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What is anatomy? Anatomy includes those structures that can be seen grossly (without the aid of magnification) and microscopically (with the aid of magnification). Typically, when used by itself, the term anatomy tends to mean gross or macroscopic anatomy—that is, the study of structures that can be seen without using ...
The anatomical position is the standard reference position of the body used to describe the location of structures (Fig. 1.1). The body is in the anatomical position when standing upright with feet together, hands by the side and face looking forward. The mouth is closed and the facial expression is neutral. The rim of...
In 1895 Wilhelm Roentgen used the X-rays from a cathode ray tube to expose a photographic plate and produce the first radiographic exposure of his wife’s hand. Over the past 35 years there has been a revolution in body imaging, which has been paralleled by developments in computer technology. X-rays are photons (a type...
Ultrasonography of the body is widely used for all aspects of medicine. Ultrasound is a very high frequency sound wave (not electromagnetic radiation) generated by piezoelectric materials, such that a series of sound waves is produced. Importantly, the piezoelectric material can also receive the sound waves that bounce...
Diffusion-weighted imaging provides information on the degree of Brownian motion of water molecules in various tissues. There is relatively free diffusion in extracellular spaces and more restricted diffusion in intracellular spaces. In tumors and infarcted tissue, there is an increase in intracellular fluid water mole...
In most instances (apart from chest radiography) the X-ray tube is 1 m away from the X-ray film. The object in question, for example a hand or a foot, is placed upon the film. When describing subject placement for radiography, the part closest to the X-ray tube is referred to first and that closest to the film is refer...
The great advantage of CT scanning is the ability to extend and compress the gray scale to visualize the bones, soft tissues, and visceral organs. Altering the window settings and window centering provides the physician with specific information about these structures. There is no doubt that MRI has revolutionized the ...
There are two types of bone, compact and spongy (trabecular or cancellous). Compact bone is dense bone that forms the outer shell of all bones and surrounds spongy bone. Spongy bone consists of spicules of bone enclosing cavities containing blood-forming cells (marrow). Classification of bones is by shape. Long bones a...
The fibrous membrane is formed by dense connective tissue and surrounds and stabilizes the joint. Parts of the fibrous membrane may thicken to form ligaments, which further stabilize the joint. Ligaments outside the capsule usually provide additional reinforcement. Another common but not universal feature of synovial j...
Synchondroses occur where two ossification centers in a developing bone remain separated by a layer of cartilage, for example, the growth plate that occurs between the head and shaft of developing long bones. These joints allow bone growth and eventually become completely ossified. Symphyses occur where two separate bo...
Cardiac muscle is striated muscle found only in the walls of the heart (myocardium) and in some of the large vessels close to where they join the heart. It consists of a branching network of individual cells linked electrically and mechanically to work as a unit. Its contractions are less powerful than those of skeleta...
Lymphatic vessels form an extensive and complex interconnected network of channels, which begin as “porous” blind-ended lymphatic capillaries in tissues of the body and converge to form a number of larger vessels, which ultimately connect with large veins in the root of the neck. Lymphatic vessels mainly collect fluid ...
Lymph from the right side of the head and neck, the right upper limb, and the right side of the thorax is carried by lymphatic vessels that connect with veins on the right side of the neck. Lymph from all other regions of the body is carried by lymphatic vessels that drain into veins on the left side of the neck. Speci...
Somatic nerves arise segmentally along the developing CNS in association with somites, which are themselves arranged segmentally along each side of the neural tube (Fig. 1.34). Part of each somite (the dermatomyotome) gives rise to skeletal muscle and the dermis of the skin. As cells of the dermatomyotome differentiate...
Muscles that move the shoulder joint are innervated mainly by spinal nerves from spinal cord levels C5 and C6. Muscles that move the elbow are innervated mainly by spinal nerves from spinal cord levels C6 and C7. Muscles in the hand are innervated mainly by spinal nerves from spinal cord levels C8 and T1. Visceral part...
Spinal sympathetic and spinal parasympathetic neurons share certain developmental and phenotypic features that are different from those of cranial parasympathetic neurons. Based on this, some researchers have suggested reclassifying all spinal visceral motor neurons as sympathetic (Espinosa-Medina I et al. Science 2016...
The ascending and descending fibers, together with all the ganglia, form the paravertebral sympathetic trunk, which extends the entire length of the vertebral column. The formation of this trunk, on each side, enables visceral motor fibers of the sympathetic part of the autonomic division of the PNS, which ultimately e...
Like the visceral motor nerves of the sympathetic part, the visceral motor nerves of the parasympathetic part generally have two neurons in the pathway. The preganglionic neurons are in the CNS, and fibers leave in the cranial nerves. In the sacral region, the preganglionic parasympathetic fibers form special visceral ...
Sensory information from the enteric system is carried back to the CNS by visceral sensory fibers. Nerve plexuses are either somatic or visceral and combine fibers from different sources or levels to form new nerves with specific targets or destinations (Fig. 1.49). Plexuses of the enteric system also generate reflex a...
Fig. 1.17 Image of the hip joints demonstrating loss of height of the right femoral head with juxta-articular bony sclerosis and subchondral cyst formation secondary to avascular necrosis. There is also significant wasting of the muscles supporting the hip, which is secondary to disuse and pain. Normal left hipBladderA...
C6 segment of spinal cordSpinal ganglionDermatomyotomeAutonomous region(where overlap ofdermatomes isleast likely)of C6 dermatome(pad of thumb)Skin on the lateral side of the forearm and on thethumb is innervated by C6 spinal level (spinal nerve).The dermis of the skin in this region develops from the somiteinitially a...
White ramus communicansGray ramus communicansSacral splanchnic nervesLumbar splanchnic nervesLeast splanchnic nervesLesser splanchnic nervesGreater splanchnic nervesPrevertebral plexusand gangliaParavertebralsympathetic trunkAbdominalandpelvic visceraAortaT5 to T9T12T9 to T10(T10 to T11)L1 to L2 Fig. 1.47 Parasympathet...
Up until the age of skeletal maturity, bony growth and development follows a typically predictable ordered state, which can be measured through either ultrasound, plain radiographs, or MRI scanning. Typically, the nondominant (left) hand is radiographed, and the radiograph is compared to a series of standard radiograph...
As the skeleton develops, there are stages of intense growth typically around the ages of 7 to 10 years and later in puberty. These growth spurts are associated with increased cellular activity around the growth plate between the head and shaft of a bone. This increase in activity renders the growth plates more vulnera...
In the clinic The importance of fascias A fascia is a thin band of tissue that surrounds muscles, bones, organs, nerves, and blood vessels and often remains uninterrupted as a 3D structure between tissues. It provides important support for tissues and can provide a boundary between structures. Clinically, fascias are e...
In normal individuals the movement of adjacent leg muscles pumps the blood in the veins to the heart. Blood is also pumped from the superficial veins through the investing layer of fascia of the leg into the deep veins. Valves in these perforating veins may become damaged, allowing blood to pass in the opposite directi...
Referred pain occurs when sensory information comes to the spinal cord from one location but is interpreted by the CNS as coming from another location innervated by the same spinal cord level. Usually, this happens when the pain information comes from a region, such as the gut, which has a low amount of sensory output....
Secondary curvatures, which are concave posteriorly, form in the cervical and lumbar regions and bring the center of gravity into a vertical line, which allows the body’s weight to be balanced on the vertebral column in a way that expends the least amount of muscular energy to maintain an upright bipedal stance. As str...
Muscles in the back can be classified as extrinsic or intrinsic based on their embryological origin and type of innervation (Fig. 2.7). The extrinsic muscles are involved with movements of the upper limbs and thoracic wall and, in general, are innervated by anterior rami of spinal nerves. The superficial group of these...
The bones of the back provide extensive attachments for muscles associated with anchoring and moving the upper limbs on the trunk. This is less true of the lower limbs, which are firmly anchored to the vertebral column through articulation of the pelvic bones with the sacrum. The upper and lower limbs are innervated by...
In the embryo, the vertebrae are formed intersegmentally from cells called sclerotomes, which originate from adjacent somites (Fig. 2.18). Each vertebra is derived from the cranial parts of the two somites below, one on each side, and the caudal parts of the two somites above. The spinal nerves develop segmentally and ...
The dens acts as a pivot that allows the atlas and attached head to rotate on the axis, side to side. The transverse processes of the atlas are large and protrude further laterally than those of the other cervical vertebrae and act as levers for muscle action, particularly for muscles that move the head at the atlanto-...
In most regions of the vertebral column, the laminae and spinous processes of adjacent vertebrae overlap to form a reasonably complete bony dorsal wall for the vertebral canal. However, in the lumbar region, large gaps exist between the posterior components of adjacent vertebral arches (Fig. 2.23). These gaps between a...
The posterior longitudinal ligament is on the posterior surfaces of the vertebral bodies and lines the anterior surface of the vertebral canal. Like the anterior longitudinal ligament, it is attached along its length to the vertebral bodies and intervertebral discs. The upper part of the posterior longitudinal ligament...
The superior fibers of the trapezius, from the skull and upper portion of the vertebral column, descend to attach to the lateral third of the clavicle and to the acromion of the scapula. Contraction of these fibers elevates the scapula. In addition, the superior and inferior fibers work together to rotate the lateral a...
Serratus posterior superior is deep to the rhomboid muscles, whereas serratus posterior inferior is deep to the latissimus dorsi. Both serratus posterior muscles are attached to the vertebral column and associated structures medially, and either descend (the fibers of the serratus posterior superior) or ascend (the fib...
The erector spinae is the largest group of intrinsic back muscles. The muscles lie posterolaterally to the vertebral column between the spinous processes medially and the angles of the ribs laterally. They are covered in the thoracic and lumbar regions by thoracolumbar fascia and the serratus posterior inferior, rhombo...
One muscle in the transversospinales group, the semispinalis capitis, has a unique action because it attaches to the skull. Contracting bilaterally, this muscle pulls the head posteriorly, whereas unilateral contraction pulls the head posteriorly and turns it, causing the chin to move superiorly and turn toward the sid...
The posterolateral sulcus on each side of the posterior surface marks where the posterior rootlets of spinal nerves enter the cord. Internally, the cord has a small central canal surrounded by gray and white matter: The gray matter is rich in nerve cell bodies, which form longitudinal columns along the cord, and in cro...
As spinal nerves and their roots pass laterally, they are surrounded by tubular sleeves of dura mater, which merge with and become part of the outer covering (epineurium) of the nerves. The arachnoid mater is a thin delicate membrane against, but not adherent to, the deep surface of the dura mater (Fig. 2.59). It is se...
When carrying out a lumbar puncture (spinal tap), the needle passes between adjacent vertebral spinous processes, through the supraspinous and interspinous ligaments, and enters the extradural space. The needle continues through the dura and arachnoid mater and enters the subarachnoid space, which contains CSF. Each sp...
Surface features of the back are used to locate muscle groups for testing peripheral nerves, to determine regions of the vertebral column, and to estimate the approximate position of the inferior end of the spinal cord. They are also used to locate organs that occur posteriorly in the thorax and abdomen. Absence of lat...
The tips of the vertebral spinous processes do not always lie in the same horizontal plane as their corresponding vertebral bodies. In thoracic regions, the spinous processes are long and sharply sloped downward so that their tips lie at the level of the vertebral body below. In other words, the tip of the TIII vertebr...
Fig. 2.9 Spinal nerves (transverse section). Fig. 2.10 Relationships of the back to other regions. Cervical region• supports and moves head• transmits spinal cord and vertebral arteries between head and neck Thoracic region• support for thoraxLumbar region• support for abdomenSacral region• transmits weight to lowe...
Transverse processDensDensForamen transversariumSuperior viewSuperior viewSuperior viewPosterior viewPosterosuperior viewBAnterior tuberclePosterior tubercleAnterior archLateral massPosterior archFacet for densFacet for occipital condyleImpressionsfor alarligamentsAlarligamentsTectorial membrane (upper partof posterior...
Fig. 2.36 Ligamenta flava. Fig. 2.37 Supraspinous ligament and ligamentum nuchae. Fig. 2.38 Interspinous ligaments. Fig. 2.39 Axial slice MRI through the lumbar spine demonstrating bilateral hypertrophy of the ligamentum flavum. Fig. 2.40 Radiograph of lumbar region of vertebral column, oblique view (“Scottie dog”). A....
Spinous process of CIIPosterior ramus of C1Obliquus capitis superior Rectus capitis posterior minorObliquus capitis inferiorRectus capitis posterior majorSplenius capitisSplenius capitisLongissimus capitisSemispinalis cervicisSemispinalis capitisSemispinalis capitisVertebral artery Fig. 2.53 Spinal cord. End of spinalc...
Spine of scapulaInferior angle of scapulaMedial border of scapulaPosition of externaloccipital protuberancePosterior superior iliac spineIliac crest Fig. 2.67 The back with the positions of vertebral spinous processes and associated structures indicated. A. In a man. B. In a woman with neck flexed. The prominent CVII a...
Vertebroplasty is a relatively new technique in which the body of a vertebra can be filled with bone cement (typically methyl methacrylate). The indications for the technique include vertebral body collapse and pain from the vertebral body, which may be secondary to tumor infiltration. The procedure is most commonly pe...
One of the commonest abnormalities in the lumbar vertebrae is a partial fusion of vertebra LV with the sacrum (sacralization of the lumbar vertebra). Partial separation of vertebra SI from the sacrum (lumbarization of first sacral vertebra) may also occur (Fig. 2.29B). The LV vertebra can usually be identified by the i...
In cervical regions of the vertebral column, cervical disc protrusions often become ossified and are termed disc osteophyte bars. In the clinic Some diseases have a predilection for synovial joints rather than symphyses. A typical example is rheumatoid arthritis, which primarily affects synovial joints and synovial bur...
The most common sites for pars interarticularis fractures are the LIV and LV levels (Fig. 2.40B,C). (Clinicians often refer to parts of the back in shorthand terms that are not strictly anatomical; for example, facet joints and apophyseal joints are terms used instead of zygapophysial joints, and spinal column is used ...
Fractures of vertebra CI (the atlas) and vertebra CII (the axis) can potentially lead to the worst types of spinal cord injury including death and paralysis due to injury of the brainstem, which contains the cardiac and respiratory centers. The atlas is a closed ring with no vertebral body. Axial-loading injuries, such...
In some instances, anesthesiologists choose to carry out extradural anesthesia. A needle is placed through the skin, supraspinous ligament, interspinous ligament, and ligamenta flava into the areolar tissue and fat around the dura mater. Anesthetic agent is introduced and diffuses around the vertebral canal to anesthet...
The collection of lumbar and sacral nerve roots beyond the conus medullaris has a horsetail-like appearance, from which it derives its name “cauda equina.” Compression of the cauda equina may be caused by a herniating disc (as in this case), fracture fragments following traumatic injury, tumor, abscess, or severe degen...
A 72-year-old fit and healthy man was brought to the emergency department with severe back pain beginning at the level of the shoulder blades and extending to the midlumbar region. The pain was of relatively acute onset and was continuous. The patient was able to walk to the gurney as he entered the ambulance; however,...
A 55-year-old woman came to her physician with sensory alteration in the right gluteal (buttock) region and in the intergluteal (natal) cleft. Examination also demonstrated low-grade weakness of the muscles of the foot and subtle weakness of the extensor hallucis longus, extensor digitorum longus, and fibularis tertius...
Another important feature of the pleural cavities is that they extend above the level of rib I. The apex of each lung actually extends into the root of the neck. As a consequence, abnormal events in the root of the neck can involve the adjacent pleura and lung, and events in the adjacent pleura and lung can involve the...
Completely surrounded by skeletal elements, the superior thoracic aperture consists of the body of vertebra TI posteriorly, the medial margin of rib I on each side, and the manubrium anteriorly. The superior margin of the manubrium is in approximately the same horizontal plane as the intervertebral disc between vertebr...
The pleura lining the walls of the cavity is the parietal pleura, whereas that reflected from the mediastinum at the roots and onto the surfaces of the lungs is the visceral pleura. Only a potential space normally exists between the visceral pleura covering lung and the parietal pleura lining the wall of the thoracic c...
The horizontal plane passing through the disc that separates thoracic vertebrae TIV and TV is one of the most significant planes in the body (Fig. 3.10) because it: passes through the sternal angle anteriorly, marking the position of the anterior articulation of the costal cartilage of rib II with the sternum. The ster...
The thoracic wall is expandable because most ribs articulate with other components of the wall by true joints that allow movement, and because of the shape and orientation of the ribs (Fig. 3.14). A rib’s posterior attachment is superior to its anterior attachment. Therefore, when a rib is elevated, it moves the anteri...
The breast lies on deep fascia related to the pectoralis major muscle and other surrounding muscles. A layer of loose connective tissue (the retromammary space) separates the breast from the deep fascia and provides some degree of movement over underlying structures. The base, or attached surface, of each breast extend...
The thoracic wall is segmental in design and composed of skeletal elements and muscles. It extends between: the superior thoracic aperture, bordered by vertebra TI, rib I, and the manubrium of the sternum; and the inferior thoracic aperture, bordered by vertebra TXII, rib XII, the end of rib XI, the costal margin, and ...
The superior margin is smooth and rounded, whereas the inferior margin is sharp. The shaft bends forward just laterally to the tubercle at a site termed the angle. It also has a gentle twist around its longitudinal axis so that the external surface of the anterior part of the shaft faces somewhat superiorly relative to...
Together, the costovertebral joints and related ligaments allow the necks of the ribs either to rotate around their longitudinal axes, which occurs mainly in the upper ribs, or to ascend and descend relative to the vertebral column, which occurs mainly in the lower ribs. The combined movements of all of the ribs on the...
In addition, the sternal angle lies on a horizontal plane that passes through the intervertebral disc between vertebrae TIV and TV (see Fig. 3.10). This plane separates the superior mediastinum from the inferior mediastinum and marks the superior border of the pericardium. The plane also passes through the end of the a...
The eleven pairs of internal intercostal muscles pass between the most inferior lateral edge of the costal grooves of the ribs above, to the superior margins of the ribs below. They extend from parasternal regions, where the muscles course between adjacent costal cartilages, to the angle of the ribs posteriorly (Fig. 3...
Each internal thoracic artery arises as a major branch of the subclavian artery in the neck. It passes anteriorly over the cervical dome of the pleura and descends vertically through the superior thoracic aperture and along the deep aspect of the anterior thoracic wall. On each side, the internal thoracic artery lies p...
The intercostal nerves end as anterior cutaneous branches, which emerge either parasternally, between adjacent costal cartilages, or laterally to the midline, on the anterior abdominal wall, to supply the skin. In addition to these major branches, small collateral branches can be found in the intercostal space running ...
Venous drainage of the diaphragm is by veins that generally parallel the arteries. The veins drain into: the brachiocephalic veins in the neck, the azygos system of veins, or abdominal veins (left suprarenal vein and inferior vena cava). The diaphragm is innervated by the phrenic nerves (C3, C4, and C5), which penetrat...
Covering the superior surface of the cervical pleura is a distinct dome-like layer of fascia, the suprapleural membrane (Fig. 3.38). This connective tissue membrane is attached laterally to the medial margin of the first rib and behind to the transverse process of vertebra CVII. Superiorly, the membrane receives muscle...
The largest and clinically most important recesses are the costodiaphragmatic recesses, which occur in each pleural cavity between the costal pleura and diaphragmatic pleura (Fig. 3.40). The costodiaphragmatic recesses are the regions between the inferior margin of the lungs and inferior margin of the pleural cavities....
On the right side, the lobar bronchus to the superior lobe branches from the main bronchus in the root, unlike on the left where it branches within the lung itself, and is superior to the pulmonary artery. The right lung has three lobes and two fissures (Fig. 3.45A). Normally, the lobes are freely movable against each ...
The left subclavian artery and vein arch over and are related to the superior lobe of the left lung as they pass over the dome of the cervical pleura and into the axilla. The trachea is a flexible tube that extends from vertebral level CVI in the lower neck to vertebral level TIV/V in the mediastinum where it bifurcate...
The bronchial arteries (Fig. 3.49) and veins constitute the “nutritive” vascular system of the pulmonary tissues (bronchial walls and glands, walls of large vessels, and visceral pleura). They interconnect within the lung with branches of the pulmonary arteries and veins. The bronchial arteries originate from the thora...
The anterior mediastinum is posterior to the body of the sternum and anterior to the pericardial sac (see Fig. 3.57). Its superior boundary is a transverse plane passing from the sternal angle to the intervertebral disc between vertebra TIV and TV, separating it from the superior mediastinum. Its inferior boundary is t...
When the pericardium is opened anteriorly during surgery, a finger placed in the transverse sinus separates arteries from veins. A hand placed under the apex of the heart and moved superiorly slips into the oblique sinus. The pericardium is supplied by branches from the internal thoracic, pericardiacophrenic, musculoph...
The obtuse margin separates the anterior and left pulmonary surfaces (Fig. 3.63)—it is round and extends from the left auricle to the cardiac apex (Fig. 3.65), and is formed mostly by the left ventricle and superiorly by a small portion of the left auricle. For radiological evaluations, a thorough understanding of the ...
The space posterior to the crista is the sinus of venae cavae and is derived embryologically from the right horn of the sinus venosus. This component of the right atrium has smooth, thin walls, and both venae cavae empty into this space. The space anterior to the crista, including the right auricle, is sometimes referr...
A single specialized trabeculum, the septomarginal trabecula (moderator band), forms a bridge between the lower portion of the interventricular septum and the base of the anterior papillary muscle. The septomarginal trabecula carries a portion of the cardiac conduction system, the right bundle of the atrioventricular b...
The interatrial septum is part of the anterior wall of the left atrium. The thin area or depression in the septum is the valve of the foramen ovale and is opposite the floor of the fossa ovalis in the right atrium. During development, the valve of the foramen ovale prevents blood from passing from the left atrium to th...
The cardiac skeleton is a collection of dense, fibrous connective tissue in the form of four rings with interconnecting areas in a plane between the atria and the ventricles. The four rings of the cardiac skeleton surround the two atrioventricular orifices, the aortic orifice and opening of the pulmonary trunks. They a...
The anterior interventricular branch (left anterior descending artery—LAD) (Fig. 3.78A,C) continues around the left side of the pulmonary trunk and descends obliquely toward the apex of the heart in the anterior interventricular sulcus (Fig. 3.78A,C). During its course, one or two large diagonal branches may arise and ...
Other cardiac veins. Two additional groups of cardiac veins are also involved in the venous drainage of the heart. The anterior veins of the right ventricle (anterior cardiac veins) are small veins that arise on the anterior surface of the right ventricle (Fig. 3.82A). They cross the coronary sulcus and enter the anter...
The left bundle branch passes to the left side of the muscular interventricular septum and descends to the apex of the left ventricle (Fig. 3.83B). Along its course it gives off branches that eventually become continuous with the subendocardial plexus of conduction cells (Purkinje fibers). As with the right side, this ...
The pulmonary trunk is contained within the pericardial sac (Fig. 3.85), is covered by the visceral layer of serous pericardium, and is associated with the ascending aorta in a common sheath. It arises from the conus arteriosus of the right ventricle at the opening of the pulmonary trunk slightly anterior to the aortic...
The major structures found in the superior mediastinum (Figs. 3.86 and 3.87) include the: thymus, right and left brachiocephalic veins, left superior intercostal vein, superior vena cava, arch of the aorta with its three large branches, trachea, esophagus, phrenic nerves, vagus nerves, left recurrent laryngeal branch o...
The lower half of the superior vena cava is within the pericardial sac and is therefore contained in the middle mediastinum. The superior vena cava receives the azygos vein immediately before entering the pericardial sac and may also receive pericardial and mediastinal veins. The superior vena cava can be easily visual...
The trachea divides into the right and left main bronchi at, or just inferior to, the transverse plane between the sternal angle and vertebral level TIV/V (Fig. 3.93), whereas the esophagus continues into the posterior mediastinum. Nerves of the superior mediastinum The vagus nerves [X] pass through the superior and po...
The left phrenic nerve enters the superior mediastinum in a position similar to the path taken by the right phrenic nerve. It lies lateral to the left vagus nerve and lateral and slightly posterior to the beginning of the left brachiocephalic vein (see Fig. 3.89), and continues to descend across the left lateral surfac...
Structures other than the thoracic duct posterior to the esophagus include portions of the hemiazygos veins, the right posterior intercostal vessels, and, near the diaphragm, the thoracic aorta. The esophagus is a flexible, muscular tube that can be compressed or narrowed by surrounding structures at four locations (Fi...
The thoracic portion of the descending aorta (thoracic aorta) begins at the lower edge of vertebra TIV, where it is continuous with the arch of the aorta. It ends anterior to the lower edge of vertebra TXII, where it passes through the aortic hiatus posterior to the diaphragm. Situated to the left of the vertebral colu...
The accessory hemiazygos vein (superior hemiazygos vein) descends on the left side from the superior portion of the posterior mediastinum to approximately vertebral level TVIII (Fig. 3.102). At this point, it crosses the vertebral column to join the azygos vein, or ends in the hemiazygos vein, or has a connection to bo...
The second type, which includes branches from the lower seven ganglia, consists mainly of preganglionic sympathetic fibers, which supply the various abdominal and pelvic viscera. These branches are large, also carry visceral afferent fibers, and form the three thoracic splanchnic nerves referred to as the greater, less...
The arch of the aorta begins and ends at the transverse plane between the sternal angle anteriorly and vertebral level TIV/V posteriorly. The arch may reach as high as the midlevel of the manubrium of the sternum. Visualizing the margins of the heart Surface landmarks can be palpated to visualize the outline of the hea...
Left pleural cavitySternal angleManubrium of sternumXiphoid processInferior thoracic apertureSuperior thoracic apertureBody of sternumRight pleural cavityDiaphragmVertebral columnRib IRibsMediastinum Fig. 3.2 Joints between ribs and vertebrae. Fig. 3.3 Superior thoracic aperture. Manubriumof sternumEsophagusCommon caro...
LaminaSpinous processTransverse processPedicleVertebral bodyPosteriorAnteriorVertebral foramenSuperior demifacetFacet for articulation with tubercle of ribSuperiorPosteriorInferiorAnteriorFacet for articulationwith tubercle of ribDemifacets for articulation with head of ribsSuperior articular processInferior articular ...
Costal partPulmonary ligamentMediastinal partPleura surroundingstructures in root of lungCervical pleuraSuprapleural membraneDiaphragmatic part Fig. 3.39 Pleural reflections. Fig. 3.40 Parietal pleural reflections and recesses. Fig. 3.41 CT image of left pleural effusion. AortaLeft lungRight lungLeft empyema with air-f...
Arch of aortaSuperior vena cavaInferior vena cavaBranch of rightpulmonary arteryAscending aortaThoracic aortaCut edge of pericardiumRight pulmonary veinsLeft pulmonary arteryLeft pulmonary veinsOblique pericardial sinus(formed by reflection onto thepulmonary veins of heart)Transverse pericardial sinus(separates arterie...