Thoracic Cage and Diaphragm Anatomy
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Questions and Answers

What is the primary source of the anterior intercostal arteries?

  • Internal thoracic arteries (correct)
  • Supreme intercostal artery
  • Subclavian arteries
  • Thoracic aorta
  • Where do the posterior intercostal arteries originate?

  • Supreme intercostal artery
  • Internal thoracic arteries
  • Costocervical trunk
  • Aorta (correct)
  • Which structure does not contribute to the vascular supply of the thoracic wall?

  • Brachiocephalic trunk (correct)
  • Subclavian artery
  • Internal thoracic artery
  • Costocervical trunk
  • How do the intercostal arteries arrange themselves around the thoracic wall?

    <p>In a basket-like pattern (D)</p> Signup and view all the answers

    What is the role of the supreme intercostal artery?

    <p>Supply the upper two posterior intercostal arteries (C)</p> Signup and view all the answers

    Which arteries mainly supply the thoracic wall?

    <p>Anterior and posterior intercostal arteries (B)</p> Signup and view all the answers

    Which artery is primarily responsible for the supply of the lower posterior thoracic wall?

    <p>Thoracic aorta (D)</p> Signup and view all the answers

    The anterior intercostal arteries are mainly branches of which larger arterial system?

    <p>Internal thoracic artery (B)</p> Signup and view all the answers

    What is the primary function of the intercostal muscles?

    <p>To provide structural support during breathing (D)</p> Signup and view all the answers

    Which intercostal muscles are located the deepest among the three types?

    <p>Innermost intercostal muscles (D)</p> Signup and view all the answers

    Where do the external intercostal muscles extend from and to?

    <p>From inferior margins of the ribs above to superior margins of the ribs below (D)</p> Signup and view all the answers

    How are the intercostal muscles innervated?

    <p>By the related intercostal nerves (B)</p> Signup and view all the answers

    What direction do the muscle fibers of the external intercostal muscles run?

    <p>Obliquely anteroinferiorly (D)</p> Signup and view all the answers

    Which muscles are located between the external and innermost intercostal muscles?

    <p>Internal intercostal muscles (D)</p> Signup and view all the answers

    What is a common characteristic of all intercostal muscles?

    <p>They provide support for the intercostal spaces (C)</p> Signup and view all the answers

    Which of the following statements about the internal intercostal muscles is true?

    <p>They are located between the external and innermost intercostals (D)</p> Signup and view all the answers

    Where do the anterior intercostal arteries that supply the upper six intercostal spaces originate?

    <p>From the internal thoracic artery (C)</p> Signup and view all the answers

    What is a characteristic of the anterior intercostal arteries in comparison to the posterior intercostal arteries?

    <p>They are generally smaller than the posterior vessels (D)</p> Signup and view all the answers

    What branches do the anterior intercostal arteries usually have in each intercostal space?

    <p>One branch that passes below the margin of the upper rib and one above the lower rib (D)</p> Signup and view all the answers

    At which vertebral level does the inferior vena cava pass through the diaphragm?

    <p>T VIII (A)</p> Signup and view all the answers

    What structure passes through the muscular part of the diaphragm just to the left of midline?

    <p>Esophagus (D)</p> Signup and view all the answers

    What does the musculophrenic artery supply?

    <p>The lower intercostal spaces (C)</p> Signup and view all the answers

    Which vein is involved in draining the thoracic wall?

    <p>Internal thoracic vein (C)</p> Signup and view all the answers

    Which nerve is responsible for the innervation of the diaphragm?

    <p>Phrenic nerve (C)</p> Signup and view all the answers

    Which structure connects to the azygos system for venous drainage?

    <p>The anterior intercostal veins (D)</p> Signup and view all the answers

    What is one of the main causes of phrenic nerve palsy?

    <p>Malignant infiltration by lung cancer (D)</p> Signup and view all the answers

    What happens to the anterior intercostal arteries as they descend?

    <p>They continue inferiorly into the anterior abdominal wall (D)</p> Signup and view all the answers

    The aorta passes through the diaphragm at which vertebral level?

    <p>T XII (B)</p> Signup and view all the answers

    What happens to the diaphragm when it contracts?

    <p>It increases thoracic volume (C)</p> Signup and view all the answers

    How do the anterior intercostal arteries meet the posterior intercostal artery branches?

    <p>Via a collateral branch of the posterior intercostal artery (B)</p> Signup and view all the answers

    What is a common manifestation of diaphragmatic paralysis?

    <p>Elevated diaphragm muscle on the affected side (C)</p> Signup and view all the answers

    What anatomical structure is the subcostal nerve associated with?

    <p>Rib XII (B)</p> Signup and view all the answers

    Which of the following is a major branch of the intercostal nerve?

    <p>Lateral cutaneous branch (B)</p> Signup and view all the answers

    Which of the following structures passes behind the diaphragm with the aorta?

    <p>Thoracic duct (C)</p> Signup and view all the answers

    What type of innervation do intercostal nerves provide to the thoracic wall?

    <p>Somatic motor innervation (D)</p> Signup and view all the answers

    The supraclavicular nerves are responsible for sensory innervation of which area?

    <p>Upper thoracic wall (A)</p> Signup and view all the answers

    Which procedure is indicated for relieving air or fluid in the pleural cavity?

    <p>Thoracostomy (A)</p> Signup and view all the answers

    What is the primary function of the external intercostal muscles?

    <p>To assist with inspiration by moving ribs superiorly (C)</p> Signup and view all the answers

    Which intercostal nerve branch contributes to the cutaneous innervation of the medial surface of the upper arm?

    <p>Intercostobrachial nerve from T2 (B)</p> Signup and view all the answers

    What role does the endothoracic fascia play in the thorax?

    <p>It forms a protective layer over the pleura. (A)</p> Signup and view all the answers

    What additional fibers do intercostal nerves carry to the periphery?

    <p>Postganglionic sympathetic fibers (C)</p> Signup and view all the answers

    Which muscles are considered part of the thoracic wall?

    <p>Levatores costarum and transversus thoracis (B)</p> Signup and view all the answers

    Where do the anterior cutaneous branches of intercostal nerves emerge?

    <p>Parasternally or laterally to the midline (A)</p> Signup and view all the answers

    Which of the following is NOT a characteristic of the intercostal muscles?

    <p>They only fill the intercostal spaces. (B)</p> Signup and view all the answers

    What is the function of the transversus thoracis muscle?

    <p>To depress the costal cartilages (C)</p> Signup and view all the answers

    Which muscles assist with altering the position of the ribs and thoracic volume during breathing?

    <p>Muscles associated with vertebrae and ribs (A)</p> Signup and view all the answers

    Which of the following statements about innervation of the thoracic muscles is correct?

    <p>The internal intercostals are innervated by T1-T12 spinal nerves. (A)</p> Signup and view all the answers

    Flashcards

    Endothoracic fascia

    A thin layer of loose connective tissue found deep to the intercostal spaces, containing variable amounts of fat, that separates the ribs and intercostal spaces from the underlying pleura.

    Intercostal muscles

    These muscles are located between the ribs, filling and supporting the intercostal spaces. They play a crucial role in breathing.

    Innermost intercostal muscle

    This muscle lies deep to the internal intercostals and helps to further depress the ribs during forced expiration.

    Transversus thoracis muscle

    This muscle runs obliquely, crossing multiple ribs and helps to depress the costal cartilages, aiding in forced expiration.

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    External intercostal muscles

    These muscles help to elevate the ribs during inspiration, increasing the volume of the thoracic cavity and helping to draw air into the lungs.

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    Internal intercostal muscles

    These muscles help to depress the ribs during forced expiration, decreasing the volume of the thoracic cavity and forcing air out of the lungs.

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    Subcostales muscles

    These muscles help to depress the ribs, aiding in forced expiration.

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    Muscles of the thoracic wall

    These muscles, along with the intercostal muscles, alter the position of the ribs and sternum, ultimately changing the volume of the thoracic cavity and affecting breathing.

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    Function of Intercostal Muscles

    These muscles provide structural support for the intercostal spaces, helping to maintain the shape of the rib cage during breathing.

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    Innervation of Intercostal Muscles

    The intercostal muscles are supplied by the intercostal nerves.

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    External Intercostal Muscles and Inhalation

    The external intercostal muscles help with inhalation by lifting the ribs upwards and outwards.

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    Internal Intercostal Muscles and Exhalation

    The internal intercostal muscles can help with exhalation by pulling the ribs downwards and inwards, but their primary role is stabilization during breathing.

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    Intercostal Arteries

    Arteries that supply the spaces between the ribs, originating from the aorta and internal thoracic artery.

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    Thoracic Aorta

    The main artery that supplies blood to the chest cavity.

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    Internal Thoracic Artery

    A large artery in the chest that branches off from the subclavian artery, providing blood to the chest wall and other structures.

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    Supreme Intercostal Arteries

    The upper two posterior intercostal arteries on each side, originating from the costocervical trunk in the neck.

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    Subclavian Artery

    The main artery that supplies blood to the shoulder and neck.

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    Costocervical Trunk

    A branch of the subclavian artery that contributes to the blood supply of the neck and shoulders.

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    Origin of Anterior Intercostal Arteries

    The anterior intercostal arteries that supply the upper six intercostal spaces originate as lateral branches from the internal thoracic artery. The lower intercostal spaces are supplied by the musculophrenic artery.

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    Anterior Intercostal Artery Branches

    The anterior intercostal arteries typically branch into two, one passing below the upper rib's margin, and the other passing above the lower rib's margin, meeting with a branch from the posterior intercostal artery.

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    Intercostal Vessel Connections

    The anterior and posterior intercostal vessels overlap and can connect through anastomoses, providing alternative pathways for blood flow.

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    Size Comparison of Intercostal Arteries

    Anterior intercostal arteries are generally smaller than the posterior intercostal vessels.

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    Superior Epigastric Artery's Path

    The superior epigastric artery, a continuation of the internal thoracic artery, goes through the diaphragm and ends near the last intercostal space.

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    Venous Drainage Pattern

    Venous drainage from the thoracic wall generally follows the pattern of arterial supply.

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    Intercostal Vein Drainage

    The intercostal veins drain into the azygos system, eventually connecting to the brachiocephalic veins in the neck.

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    Internal Thoracic Vein Drainage

    The internal thoracic vein drains into the brachiocephalic veins in the neck.

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    Location of subcostal nerve

    The subcostal nerve (T12) is located below the 12th rib, while typical intercostal nerves run between the ribs.

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    Lateral cutaneous branch function

    The lateral cutaneous branch is the largest branch of an intercostal nerve. It divides into an anterior branch and a posterior branch that innervate the skin.

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    Anterior cutaneous branch function

    The intercostal nerves end as anterior cutaneous branches, supplying the skin of the anterior chest and abdominal wall.

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    Intercostal nerve motor function

    Intercostal nerves provide motor innervation to the intercostal, subcostal, and transversus thoracis muscles.

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    Intercostal nerve sensory function

    Intercostal nerves provide sensory innervation to the skin and parietal pleura, the lining of the chest cavity.

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    Intercostal nerve sympathetic function

    Intercostal nerves carry postganglionic sympathetic fibers, contributing to the autonomic nervous system.

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    T1 nerve contribution to brachial plexus

    The anterior ramus of T1 contributes to the brachial plexus, which innervates the upper limb.

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    Intercostobrachial nerve function

    The intercostobrachial nerve, a branch of the second intercostal nerve, innervates the medial surface of the upper arm.

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    IVC passage through diaphragm

    The inferior vena cava (IVC) passes through the central tendon of the diaphragm, at approximately vertebral level TVIII.

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    Esophagus passage through diaphragm

    The esophagus, carrying food from the mouth to the stomach, passes through the muscular part of the diaphragm just to the left of the midline, at about vertebral level TX.

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    Aorta passage through diaphragm

    The aorta, the largest artery in the body, passes behind the posterior attachment of the diaphragm, at vertebral level TXII.

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    Thoracic duct passage through diaphragm

    The thoracic duct, which transports lymph fluid, passes behind the diaphragm with the aorta.

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    Innervation of the diaphragm

    The phrenic nerves (C3, C4, and C5) innervate the diaphragm, controlling its contraction and relaxation.

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    Diaphragm contraction

    When the diaphragm contracts, its domes flatten, increasing the volume of the thoracic cavity and causing inhalation.

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    Diaphragmatic paralysis

    Diaphragmatic paralysis, or weakness, occurs when the phrenic nerves are damaged, often due to lung cancer or other medical conditions.

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    Causes of phrenic nerve palsy

    Common causes of phrenic nerve palsy, besides lung cancer, include postviral neuropathy, trauma, surgical injury, and degenerative changes in the cervical spine.

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    Study Notes

    Thoracic Cage and Diaphragm

    • Intercostal spaces are the areas between adjacent ribs, filled with intercostal muscles.
    • Intercostal nerves and associated major arteries and veins are located in the costal groove, along the inferior margin of the superior rib.
    • The vein is the superiormost structure within the costal groove, followed by the artery, and then the nerve.
    • The nerve often isn't protected by the groove.
    • Deep to the intercostal spaces and ribs is endothoracic fascia.
    • Superficial to the spaces are deep fascia, superficial fascia, and skin.
    • Muscles associated with upper limbs and back overlie the spaces.
    • Muscles of the thoracic wall include those that fill and support the intercostal spaces, those that pass between the sternum and ribs, and those that cross several ribs.

    Intercostal Muscles

    • Three flat muscles in each intercostal space, passing between adjacent ribs.
    • External intercostal muscles are the most superficial.
    • Internal intercostal muscles are sandwiched between external and innermost muscles.
    • Innermost intercostal muscles are the deepest.
    • Intercostal muscles are innervated by related intercostal nerves.

    Subcostales and Transversus Thoracis Muscles

    • Subcostales are in the same plane as innermost intercostals.
    • Transversus thoracis muscles are found on the deep surface of the anterior thoracic wall.
    • Both are in the same plane as the innermost intercostals.
    • These muscles are more numerous in the lower regions of the posterior thoracic wall. They span multiple ribs.

    Arterial Supply

    • Vessels supplying the thoracic wall mostly consist of posterior and anterior intercostal arteries.
    • These arteries arise (originate) from the aorta and internal thoracic arteries.
    • Posterior intercostal arteries originate from vessels associated with the posterior thoracic wall.

    Venous Drainage (Thoracic Wall)

    • Venous drainage generally parallels arterial supply.
    • Intercostal veins ultimately drain into the azygos system of veins or into internal thoracic veins.
    • Upper posterior intercostal veins often join to form superior intercostal veins, which empty into the brachiocephalic veins.

    Intercostal Nerves

    • Innervation of the thoracic wall is mainly conducted by intercostal nerves.
    • Anterior rami of spinal nerves (T1-T11)
    • Intercostal nerves pass laterally in intercostal spaces.
    • Largest branch = lateral cutaneous branch, which divides into anterior and posterior branches that innervate the overlying skin.

    Diaphragm

    • Musculotendinous structure that separates the thoracic cavity from the abdominal cavity.
    • Attached to the xiphoid process of the sternum, costal margin, ribs 11 and 12, lumbar vertebrae and ligaments spanning structures of the posterior abdominal wall.
    • Structures that pass between thorax and abdomen may pass through the diaphragm or between the diaphragm and its attachments.
    • Inferior vena cava passes through the central tendon at approximately vertebral level T8.
    • Innervated by phrenic nerves (C3, C4, C5).

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    Description

    Explore the structures and functions of the thoracic cage and diaphragm in this quiz. Learn about intercostal spaces, muscles, and associated nerves and vessels, as well as the anatomical relationships that define this region. Ideal for students studying human anatomy.

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