Systemic Anatomy for Respiratory Technology PDF

Systemic anatomy for respiratory Technology Of Respiratory Therapy the Program by Marwa Abdel-Samad Al-Gholam MD Anatomy and Embryology Assistant Professor of Anatomy and Embryology Menoufia Univer...

Systemic anatomy for respiratory Technology Of Respiratory Therapy the Program by Marwa Abdel-Samad Al-Gholam MD Anatomy and Embryology Assistant Professor of Anatomy and Embryology Menoufia University Intercostal vessels  Objectives of the lecture ✓ Describe the arterial supply and the venous drainage of the thoracic wall 1- Intercostal arteries ❑ The upper nine intercostal spaces contain three arteries, one posterior intercostal and two anterior intercostal arteries, per space. ❑ The tenth and eleventh spaces (being incomplete anteriorly), contain a single posterior intercostal artery in each space.  Internal thoracic artery 1st part of subclavian A Oblique part of internal thoracic A Vertical part of internal thoracic A Termination of internal thoracic A Musculophrenic A Superior epigastric A Intercostal a. 1)The anterior intercostal a First 6 spaces ……..internal thoracic artery from subclavian a Subclavian a. Ant. intercostal a Internal thoracic a (internal mammary) 2)The anterior intercostal a lower spaces from musculophrenic a. -internal thoracic artery. Musculophrenic a Superior epigastric a. Anterior Intercostal Arteries: Origin: The upper 6 pairs of anterior intercostal arteries: arise from the internal thoracic artery. The 7th, 8th and 9th pairs of anterior intercostal arteries: arise from the musculophrenic artery. The lower two intercostal spaces have no anterior intercostals arteries. These spaces are supplied by the posterior intercostal arteries and their collateral branches.  Branches of internal thoracic A Internal thoracic A Pericardiophrenic A Phrenic N Perforating br. Anterior intercostal A Costal cartilage Superior epigastric A Musculophrenic A Diaphragm Branches: (1) Pericardial branches: to the pericardium. (2) Pericardiacophrenic artery: supply diaphragm, pleura and pericardium. (3) Anterior intercostal arteries: two arteries for each of the upper 6 intercostal spaces. (4) Perforating branches: to supply the breast (Mammary gland). (5) Musculophrenic artery: is the lateral terminal branch. It gives off anterior intercostal branches to the 7th, 8th and 9th intercostal spaces. (6) Superior epigastric artery: is the medial terminal branch of the internal thoracic artery.  Intercostal a. 2)Posterior intercostal a. ❑First 2 spaces from superior intercostal a., a branch of the subclavian a. ❑Lower 9 spaces from descending thoracic aorta Costocervical trunk Posterior intercostal a. 1 2 Intercostal a. Posterior intercostal Lower 9 space descending thoracic aorta Posterior Intercostal Arteries: Origin: The upper two posterior intercostal arteries arise from the superior intercostal artery ( a branch of the costocervical trunk of the 2nd part of the subclavian artery). From 3-11 posterior intercostal and subcostal arteries - Arise posteriorly from the descending thoracic aorta. - Because the aorta is slightly to the left of the vertebral column, the right arteries have a longer course than those on the left side. - The right arteries cross the vertebrae and pass posterior to the esophagus, thoracic duct, azygos vein, and the right lung and pleura.  Superior intercostal A 1st part of 1st posterior intercostal A subclavian A 2nd 3rd Arch of aorta Posterior intercostal arteries  Course of Rt posterior intercostal A A in posterior part of intercostal space Dorsal branch A Descending aorta A entering the groove A in the costal groove Collateral branch Anterior intercostal A Internal thoracic A  Veins Post. intercostal V. drain into azygos or hemiazygos v. Ant. intercostal v. drain into internal thoracic & musculophrenic v  Posterior intercostal Vs Rt brachiocephalic Lt brachiocephalic 1st 1st 2nd, 3rd 2nd + 3rd Superior intercostal Superior intercostal SVC Superior hemiazygos Azygos V Inferior hemiazygos Ascending lumbar Ascending lumbau Beginning of azygos from IVC Posterior Intercostal Veins: Accompany the posterior intercostal arteries and intercostal nerves, and lie most superior in the costal grooves (VAN). Like the arteries, there are 11 posterior intercostal veins and one subcostal vein on each side. Unlike the arteries, where the corresponding arteries have the same origins on both sides, the veins differ in their mode of termination on the two sides with the exception of the 1st posterior intercostal vein as follows:  Vein Right side Left side 1st terminates into - terminates into left posterior right brachiocephalic vein intercosta brachiocephalic v. l 2nd & 3rd - unite to form right - unite to form left posterior superior superior intercostal vein, intercosta intercostal vein, which terminates in the l which terminates left brachiocephalic vein. in the arch of azygos vein. 4th – 11th - terminate into the 4th–8th superior posterior vertical part of hemiazygos vein. intercosta azygos vein. 9th–11th inferior l hemiazygos vein Anterior intercostal V. Internal thoracic v Like the arteries, there're two anterior intercostal veins in each space. Also, the 10th and 11th spaces have no anterior intercostal veins. - The anterior intercostal veins of the upper spaces open into the internal thoracic vein. - The anterior intercostal veins of 7th, 8th and 9th spaces join the venae commitantes of musculophrenic artery. Musculophrenic v Internal thoracic V Brachiocephalic Vein Internal Thoracic Vei 3rd Veina comitantes Formed by the union of the two venae comitantes of the internal mammary artery at the level of the third costal cartilage. Ascends close to the artery on its medial side. Terminates in the corresponding brachiocephalic vein. Tributaries: correspond to the branches of the artery.