Thoracic_Vasculature_Student_2023 (1).pptx

Thoracic Vasculature Mr. Kristopher Vaudrey Objectives • Describe the arterial outflow from the heart and its course through the thorax; name, locate, and identify the thoracic branches of the aorta and what they supply. • Describe the collateral arterial circulation of the trunk wall that permits...

Thoracic Vasculature Mr. Kristopher Vaudrey Objectives • Describe the arterial outflow from the heart and its course through the thorax; name, locate, and identify the thoracic branches of the aorta and what they supply. • Describe the collateral arterial circulation of the trunk wall that permits bypassing occlusions of the descending thoracic aorta. • Describe the venous drainage of the thorax, including the caval system; azygous system; vertebral venous plexus; and the connections between these systems. • Name and identify the superficial veins of the anterior thoraco-abdominal wall and the collateral routes between them that permit bypassing of blockages in the major thoracic and abdominal veins. Further, locate where anastomoses between various veins occur which permit these bypasses. • Describe the lymphatic drainage of the thorax, including the names of the mediastinal groups of lymph nodes and the pattern of thoracic lymphatic drainage from both superficial and deep thoracic locations to nodes and from those nodes to the venous return. Thoracic Vasculature: Review lood flow through the heart4,5 2 circulatory systems • Pulmonary • Systemic Pulmonary Circulation4,5 Pulmonary trunk and arteries • Delivers deoxygenated blood to the lungs Anterior view Posterior view Pulmonary Circulation4 Pulmonary trunk and arteries • Begins at the pulmonic valve, arising from the right ventricle • Runs superiorly in the middle mediastinum • Splits into the right and left pulmonary arteries • Pulmonary arteries travel to the roots of the lungs Anterior view Where is the right pulmonary artery in the anterior view? It is located posterior to the ascending aorta and the superior vena cava. Posterior view Pulmonary Circulation4,5 Pulmonary veins • Deliver oxygenated blood from the lungs to the left atrium of the heart Thoracic Vasculature: Arteries horacic Vasculature - Arteries5 Aorta • Provides oxygenated blood to: • Coronary circulation (heart) • Systemic circulation (body) horacic Vasculature - Arteries4 Aorta • Begins at the aortic valve arising from the left ventricle • Ends where vessel passes through the thoraco-abdominal diaphragm (T12 vertebral level horacic Vasculature – Arteries3,4 Primary branches of the aorta Ascending aorta • Right coronary artery • Left coronary artery Aortic arch • Brachiocephalic artery • Left common carotid artery • Left subclavian artery In which section of the mediastinum is the ascending aorta located? The aortic arch? The middle mediastinum, superior mediastinum horacic Vasculature - Arteries5 imary branches of the thoracic aorta Descending thoracic aorta • Posterior intercostal arteries 311 • Posterior intercostal a.a. 1 & 2 arise from the costocervical trunk (branch of subclavian a.) • Bronchial arteries • Esophageal arteries • Pericardial • Mediastinal • Subcostal arteries (in 12th intercostal space) horacic Vasculature - Arteries3,4,5 Internal Thoracic (Mammary) Artery • Branch of the subclavian • Passes inferiorly on either side of the sternum • Arterial Supply for the anterior thoracic wall • Gives off anterior intercostal Internal thoracic a. branches horacic Vasculature – Arteries3 Two terminal branches of the internal thoracic artery: • Musculophrenic artery • Superior epigastric artery horacic Vasculature - Arteries5 Intercostal arteries • Posterior intercostal arteries • Anterior intercostal arteries anastomosis between anterior and posterior intercostal arteries horacic Vasculature - Arteries3,4 Collateral Circulation horacic Vasculature - Arteries5 Thoracic Arterial Collaterals Note the: 1. Posterior intercostals 2. Anterior intercostals (difficult to see, but they are there!) 3. Internal thoracics 4. Superior epigastrics 9 year old boy with coarctation of aorta, demonstrating enlargement of collaterals bypassing blockage Rib notching due to enlargement of internal thoracic arteries in the coarctation of aorta Marloes, MI, and RB Tanke, 2009 Aortic Coarctation. Circulation, 120:1294-1295. horacic Vasculature – Arteries1 horacic Vasculature - Arteries3 Collateral circulation between the superior and inferior epigastric arteries Anastomosis Between superior and Inferior epigastric arteries horacic Vasculature - Arteries Collateral circulation between the superior and inferior epigastric arteries. https://www.imaios.com/en/e-Anatomy/Whole-body/Lymph-nodes-CT Internal thoracic artery https://www.imaios.com/en/e-Anatomy/Whole-body/Lymph-nodes-CT https://www.imaios.com/en/e-Anatomy/Whole-body/Lymph-nodes-CT https://www.imaios.com/en/e-Anatomy/Whole-body/Lymph-nodes-CT Thoracic Vasculature: Veins horacic Vasculature – Veins1 Superior Vena Cava • Formed by the union of the left and right brachiocephalic veins horacic Vasculature - Veins4 Azygous System • Accessory hemiazygous vein • Left side of vertebral column • Receives posterior intercostal veins (4-8) • Drains into hemiazygous vein • Hemiazygous vein • Left side of vertebral column • Receives posterior intercostal veins (9-11) Note: Both sides 1st posterior intercostal vein joins the brachiocephalic v.; on the left side the 2nd – 3rd intercostal v.v. form a left superior intercostal v. horacic Vasculature - Veins4 Azygous System • Azygous vein • Right side of vertebral column • Receives posterior intercostal veins (5-11) & the hemiazygous vein • Drains into the SVC Note: Both sides 1st posterior intercostal vein joins the brachiocephalic v.; on the right 2nd 4th intercostal v.v. form the right superior intercostal v. & then join the arch of azygous v.. horacic Vasculature – Veins1,4 Superior Vena Cava and the Azygos vein Where is the SVC located at in the mediastinum? Superior and Middle Mediastinum horacic Vasculature - Veins3,4 • Caval system and azygous system • Right ascending lumbar veins joins IVC • Azygous joins SVC S V C I V C Connections between: Note: the veins of the body cavities and trunk wall lack valves. Therefore, flow direction depends upon pressure differentials. This can facilitate the spread of • Azygous system and vertebral venous plexus • Anterior external vertebral venous plexus joins azygous and posterior intercostal veins along vertebral column • Caval system and vertebral plexus horacic Vasculature - Veins4 Veins running in the superficial fascia that provide collateral routes of venous drainage through the trunk Connections to the deep venous return: Superiorly: • Thoracoepigastric will drain into the axillary v. Inferiorly: • Superficial epigastric and superficial circumflex iliac vv. are tributaries of the great saphenous, Femoral v. which is a tributary of the _________. horacic Vasculature - Veins Veins of the body wall providing various collateral pathways bypassing blockage of the Superior Vena Cava Routes: • Thoracoepigastric to great saphenous • Superficial internal thoracic tributaries to great saphenous • Internal thoracic to external iliac • Paraumbilicals to portal vein https://www.imaios.com/en/e-Anatomy/Whole-body/Lymph-nodes-CT https://www.imaios.com/en/e-Anatomy/Whole-body/Lymph-nodes-CT Thoracic Vasculature: Lymphatics oracic Vasculature - Lymphatics3,4 Lymphatic drainage of the thoracic walls • Lymphatic drainage pathways largely parallel the vascular Paravertebral (intercostal) nodes pathways of the body wall. Do lymphatic vessels have valves? How would this impact flow? Do Yes, they have valves. Prevents backflow or retrograde flow. oracic Vasculature - Lymphatics4 Lymphatic pathways of the thoracic wall • Parasternal nodes • Paravertebral (intercostal) nodes Parasternal nodes Paravertebral (Intercostal) nodes oracic Vasculature - Lymphatics4 Lymphatic pathways of the thoracic wall • Parasternal nodes • Paravertebral (intercostal) Superficial nodes (body wall) Paravertebral (Intercostal) nodes Parastern al nodes oracic Vasculature - Lymphatics4 Deep Lymphatics • Paratracheal nodes • Aortic Arch node • Bronchopulmonary (hilar) nodes • Inferior tracheobronchial (subcarinal) nodes oracic Vasculature - Lymphatics4 Deep Lymphatics • Paratracheal nodes • Aortic Arch node • Bronchopulmonary (hilar) nodes • Inferior tracheobronchial (subcarinal) nodes Deep (visceral) Overview of the Lymphatic Pathways in the Thorax References 1. Hansen, JT. Netter's Clinical Anatomy. 4th ed. Philadelphia, PA: Elsevier, Inc; 2019. https://www-clinicalkey-com.ezproxy.ad.bcomnm.org/#!/content/book/3-s2.0-B978032 3531887000068?scrollTo=%23hl0003049 . Accessed August 5th, 2019. 2. Drake, RL. Gray's Atlas of Anatomy. 2nd ed. Philadelphia, PA: Elsevier, Inc; 2015. https://www-clinicalkey-com.ezproxy.ad.bcomnm.org/#!/browse/book/3-s2.0-C2011006 1720 . Accessed August 5th, 2019. 3. Jenkins, DB. Hollinshead’s: Functional Anatomy of the Limbs and Back, 8th Edition. Philadelphia, PA: Saunders; 2002. 4. Gilroy, A.M. Gilroy Atlas of Anatomy. 3rd ed. New York: Thieme Medical Publishers, Inc. http://www.thiemeteachingassistant.com.ezproxy.ad.bcomnm.org/Thieme%20Teaching %20Assistant . Accessed August 21st, 2019. 5. Moore, K. L. Clinically Oriented Anatomy. 8th Ed. Philadelphia, PA: Wolters Kluwer, 2018. https://meded-lwwhealthlibrary-com.ezproxy.ad.bcomnm.org/book.aspx?bookid=2212 . Accessed June, 2020. 6. Schuenke, M. Schuenke, Atlas of Anatomy. 2nd ed. Vol. 1. New York: Thieme Medical Publishers, Inc.