thorak 1

7/18/2019 Thorak 1

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THORACIC CAVITYTHORACIC CAVITY

MEDIASTINUMMEDIASTINUM

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MediastinumMediastinum

Mediastinum = space between luns!Mediastinum = space between luns!

Supe"i#" mediastinum$Supe"i#" mediastinum$

Sepa"ated %"#m in%e"i#" b& '#"i(#ntal planeSepa"ated %"#m in%e"i#" b& '#"i(#ntal planebetween ste"nal anle and IV disc T)*T+!between ste"nal anle and IV disc T)*T+!

,i! -!.)/ p -.+!,i! -!.)/ p -.+!

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MediastinumMediastinum

In%e"i#"$In%e"i#"$

Ante"i#"$ Ante"i#"$

Middle$Middle$

0#ste"i#"$0#ste"i#"$

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Supe"i#" MediastinumSupe"i#" Mediastinum

Ret"#ste"nal$Ret"#ste"nal$

1"eat 2essels and b"anc'es!1"eat 2essels and b"anc'es!

T'&mus!T'&mus!

0"e2e"teb"al$0"e2e"teb"al$

T"ac'eaT"ac'ea

Es#p'ausEs#p'aus

T'#"acic ductT'#"acic ductS&mpat'etic t"un3sS&mpat'etic t"un3s

Vaus ne"2esVaus ne"2es

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In%e"i#" MediastinumIn%e"i#" Mediastinum

Ante"i#"$ Ante"i#"$

T'&mus/ %at/ l&mp' n#desT'&mus/ %at/ l&mp' n#des

Middle$Middle$0e"ica"dium0e"ica"dium

0'"enic ne"2es0'"enic ne"2es

0e"ica"diac#p'"enic a"te"&0e"ica"diac#p'"enic a"te"&

Hea"t and "eat 2esselsHea"t and "eat 2essels

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In%e"i#" MediastinumIn%e"i#" Mediastinum

0#ste"i#"$0#ste"i#"$

Es#p'ausEs#p'aus

T'#"acic ductT'#"acic duct

A#"ta and b"anc'es A#"ta and b"anc'es

Vaus ne"2esVaus ne"2es

S&mpat'etic t"un3sS&mpat'etic t"un3s

A(&#s s&stem #% 2eins A(&#s s&stem #% 2eins

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SUPERIORSUPERIOR


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T'&musT'&mus

Occupies supe"i#" mediastinum #n eit'e"Occupies supe"i#" mediastinum #n eit'e"

side #% t'e midline!side #% t'e midline!

4e'ind manub"ium!4e'ind manub"ium!C#2e"ed b& c#n2e"in pleu"a #% t'eC#2e"ed b& c#n2e"in pleu"a #% t'e

luns!luns!

In2#lutes wit' %at a%te" pube"t&!In2#lutes wit' %at a%te" pube"t&!

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T'&musT'&mus

4l##d suppl&$4l##d suppl&$

Ante"i#" mediastinal a"te"ies %"#m inte"nal Ante"i#" mediastinal a"te"ies %"#m inte"nal

t'#"acic a"te"&!t'#"acic a"te"&!

In%e"i#" t'&"#id a"te"ies %"#m subcla2ianIn%e"i#" t'&"#id a"te"ies %"#m subcla2ian

a"te"&!a"te"&!

Ven#us d"ainae$Ven#us d"ainae$

Int# le%t b"ac'i#cep'alic 2ein!Int# le%t b"ac'i#cep'alic 2ein!

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T'&musT'&mus

Inne"2ati#n$Inne"2ati#n$

Vaus ne"2e!Vaus ne"2e!

Ca"diac s&mpat'etic ple5us!Ca"diac s&mpat'etic ple5us!

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Middle Mediastinum 6in%e"i#"7Middle Mediastinum 6in%e"i#"7

0e"ica"dium$0e"ica"dium$

Encl#ses 'ea"t!Encl#ses 'ea"t!

6,i! -!.+/ p -.87!6,i! -!.+/ p -.87!

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Visce"al 6se"#us7 6,i -!.8/ p -.97$Visce"al 6se"#us7 6,i -!.8/ p -.97$

= epica"dium!= epica"dium!

A"te"ial mes#ca"dium! A"te"ial mes#ca"dium!

Ven#us mes#ca"dium!Ven#us mes#ca"dium!

T"ans2e"se sinus$T"ans2e"se sinus$

Space between a"te"ial and 2en#usSpace between a"te"ial and 2en#us

mes#ca"dium!mes#ca"dium!

Obli:ue sinus$Obli:ue sinus$

Space between "i't and le%t pulm#na"& 2eins!Space between "i't and le%t pulm#na"& 2eins!

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0e"ica"dial ca2it&!0e"ica"dial ca2it&!

0a"ietal 6se"#us7$0a"ietal 6se"#us7$

,used t# %ib"#us pe"ica"dium!,used t# %ib"#us pe"ica"dium!

,ib"#us$,ib"#us$

,used wit' cent"al tend#n #% diap'"am$,used wit' cent"al tend#n #% diap'"am$

0e"ica"diac#p'"enic liament!0e"ica"diac#p'"enic liament!

,used wit' ste"num$,used wit' ste"num$

Supe"i#" and in%e"i#" ste"n#pe"ica"dialSupe"i#" and in%e"i#" ste"n#pe"ica"dial

liaments!liaments!

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4l##d suppl& 6,i! -!.;/ p -.97$4l##d suppl& 6,i! -!.;/ p -.97$

0e"ica"dial a"te"ies!0e"ica"dial a"te"ies!

0e"ica"diac#p'"enic a"te"ies!0e"ica"diac#p'"enic a"te"ies!

Muscul#p'"enic a"te"ies!Muscul#p'"enic a"te"ies!

Ne"2e suppl&$Ne"2e suppl&$

CN <!CN <!0'"enic ne"2e!0'"enic ne"2e!

S&mpat'etic t"un3!S&mpat'etic t"un3!

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POSTERIORPOSTERIOR


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Es#p'ausEs#p'aus

,"#m base #% nec3 t#$,"#m base #% nec3 t#$

e%t #% midline t#$e%t #% midline t#$

Midline t#$Midline t#$

e%t #% midline!e%t #% midline!

0asses t'"#u' diap'"am at le2el #% T->!0asses t'"#u' diap'"am at le2el #% T->!

ies$ies$4e'ind t"ac'ea!4e'ind t"ac'ea!

In %"#nt #% 2e"teb"al c#lumn!In %"#nt #% 2e"teb"al c#lumn!

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Es#p'aus 4l##d Suppl&Es#p'aus 4l##d Suppl&

4"#nc'ial a"te"&!4"#nc'ial a"te"&!

T'#"acic a#"ta!T'#"acic a#"ta!

e%t ast"ic a"te"&!e%t ast"ic a"te"&!e%t in%e"i#" p'"enic a"te"&!e%t in%e"i#" p'"enic a"te"&!

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Es#p'aus Inne"2ati#nEs#p'aus Inne"2ati#n

Es#p'aeal ple5us$Es#p'aeal ple5us$

C#ntinuati#n #% p#ste"i#" pulm#na"& ple5us!C#ntinuati#n #% p#ste"i#" pulm#na"& ple5us!

,#"med b& "i't and le%t 2aus ne"2es$,#"med b& "i't and le%t 2aus ne"2es$

Ri't 2aus ne"2eRi't 2aus ne"2e p#ste"i#" 2aus ne"2e!p#ste"i#" 2aus ne"2e!

e%t 2aus ne"2ee%t 2aus ne"2e ante"i#" 2aus ne"2e!ante"i#" 2aus ne"2e!

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Es#p'aus Inne"2ati#nEs#p'aus Inne"2ati#n

Uppe" t'i"d$Uppe" t'i"d$

V#lunta"& muscle!V#lunta"& muscle!

Inne"2ated b& "ecu""ent la"&neal ne"2e!Inne"2ated b& "ecu""ent la"&neal ne"2e!

#we" tw#*t'i"ds$#we" tw#*t'i"ds$

In2#lunta"& muscle!In2#lunta"& muscle!

Inne"2ated b& 2aus and s&mpat'etic c'ain!Inne"2ated b& 2aus and s&mpat'etic c'ain!

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e%t T'#"acic ducte%t T'#"acic duct

A"ises %"#m ciste"na c'&li$ A"ises %"#m ciste"na c'&li$

At uni#n #% "i't and le%t lumba" t"un3s! At uni#n #% "i't and le%t lumba" t"un3s!

4eins #n t'e %"#nt #% 2e"teb"al b#d& T*-?4eins #n t'e %"#nt #% 2e"teb"al b#d& T*-?#" *-!#" *-!

Runs up t'"#u' t'e t'#"a5 al#n t'e %"#ntRuns up t'"#u' t'e t'#"a5 al#n t'e %"#nt

#% t'e 2e"teb"al c#lumn!#% t'e 2e"teb"al c#lumn!

At %i"st it lies t# t'e "i't #% midline! At %i"st it lies t# t'e "i't #% midline!

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It m#2es #2e" t# t'e le%t side w'en itIt m#2es #2e" t# t'e le%t side w'en it

"eac'es le2el T*+!"eac'es le2el T*+!

Recei2es m#st #% l&mp' %"#m b#d& bel#wRecei2es m#st #% l&mp' %"#m b#d& bel#w

diap'"am!diap'"am!

D"ains le%t side #% t'#"acic ca2it& and pa"tD"ains le%t side #% t'#"acic ca2it& and pa"t

#% "i't!#% "i't!

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Recei2es l&mp' %"#m le%t inte"nal @uula"Recei2es l&mp' %"#m le%t inte"nal @uula"

l&mp' t"un3!l&mp' t"un3!

Recei2es l&mp' %"#m le%t subcla2ian l&mp'Recei2es l&mp' %"#m le%t subcla2ian l&mp'

t"un3!t"un3!

Empties int# 2en#us s&stem at @uncti#n #%$Empties int# 2en#us s&stem at @uncti#n #%$

e%t inte"nal @uula" 2ein!e%t inte"nal @uula" 2ein!

e%t subcla2ian 2ein!e%t subcla2ian 2ein!

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Ri't T'#"acic ductRi't T'#"acic duct

D"ains uppe" "i't t'#"acic ca2it&/ "i'tD"ains uppe" "i't t'#"acic ca2it&/ "i't

uppe" e5t"emit&/ and "i't side #% 'eaduppe" e5t"emit&/ and "i't side #% 'ead

and nec3!and nec3!


Ri't inte"nal @uula" 2ein!Ri't inte"nal @uula" 2ein!

Ri't subcla2ian 2ein!Ri't subcla2ian 2ein!

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T'#"acic S&mpat'etic C'ainT'#"acic S&mpat'etic C'ain

ies aainst nec3 #% "ibs andies aainst nec3 #% "ibs and

c#st#2e"teb"al @uncti#ns!c#st#2e"teb"al @uncti#ns!

-? t'#"acic anlia pai"s$-? t'#"acic anlia pai"s$

,i"st #ne #%ten %used wit' in%e"i#" ce"2ical,i"st #ne #%ten %used wit' in%e"i#" ce"2ical

anli#n$anli#n$

Re%e""ed t# as stellate anli#n c#llecti2el&!Re%e""ed t# as stellate anli#n c#llecti2el&!

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Ce"2ical anlia$Ce"2ical anlia$

Supe"i#"!Supe"i#"!

Middle!Middle!

In%e"i#"!In%e"i#"!

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T'e p"eanli#nic s&mpat'etic suppl& t#T'e p"eanli#nic s&mpat'etic suppl& t#t'e t'#"acic 2isce"a a"e %"#m T-+!t'e t'#"acic 2isce"a a"e %"#m T-+!

T'e p#stanli#nics a"e %"#m$T'e p#stanli#nics a"e %"#m$

Supe"i#"/ middle/ and in%e"i#" ce"2icalSupe"i#"/ middle/ and in%e"i#" ce"2icalanlia!anlia!

T-*T+ pa"a2e"teb"al anlia!T-*T+ pa"a2e"teb"al anlia!

T'e& e5it t'e c'ain as di"ect %ibe"s andT'e& e5it t'e c'ain as di"ect %ibe"s andt"a2el d#wnwa"ds t# ente" t'e t'#"a5$t"a2el d#wnwa"ds t# ente" t'e t'#"a5$

As ca"di#pulm#na"& splanc'nic ne"2es! As ca"di#pulm#na"& splanc'nic ne"2es!

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T'e ca"di#pulm#na"& splanc'nic ne"2esT'e ca"di#pulm#na"& splanc'nic ne"2es

t"a2el #n t'ei" #wn and d# n#t acc#mpan&t"a2el #n t'ei" #wn and d# n#t acc#mpan&

#t'e" ne"2es #" 2essels!#t'e" ne"2es #" 2essels!

,uncti#n$,uncti#n$

C#"#na"& a"te"& dilati#n!C#"#na"& a"te"& dilati#n!

Inc"ease 'ea"t "ate!Inc"ease 'ea"t "ate!

4"#nc'#dilati#n!4"#nc'#dilati#n!

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Splanc'nic Ne"2esSplanc'nic Ne"2es

C#mp#sed #% p"eanli#nic %ibe"s andC#mp#sed #% p"eanli#nic %ibe"s and

2isce"al sens#"& %ibe"s!2isce"al sens#"& %ibe"s!

Suppl& abd#minal 2isce"a!Suppl& abd#minal 2isce"a!

S&napse in p"e2e"teb"al anlia!S&napse in p"e2e"teb"al anlia!

Re%e" in te5t t# ,iu"e -!)-/ pae B.!Re%e" in te5t t# ,iu"e -!)-/ pae B.!

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1"eate"$1"eate"$

T+*T9!T+*T9!

S&napses in celiac anli#n!S&napses in celiac anli#n!

esse"$esse"$

T->*T--!T->*T--!

S&napses in t'e supe"i#" mesente"icS&napses in t'e supe"i#" mesente"ic

anli#n!anli#n!

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east$east$

T-?!T-?!

S&napses in t'e a#"tic#"enal anli#n!S&napses in t'e a#"tic#"enal anli#n!

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Vaus Ne"2eVaus Ne"2e

C"anial ne"2e <C"anial ne"2e <

Ma@#" pa"as&mpat'etic suppl& t# t'#"acicMa@#" pa"as&mpat'etic suppl& t# t'#"acic

and abd#minal 2isce"a!and abd#minal 2isce"a!

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C#u"se #% Vaus Ne"2eC#u"se #% Vaus Ne"2e

0a"allel t# es#p'aus$0a"allel t# es#p'aus$

Inne"2ates es#p'ausInne"2ates es#p'aus

0asses p#ste"i#" t# "##t #% lun #n eac'0asses p#ste"i#" t# "##t #% lun #n eac'

side!side!

0ie"ces diap'"am wit' es#p'aus!0ie"ces diap'"am wit' es#p'aus!

4ec#mes ast"ic ne"2e!4ec#mes ast"ic ne"2e!Supplies 2isce"a in t'#"acic ca2it&!Supplies 2isce"a in t'#"acic ca2it&!

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Vaus Ne"2e 4"anc'esVaus Ne"2e 4"anc'es

Ca"diac b"anc'es t# ca"diac ple5us!Ca"diac b"anc'es t# ca"diac ple5us!

0ulm#na"& b"anc'es t# pulm#na"& ple5us!0ulm#na"& b"anc'es t# pulm#na"& ple5us!

Es#p'aeal b"anc'es t# es#p'aealEs#p'aeal b"anc'es t# es#p'aealple5us!ple5us!

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Vaus Ne"2e 4"anc'esVaus Ne"2e 4"anc'es

e%t "ecu""ent la"&neal ne"2e %"#m le%te%t "ecu""ent la"&neal ne"2e %"#m le%t

2aus$2aus$

H##3s a"#und a"c #% a#"ta t# le%t #%H##3s a"#und a"c #% a#"ta t# le%t #%

liamentum a"te"i#sum!liamentum a"te"i#sum!

Ri't "ecu""ent la"&neal ne"2e %"#m "i'tRi't "ecu""ent la"&neal ne"2e %"#m "i't

2aus$2aus$

H##3s a"#und subcla2ian a"te"&!H##3s a"#und subcla2ian a"te"&!

T'e"e%#"e$ a"ises in nec3/ n#t t'#"a5!T'e"e%#"e$ a"ises in nec3/ n#t t'#"a5!

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0'"enic Ne"2e0'"enic Ne"2e

A"ises in nec3 %"#m$ A"ises in nec3 %"#m$

Vent"al "ami #% C.*+ 6C) = ma@#"Vent"al "ami #% C.*+ 6C) = ma@#"c#nt"ibuti#n7c#nt"ibuti#n7

0asses ante"i#" t# pulm#na"& "##t #n eac'0asses ante"i#" t# pulm#na"& "##t #n eac'side 6#nl& ne"2e t# d# s#7!side 6#nl& ne"2e t# d# s#7!

S#le m#t#" inne"2ati#n t# diap'"am!S#le m#t#" inne"2ati#n t# diap'"am!

Sens#"& %ibe"s t# pe"ica"dium/ mediastinalSens#"& %ibe"s t# pe"ica"dium/ mediastinalpleu"a/ and pleu"al and pe"it#nealpleu"a/ and pleu"al and pe"it#nealc#2e"ins #% diap'"am!c#2e"ins #% diap'"am!

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0'"enic Ne"2e0'"enic Ne"2e

0ain 2ia p'"enic ne"2es usuall& "e%e""ed t#0ain 2ia p'"enic ne"2es usuall& "e%e""ed t#

base #% nec3 and tip #% s'#ulde"!base #% nec3 and tip #% s'#ulde"!

Acc#mpanied b& pe"ica"diac#p'"enic Acc#mpanied b& pe"ica"diac#p'"enic

a"te"ies!a"te"ies!

4"anc'es #% inte"nal t'#"acic a"te"ies4"anc'es #% inte"nal t'#"acic a"te"ies

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&mp'atic D"ainae&mp'atic D"ainae

+> t"ac'e#b"#nc'ial l&mp' n#des $+> t"ac'e#b"#nc'ial l&mp' n#des $

S#me #% t'e la"est l&mp' n#des in t'eS#me #% t'e la"est l&mp' n#des in t'eb#d&!b#d&!

Include$Include$0a"at"ac'eal0a"at"ac'eal

Supe"i#" t"ac'e#b"#nc'ialSupe"i#" t"ac'e#b"#nc'ial

In%e"i#" t"ac'e#b"#ncialIn%e"i#" t"ac'e#b"#ncial

4"#nc'#pulm#na"&4"#nc'#pulm#na"&0ulm#na"&0ulm#na"&

Te5t$ p -.-/ ,i! -!.?Te5t$ p -.-/ ,i! -!.?

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&mp' D"ainae #% T'#"acic Ca2it&&mp' D"ainae #% T'#"acic Ca2it&

0a"aste"nal n#des$0a"aste"nal n#des$

ie be'ind ste"num al#n c#u"se #% inte"nalie be'ind ste"num al#n c#u"se #% inte"nal

t'#"acic a"te"&!t'#"acic a"te"&!

Recei2e l&mp' %"#m t'#"acic wall/ uppe"Recei2e l&mp' %"#m t'#"acic wall/ uppe"

ante"i#" abd#minal wall/ and diap'"am!ante"i#" abd#minal wall/ and diap'"am!

Als# "ecei2e sini%icant am#unt #% l&mp' Als# "ecei2e sini%icant am#unt #% l&mp'

%"#m mamma"& land!%"#m mamma"& land!Dump int# pa"aste"nal l&mp' c'annel!Dump int# pa"aste"nal l&mp' c'annel!

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0#ste"i#" inte"c#stal n#des$0#ste"i#" inte"c#stal n#des$

ie in p#ste"i#" inte"c#stal space betweenie in p#ste"i#" inte"c#stal space between

'eads #% "ibs!'eads #% "ibs!

Recei2e l&mp' %"#m t'#"acic wall andRecei2e l&mp' %"#m t'#"acic wall and

pa"a2e"teb"al "ei#ns!pa"a2e"teb"al "ei#ns!

D"ain int# t'#"acic duct$D"ain int# t'#"acic duct$

,"#m le%t and l#we" "i't!,"#m le%t and l#we" "i't!D"ain int# "i't l&mp'atic duct$D"ain int# "i't l&mp'atic duct$

,"#m uppe" "i't!,"#m uppe" "i't!

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Diap'"amatic n#des$Diap'"amatic n#des$

ie #n uppe" su"%ace #% diap'"am!ie #n uppe" su"%ace #% diap'"am!

Recei2e l&mp' %"#m diap'"am/ pe"ica"dium/Recei2e l&mp' %"#m diap'"am/ pe"ica"dium/

uppe" su"%ace #% li2e"!uppe" su"%ace #% li2e"!

D"ain t# pa"aste"nal and p#ste"i#"D"ain t# pa"aste"nal and p#ste"i#"

mediastinal n#des!mediastinal n#des!

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0#ste"i#" mediastinal n#des$0#ste"i#" mediastinal n#des$

ie al#n es#p'aus and descendinie al#n es#p'aus and descendin

t'#"acic a#"ta!t'#"acic a#"ta!

4"ac'i#cep'alic n#des$4"ac'i#cep'alic n#des$

ie al#n b"ac'i#cep'alic 2eins!ie al#n b"ac'i#cep'alic 2eins!

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&mp'atic D"ainae #% T'#"a5&mp'atic D"ainae #% T'#"a5

&mp' T"un3s&mp' T"un3s

4"#nc'i#mediastinal l&mp' t"un3s "ecei2e4"#nc'i#mediastinal l&mp' t"un3s "ecei2e

l&mp' %"#m$l&mp' %"#m$

0#ste"i#" mediastinal n#des0#ste"i#" mediastinal n#des

4"ac'i#cep'alic n#des4"ac'i#cep'alic n#des

T"ac'e#b"#nc'ial n#desT"ac'e#b"#nc'ial n#des

0a"aste"nal n#des0a"aste"nal n#des

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T'#"acic DuctT'#"acic Duct

4eins in abd#men #n "i't side #% midline!4eins in abd#men #n "i't side #% midline!

Recei2es m#st #% l&mp' %"#m b#d& bel#wRecei2es m#st #% l&mp' %"#m b#d& bel#w

diap'"am!diap'"am!

D"ains le%t side #% t'#"acic ca2it& and pa"t #%D"ains le%t side #% t'#"acic ca2it& and pa"t #%

"i't!"i't!

Recei2es l&mp' %"#m le%t inte"nal @uula"Recei2es l&mp' %"#m le%t inte"nal @uula"l&mp' t"un3!l&mp' t"un3!

7/18/2019 Thorak 1



T'#"acic Duct 6c#nt!7$T'#"acic Duct 6c#nt!7$

Recei2es l&mp' %"#m le%t subcla2ian l&mp'Recei2es l&mp' %"#m le%t subcla2ian l&mp'

t"un3!t"un3!


e%t inte"nal @uula" 2ein!e%t inte"nal @uula" 2ein!

e%t subcla2ian 2ein!e%t subcla2ian 2ein!

7/18/2019 Thorak 1



Ri't &mp'atic Duct$Ri't &mp'atic Duct$

D"ains uppe" "i't t'#"acic ca2it&/ "i't uppe"D"ains uppe" "i't t'#"acic ca2it&/ "i't uppe"

e5t"emit&/ and "i't side #% 'ead and nec3!e5t"emit&/ and "i't side #% 'ead and nec3!


Ri't inte"nal @uula" 2ein!Ri't inte"nal @uula" 2ein!

Ri't subcla2ian 2ein!Ri't subcla2ian 2ein!

thorak 1

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