The thoracic wallconsists ofa bony framework thatis heldtogether by twelve thoracic vertebrae posteriorly which give rise to ribs that encircle the lateral and anterior thoracic cavity. The first nine ribs curve around the lateral thoracic wall and connect to the manubrium and sternum. Ribs 10-12 are relatively short and attach to the costal margins of the ribs just above them. Ribs 10-12, due to their short course, they do not reach the sternum.
The first seven ribs are termedtrue ribs and attach to the manubrium and directly attach to the body of the sternum. Ribs eight to ten only attach to the inferior part of sternum via the costal cartilages.Ribs 11-12 are termedfloating ribs because they do not attach directly to the sternum.Ribs eight to ten are knownas false ribs because they lack direct attachment to the sternum. At the level of the spine, the ribs articulate with the costal facet of two opposing vertebrae. An articular capsule surrounds the head of each rib, and the attachment to the transverse processis madewith the help of the radiate ligament. Once the ribs leave the vertebrae, they gently curve around the lateral thoracic wall and approach the anterior wall of the thoracic cavity.
The vertical bone of the chest, the sternum, defines the anterior chest wall. The three separate bone segments of different size and shape that make up the sternum include 1) the thick manubrium, 2) long body of the sternum, and 3) the xiphoid process. It develops independently of the ribs. In sporadic cases, the sternum may not fully form, andthe underlying heart may be exposed.
The most superior portion of the sternum is the manubrium, and it is also the first to form during embryogenesis.The sternal body and xiphoid process soon follow the manubrium in development. Anatomically, the manubriumis locatedat the level of thoracic vertebral bodies T3 and T4. The manubrium is also the widest and thickest segment of the sternum. During a physical exam of the chest, one noticeable feature of the manubrium isthe presence ofthe suprasternal notch. On either side of this notch, one will feel the thick attachment from the clavicles. For access to the superior mediastinum, suprasternal goiter or thymus, some thoracic surgeons will only make a midline incision in the manubrium.
The sternal body is locatedat the level of vertebral bodies T5-T9. It covers a significant portion of the mid-chest and is very strong. To access the chest cavity, surgeons usually cut through the sternum with a mechanical saw.
The xiphoid process is a thin andvery smallbone. Itssize may vary from two to fivecm, and its shape is also variable. The xiphoid may appear bifid, oval orbe curvedinwards/outwards. In younger individuals, the xiphoid is mostly cartilaginous butis nearly wholly ossifiedby age 40.By the age of 60 and over, the xiphoidis almost certainlycompletely calcified. To perform pericardiocentesis safely the needle has tobe placeddirectly underneath the xiphoid because the heart is just a few fingerbreadths below.
Structure and Function
The thoracic cavity subdivides into three compartments; the mediastinum and two pleural cavities, one on each side. The mediastinum is the median compartment containing the heart and great vessels; whereas, the pleural cavities contain the lungs. The thoracic cage protects the lungs and the heart as well as provide attachments for the muscles of the thorax, upper extremities, back, and the abdomen. It communicates superiorly with the neck via the thoracic outlet and inferiorly separates the abdomen by the respiratory diaphragm.
The boundaries of the thoracic wall are important landmarks used by clinician and surgeons for various procedures including sternotomy, pericardiocentesis in patients with cardiac tamponade and thoracentesis for pleural effusion. The thoracic wall is bounded anteriorly by the sternum and costal cartilages; laterally by the ribs and intercostal spaces; posteriorly by the thoracic vertebrae and intervertebral discs; superiorly by the suprapleural membrane and inferiorly by the respiratory diaphragm.
The formation of somite begins as the paraxial mesoderm starts to spiral into an organized cell called somitomere. These somitomeres cluster together by epithelium and separate from the presomitic paraxial mesoderm to form individual somites. The differentiation in somite forms the cartilage of the vertebrae, ribs, the muscle of the rib cage, limb and even dermis of the skin.
Blood Supply and Lymphatics
Three arteries supply each intercostal space; the posterior intercostal artery and two branches of anterior intercostal arteries. These intercostal blood vessels run along with the nerves between the internal intercostal muscle and innermost intercostal muscles in the costal groove. They are arranged in order from superior to inferior:vein, artery, and nerve.
The posterior intercostal artery for first two intercostal spaces is fed from the superior (supreme)intercostalartery. This artery arises from the costocervical trunk of the subclavian artery. The remaining pair of posterior intercostal arteries from 3rd - 11th intercostal spaces and a pair of subcostalarteries emerge directly descending thoracic aorta.
The anterior intercostal arteries of 1st–6th intercostal spaces are branches of the internal thoracic artery which derive from the first portion of the subclavian artery. The anterior intercostal arteries of 7th–9th intercostal spaces are branches of the musculophrenic artery which is a terminal tributary of the internal thoracic artery. The anterior and posterior intercostal arteries anastomose laterally in the costal groove.
The corresponding posterior intercostal vein drains into azygos or hemiazygos veins and the corresponding anterior intercostal veins drain into internal thoracic or musculophrenic veins. The lymphatics of the thoracic wall drains into parasternal lymph nodes and intercostal lymph nodes. The parasternal lymph nodes and intercostal lymph nodes from the upper thorax drain into the bronchomediastinal trunk, whereas, the intercostal nodes from the lower thorax drains into the thoracic duct.
The thoracic wall is primarily innervated by the intercostal nerves, which are the anterior rami of spinal nerves of T1-T11 and the anterior ramus of T12 is asubcostal nerve. Each intercostal nerve supplies a dermatome and a myotome. Only the anterior ramus of T1 forms the lower trunk of the brachial plexus; the remaining intercostals do not form a plexus.
There are three intercostal muscles; externally intercostal, internal intercostal and innermost intercostal muscles. These muscles are present in the intercostal spaces and the intercostal nerves and blood vessels runbetween them. The most superficial layer is the external intercostal muscle. The external intercostal muscles extend posteriorly from the rib tubercle to the costochondral junction anteriorly where the anterior (external) intercostal membrane takes the place of the muscle fibers.
The internal intercostal muscle forms the intermediate layer. This muscle extends anteriorly from the sternum to the rib cage posteriorly where the muscle fibers are replaced the posterior (internal) intercostal membrane. The innermost intercostal muscle forms the deepest layer and is lined internally by the endothoracic fascia, which in turnis lined internally by the parietal pleura.
The difference in size of the sternum in both genders may provide essential clues in determining the skeletal remains during forensic evaluation.
Understanding the anatomy of the thorax is vital, as it provides access to the heart, great vessels, lungs, diaphragm, and mediastinum.
The intercostal nerve block is a procedure through which local anesthetic agent is injected around the intercostal nerve between the paravertebral line and the area of required anesthesia for different surgical procedures. However, the surgeon needs to anesthetize the adjacent nerve as well because of considerable overlapping of contiguous dermatomes occurs.
Median sternotomies are the most commonly performed osteotomy in the world and a standard incision for thoracic and cardiac surgery. The median sternotomy is a critical procedure in which the surgeon splits the sternum in the median plane to gain access to the heart, great vessels,as well as the lungs.
Flail chest is an extremely painful injury affecting the respiration, often caused by blunt chest trauma, resultingin multiple successive rib fractures. The fractured ribs of the anterior and/or lateral chest wall move inward on inspiration and outward on expiration (paradoxical)and maybe associated with pneumothorax and/orcontusion of the heart and lung. Today, flail chest management is through pain control, pulmonary toilet, and early ambulation. It is not common to surgically repair the ribs.
The vitality of the organs, vessels, and nerves locatedwithin the thoracic cavity predispose it to be a location of high clinical significance.
The sternum is a commonly used site for bone marrow aspiration because it possesses hematopoietic marrow throughout life. However, the surgeon needs to exercise great care because if the sternal puncture is improperly executed, the needle can pierce the structures related to the posterior surface of the manubrium such as the left brachiocephalic vein in the upper part and aortic arch in the lower part.
Thoracentesis is a diagnostic procedure that is performed by the surgeon to remove excess fluid from the thoracic cavity for both diagnostic or therapeutic purposes. This procedure can be performed in two positions depending on the comfort of the patient. If the patient is lying supine, the needle placement is typically in the midaxillary line between the 6th- 8th ribs, and if the patient is in an upright or seated position, then the needleis placed between the 9th- 10thrib posteriorly in themidscapular line. However, in both cases, a too low needle insertion can result in puncture of the liver or the spleen
Pericardiocentesis is also a necessary procedure as it can be life-saving in a patient with cardiac tamponade. Pericardiocentesis may be guided using surface landmarks (“blindly”) in emergencies or electrocardiogram/echocardiography may be used to advance the needle to avoid complications. The needle is inserted 1-2cm lateral to the apex beat within the fifth, sixth or seventh intercostal space to remove excess fluid from the pericardial sac. The needle is advanced over the superior border of the rib to avoid intercostal nerves and vessels. If this performed improperly, the needle can puncture left ventricle or causes pneumothorax.
In patients with the thoracic outlet syndrome (TOS), there is compression of the neurovascular structures in the thoracic outlet, resulting in pain, numbness, weakness, muscle wasting, fatigue in the upper limbs as well as ischemia. The brachial plexuses of nerves (C5, C6, C7, C8, andT1) and subclavian vessels (artery and vein) are closely related to the first rib as well as the clavicle as they enter the upper limb. These structuresmay undergo compression between the scalene muscles and the first rib. Pancoast tumors, as well as the presence ofa rudimentary cervical rib, are among the potential causes of TOS.
The chest wall deformities, including pectus excavatum and pectus carinatum, are one of the most common congenital chest wall defects seen in young people. Surgical correction is needed in some people to avoid complications which may lead to heart and lungs dysfunction. However, these techniques require aggressive resection of the cartilage and rib cage, leading to severe post-operational complications such as infections, and delayed healing.
The Thorax; Anterior View. Contributed by Gray's Anatomy Plates
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The thoracic wall is made up of five muscles: the external intercostal muscles, internal intercostal muscles, innermost intercostal muscles, subcostalis, and transversus thoracis. These muscles are primarily responsible for changing the volume of the thoracic cavity during respiration.Is thorax the same as chest wall? ›
The thoracic, or chest wall, consists of a skeletal framework, fascia, muscles, and neurovasculature – all connected together to form a strong and protective yet flexible cage. The thorax has two major openings: the superior thoracic aperture found superiorly and the inferior thoracic aperture located inferiorly.What is the chest wall thorax responsible for? ›
The bones in the chest wall include the ribs, sternum (breastbone), and spine. The chest wall also helps support breathing and movement of the upper arms and shoulders.What is the anatomy of the thorax? ›
The contents of the thorax include the heart and lungs (and the thymus gland); the major and minor pectoral muscles, trapezius muscles, and neck muscle; and internal structures such as the diaphragm, the esophagus, the trachea, and a part of the sternum known as the xiphoid process.What are the 10 layers of thoracic wall? ›
The chest wall has 10 layers, namely (from superficial to deep) skin (epidermis and dermis), superficial fascia, deep fascia and the invested extrinsic muscles (from the upper limbs), intrinsic muscles associated with the ribs (three layers of intercostal muscles), endothoracic fascia and parietal pleura.What is the lining of the chest wall called? ›
The chest cavity is lined by a thin shiny membrane called the pleura, which covers the inside surface of the rib cage and spreads over the lungs as well. Normally, the pleura produces a small amount of fluid which serves as a lubricant to the lungs as they move back and forth against the chest wall during respiration.What is a thorax CT scan looking for? ›
To determine the size, shape, and position of organs in the chest and upper abdomen. To look for bleeding or fluid collections in the lungs or other areas. To look for infection or inflammation in the chest. To look for blood clots in the lungs.What happens if the thoracic wall is punctured? ›
The puncture in thoracic wall, would mean the wound to the pleural/chest wall, as it is defined so for its function of respiration. This would eventually lead to the damage of pleural membrane which in turn would disrupt the pressure balance of gases, which would lead to the collapsing of the lungs.Is the thoracic wall the rib cage? ›
The thoracic cage (rib cage) is the skeleton of the thoracic wall. Costovertebral: formed by the ribs and bodies of the vertebrae.Which side of the thorax is the heart on? ›
The Heart Is Located in the Center of the Thoracic Cavity. The heart is located in the middle of the thoracic cavity, oriented obliquely, with the apex of the heart pointing down and to the left, as shown in Figures 5.4. 1 and 5.4.
 The thoracic cavity contains organs and tissues that function in the respiratory (lungs, bronchi, trachea, pleura), cardiovascular (heart, pericardium, great vessels, lymphatics), nervous (vagus nerve, sympathetic chain, phrenic nerve, recurrent laryngeal nerve), immune (thymus) and digestive (esophagus) systems.Does the thorax include the heart? ›
The area of the body between the neck and the abdomen. The thorax contains vital organs, including the heart, major blood vessels, and lungs. It is supported by the ribs, breastbone, and spine.What are the three sections of the thorax? ›
The middle tagma, or thorax, comprises three large segments: prothorax (anterior most segment), mesothorax (middle), and metathorax (posterior) (Figure 33.3).What are the two major components of the thorax? ›
Answer and Explanation: The major components of the thorax (excluding the vertebral column) are the ribs and the sternum. The sternum is the bone that the true ribs attach to and is also known as the breast bone. These bones form the thoracic cage.What is injury of thorax? ›
Thoracic trauma is broadly categorized by mechanism into blunt or penetrating trauma. The most common cause of blunt chest trauma is motor vehicle collisions (MVC) which account for up to 80% of injuries. Other causes include falls, vehicles striking pedestrians, acts of violence, and blast injuries.What are the 2 largest organs found in the thoracic cavity? ›
These organs include the heart and lungs.How long does it take for a chest wall injury to heal? ›
Although chest wall injuries can be painful, you can expect this discomfort to improve over a period of three to six weeks. This may take longer for more severe injuries. Chest wall injuries are managed differently depending on the severity of your injuries and the symptoms you are experiencing.Are there 10 ribs located in the thorax? ›
The thoracic cage (rib cage) forms the thorax (chest) portion of the body. It consists of the 12 pairs of ribs with their costal cartilages and the sternum (Figure 7.5. 1).What is the space between the lungs and chest wall called? ›
The pleural space is the thin gap between the pleura of the lung and of the inner chest wall. The pleura is a double layer of membranes that surrounds the lungs. Inside the space is a small amount of fluid.What is the hole in your chest called? ›
Pectus excavatum is due to too much growth of the connective tissue that joins the ribs to the breastbone (sternum). This causes the sternum to grow inward. As a result, there is a depression in the chest over the sternum, which may appear quite deep. If the condition is severe, the heart and lungs can be affected.
Pleurisy is inflammation of the pleura. It's usually caused by another condition, such as an infection, but sometimes no cause can be identified. The pleura are two thin sheets of tissue that separate the lungs and ribcage. One is attached to the ribcage and the other is attached to the lungs.What are abnormal findings of the thorax? ›
Thoracic abnormalities include pectus excavatum (sunken chest), pectus carinatum (protruding chest) and congenital pulmonary airway malformations (CPAM).Can you eat before a thorax CT scan? ›
EAT/DRINK : If your doctor ordered a CT scan without contrast, you can eat, drink and take your prescribed medications prior to your exam. If your doctor ordered a CT scan with contrast, do not eat anything three hours prior to your CT scan. You are encouraged to drink clear liquids.Is CT thorax painful? ›
CT scans are quick, painless and generally safe. But there's a small risk you could have an allergic reaction to the contrast dye used and you'll be exposed to X-ray radiation. The amount of radiation you're exposed to during a CT scan varies, depending on how much of your body is scanned.What are symptoms of a thoracic injury? ›
Symptoms and Signs of Thoracic Trauma
Symptoms include pain, which usually worsens with breathing if the chest wall is injured, and sometimes shortness of breath. Common findings include chest tenderness, ecchymoses, and respiratory distress; hypotension or shock may be present.
Although there are a wide range of complications following thoracic trauma, respiratory failure, pneumonia, and pleural sepsis are the most common potentially preventable problems. Respiratory failure and pneumonia are directly related to the severity of the injury and the age and condition of the patient.What happens if thoracic wall but not lung is punctured? ›
If the thoracic wall but not lungs is punctured then man dies as the lungs collapsed.Is thorax and ribs the same? ›
The thoracic cage (rib cage) forms the thorax (chest) portion of the body. It consists of the 12 pairs of ribs with their costal cartilages and the sternum ([link]). The ribs are anchored posteriorly to the 12 thoracic vertebrae (T1–T12). The thoracic cage protects the heart and lungs.What is the difference between thorax and rib cage? ›
Both of these are same. Thoracic cage is also known as rib cage. It is the arrangement of bones in thorax of vertebrates. It is formed of thoracic vertebrae and ribs, the sternum (breastbone), and the costal cartilages.Is thoracic front or back? ›
The thoracic spine is located in the upper and middle part of the back. Twelve vertebrae are located in the thoracic spine and are numbered T-1 to T-12. Each number corresponds with the nerves in that section of the spinal cord: T-1 through T-5 nerves affect muscles, upper chest, mid-back and abdominal muscles.
Heart: An hollow organ located in between the lungs just behind the breastbone. It supplies blood to all parts of the body.Is the heart and lungs in the thorax? ›
The heart and lungs are located in the thorax, or chest cavity. The heart pumps blood from the body to the lungs, where the blood is oxygenated. It then returns the blood to the heart, which pumps the freshly oxygenated blood to the rest of the body.Where does the thorax start and end? ›
Your thoracic spine is the middle section of your spine. It starts at the base of your neck and ends at the bottom of your ribs.Why is the thorax important? ›
Understanding the anatomy of the thorax is vital, as it provides access to the heart, great vessels, lungs, diaphragm, and mediastinum.What nerves are in the thoracic wall? ›
Innervation of Thoracic Wall
Innervation of the thoracic wall is primarily by the intercostal nerves, which are the anterior rami of spinal nerves T1 to T11 and lie in the intercostal spaces between adjacent ribs (Fig. 9‑1). The ventral ramus of spinal nerve T12 (the subcostal) is inferior to the 12th rib.
It has three sections: the manubrium, the body, and the xiphoid process. Thorax —The bones that surround and form the chest cavity. The thorax includes the sternum and the ribs. True ribs —The first seven ribs, 1-7, directly attached to the sternum.Which bone is connected to the thorax? ›
The bones of the thorax are the thoracic vertebrae, the twelve pairs of ribs, and the sternum. Connecting the upper ten pairs of ribs to the sternum are the costal cartilages.Is the sternum the thorax? ›
The sternum is the bone that lies in the anterior midline of our thorax. It forms part of the rib cage and the anterior-most part of the thorax. Its functions are to protect the thoracic organs from trauma and also form the bony attachment for various muscles.What separates the thorax and abdomen? ›
The diaphragm is a thin dome-shaped muscle which separates the thoracic cavity (lungs and heart) from the abdominal cavity (intestines, stomach, liver, etc.).What are the four major thoracic organs? ›
It's divided into three main parts: right pleural cavity, left pleural cavity and mediastinum. The five organs in your thoracic cavity are your heart, lungs, esophagus, trachea and thymus.
- Contents of intercostal space.
- Intercostal muscles and their action.
- Contents of costal groove from above downwards.
- Branches of internal thoracic artery.
- Branches of a typical intercostal nerve. ...
- Medial branches from the thoracic part of sympathetic chain/trunk.
- Differences between right and left lung.
The lungs are the cone-shaped organs located in the pleural spaces in the right and left sides of the bony thorax. The right lung is divided into three separate and distinct lobes by deep fissures. The left lung has only two lobes.How long does a thoracic strain take to heal? ›
This may happen because of severe coughing or heavy lifting. Or it may be caused by twisting injuries of the upper back, such as from a fall or a car or bike accident. This often causes increased pain when you move or breathe deeply. This may take 3 to 6 weeks or longer to heal.How do you treat thorax pain? ›
- Artery relaxers. Nitroglycerin — usually taken as a tablet under the tongue — relaxes heart arteries, so blood can flow more easily through the narrowed spaces. ...
- Aspirin. ...
- Thrombolytic drugs. ...
- Blood thinners. ...
- Acid-suppressing medications. ...
The most common causes of pleuritic chest pain are bacterial or viral infections, pulmonary embolism, and pneumothorax. Other less common causes include rheumatoid arthritis, lupus, and cancer. Pneumonia or lung abscess. These lung infections can cause pleuritic and other types of chest pain, such as a deep chest ache.What are the boundaries of the thorax? ›
The boundaries of the Thoracic Cavity are the Ribs (and Sternum), Vertebral Column, and the Diaphragm. The Diaphragm seperates the Thoracic Cavity from the Abdominal Cavity. Mediastinum - Space between the left and right Pleural Cavities.What are the 3 parts of the thoracic cavity? ›
Your thoracic cavity is a space in your chest that contains organs, blood vessels, nerves and other important body structures. It's divided into three main parts: right pleural cavity, left pleural cavity and mediastinum. The five organs in your thoracic cavity are your heart, lungs, esophagus, trachea and thymus.What are the 12 pairs of bones forming the wall of the thorax? ›
Ribs. Each rib is a curved, flattened bone that contributes to the wall of the thorax. The ribs articulate posteriorly with the T1–T12 thoracic vertebrae, and most attach anteriorly via their costal cartilages to the sternum. There are 12 pairs of ribs.What 5 organs are found in the thoracic cavity? ›
 The thoracic cavity contains organs and tissues that function in the respiratory (lungs, bronchi, trachea, pleura), cardiovascular (heart, pericardium, great vessels, lymphatics), nervous (vagus nerve, sympathetic chain, phrenic nerve, recurrent laryngeal nerve), immune (thymus) and digestive (esophagus) systems.What are the 3 types of ribs of the bony thorax? ›
According to their attachment to the sternum, the ribs are classified into three groups: true, false, and floating ribs.
The mediastinum is the partition between the lungs and includes the mediastinal pleura. It is commonly applied to the internal between the two pleural sacs, the sternum and the thoracic vertebral column extending to the diaphragm.Is the chest part of the thorax? ›
In vertebrates (fishes, amphibians, reptiles, birds, and mammals), the thorax is the chest, with the chest being that part of the body between the neck and the abdomen.