1. Surface Anatomy of Thorax, Lungs and Breast
Fady Anis

2. Objectives Anterior Thoracic Wall Planes Surface markings Breast
Lungs and Pleura

3. Anterior Planes 3 Anterior Planes 3 Anterolateral Planes Median Plane
2x Midclavicular Plane
3 Anterolateral Planes
Anterior Axillary Plane
Midaxillary Plane
Posterior Axillary Plane

4. Other Surface Lines Sternal Angle – T4/T5 – Rib 2
Suprasternal – above sternum
Xiphisternal – T9 – Rib 7
Subcostal – L3

5. Surface Markings Things to Notice: Clavicle – coronoid process
Manubrium (Rib 1 and Rib 2 attach to the manubrium) – T3 – T4
12 pair of ribs – some people have 13 (cervical rib) – also identify true vs. false ribs and which part of the sternum they articulate to.
Sternum T5- T9 –Rib 2-7
Xiphoid Process – T9 – Rib7
Sternal Angle/ Angle of louis – T4/T5
Jugular Notch – T2
8. Costal margin
Costal Cartilage
Coracoid process and acromion of scapula
Subcostal angle
Intercostal Space

6. The Breast The breast overlies the 2nd-6th Ribs
Overlying pectoralis major and serratus anterior
It contains ~20 lactiferous ducts opening into nipple
Nipple is located at the 4th ICS – In males and varies in females
Areola = Pigmented area around nipple
The female breast develops during pregnancy due to prolactin along with progesterone and oestrogen and also at that same time you have hyperpigmentation of the areola. Lactiferous ducts are closed off with keratin plugs until the female has given birth in which then you have the release of breast milk.

7. The Breast Lymphatic Drainage
7 Lymph drainage sites :
Apical Axillary LN
Central Axillary LN
Lateral Axillary LN
Pectoral Axillary LN
Supra/infra Clavicular LN
Parasternal Nodes LN
Abdominal LN
These nodes are important as you have a feel of them if there is suspected breast cancer pathology. Enlarged lymph nodes could indicate breast cancer, it is important to test both breasts as the cancer can spread to the other breast via the parasternal lymph nodes.

8. Vasculature of the breast
Medial mammary branches of anterior intercostal branches of the internal thoracic artery
Lateral thoracic
Thoraco-acromial arteries
Posterior intercostal arteries, from the thoracic aorta

9. Lungs - Pleura
The pleura of the lungs are divided into 2 different parts:
Parietal Pleura = Adheres to the Internal thoracic wall
Visceral Pleura = Attached to the lungs
In between the two layers you have the pleural space which is filled with serous fluid reducing friction and provides surface tension to push parietal pleura against thoracic wall
The parietal pleura has nervous innervation while the visceral pleura does not.

10. Pleural Parts 4 Pleural Parts
Costal part- covers the internal surface of thoracic wall and is separated from wall by endothoracic fascia
Mediastinal part- lateral aspects of mediastinum
Diaphragmatic part- superior surface of diaphragm
Cervical pleura- extends superior to thoracic inlet into the root of the neck

12. 3 Pleural Reflections
Pleural Reflections = Pleural folds / change in direction of pleura – 1 Anterior, 1 Posterior and 1 Inferior
Sternal line – Costal Pleura continuous with mediastinal pleura Anteriorly
Costal line – Costal pleura continuous with diaphragmatic Inferiorly
Vertebral line – Costal pleura becomes continuous with mediastinal pleura Posteriorly
The vertebral pleura is the most gradual reflection while the sternal reflection anteriorly is the steepest.

13. Parietal Vs. Visceral Pleura
2, 4, 6, 8, 10
Together cc2-4, cardiac notch to cc6, midaxillary cc8, rib 10 posteriorly
Parietal pleura:
2, 4, 6, 8, 10, 12
Together cc2-4, cardiac notch to cc6, midclav cc8, midaxillary cc10, 12 rib posteriorly
Parietal pleura is therefore larger than the visceral plaeura – in deep inhalation the lungs fill the costodiaphragmatic spaces. The costodiaphragmatic spaces and costomediastinal spaces can fill up with fluid during infection and compress the organs from moving.

14. Thoracic Dermatomes Nipple - T4 Xiphoid - T7 Umbilical – T10
Suprapubic – L1

15. Pleural Effusion

16. QUIZ! (T or F) The rib overlies Rib 2-6?
True
There are 4 pleural reflections – Diaphragmatic, Mediastinal, Cervical and costal ?
False – there are 3 reflections – Sternal, vertebral and costal
One of the lymph drainage sites is the medial axillary LN?
False – Apical, pectoral central and lateral
The four branches supplying the breast are Lateral Thoracic, medial mammary, thoraco-acromial and posterior intercostal arteries ?

17. Thank you for listening !
If you have any questions the Fadz –