BMS 204 Vessels of Thorax Fall 2024 Galala University PDF

BMS 204 Faculty of medicine Fall 20 24 Galala University gu.edu. eg  G A L A L A U N I V E R S I T Y THE FUTURE STARTS HERE Vessels of thorax Dr.Waleed Nasr T H E F U...

BMS 204 Faculty of medicine Fall 20 24 Galala University gu.edu. eg  G A L A L A U N I V E R S I T Y THE FUTURE STARTS HERE Vessels of thorax Dr.Waleed Nasr T H E F U T U R E S T A R T S H E R E At the end of this lecture, the students should be able to: Describe, beginning, course, termination, important relations and branches of the arteries of the thorax Describe beginning, course, termination, important relations and tributaries of the veins of the thorax  Pulmonary trunk Begins: from the pulmonary orifice at 3rd left sternocostal junction. Course : It runs upwards, backwards and to the left, winding around the left side of the ascending aorta.It has triple relation with ascending aorta end :at the level of the sternal angle (disc between T4 and T5) by dividing into right and left pulmonary arteries. The bifurcation lies below the arch of the aorta.  Pulmonary trunk Branches :These are the right and left pulmonary arteries; the right pulmonary artery is longer and wider than the left. The two pulmonary arteries run horizontally along the upper border of the right and left atria above the superior pulmonary veins.  Aorta Thoracic aorta has 3 parts ascending Arch descending  Ligamentum arteriosum: fibrous band which extends between the left pulmonary artery and the arch of the aorta. It is the obliterated, fibrosed ductus arteriosus of the fetus which shifts the oxygenated blood to the aorta instead of going to the non- functioning lungs. It has the following 2 important relations: Superficial cardiac plexus: on its right anterior aspect. Left recurrent laryngeal nerve: on its left posterior aspect.  Ascending aorta begin: at the aortic orifice at the 3rd left intercostal space. Course : It runs obliquely upwards, forwards and to the right to end behind the 2nd right sternocostal junction by becoming arch of aorta. Relations: It has triple relation with pulmonary trunk At first pulmonary trunk is in front Then to the left Then right pulmonary artery is post  Ascending aorta Branches of ascending aorta: Right coronary artery: arises from the anterior aortic sinus. Left coronary artery: arises from the left posterior aortic sinus.  Arch of aorta Begins at the 2nd right sternocostal junction as a continuation of ascending aorta. Course It passes first upwards, backwards and to left in front of the trachea, then backwards and downwards on the left side of the trachea. Ends: on the left side of disc between T4 and T5 by becoming the descending thoracic aorta. Relations: The upper convex aspect is related to: Origins of its 3 large branches. Left brachiocephalic vein: runs obliquely along upper border. The lower concave aspect is related to: Bifurcation of pulmonary trunk into right and left pulmonary arteries. Left principal bronchus. Ligamentum arteriosum. Superficial cardiac plexus. Left recurrent laryngeal nerve.  Arch of aorta The left anterior aspect is related to: The mediastinal surfaces of the left pleura and lung Separated by Left phrenic nerve Left vagus nerve,. Superior cervical cardiac branch of left sympathetic chain. Inferior cervical cardiac branch of left vagus nerve. Left superior intercostal vein. The right posterior aspect is related to: Trachea. Esophagus: behind the trachea. Left recurrent laryngeal nerve. Thoracic duct: behind left border of the oesophagus. Branches: brachiocephalic, left common carotid and left subclavian arteries  Descending aorta Begin: on the left side of the disc between T4 and T5 as the continuation of the arch of the aorta. Course :It descends first on the left side of the bodies of 3 thoracic vertebrae (T5-T7) then in front of the lower 5 thoracic vertebrae (T8-T12). end at the lower border of T12, by passing through the aortic opening of the diaphragm to continue as the abdominal aorta. Branches: Nine pairs of posterior intercostal arteries (from 3rd to 11th). One pair of subcostal arteries. Two left bronchial arteries. Four or five esophageal branches. Few small twigs to the pericardium, and diaphragm  Brachiocephalic Veins The 2 brachiocephalic veins (right and left) drain the upper limbs (brachium) as well as the head and neck (cephalic). They also drain the anterior wall of the thorax, the upper part of the posterior wall of the thorax as well as lymph from the whole body. The 2 veins end at 1st right costal cartilage, close to sternum by uniting together to form the S.V.C.  Right brachiocephalic Veins It descends vertically in the superior mediastinum, extending from the medial end of the right clavicle to the lower margin of the 1st right costal cartilage, close to the sternum (surface anatomy as well). Tributaries Right internal thoracic vein and right 1st posterior intercostal vein. Right lymphatic duct.  Left brachiocephalic Veins Descends obliquely downwards and to the right behind the upper ½ of the manubrium sterni, from the medial end of the left clavicle to the lower border of the 1st right costal cartilage, close to the sternum (surface anatomy as well). It runs in the superior mediastinum, along the upper aspect of the arch of the aorta, crossing in front of the origins of its 3 large branches Tributaries Left internal thoracic vein, left 1st posterior intercostal vein and left superior intercostal vein. Thoracic duct.  sup vena cava It measures about 2 inches (5 cm) long. Its upper ½ lies in the superior mediastinum while its lowe r ½ lies in the middle mediastinum, inside the fibrous pericardium.. Formation :by the union of the 2 brachiocephali c veins at 1st right costal cartilage close to sternum. Course : It descends vertically to pierce the pericardium at the level of the 2nd right costal cartilage. End: by opening into the right atrium behind the 3rd right costal cartilage, close to the sternum. Tributaries: The S.V.C. has only one tributary, the azygos vein, d which enters it from behind, at the level of the 2n right costal cartilage just before it pierces the pericardium.