epigastric artery
Perforating branch
Anterior cutaneous branch of intercostal nerve
Pectoralis major muscle
External oblique muscle
Anterior branch of lateral cutaneous branch of intercostal nerve
Lateral cutaneous branch of intercostal nerve
Serratus anterior muscle
Internal intercostal membrane deep to external intercostal muscle
Intercostal nerve (ventral ramus of thoracic spinal nerve)
Costotransverse ligament
Medial branch of Dorsal ramus of thoracic nerve
Lateral branch of Dorsal ramus of thoracic nerve
Erector spinae muscle
Dorsal root (spinal) ganglion
Ventral root
Spinal (radicular, or segmental medullary) branch of posterior intercostal artery
Dorsal branch of posterior intercostal artery
Trapezius muscle
Rhomboid major muscle
Erector spinae muscle
Posterior intercostal artery
Internal intercostal membrane
Scapula
Infraspinatus muscle
Subscapularis muscle
Serratus anterior muscle
Gray and white rami communicantes
Sympathetic trunk and ganglia
Innermost intercostal muscle
Internal intercostal muscle
External intercostal muscle
Transversus thoracis muscle
Sternum
Internal thoracic artery
External intercostal muscle
Internal intercostal muscle
Innermost intercostal muscle
Thoracic aorta
Right posterior intercostal arteries (cut)
Body Wall | Phrenic Nerve
Right phrenic nerve
3rd cervical ventral rami
4th cervical ventral rami
5th cervical ventral rami
Anterior scalene muscle
Right common carotid artery
Brachial plexus
Right subclavian artery
Right vagus nerve (X)
Right internal thoracic artery (cut)
Brachiocephalic trunk
Right pericardiacophrenic artery (cut)
Superior vena cava
Root of right lung
Pericardial branch of phrenic nerve
Mediastinal part of parietal pleura
Diaphragmatic part of parietal pleura (cut)
Phrenicoabdominal branches of phrenic nerves to inferior surface of diaphragm
Left phrenic nerve
3rd cervical ventral rami
4th cervical ventral rami
5th cervical ventral rami
Anterior scalene muscle
Brachial plexus
Left subclavian artery
Left vagus nerve (X)
Left common carotid artery
Left internal thoracic artery
Thoracic cardiac nerves
Left pericardiacophrenic artery (cut)
Left recurrent laryngeal nerve
Root of left lung
Mediastinal part of parietal pleura
Costal part of parietal pleura
Phrenic nerves
(efferent and afferent fibers)
Lower intercostal nerves (afferent only from peripheral part of diaphragm)
Body Wall | Diaphragm: Thoracic Surface
Azygos vein
Costal part of parietal pleura
Right greater thoracic splanchnic nerve
Right sympathetic trunk
T8-9
Thoracic (descending) aorta
Neck of rib
Left sympathetic trunk
Left greater thoracic splanchnic nerve
Hemiazygos vein
Mediastinal pleura
Esophagus
Diaphragmatic part of parietal pleura (cut away)
Left leaflet of central tendon
Mediastinal part of parietal pleura and pericardium (cut)
Left phrenic nerve and pericardiacophrenic artery and vein
Pericardium
Left costomediastinal recess of pleural cavity
Transversus thoracis muscle
Left internal thoracic artery and veins
5th costal cartilage
Middle leaflet of central tendon covered by pericardium
Sternum
Anterior mediastinum
Right costomediastinal recess of pleural cavity
Right internal thoracic artery and veins
Inferior vena cava (receiving hepatic veins)
Right costodiaphragmatic recess of pleural cavity
Mediastinal part of parietal pleura and pericardium (cut)
Right phrenic nerve and pericardiacophrenic artery and vein
Diaphragmatic part of parietal pleura (cut away)
Right leaflet of central tendon
Thoracic duct
Body Wall | Diaphragm: Abdominal Surface
Costal part of diaphragm
Least thoracic splanchnic nerve
Lesser thoracic splanchnic nerve
Greater thoracic splanchnic nerve
Right crus of diaphragm
Caval opening
Right inferior phrenic artery
Anterior branch of right phrenic nerve
Sternal part of diaphragm
Sternocostal triangle
Anterior branch of left phrenic nerve
Costal part of diaphragm
Central tendon of diaphragm
Esophageal hiatus
Fibers from right crus passing to left of esophageal hiatus
Left inferior phrenic artery
Recurrent branch to esophagus
Anterior branch
Lateral branch
Left superior suprarenal artery
Left phrenic nerve
Left crus of diaphragm
Lumbocostal triangle
12th rib
Lateral arcuate ligament
Lumbar part of diaphragm
Medial arcuate ligament
Transverse process of L1 vertebra
Median arcuate ligament
Abdominal aorta
Aortic hiatus
Celiac trunk
Sympathetic trunk
Psoas major muscle
Quadratus lumborum muscle
Transversus abdominis muscle
Lungs | Topography of Lungs: Anterior View
Liver
Right dome of diaphragm
Gallbladder
Pleural reflection
Inferior border of right lunk
Costodiaphragmatic recess of pleural cavity
Oblique fissure of right lung
Costomediastinal recess of pleural cavity
Right nipple
Horizontal fissure of right lung (often incomplete)
Right border of heart
1st rib and costal cartilage
Clavicle
Sternoclavicular joint
Cervical (cupula, or dome, of parietal pleura)
Thyroid gland
Thyroid cartilage
Cricoid cartilage
Trachea
Jugular (suprasternal) notch
Apex of lung
Arch of aorta
Cardiac notch of left lung
Left border of heart
Left nipple
Oblique fissure of left lung
Costodiaphragmatic recess of pleural cavity
Spleen
Inferior border of left lung
Left dome of diaphragm
Pleural reflection
Stomach
Bare area of pericardium
Xiphoid process
Lungs | Topography of Lungs: Posterior View
Left suprarenal gland
Left dome of diaphragm
Left kidney
Inferior border of left lung
Pleural reflection
Spleen
Costodiaphragmatic recess of pleural cavity
Left border of coral parietal pleura
Spine of scapula
Oblique fissure of left lung
1st rib
Apex of left lung
Spinous process of T1 vertebra
Cervical (cupula, or dome, of) parietal pleura
1st rib
Oblique fissure of right lung
Clavicle
Horizontal fissure of right lung (often incomplete)
Right border of costal parietal pleura
Costodiaphragmatic recess of pleural cavity
Liver
Pleural reflection
Inferior border of right lung
Right kidney
Right dome of diaphragm
Right suprarenal gland
Lungs | Lungs in Situ: Anterior View
Pleural reflections
Xiphoid process
7th costal cartilage
Diaphragm
Diaphragmatic part of parietal pleura
Costodiaphragmatic recess
Horizontal fissure of right lung
Oblique fissure
Superior lobe of right lung
Middle lobe of right lung
Inferior lobe of right lung
Intercostal muscles
Pectoralis minor muscle
Pectoralis major muscle
Clavicle
Costal part of parietal pleura (cut away)
External jugular vein
Sternocleidomastoid muscle
Manubrium of sternum
Omohyoid, sternothyroid and sternohyoid muscles
Thyroid gland
Trachea and inferior thyroid veins
Common carotid artery
Internal jugular vein
Phrenic nerve
Anterior scalene muscle
Thoracic duct
Brachial plexus
Subclavian artery and vein
Internal thoracic artery and vein
Axillary artery and vein
Cardiac notch of left lung
Superior lobe of left lung
Inferior lobe of right left lung
Oblique fissure
Musculophrenic artery
Lingula of superior lobe of left lung
Internal thoracic artery
Mediastinal part of parietal pleura
Fibrous pericardium
Lungs | Lungs: Medial Views
Right lung
Groove for subclavian artery
Groove for brachiocephalic vein
Groove for 1st rib
Groove for superior vena cava
Superior lobe
Area for thymus and fatty tissue of anterior mediastinum
Anterior border
Hilum
Horizontal fissure
Cardiac impression
Oblique fissure
Middle lobe
Groove for inferior vena cava
Diaphragmatic surface
Apex
Area for trachea
Area for esophagus
Groove for azygos vein
Oblique fissure
Pleura (cut edge)
Right superior lobar (eparterial) bronchus
Right pulmonary arteries
Right bronchial artery
Right intermediate bronchus
Right superior pulmonary veins
Bronchopulmonary (hilar) lymph nodes
Right inferior pulmonary veins
Inferior lobe
Groove for esophagus
Pulmonary ligament
Inferior border
Left lung
Area for trachea and esophagus
Oblique fissure
Groove for arch of aorta
Pleura (cut edge)
Left pulmonary artery
Left bronchial arteries
Left main bronchus
Left superior pulmonary veins
Bronchopulmonary veins
Bronchopulmonary (hilar) lymph nodes
Inferior lobe
Left inferior pulmonary vein
Groove for descending aorta
Inferior border
Apex
Groove for subclavian artery
Groove for left brachiocephalic vein
Groove for 1st rib
Anterior border
Area for thymus and fatty tissue of anterior mediastinum
Superior lobe
Hilum
Cardiac impression
Pulmonary ligament
Cardiac notch
Oblique fissure
Groove for esophagus
Diaphragmatic surface
Lingula
Lungs | Bronchopulmonary Segments
Anterior view
Right lung
Superior lobe
Apical (S1)
Anterior (S3)
Posterior (S2)
Middle lobe
Lateral (S4)
Medial (S5)
Inferior lobe
Anterior basal (S8)
Medial basal (S7)
Lateral basal (S9)
Posterior basal (S10)
Left lung
Superior lobe
Apico-posterior (S1+2) of Superior division (culmen)
Anterior (S3) of Superior division (culmen)
Superior lingular (S4) of Superior division (culmen)
Inferior lingular (S5) of Superior division (culmen)
Inferior lobe
Anteromedial basal (S7+8)
Posterior basal (S10)
Lateral basal (S9)
Posterior view
Left lung
Superior lobe
Apico-posterior (S1+2) of Superior division (culmen)
Anterior (S3) of Superior division (culmen)
Superior lingular (S4) of Lingular division
Inferior lobe
Superior (S6)
Lateral basal (S9)
Posterior basal (S10)
Right lung
Superior lobe
Apical (S1)
Posterior (S2)
Anterior (S3)
Middle lobe
Lateral (S4)
Inferior lobe
Superior (S6)
Lateral basal (S9)
Posterior basal (S10)
T1
T2
T3
T4
T5
T6
T7
T8
T9
T10
Lungs | Bronchopulmonary Segments (continued)
Lateral views
Right lung
Superior lobe
Apical (S1)
Posterior (S2)
Anterior (S3)
Middle lobe
Lateral (S4)
Medial (S5)
Inferior lobe
Superior (S6)
Anterior basal (S8)
Lateral basal (S9)
Left lung
Superior lobe
Apico-posterior (S1+2) of Superior division (culmen)
Anterior (S3) of Superior division (culmen)
Superior lingular (S4) of Lingular division
Inferior lingular (S5) of Lingular division
Inferior lobe
Superior (S6)
Antero-medial basal (S7+8)
Lateral basal (S9)
Medial views
Right lung
Superior lobe
Apical (S1)
Posterior (S2)
Anterior (S3)
Middle lobe
Medial (S5)
Inferior lobe
Superior (S6)
Medial basal (S7)
Anterior basal (S8)
Lateral basal (S9)
Posterior basal (S10)
Left lung
Superior lobe
Apico-posterior (S1+2) of Superior division (culmen)
Anterior (S3) of Superior division (culmen)
Superior lingular (S4) of Lingular division
Inferior lingular (S5) of Lingular division
Inferior lobe
Superior (S6)
Anteromedial basal (S7+8)
Lateral basal (S9)
Posterior basal (S10)
Lungs | Trachea and Major Bronchi
Thyroid cartilage
Median cricothyroid ligament
Cricoid cartilage
Connective tissue sheath (visceral layer of pretracheal fascia) (cut away)
Annular (intercartilaginous) ligaments
Tracheal cartilages
Mucosa of posterior tracheal wall shows longitudinal folds formed by dense collections of elastic fibers
Superior lobar (eparterial bronchus)
B1 to superior lobe
B2 to superior lobe
B3 to superior lobe
Middle lobar bronchus
B4 to middle
B5 to middle
B6 to inferior lobe
B7 to inferior lobe
B8 to inferior lobe
B9 to inferior lobe
B10 to inferior lobe
Intrapulmonary
Extrapulmonary
Right and left main bronchi
Intermediate bronchus
Inferior lobar bronchus
Inferior lobar bronchus
Superior lobar bronchus
B1+2 to superior lobe
B3 to superior lobe
Superior division bronchus to superior lobe
Lingular bronchus to superior lobe
B4 to lingula
B5 to lingula
B6 to inferior lobe
B7+8 to inferior lobe
B9 to inferior lobe
B10 to inferior lobe
Cross section through trachea
Posterior wall
Nerve Small arteries
Gland Elastic fibers
Lymph vessels
Epithelium
Esophageal muscle
Trachealis (smooth) muscle
Anterior wall
Connective tissue sheath (visceral layer of pretracheal fascia)
Tracheal cartilage (ring)
Elastic fibers
Gland
Small artery
Lymph vessels
Nerve
Epithelium
Lungs | Nomenclature of Bronchi: Schema
Tracheal
Right main bronchi
Left main bronchi
Superior lobar (eparterial bronchus)
Intermediate bronchus
Middle lobar bronchus
Inferior lobar bronchus
Superior lobar bronchus
Superior division bronchus
Inferior lobar bronchus
Lingular bronchus
B1 (apical)
B1ai
B1aii
B1bi⍺
B1biβ
B1bi
B1b
B1bii⍺
B1biiβ
B1bii
B2 (posterior)
B2ai⍺
B2aiβ
B2a
B2ai
B2aii
B2bi
B2ii
B2b
B3 (anterior)
B3ai
B3ai⍺
B3aiβ
B3aii⍺
B3aiiβ
B3aii
B3a
B3bii
B3bi
B3b
B4 (lateral)
B4a
B4ai
B4aii
B4b
B4bi
B4bii
B5 (medial)
B5a
B5b
B6 (superior, lower lobe)
B6c
B6ci
B6cii
B6bii
B6b
B6bi
B6a
B6aii
B6ai
B7 (medial basal)
B7a
B7b
B7bi
B7bii
B8 (anterior basal)
B8a
B8ai
B8aii
B8b
B8bi
B8bii
B9 (lateral basal)
B9a
B9ai⍺
B9aiβ
B9aii
B9bi
B9bii
B9biiβ
B9bii⍺
B9b
B10 (posterior basal)
B10a
B10ai
B10aii
B10b
B10bi
B10bii
B1+2 (apicoposterior)
B1+2c
B1+2ci
B1+2cii
B1+2a
B1+2ai
B1+2aii
B1+2aiiβ
B1+2aii⍺
B1+2biiβ
B1+2bii⍺
B1+2bi⍺
B1+2biβ
B1+2bii
B1+2bi
B1+2b
B3 (anterior)
B3c
B3a
B3ai
B3aii
B3bi
B3bii
B3b
B4 (superior lingular)
B4a
B4ai
B4aii
B4bi
B4bii
B4b
B5 (inferior lingular)
B5a
B5b
B6 (superior, lower lobe)
B6a
B6b
B6c
B7+8 (anteromedial basal)
B7+8a
B7+8ai
B7+8aii
B7+8b
B7+8bi
B7+8bii
B9 (lateral basal)
B9a
B9ai
B9aii
B9b
B9bi
B9bii
B9bi⍺
B9biβ
B10 (posterior basal)
B10a
B10ai
B10aii
B10c
B10ci
B10cii
B10b
B10bi
B10bii
Nomenclature in common usage for bronchopulmonary segments (Plates 200 and 201) is that of Jackson and Huber, and segmental bronchi are named accordingly. Ikeda proposed nomenclature (as demonstrated here) for bronchial subdivisions as far as 6th generation. For simplification on this illustration, only some bronchial subdivisions are labeled as far as 5th or 6th generation. Segmental bronchi (B) are numbered from 1 to 10 in each lung, corresponding to pulmonary segments. In left lung, B1 and B2 are combined as B7 and B8. Subsegmental, or 4th order, bronchi are indicated by addition of lowercase letters a, b, or c when an additional branch is present. Fifth order bronchi are designated by Roman numerals i (anterior) or ii (posterior) and 6th order bronchi by Greek letters ⍺ and ꞵ. Several texts use alternate numbers (as proposed by Boyden) for segmental bronchi.
Variations of standard bronchial pattern shown here are common, especially in peripheral airways.
Lungs | Intrapulmonary Airways: Schema
Subdivisions of intrapulmonary airways
Segmental bronchus
Cartilages of Bronchi
Large intrasegmental bronchi (about 5 generations)
Cartilages of Bronchi become sparser (mostly at points of branching)
Small intrasegmental bronchi (about 15 generations)
No further cartilages
Bronchioles
Terminal bronchiole of Lobule
Respiratory bronchioles (3-8 orders) of Lobule
Alveolar sacs and alveoli of Lobule
Acinus (part of lung supplied by terminal bronchiole)
Smooth muscle of Terminal bronchiole
Elastic fibers of Terminal bronchiole
Alveolus of Terminal bronchiole
1st order of Respiratory bronchioles (alveoli appear at this level)
2nd order of Respiratory bronchioles (alveoli appear at this level)
3rd order of Respiratory bronchioles (alveoli appear at this level)
Alveolar ducts
Alveolar sac
Alveoli
Opening of alveolar duct
Pores of Kohn
Structure of intrapulmonary airways
Lungs | Intrapulmonary Blood Circulation: Schema
Pulmonary artery (from right heart)
Terminal bronchiole
Bronchial artery (from left heart via thoracic aorta)
Pulmonary vein (to left heart)
Respiratory bronchioles
Pulmonary vein (to left heart)
Capillary plexuses within alveolar wall
Septum
Visceral pleura and subpleura capillaries
Capillary bed within alveolar wall (cut away in places)
Pulmonary arteries and their branches distribute segmentally with the bronchi
Pulmonary veins and their tributaries drain intersegmentally
Lungs | Great Vessels of Superior Mediastinum
Cricoid cartilage
Thyroid gland
Right common carotid artery
Right vagus nerve (X)
Anterior scalene muscle
Phrenic nerve
Right internal jugular vein
External jugular vein
Brachial plexus
Right subclavian artery and vein
Brachiocephalic trunk
Right brachiocephalic trunk
Phrenic nerve and pericardiacophrenic artery and vein (cut)
Superior vena cava
Right superior lobar (eparterial) bronchus
Right pulmonary artery
Pulmonary trunk
Right pulmonary veins
Mediastinal part of parietal pleura (cut edge)
Costal part of parietal pleura (cut edge)
Right costodiaphragmatic recess of pleural cavity
Right intermediate bronchus
Phrenic nerve (cut)
Azygos vein
Thoracic duct
Inferior vena cava
Esophagus and esophageal plexus
Diaphragm
Pericardium (cut edge)
Left main bronchus
Diaphragmatic part of parietal pleura and cut edge
Phrenic nerve (cut)
Costal part of parietal pleura (cut edge)
Mediastinal part of parietal pleura (cut edge)
Left pulmonary veins
Left pulmonary artery
Ligamentum arteriosum
Left recurrent laryngeal nerve
Vagus nerve (X)
Arch of aorta
Internal thoracic artery
Left brachiocephalic vein
Left subclavian artery and vein
Brachial plexus
Thoracic duct
Phrenic nerve (cut)
Anterior scalene muscle
Left vagus nerve (X)
Left common carotid artery
Trachea
Thyroid cartilage
Lungs | Bronchial Arteries and Veins
Esophagus
Trachea (pulled to left by hook)
3rd right posterior intercostal artery
Superior left bronchial artery
Right bronchial artery
Right main bronchus
Aorta (pulled aside by hook)
Left main bronchus (pulled to the right by hook)
Inferior left bronchial artery
Esophageal artery
Esophageal branch of bronchial artery
Variations in bronchial arteries
Right and left bronchial arteries originating from aorta by single stem
Only single bronchial artery to each bronchus (normally, two to left bronchus)
Bronchial veins
Azygos vein
Right bronchial vein
Right main bronchus (pulled to left and rotated by hook)
Left main bronchus (turned up by hook)
Left bronchial vein
Accessory hemiazygos vein
Left bronchial vein
Left main bronchus (turned up by hook)
Lungs | Lymph Vessels and Nodes of Lung
Right paratracheal nodes
Right superior tracheobronchial nodes
Bronchomediastinal lymphatic trunk
Brachiocephalic vein
Inferior deep cervical (scalene) node
Internal jugular vein and jugular lymphatic trunk
Right lymphatic duct
Subclavian vein and subclavian lymphatic trunk
Bronchopulmonary (hilar) nodes
Pulmonary (intra-pulmonary) nodes
Subpleural lymphatic plexus
Interlobular lymph vessels
Drainage follows bronchi, arteries and veins
Inferior tracheobronchial (carinal) nodes
Pulmonary ligaments
Routes to mediastinum
Left paratracheal nodes
Bronchomediastinal lymphatic trunk
Brachiocephalic vein
Inferior deep cervical (scalene) node
Virchow’s node
Thoracic duct
Left superior tracheobronchial nodes
(Aortic arch) node of ligamentum arteriosum
Bronchopulmonary (hilar) nodes
Pulmonary (intrapulmonary) nodes
Subpleural lymphatic plexus
Interlobular lymph vessels
Drainage follows bronchi, arteries and veins
Right lung: All lobes drain to pulmonary and bronchopulmonary (hilar) nodes, then to inferior tracheobronchial (carinal) nodes, right superior tracheobronchial nodes, and right paratracheal nodes on way to brachiocephalic vein via bronchomediastinal lymphatic trunk and/or inferior deep cervical (scalene) node.
Left lung: Superior lobe drains to pulmonary and bronchopulmonary (hilar) nodes, inferior tracheobronchial (carinal) nodes, left superior tracheobronchial nodes, left paratracheal nodes and/or (aortic arch) node of ligamentum arteriosum, then to brachiocephalic vein via left bronchomediastinal trunk and thoracic duct. Left inferior lobe drains also to pulmonary and bronchopulmonary (hilar) nodes and to inferior tracheobronchial (carinal) nodes, but then mostly to right superior tracheobronchial nodes, where it follows same route as lymph from right lung.
Lungs | Autonomic Nerves in Thorax
Cervicothoracic (stellate) ganglion
Ansa subclavia
Cervical cardiac nerves (sympathetic and vagal)
Thoracic (sympathetic) cardiac branches
Sympathetic trunk
Vagus nerve (X) (cut) and branches to cardiac and pulmonary plexuses
Thoracic (sympathetic) cardiac branches
Anterior pulmonary plexus
Posterior pulmonary plexus (protruding from behind right bronchus)
6th intercostal nerve
Gray and white rami communicantes
6th thoracic sympathetic ganglion
Greater thoracic splanchnic nerve
Sympathetic branch to esophageal plexus
Thoracic duct
Lesser thoracic splanchnic nerve
Least thoracic splanchnic nerve
Azygos vein (cut)
Inferior vena cava (cut)
Left recurrent laryngeal nerve
Cervical cardiac nerves (sympathetic and vagal)
Vagus nerve (X) (cut)
Thoracic (sympathetic) cardiac branches
Left recurrent laryngeal nerve
Thoracic cardiac branch of vagus nerve
Cardiac plexus
Anterior pulmonary plexus
Posterior pulmonary plexus (protruding from behind left bronchus)
Sympathetic trunk
Thoracic aortic plexus
Esophageal plexus
8th intercostal nerve
Gray and white rami communicantes
Greater thoracic splanchnic nerve
Lesser thoracic splanchnic nerve
Anterior vagal trunk
Diaphragm (pulled down)
Lungs | Innervation of Tracheobronchial Tree: Schema
Parasympathetic fibers
Sympathetic fibers
Afferent fibers
From hypothalamic and higher centers
Descending tracts in spinal cords
Thoracic spinal cord
T1
T2
T3
T4
T5
Sympathetic trunk
Glossopharyngeal nerve (IX)
Vagus nerve (X) (cholinergic; efferent to smooth muscle and glands; afferent from aorta, tracheobronchial mucosa and alveoli)
Superior cervical sympathetic ganglion
Sympathetic nerves (adrenergic)
Carotid sinus
Carotid body
Common carotid artery
Arch of aorta
Superior laryngeal nerve
Left recurrent laryngeal nerve
Larynx
Cough receptors
Pulmonary plexus
Irritant receptors
Stretch receptors (Hering-Breuer reflex)
Heart | Heart in Situ
Inferior thyroid veins
Thymus
Brachiocephalic trunk
Right brachiocephalic vein
Phrenic nerve
Anterior scalene muscle
Brachial plexus
External jugular vein
Subclavian artery and vein
Superior vena cava
1st rib
Phrenic nerve and pericardiacophrenic artery and vein
Right lung
Costal parts of parietal pleura
Diaphragmatic parts of parietal pleura
Mediastinal parts of parietal pleura
Diaphragm Line of fusion of fibrous pericardium to diaphragm
Pericardium
Superior epigastric artery
Internal thoracic artery
Musculophrenic artery
Trachea
Left common carotid artery
Left brachiocephalic vein
Internal jugular vein
Vagus nerve (X)
Arch of aorta
Thoracic duct
Left recurrent laryngeal nerve
Internal thoracic artery
Phrenic nerve and pericardiacophrenic artery and vein
Mediastinal part of parietal pleura
Left lung
Heart | Heart: Anterior Exposure
Pericardium (cut edge) at site of reflection from great vessels
Right vagus nerve
Right internal jugular vein
Right recurrent laryngeal nerve
Right brachiocephalic vein
Phrenic
Subclavian artery and vein
Internal thoracic artery and vein
Phrenic nerve and pericardiacophrenic artery and vein
Superior vena cava
Right pulmonary artery
Transverse pericardial sinus
Right superior pulmonary vein
Hilum of right lung
Mediastinal pleura (cut edge)
Pericardium (cut edge)
Right atrium
Right auricle (atrial appendage)
Coronary sulcus and right coronary artery
Right ventricle
Conus arteriosus
Anterior interventricular sulcus and anterior interventricular branch of left coronary artery
Inferior border (acute margin of heart)
Left auricle (atrial appendage
Left ventricle
Apex of heart
Left border (obtuse margin) of heart
Pericardium (cut edge)
Mediastinal part of parietal pleura (cut edge)
Hilum of left lung
Left superior pulmonary vein
Transverse pericardial sinus
Left pulmonary artery
Pulmonary trunk
Left recurrent laryngeal nerve
Ligamentum arteriosum
Left vagus nerve (X)
Left internal jugular vein
Left common carotid artery
Arch of aorta
Left brachiocephalic vein
Brachiocephalic trunk
Heart | Radiograph of Chest
Apex of heart
Aortic arch
Clavicle
Coracoid process of scapula
Dome of diaphragm (right)
Inferior vena cava
Pulmonary artery (left)
Right atrium
Spine of scapula
Superior vena cava
Trachea (air)
Left ventricle
Precordial areas of auscultation
Aortic area
Pulmonic area
Tricuspid area
Mitral area
Valves
Pulmonic valve
Aortic valve
Mitral valve
Heart | Heart: Base and Diaphragmatic Surfaces
Base of heart: posterior view
Right pulmonary artery
Left pulmonary artery
Left auricle (atrial appendage)
Left superior pulmonary vein
Left atrium
Left inferior pulmonary vein
Pericardial reflection
Oblique vein of left atrium (of Marshall)
Coronary sinus
Left ventricle
Apex
Arch of aorta
Right auricle (atrial appendage)
Superior vena cava
Right superior pulmonary vein
Right atrium
Sulcus terminalis
Right inferior pulmonary vein
Coronary sulcus
Inferior vena cava
Right ventricle
Base and diaphragmatic surfaces: posteroinferior view
Left subclavian artery
Left common carotid artery
Left pulmonary artery
Left superior pulmonary vein
Left auricle (atrial appendage)
Left inferior pulmonary vein
Oblique vein of left atrium (of Marshall)
Left atrium
Pericardial reflection
Coronary sinus
Left ventricle
Brachiocephalic trunk
Superior vena cava
Arch of aorta
Right pulmonary artery
Right superior pulmonary vein
Right inferior pulmonary vein
Sulcus terminalis
Right atrium
Inferior vena cava
Coronary sulcus and right coronary artery
Posterior interventricular sulcus and posterior interventricular branch of right coronary artery (posterior descending artery)
Right ventricle
Heart | Pericardial Sac
Heart drawn out of opened pericardial sac: left lateral view
Superior vena cava
Pericardium (cut edge)
Ascending aorta
Left auricle (atrial appendage)
Left ventricle
Coronary sinus
Posterior interventricular sulcus
Right ventricle
Diaphragmatic part of pericardium
Sternocostal part of pericardium (cut edge)
Arch of aorta
Pulmonary trunk
Transverse pericardial sinus
Left pulmonary veins
Oblique vein of left atrium (Marshall’s)
Oblique pericardial sinus
Left atrium
Right pulmonary vein
Esophageal prominence
Right atrium
Inferior vena cava
Pericardial sac with heart removed: anterior view
Right phrenic nerve and pericardiacophrenic vessels
Superior vena cava
Transverse pericardial sinus
Superior vena cava
Right pulmonary veins
Mediastinal part of parietal pleura (cut edge)
Pericardium (cut edge)
Inferior vena cava
Line of fusion of fibrous pericardium to diaphragm
Arch of aorta
Ascending aorta
Mediastinal part of parietal pleura (cut edge)
Left phrenic nerve and pericardiacophrenic vessels
Pulmonary trunk (bifurcation)
Left lung
Left pulmonary veins
Pericardium (cut edge)
Oblique pericardial sinus
Esophageal prominence
Diaphragmatic part of pericardium
Heart | Coronary Arteries and Cardiac Veins
Sternocostal surface
Sinuatrial (SA) nodal branch
Atrial branch of right coronary artery
Right coronary artery
Anterior cardiac veins
Small cardiac vein
Right (acute) marginal branch of right coronary artery
Interventricular septal branches
Left auricle (cut)
Left coronary artery
Circumflex branch of left coronary artery
Great cardiac vein
Left (obtuse) marginal artery
Anterior interventricular branch (left anterior descending) of left coronary artery
Diagonal branch of anterior interventricular artery
Diaphragmatic surface
Oblique vein of left atrium (of Marshall)
Great cardiac vein
Circumflex branch of left coronary artery
Left marginal branch
Coronary sinus
Posterior left ventricular branch
Posterior vein of left ventricle
Middle cardiac vein
Interventricular
Septal branches
Sinuatrial (SA) nodal branch
Sinuatrial (SA) node
Small cardiac vein
Right coronary artery
Posterior interventricular branch (posterior descending) of right coronary artery
Right marginal branch
Heart | Coronary Arteries and Carddiac Veins: Variations
Anterior interventricular (left anterior descending) branch of left coronary artery is very short. Apical part of anterior (sternocostal) surface supplied by branches from posterior interventricular (posterior descending) branch of right coronary artery curving around apex.
Posterior interventricular (posterior descending) branch is derived from circumflex branch of left coronary artery instead of from right coronary artery.
Posterior interventricular (posterior descending) branch is absent. Area supplied chiefly by small branches from circumflex branch of left coronary artery and from right coronary artery.
Posterior interventricular (posterior descending) branch is absent. Area supplied chiefly by elongated anterior interventricular (left anterior descending) branch curving around apex.
Heart | Coronary Arteries: Arteriorgraphic Views
Right coronary artery: left anterior oblique view
Arteriogram
Sinuatrial (SA) nodal branch
Right coronary artery
Atrioventricular (AV) nodal branch
Branches to back of left ventricle
Right (acute) marginal branch
Posterior interventricular branch (posterior descending artery)
Right coronary artery: right anterior oblique view
Sinuatrial (SA) nodal branch
Conus (arteriosus) branch
Right coronary artery
Right (acute) marginal branch
Arteriogram
Atrioventricular (AV) nodal branch
Right posterolateral branches (to back of left ventricle)
Posterior interventricular branch (posterior descending artery)
Heart | Coronary Arteries: Arteriorgraphic Views (continued)
Left coronary artery: left anterior oblique view
Left coronary artery
Circumflex branch
Arteriogram
Anterior interventricular branch (left anterior descending)
Diagonal branches of anterior interventricular branch
Atrioventricular branch of circumflex branch
Left (obtuse) marginal branch
Posterolateral branches
(Perforating) interventricular septal branches
Left coronary artery: right anterior oblique view
Left coronary artery
Anterior interventricular branch (left anterior descending)
Circumflex branch
(Perforating) interventricular septal branches
Left (obtuse) marginal branch
Posterolateral branches
Diagonal branch of…
…Anterior interventricular branch
Atrioventricular branch of circumflex branch
Heart | Right Atrium and Ventricle
Opened right atrium: right lateral view
Ascending aorta
Superior vena cava
Right pulmonary artery
Pericardial reflection
Right superior pulmonary vein
Left atrium
Right inferior pulmonary vein
Interatrial septum
Limbus of fossa ovalis
Fossa ovalis
Valve (Eustachian) of inferior vena cava
Inferior vena cava
Pulmonary trunk
Right auricle (atrial appendage)
Conus arteriosus
Crista terminalis
Atrioventricular part of membranous septum
Septal cusp of tricuspid valve
Pectinate muscles
Opening of coronary sinus
Valve (Thebesian of coronary sinus)
Opened right ventricle: anterior view
Pericardial reflection
Aorta
Transverse pericardial sinus
Superior vena cava
Right auricle (atrial appendage)
Right atrium
Parietal limb
Membranous part of interventricular septum
Anterior cusp of Tricuspid valve
Septal cusp of Tricuspid valve
Posterior cusp of Tricuspid valve
Chordae tendineae
Posterior papillary muscle
Anterior papillary muscle
Trabeculae carneae
Pulmonary trunk
Transverse pericardial sinus
Anterior semilunar cusp of Pulmonary valve
Right semilunar cusp of Pulmonary valve
Left semilunar cusp of Pulmonary valve
Conus arteriosus
Supraventricular crest
Septal papillary muscle
Interventricular septum (muscular part)
Septomarginal trabecula (moderator band)
Heart | Left Atrium and Ventricle
Flap opened in posterolateral wall of left ventricle
Posterior papillary muscle
Chordae tendineae
Anterior papillary muscle
Posterior cusp of Mitral valve
Anterior cusp of Mitral valve
Oblique vein of left atrium (of Marshall)
Left auricle (atrial appendage)
Fold of left superior vena cava (ligament of Marshall)
Transverse pericardial sinus
Pericardial reflection
Arch of aorta
Ligamentum arteriosum
Left pulmonary artery
Right pulmonary artery
Left pulmonary veins
Left atrium
Right pulmonary veins
Coronary sinus
Inferior vena cava
Section through left atrium and ventricle with mitral valve cut away
Mitral valve (cut away)
Muscular part of interventricular septum
Interventricular part of Membranous septum
Atrioventricular part of Membranous septum
Left semilunar cusp of Aortic valve
Right semilunar cusp of Aortic valve
Posterior semilunar cusp of Aortic valve
Conus arteriosus
Left auricle (atrial appendage)
Arch of aorta
Left pulmonary artery
Right pulmonary artery
Left superior pulmonary vein
Valve of foramen ovale
Right pulmonary veins
Left atrium
Coronary sinus
Inferior vena cava
Heart | Valves of Fibrous Skeleton of Heart
Heart in diastole: viewed from base with atria removed
Left fibrous ring (of mitral valve)
Anterior cusp of Mitral valve
Commissural cusps of Mitral valve
Posterior cusp of Mitral valve
Circumflex branch*
Right (coronary) semilunar cusp of Aortic valve
Left (coronary) semilunar cusp of Aortic valve
Posterior (noncoronary) semilunar cusp of Aortic valve
Anterior semilunar cusp of Pulmonary valve
Right semilunar cusp of Pulmonary valve
Left semilunar cusp of Pulmonary valve
Conus arteriosus
Left fibrous trigone
Right coronary artery
Atrioventricular part of membranous septum
Anterior cusp of Tricuspid valve
Septal cusp of Tricuspid valve
Posterior cusp of Tricuspid valve
Right fibrous ring (of tricuspid valve)
Right fibrous trigone
Atrioventricular (AV) nodal branch✝
Posterior interventricular branch✝
Heart in systole: viewed from base with atria removed
Posterior interventricular branch✝
Left fibrous ring (of mitral valve)
Posterior cusp of Mitral valve
Anterior cusp of Mitral valve
Circumflex branch*
Posterior (noncoronary) semilunar cusp of Aortic valve
Left (coronary) semilunar cusp of Aortic valve
Right (coronary) semilunar cusp of Aortic valve
Left semilunar cusp of Pulmonary valve
Right semilunar cusp of Pulmonary valve
Anterior semilunar cusp of Pulmonary valve
Conus arteriosus
Left fibrous trigone
Right coronary artery
Interventricular part of Membranous septum
Atrioventricular part of Membranous septum
Anterior cusp of Tricuspid valve
Septal cusp of Tricuspid valve
Posterior cusp of Tricuspid valve
Right fibrous ring (of tricuspid valve)
Right fibrous trigone
Atrioventricular (AV) nodal branch✝
Heart | Valves and Fibrous Skeleton of Heart (continued)
Aortic valve
Muscular part of interventricular septum
Broken line indicating level of origin of tricuspid valve on opposite side of septum
Atrioventricular part of Membranous septum
Interventricular part of Membranous septum
Opening of right coronary artery
Aortic sinuses (of Valsalva)
Ascending aorta
Commissure of semilunar valve cusps
Opening of left coronary artery
Nodule of semilunar valve (body of Arantius)
Lunula
Left semilunar cusp of Aortic valve
Posterior semilunar cusp of Aortic valve
Right semilunar cusp of Aortic valve
Anterior papillary muscle
Anterior cusp of mitral valve
Tricuspid (right atrioventricular) valve
Posterior papillary muscle (sectioned)
Septal papillary muscle
Chordae tendineae
Opening of coronary sinus
Right atrium
Opening of inferior vena cava
Atrioventricular part of Membranous septum
Interventricular part (behind valve) of Membranous septum
Posterior cusp of Tricuspid valve
Anterior cusp of Tricuspid valve
Septal cusp of Tricuspid valve
Posterior papillary muscle (sectioned)
Anterior papillary muscle
Mitral (left atrioventricular valve)
Posterior papillary muscle
Anterior papillary muscle (sectioned)
Chordae tendineae
Left atrium
Anterior cusp of Mitral valve
Posterior cusp of Mitral valve
Commissural cusps of Mitral valve
Anterior papillary muscle (sectioned)
Fibrous (Albini’s) nodules
Heart | Atria, Ventricles, and Interventricular Septum
Atrioventricular part of Membranous septum
Interventricular part of Membranous septum
Superior vena cava
Posterior semilunar (non-coronary) cusp of Aortic valve
Left semilunar cusp of Aortic valve
Ascending aorta
Aortic sinus (of Valsalva)
Right superior pulmonary vein
Anterior cusp of Mitral valve
Posterior cusp of Mitral valve
Left pulmonary veins
Left auricle (atrial appendage)
Left atrium
Anterior cusp of mitral valve
Pulmonary trunk
Openings of coronary arteries
Ascending aorta
Right auricle (atrial appendage)
Left semilunar cusp of Aortic valve
Right semilunar cusp of Aortic valve
Supraventricular crest
Outflow to pulmonary trunk
Conus arteriosus
Right anterior papillary muscle (cut)
Right ventricle
Septomarginal trabecula
(moderator band)
Septal (medial) papillary muscle
Left ventricle
Left anterior papillary muscle
Left posterior papillary muscle
Left ventricle
Muscular part of interventricular septum
Right posterior papillary muscle
Right anterior papillary muscle (cut)
Right ventricle
Posterior cusp of Tricuspid valve
Septal cusp of Tricuspid valve
Anterior cusp (retracted) of Tricuspid valve
Right atrium
Heart | Conducting System of Heart
Right side
Inferior vena cava
Right fibrous ring (of tricuspid valve)
Note: Specific internodal conduction pathways in the atria may exist based on strong physiological and some anatomical evidence
Crista terminalis
Sinuatrial (SA) node
Sinuatrial (SA) nodal artery
Superior vena cava
Ascending aorta
Atrioventricular part of Membranous septum
Interventricular part of Membranous septum
Pulmonary valve
Atrioventricular (AV) node
Atrioventricular (AV) bundle (of His)
Right bundle
Purkinje fibers
Septomarginal trabecula (moderator brand)
Anterior papillary muscle
Subendocardial branches (Purkinje fibers)
Left side
Posterior papillary muscle
Subendocardial branches (Purkinje fibers)
Anterior papillary muscle
Left bundle
Atrioventricular part of Membranous septum
Interventricular part of Membranous septum
Right semilunar cusp of Aortic valve
Left semilunar cusp of Aortic valve
Posterior semilunar cusp of Aortic valve
Arch of aorta
Pulmonary trunk
Superior vena cava
Left auricle
Right pulmonary veins
Mitral valve (cut away)
Muscular part of interventricular septum
Heart | Nerves of Heart
Superior cervical sympathetic ganglion
Right vagus nerve (X)
(Conjoined sympathetic and vagal) superior cervical cardiac nerves
Middle cervical sympathetic ganglion
Middle cervical (sympathetic) cardiac nerve
Phrenic nerve
Inferior cervical (vagal) cardiac branch
Vertebral ganglion
Inferior thyroid artery
Vertebral artery
Cervicothoracic (stellate) ganglion
Ansa subclavia
Right recurrent laryngeal nerve
Inferior cervical (sympathetic) cardiac nerves
Thoracic cardiac branch of vagus nerve
4th thoracic sympathetic ganglion
Thoracic (sympathetic) cardiac branches
Cardiac plexus
Phrenic nerve (cut)
Superior cervical sympathetic ganglion
Left vagus nerve (X)
Superior cervical (sympathetic) cardiac nerve
Superior cervical (vagal) cardiac branch
Middle cervical sympathetic ganglion
Phrenic nerve
Middle cervical (sympathetic) cardiac nerve
Inferior cervical (vagal) cardiac branch
Vertebral ganglion
Cervicothoracic (stellate) ganglion
Inferior cervical sympathetic cardiac nerves
3rd thoracic sympathetic ganglion
Thoracic (sympathetic) cardiac branches
Thoracic cardiac branch of vagus nerve
Left recurrent laryngeal nerve
Heart | Innervation of Heart: Schema
Sympathetic preganglionic
Sympathetic postganglionic
Parasympathetic preganglionic
Parasympathetic postganglionic
Visceral afferent accompanying sympathetic fibers
Visceral afferent accompanying parasympathetic fibers
4th thoracic sympathetic ganglion
Thoracic (sympathetic) cardiac branches
Gray ramus communicans
White ramus communication
2nd thoracic sympathetic ganglion
Thoracic cardiac branch of vagus nerve
Inferior cervical (sympathetic) cardiac nerve
1st intercostal nerve
Cervicothoracic (stellate) ganglion
Ansa subclavia
Vertebral ganglion (variation)
Middle cervical (sympathetic) cardiac nerve
Middle cervical sympathetic ganglion
Superior cervical (sympathetic) cardiac nerve
Superior cervical sympathetic ganglion
Posterior nucleus of vagus nerve
Medulla oblongata
Nucleus of solitary tract
Vagus nerves
Superior cervical (vagal) cardiac branches
Inferior cervical (vagal) cardiac branches
Ascending connections
TI
T2
T3
T4
Cardiac plexus
Heart | Innervation of Blood Vessels: Schema
Preganglionic sympathetic fibers
Postganglionic sympathetic fibers
Postganglionic sympathetic fibers to lumbar and sacral plexuses and to nerves of lower limb
Lower lumbar sympathetic trunk ganglia
Gray ramus communicans
Spinal nerves
Fibers direct to vessels
Upper lumbar sympathetic trunk ganglia
Abdominopelvic splanchnic nerves
Lower thoracic sympathetic trunk ganglia
Intercostal nerves
Upper thoracic sympathetic trunk ganglia
Cardiopulmonary splanchnic and aortic nerves
Brachial plexus
Cervical cardiac nerves
White ramus communicans
Gray rami communicantes
Cervical sympathetic trunk ganglia
Internal carotid nerve
Heart | Prenatal and Postnatal Circulation
Prenatal circulation
Pulmonary trunk
Superior vena cava
Right pulmonary artery
Right pulmonary vein
Foramen ovale
Hepatic vein
Ductus venosus
Liver
Hepatic portal vein
Umbilical vein
Umbilical arteries
Aorta
Ductus arteriosus
Left pulmonary artery
Left pulmonary vein
Inferior vena cava
Aorta
Celiac trunk
Superior mesenteric artery
Kidney
Gut
Postnatal circulation
Ligamentum arteriosum (obliterated ductus arteriosus)
Fossa ovalis (obliterated foramen ovale)
Ligamentum venosum (obliterated ductus venosus)
Ligamentum teres (round ligament) of liver (obliterated umbilical vein)
Medial umbilical ligaments (occluded part of umbilical arteries)
Mediastinum | Mediastinum: Right Lateral View
*Nerves and vessels commonly run independently
Cervical (cupula, or dome, of) parietal pleura and suprapleural membrane (Sibson’s fascia)
1st rib
Trachea
Right vagus nerve (X)
Esophagus
Sympathetic trunk
Right superior intercostal vein
4th thoracic vertebral body
Arch of azygos vein
Right main bronchus and bronchial artery
Azygos vein
Posterior intercostal vein and artery and intercostal nerve
Internal intercostal muscle
Internal intercostal membrane deep to external intercostal muscle
Gray and white rami communicantes
Costal part of parietal pleura (cut edge)
Greater thoracic splanchnic nerve
Esophagus and esophageal plexus
Bronchopulmonary (hilar) lymph nodes
Pulmonary ligament (cut)
Anterior scalene muscle and phrenic nerve
Brachial plexus
Right subclavian artery and vein
Clavicle
Subclavius muscle
1st rib
Right and left brachiocephalic veins
Right internal thoracic artery
Thymus (seen through mediastinal pleura)
Superior vena cava
Phrenic nerve and pericardiacophrenic artery and vein*
Right pulmonary artery
Mediastinal part of parietal pleura (cut edge)
Fibrous pericardium over right atrium
Right pulmonary veins
Inferior vena cava (covered by mediastinal part of parietal pleura)
Diaphragm (covered by diaphragmatic part of parietal pleura)
Costal part of parietal pleura (cut edge)
Costodiaphragmatic recess of pleural activity
Mediastinum | Mediastinum: Left Lateral View
*Nerve and vessels commonly run independently
Anterior scalene muscle and phrenic nerve
Brachial plexus
Left subclavian vein and artery
Subclavius muscle
Clavicle
Left brachiocephalic vein
Left internal thoracic artery
Thymus (seen through mediastinal pleura)
Ligamentum arteriosum
Left pulmonary artery
Left phrenic nerve and pericardiacophrenic artery and vein*
Mediastinal part of parietal pleura (cut edge)
Fibrous pericardium
Left pulmonary veins
Pulmonary ligament (cut)
Fat pad
Esophagus and esophageal plexus (covered by mediastinal part of parietal pleura)
Diaphragm (covered by diaphragmatic part of parietal pleura)
Costodiaphragmatic recess of pleural cavity
Costal part of parietal pleura (cut edge)
Cervical (cupula, or dome, of) parietal pleura and suprapleural membrane (Sibson’s fascia)
1st rib
Esophagus
Thoracic duct
Left vagus nerve (X)
Left superior intercostal vein
Arch of aorta
Left recurrent laryngeal nerve
Bronchopulmonary (hilar) lymph nodes
Accessory hemiazygos vein
Posterior intercostal vein and artery and intercostal nerve
Internal intercostal muscle
Internal intercostal membrane deep to external intercostal muscle
Gray and white rami communicantes
Costal pleura (cut edge)
Sympathetic trunk
Greater thoracic splanchnic nerve
Thoracic (descending) aorta
Left main bronchus and bronchial artery
Mediastinum | Esophagus in Situ
Common carotid artery
Anterior scalene muscle
Phrenic nerve
Posterior scalene muscle
Brachial plexus
Subclavian artery
Thyrocervical trunk
Vagus nerve (X)
1st rib (cut)
Brachiocephalic trunk
Trachea
Arch of aorta
Arch of azygos vein
Right main bronchus
Superior lobar (eparterial) bronchus
Thoracic part of esophagus
Esophageal plexus
Mediastinal part of parietal pleura (cut edge)
Inferior vena cava (cut)
Hepatic veins (cut)
Right and left crura of diaphragm
Inferior phrenic arteries
Celiac trunk
Abdominal aorta
Longus colli muscle
Cervical part of esophagus
Recurrent laryngeal nerves
Thoracic duct
Internal jugular vein (cut)
Subclavian vein (cut)
Left brachiocephalic vein (cut)
Internal thoracic artery (cut)
Phrenic nerve (cut)
Common carotid artery
Subclavian artery
Vagus nerve (X)
Left recurrent laryngeal nerve
Bifurcation of trachea
Costal pleura (cut edge)
Left main bronchus
Thoracic (descending) aorta
Mediastinal part of parietal pleura (cut edge)
Pericardium (cut edge)
Diaphragm
Diaphragmatic part of parietal pleura
Anterior vagal trunk
Stomach
Abdominal part of esophagus
Mediastinum | Topography and Constrictions of Esophagus
Incisor teeth
Oropharynx
Epiglottis
Piriform fossa (recess)
Thyroid cartilage
Cricoid cartilage
Pharyngo esophageal constriction
Cricopharyngeus (muscle) part of inferior pharyngeal constrictor
Thoracic (aortobronchial) constriction
Trachea
Arch of aorta
Left main bronchus
Diaphragmatic constriction (inferior esophageal “sphincter”)
Abdominal part of esophagus
Cardiac part of stomach
Diaphragm
Fundus of stomach
Lateral view
Inferior pharyngeal constrictor muscle
Thyroid cartilage
Cricoid cartilage
Cricopharyngeus (muscle) part of inferior pharyngeal constrictor
Trachea
Esophagus
Arch of aorta
Sternum
Heart in pericardium
Diaphragm
C4
C6
T1
T3
T5
T7
T9
T11
L1
L3
Mediastinum | Musculature of Esophagus
Thyroid cartilage
Cricoid cartilage
Trachea
Left main bronchus
Inferior pharyngeal constrictor muscle
Pharyngeal raphe
Zone of sparse muscle fibers
Cricopharyngeus (muscle) part of inferior pharyngeal constrictor
Main longitudinal muscle bundle passing upward and ventrally to attach to middle of posterior surface of cricoid cartilage
Accessory muscle bundle from posterolateral surface of cricoid cartilage
Additional fibers from contralateral side of cricopharyngeus (muscle) part of inferior pharyngeal constrictor
Circular muscle layer with sparse longitudinal fibers in V-shaped area (of Laimer)
Bare area on ventral surface of esophagus
Lateral mass of longitudinal muscle
Fibroelastic membranes with sparse muscle fibers
Window cut in longitudinal muscle layer
Circular muscle layer
Mediastinum | Pharyngoesophageal Junction
Posterior view with pharynx opened and mucosa removed
Superior pharyngeal constrictor muscle
Root of tongue
Epiglottis
Middle pharyngeal constrictor muscle
Palatopharyngeus muscle of Longitudinal pharyngeal muscles
Stylopharngeus muscle of Longitudinal pharyngeal muscles
Pharyngoepiglottic fold
Laryngeal inlet (aditus)
Thyroid cartilage (superior horn)
Thyrohyoid membrane
Internal branch of superior laryngeal nerve and superior laryngeal artery and vein
Oblique arytenoid muscle
Transverse arytenoid muscle
Thyroid cartilage
Posterior cricoarytenoid muscle
Inferior pharyngeal constrictor muscle
Pharyngeal aponeurosis (cut away)
Zone of sparse muscle fibers
Cricopharyngeus (muscle) part of inferior pharyngeal constrictor
Cricoid cartilage (lamina)
Cricoesophageal tendon (attachment of longitudinal esophageal muscle)
Circular esophageal muscle
Esophageal mucosa and submucosa
Circular muscle in V-shaped area (of Laimer)
Right recurrent laryngeal nerve
Longitudinal esophageal muscle
Window cut in longitudinal muscle exposes circular muscle layer
Mediastinum | Esophagogastric Junction
Esophageal mucosa
Submucosa
Diaphragm
Subhiatal fat ring
Zigzag (Z) line: juncture of esophageal and gastric mucosa
Cardiac part (cardia) of stomach
Gastric folds (rugae)
Longitudinal esophageal muscle
Circular esophageal muscle
Gradual esophageal muscle
Gradual slight muscular thickening
Phrenoesophageal ligament (ascending or upper limb)
Supradiaphragmatic fascia
Diaphragm
Infradiaphragmatic (transversalis) fascia
Phrenoesophageal ligament (descending limb)
Peritoneum
Cardiac notch
Sliding hernia
Esophagus
Squamocolumnar junction
Peritoneal sac
Fundus of stomach
Cardiac notch
Longitudinal esophageal muscle (cut)
Circular esophageal muscle (shown here as spiral)
Collar of Helvetius
Window cut in middle circular muscle layer of stomach
Innermost oblique muscle layer of stomach (forms sling)
Outer longitudinal muscle layer of stomach (cut)
Mediastinum | Arteries of Esophagus
Esophageal branch of Inferior thyroid artery
Common carotid artery
Subclavian artery
Esophageal branch
Esophageal branch of Inferior thyroid artery
Cervical part of esophagus
Thyrocervical trunk
Subclavian artery
Vertebral artery
Internal thoracic artery
Common carotid artery
Brachiocephalic trunk
Trachea
Arch of aorta
3rd right posterior intercostal artery
Right bronchial artery
Superior left bronchial artery
Esophageal branch of right bronchial artery
Inferior left bronchial artery and esophageal branch
Thoracic (descending) aorta
Thoracic part of esophagus
Abdominal part of esophagus
Diaphragm
Stomach
Esophageal branch of left gastric artery
Left gastric artery
Celiac trunk
Splenic artery (cut)
Common hepatic artery (cut)
Inferior phrenic arteries
Common variations: Esophageal branches may originate from left inferior phrenic artery and/or directly from celiac trunk. Branches to abdominal esophagus may also come from splenic or short gastric arteries.
Mediastinum | Veins of Esophagus
Inferior thyroid vein
Internal jugular vein
External jugular vein
Subclavian vein
Vertebral vein
Right brachiocephalic vein
Superior vena cava
Right superior intercostal vein
Esophagus
6th right posterior intercostal vein
Azygos vein
Junction of accessory hemiazygos and azygos veins
Inferior vena cava (cut)
Diaphragm
Liver
Hepatic veins
Inferior vena cava
Hepatic portal vein
Right renal vein
Left gastric vein
Right gastric vein
Esophageal branches of left gastric vein
Right gastro-omental (gastroepiploic) vein
Superior mesenteric vein
Inferior mesenteric vein
Left gastro-omental (gastroepiploic) vein
Left renal vein
Omental (epiploic) veins
Left suprarenal vein
Splenic vein
Short gastric veins
Left inferior phrenic vein
Hemiazygos vein
Accessory hemiazygos vein
Esophageal veins (plexus)
Left superior intercostal vein
Left brachiocephalic vein
Thoracic duct
Subclavian
Internal jugular vein
Inferior thyroid vein
Submucous venous plexus
Mediastinum | Lymph Vessels and Nodes of Esophagus
Celiac nodes
Juxtaesophageal and superior phrenic nodes
Superior and inferior tracheobronchial nodes
Paratracheal nodes
Inferior deep cervical (internal jugular) nodes
Virchow’s node
Thoracic duct
Posterior mediastinal nodes of Posterior parietal nodes
Intercostal nodes of Posterior parietal nodes
Superior phrenic nodes
Left gastric nodes (cardiac nodes of stomach)
Mediastinum | Nerves of Esophagus
Anterior view
Esophagus
Recurrent laryngeal nerves
Right recurrent laryngeal nerve
Ansa subclavia
3rd intercostal nerve
Gray and white rami communicantes
3rd thoracic sympathetic ganglion
Thoracic sympathetic trunk
Right greater thoracic splanchnic nerve
Sympathetic fibers along left inferior phrenic artery
Branch of posterior vagal trunk to celiac plexus
Greater thoracic splanchnic nerves
Sympathetic fibers along esophageal branch of left gastric artery
Celiac plexus and ganglia
Superior ganglion of vagus nerve
Superior cervical of sympathetic ganglion
Inferior ganglion of vagus nerve
Pharyngeal branch of vagus nerve
Vagus nerve (X)
Superior laryngeal nerve
Cervical sympathetic trunk
Middle cervical sympathetic ganglion
Cervical (sympathetic and vagal) cardiac nerves
Vertebral ganglion of cervical sympathetic trunk
Ansa subclavia
Branch to esophagus and recurrent nerve from stellate ganglion
Cervicothoracic (stellate) ganglion
Left recurrent laryngeal nerve
Thoracic (vagal and sympathetic) cardiac branches
Cardiac plexus
Pulmonary plexuses
Esophageal plexus (anterior portion)
Branches to esophageal plexus from sympathetic trunk, greater, thoracic splanchnic nerve, and thoracic
aortic plexus
Left greater thoracic splanchnic nerve
Anterior vagal trunk
Vagal branch to hepatic plexus via lesser omentum
Principal anterior vagal branch to lesser curvature of stomach
Vagal branch to fundus and body of stomach
Posterior view
Esophageal plexus (posterior portion)
Posterior vagal trunk
Vagal branch to celiac plexus
Posterior vagal branch to lesser curvature
Vagal branch to fundus and cardiac part of stomach
Mediastinum | Mediastinum: Cross Section
Sternum
Right ventricle
Septal cusp of Tricuspid valve
Posterior cusp of Tricuspid valve
Anterior cusp of Tricuspid valve
Interventricular part of membranous septum
Atrioventricular part of membranous septum
Superior vena cava
Right atrium
Pericardial cavity
Mediastinal part of parietal pleura
Right lung (middle lobe)
Phrenic nerve and pericardiacophrenic artery and vein
Branches of right main bronchus
Right inferior pulmonary vein
Oblique pericardial sinus
Esophagus and esophageal plexus
Azygos vein
Thoracic duct
T8 vertebra
Left greater thoracic splanchnic nerve
Left sympathetic trunk
Hemiazygos vein
8th rib
Thoracic (descending) aorta
Left inferior pulmonary vein
Branches of left main bronchus
Left lung (superior lobe)
Coronary sinus
Left atrium
Anterior cusp of Mitral valve
Posterior cusp of Mitral valve
Phrenic nerve and pericardiacophrenic artery and vein
Papillary muscle
Left ventricle
Muscular part of interventricular septum
Pleural cavity
Pectoralis major muscle
Transversus thoracis muscle
Internal thoracic artery and vein
5th left costal cartilage
Regional Scans | Chest Scans: Axial CT Images
Series of chest axial CT images from superior (A) to inferior (C)
Ascending aorta
Descending aorta
Azygos vein
Body of vertebra
Inferior vena cava
Liver
Left (main stem) bronchus
Left superior lobe of lung
Left ventricle
Pulmonary artery
Rib
Right (main stem) bronchus
Right superior lobe of lung
Right ventricle
Sternum
Spinal cord
Spinous process of vertebra
Superior vena cava
Trachea (bifurcation)
Cross-Sectional Anatomy | Cross Section of Thorax at T3 Level
Transverse Section: Lower Level of T3, Sternoclavicular Joint
Manubrium
Brachiocephalic trunk
Trachea
Left brachiocephalic vein
Left common carotid artery
Left vagus nerve (X)
Pectoralis minor muscle
Left subclavian artery
Shaft or left humerus
Long head of triceps brachii muscle
Teres minor muscle
Scapula
Left lung
Infraspinatus muscle
Serratus anterior muscle
Left recurrent laryngeal nerve
Thoracic duct
Erector spinae muscle
Rhomboid major muscle
Transversospinalis muscle
Spinal cord
Body of T3 vertebra
Trapezius muscle
Costotransverse joint
Rhomboid major muscle
Esophagus
Right vagus nerve (X)
Phrenic nerve
Subscapularis muscle
Intercostal muscles
Teres minor muscle
Deltoid muscle
Surgical neck of right humerus
Tendon of long head of biceps brachii muscle
Axillary fossa
Right lung
Pectoralis major muscle
Costal cartilage of 1st rib
Right brachiocephalic vein
Clavicle
Sternoclavicular joint (articular disc)
Mediastinal lymph node
Cross-Sectional Anatomy | Cross Section of Thorax at T3-4 Level
Transverse Section: T3-4 Intervertebral Disc, Manubrium
Trachea
Thymus
Manubrium
Arch of aorta
Internal thoracic artery and vein
Left lung
Ribs
Pectoralis major muscle
Pectoralis minor muscle
Axillary fossa
Combined short head of biceps brachii and coracobrachialis muscles
Tendon of long head of biceps brachii muscle
Shaft of humerus
Lateral head of triceps brachii muscle
Long head of triceps brachii muscle
Left latissimus dorsi tendon (inserting onto humerus)
Teres major muscle
Subscapularis muscle
Teres minor muscle
Scapula
Infraspinatus muscle
Oblique fissure (of left lung)
Left vagus nerve (X)
Left recurrent laryngeal nerve
Spinal cord
Trapezius muscle
Rhomboid muscle
T3-4 intervertebral disc
Thoracic duct
Esophagus
Scapula
Teres minor muscle
Teres major muscle
Long head of triceps brachii muscle
Deltoid muscle
Shaft of humerus
Latissimus dorsi
Tendon of long head of biceps brachii muscle
Serratus anterior muscle
Intercostal muscles
Right lung
Arch of azygos vein
Right phrenic nerve
Superior vena cava
Superior tracheobronchial lymph node
Cross-Sectional Anatomy | Cross Section of Thorax at T4-5 Level
Transverse Section: T4-5 Intervertebral Disc, Sternal Angle
Manubriosternal junction
Internal thoracic artery and vein
2nd costal cartilage
Pulmonary trunk
Left pulmonary artery
Left lung
Pectoralis minor muscle
Ribs
Long head of biceps brachii muscle
Shaft of humerus
Latissimus dorsi tendon
Teres major muscle
Serratus anterior muscle
Subscapularis muscle
Left main bronchus
Descending aorta
Accessory hemiazygos vein
Trapezius muscle
Thoracic duct
T4-5 intervertebral disc
Esophagus
Azygos vein
Right main bronchus
Rhomboid major muscle
Infraspinatus muscle
Scapula
Teres major muscle
Long head of triceps brachii muscle
Latissimus dorsi tendon
Lateral head of triceps brachii muscle
Deltoid muscle
Coracobrachialis
Tendon of long head of biceps brachii muscle
Axillary fossa
Right lung
Pectoralis major muscle
Superior vena cava
Right pulmonary artery
Ascending aorta
Inferior tracheobronchial lymph nodes
Cross-Sectional Anatomy | Cross Section of Thorax at T7 Level
Transverse Section: Level of T7, 3rd Interchondral Space
Sternum (body)
Right ventricle
Anterior interventricular sulcus
Pectoralis major muscle
Apex of heart
Interventricular septum
Papillary muscle
Left ventricle
Leaflet of mitral valve
Coronary sulcus
Coronary sinus
Oblique pericardial sinus
Descending aorta
Thoracic duct
Latissimus dorsi muscle
Triangle of auscultation
Head of 7th rib
Body of T7 vertebra
Trapezius muscle
Zygapophyseal (facet) joint
Neck of 7th rib
Triangle of auscultation
Inferior angle of scapula
Latissimus dorsi muscle
Serratus anterior muscle
Azygos vein
Esophagus
Right inferior pulmonary vein
Superior vena cava
Interatrial septum
Right atrium
Left atrium
Internal thoracic artery and vein
Coronary sulcus
Orifice of tricuspid valve
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