Thoracic Apertures and Thoracic wall Flashcards
The margins of the Superior Thoracic Aperture
Anterior: Manunrioum of sternum
lateral: Medial of Rib1
posterior: Body of T1 vertebrae
Structures passing between upper limb and thorax:
The subclavian artery and vein
Structures passing between head & neck and thorax:
Internal jugular vein, common carotid artery,
oesophagus and trachea
The margins of Inferior Aperture
Anterior: Xiphoid process
Anterior lateral; Costal margin (distal
cartilaginous ends of ribs 7-10)
Posterolateral: Rib 12 and distal end of rib 11
Posterior: Body of T12 vertebrae
The neurovascular Bundle
lies in the costal groove.
found in the lower margin of internal surface of rib.
Between internal and innermost intercostal muscles.
The content of neurovascular Bundle:
INTERCOSTAL VEIN, ARTERY AND NERVE
Often not protected by groove
Most at-risk structure if an object perforates upper aspect of intercostal space
CLINICAL: Thoracostomy Tube Insertion
Tube is inserted on the chest to relieve air/fluid trapped in the pleural cavity
Position of tube:
- Between anterior axillary and mid-axillary anatomical lines (from anterior to posterior)
- Fourth or fifth intercostal space (position of ribs needs to be clearly marked)
- Superior border of rib (lowest position in intercostal space)
Neurovascular bundle runs in neurovascular plane (superior aspect of intercostal space, just below the rib) – above position avoids injury to bundle
The internal thoracic artery
Course
Passes anteriorly over superior aspect of pleura
Descends vertically through superior thoracic aperture
Along deep aspect of anterior thoracic wall
Lies posterior to costal cartilages of upper 6 ribs, ~1cm lateral to sternum
Perforating branches of internal thoracic artery
- Pass directly forward between costal cartilages - Supply structures external to thoracic wall
- Accompany anterior cutaneous branches of
intercostal nerves
