Grants atlas of anatomy 13th ed a agur, a dalley (lippincott, 2013) 1

Anterior axillary foldPosterior axillary fold Sternocostal head of pectoralis major Serratus anterior Rectus abdominisLinea alba Anterior View Xiphoid process AreolaNipple... Anterior Vi

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9 8 7 6 5 4 3 2 1

To my husband Enno and my children Erik and Kristina

for their support and encouragement

(A.M.R.A.)

To Muriel

My bride, best friend, counselor, and mother of our sons;

To my family Tristan, Lana, Elijah, Finley, Sawyer,

Denver, and Skyler With great appreciation for their support, humor, and patience

(A.F.D.)

And with sincere appreciation for the anatomical donors Without whom our studies would not be possible

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Anterior axillary fold

Posterior axillary fold

Sternocostal head of

pectoralis major

Serratus anterior

Rectus abdominisLinea alba

Anterior View

Xiphoid process

AreolaNipple

Medial mammary branches ofanterior pectoral cutaneousbranches of intercostal nerves

Supraclavicular nerves (C3 and C4)

Clavipectoral(deltopectoral)triangle

Intercostobrachial nerve (T2)

Lateral mammary and posterior branches

of lateral pectoral cutaneous

nerves (T3 to T6)(from intercostal nerves)

Anterioraxillary fold

Supernumerarynipple (polythelia)

Xiphoid process

A. Anterior View

Site of axillary process (tail)

Areolar tubercle

Nipple Areola

B Anterior View

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Orientation for C and D Orientation for A and B

D Superior View

Interpectoral lymph nodes

Parasternal lymph node

*Apical lymph node

Supraclavicular lymph nodesSubclavian lymphatic trunk

Subareolar lymphatic plexus

Infraclavicular lymph nodes

Jugular lymphatic trunkLeft internal jugular vein

Right lymphatic duct

Bronchomediastinal lymphatic trunk

A Anterior View

*Axillary lymph nodes

Lateral mammary branches of lateral cutaneous branches of posterior intercostal arteries

Lateral mammary branches of lateral thoracic artery

Lateral thoracic artery

Pectoral branch of thoraco-acromial artery

Mammary branch of anterior intercostal veinSubclavian vein

Internal thoracic veinPerforating branchesSternal branchesMedial mammary veins

7 6 5

8

10 10

9

Anterior View

S t e r n u m

S t e r n u m

1st thoracic vertebra

Clavicle

Scapula

ManubriumManubriosternal joint(sternal angle)Body

Costal cartilage

8th rib

10th ribCostal

margin

Body of 12th thoracic vertebra

Costochondraljoint

12th

8th intercostal space

Xiphoidprocess

Xiphisternaljoint

1st thoracic vertebra

1st ribClavicle

Scapula

7th rib

Angle of the 9th rib

12thSpinous process of

1st lumbar vertebra

Floating (free) ribs(11 - 12)9th intercostal spaceInferior angle of scapula

Spine ofscapula

Jugular (suprasternal) notch

Xiphoid process

Xiphisternal joint

Clavicular

notch

Transverseridge

A Anterior View

E Anterior View

Manubrium

Sternalangle

1st

2nd

4thXiphisternaljoint3rd

Xiphoid process

7th6th5th4th3rd2nd1st

Body(sternebrae):

Costal notches:

Anterior sternocostal radiate ligaments

Interchondral ligamentAnterior costoxiphoid ligament

Interchondral joint

Sternocostal joints

Intra-articularligament

Manubriosternal joint

C Lateral View Clavicular notch

ligament

Articular cavities of sternoclavicular joint

Cut edges of fibrous layer

of joint capsule

ClavicleArticular disc

Synovialmembrane

Manubrium

B Anterior View

Costoclavicularligament

1st costalcartilage

21st year±

14th year±

7th year±

In about 10% of adults(30-80 years)

Commonly aftermiddle life

1st

2nd

3rd4th

D Anterior View

Sternebrae

Costal cartilages:

costal cartilage

Tubercle

Nonarticular partArticular part

Crest of neck

NeckHead

Crest of head

Single facet

on head

Superior facetInferior facet

Single facet

on head

Head

HeadNeck

Neck

Scalenetubercle

Groove forsubclavian vein

Groove forsubclavian artery

1st rib

2nd rib

TubercleTubercle for serratus anterior

A Posterior View

B Superior View

C Superior View

Tubercle

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B Posterolateral View

Superior costal(demi-) facetSuperior articular facet

Transverse costal facet

for tubercle of 6th rib

Transverse costalfacet for tubercle

of 6th rib

Transverseprocess of T7

Costotransverse

joint

Spinous process of T7

7th rib

Inferior costal(demi-) facet

Vertebralbody

T6

T7

T6

T7Superior articular facet

Spinousprocess

of T6

7th rib

Vertebralbody

Crest

of head

Joints of head of rib

Tubercle

of 7thrib

Transverse process

6th ribRib

Vertebral body

Costotransverse joint

Joint of head of rib

Plane of section for B

Radiate ligament of head of rib

Superior articular process

Collateral branches of intercostal

vessels and nerveIntercostal nerve

Internal intercostal membrane

Subcostales Innermost intercostal

Splanchnic nerveSympathetic trunk

Rami communicantes

Anterior ramus

of thoracic nervePosterior ramus

Spinal ganglion

Radiate ligament of head of rib

Anterior longitudinal ligament

Transverse process

External intercostal Superior costotransverse ligament

Anterior View

arteryveinPosterior intercostal

Tip of transverseprocess

Internal intercostal membrane

of the 10th intercostal space

Levatores costarum

Lateral costotransverse ligament

Angle of 8th ribPosterior ramus of thoracic nerve

Posterior intercostal vessels and intercostal nerve,posterior to transparent parietal pleura covering the lungCollateral branch of intercostal nerve

Innermost intercostal

Internal intercostal

External intercostal

Semispinalis

7th rib

IliocostalisLongissimus

Posterior View

External oblique9th rib

Anterior View

Posterior ramus Posterior branch of posterior intercostal artery

Posterior intercostal artery

Aorta

Lateral pectoral cutaneous branch

Anterior intercostal artery

Internal thoracic arteryAnterior perforating branch

Transversus thoracis

Anterior pectoral cutaneous branch External intercostal membrane

Innermost intercostal Internal intercostal

Parietal pleura(cut edge)

Sympathetic trunk

Common membrane of innermostintercostal and transversus thoracisRami communicantes

Transverse Section

Site of anastomosis/potentialcollateral pathway betweenposterior and anteriorintercostal arteries

Innermost

intercostal

Transversus thoracis

S t e r n u m

Subcostales Anterior View

Ribs:

Serratus posterior superior

Serratus posterior inferior

Levatores costarum

Posterior View

Ribs:

External intercostal

Musclesremoved

Internal intercostal

2

2

3 3

4 4

5 5

6 6

7 7

8 8

9 9

10

10 11 12

3 4 5 6 7 8 9 10 11 12

1 1

2

2

3 3

4 4

5 5

6 6

7 7

8 8

9 9

10

10 11 12

3 4 5 6 7 8 9 10 11 12

8th costal cartilage Rectus abdominis

Brachial plexusAxillary artery

Sternohyoid

Internal thoracic vein

Anterior intercostal artery

Anterior View

Clavicular headSternal head

Posterior View

Internal thoracic artery

Anterior intercostal artery

Transversus abdominis

Xiphoid processInternal

intercostal

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Left brachiocephalic veinRight subclavian artery

Left vagus nerve Arch of aorta

Left phrenic nerve Superior lobe of left lung

Parietal layer of serous pericardium

Horizontal fissure Superior lobe of right lung

Right vagus nerve

Costal surface of lung

Right phrenic nerve

Fibrous pericardium and mediastinalpart of parietal pleura

Sternocostal surface of heartcovered with visceral layer

of serous pericardium

Left subclavian vein

Superior vena cava

Right brachiocephalic vein

Right subclavian vein

Internal jugular vein

Right common carotid artery Apex of left lung

Left crus of diaphragm

Diaphragm

Costochondral

junction

Right atrium

Right subclavian artery

Left pulmonary artery

Pulmonary trunk

Lingula

Line of (parietal) pleural reflectionRight internal jugular vein

1st rib

Clavicle

Coracoid process

Arch of aortaLeft pulmonary artery

Left auricle

Left ventricleApex of heartRight dome of diaphragm

Ascendingaorta

Pulmonarytrunk

LeftauricleRight

atriumSVC

IVC

Ascending aorta

Inferior vena cava

Leftpulmonaryartery

Rightpulmonaryartery

A Anterior View

Nasal cavity

Pharyngeal opening ofpharyngotympanic tubeNasal part

INFLATED LUNG

*Cervical part

*Costal part

*Diaphragmatic part

*Mediastinal part

Root

of lung

Root of lung

Parietal pleuraVisceral pleura

Visceral pleura

D Coronal Section

Right lungRight lung

*Cervical part (cupula)

*Costal part

*Costal part

*Mediastinal part

Left lung

Costodiaphragmatic recess

*Diaphragmatic part

Apex of heartDiaphragm

Left main bronchus

Right main

bronchus

*Parts of parietal pleura

*Parts of parietal pleura

C Transverse Section, Inferior View

T12

Costal

Cervical Parts of parietal pleura:

1 2 3 4 5

6 7 8 9 10 11 12

A Lateral View B Lateral View

HorizontalfissureAnterior border

Inferior lobe Middle lobe

Costal part ofdiaphragm

Right dome ofdiaphragm

Superior lobe

Horizontal fissureOblique fissure

ApexNeck of 1st rib

Sternum

6th rib8th rib