Anatomia en el Anfiteatro - Dr. Durand - Torax

6 TORAX Generalidades

443

T\u00f3rax parietal, proyecciones 446 Diafragma

452

Topograf\u00eda tor\u00e1xica

455

Gl\u00e1ndula mamaria

457

Pericardio

459

Coraz\u00f3n

460

Aparato respiratorio

469

Pulmones

471

Mediastino

473

442

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TORAX, generalidades: El t\u00f3rax parietal est\u00e1 formado por

Tiene forma

Orificio Superior: Di\u00e1metro \u00e1nteroque

se

inicia Figura N\u00ba 1014: T\u00f3rax, vista anterior.

Figura N\u00ba 1015: Jaula tor\u00e1xica.

Estern\u00f3n:

Es un hueso largo (15-18 cm.), plano,

El manubrio es ancho por arriba y

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El

cuerpo

se

ensancha

El cuerpo esternal presenta en ambos

El ap\u00e9ndice xifoides puede adoptar Figura N\u00ba 1017: Estern\u00f3n, vista anterior. formas variables o a\u00fan faltar. El estern\u00f3n est\u00e1 rodeado de una

Arco costal:

Est\u00e1 formado por una costilla y un

Los arcos costales tienen una

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Las dos primeras costillas y las tres

Costilla Tipo: Tiene una cara lateral y

otra medial; un borde superior romo y

Cada costilla tiene un extremo

Figura Nº 1019: Costilla típica (8ª), con

Primera Costilla: Es la más corta de las

costillas, tiene cara superior e inferior,

Segunda Costilla: En la cara externa

tiene una rugosidad para la inserción del Las costillas 10ª, 11ª Y 12ª tienen una

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TORAX PARIETAL, proyecciones: Formado por la piel, el celular

Líneas Verticales: Línea Medioesternal. Línea Lateroesternal: Se traza -

Línea

-

Línea Paraesternal: Es la paralela

Medioclavicular: Es

-

Línea Axilar Anterior: baja desde el borde pectoral. Línea Axilar Media: baja desde Figura Nº 1020: Líneas verticales en el el hueco axilar. tórax. Línea Axilar Posterior: baja desde el borde del dorsal ancho. Línea Escapular: es trazada por el borde espinal del omóplato. Línea Vertebral media.

Líneas Horizontales: Línea Clavicular: coincide con el

relieve clavicular. Linea de la espina de la escápula (T3). Línea del Angulo Esternal de Louis, a este nivel (T4) hallamos: 1-La división del mediastino en superior e inferior (Figura Nº 1021). 2-Termina la tráquea y se divide en bronquios derecho e izquierdo.

6-Las pleuras mediastínicas se unen en la línea media.

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De la escápula, el séptimo espacio

-En el nivel T8 está el hiato -A nivel de T10 está el hiato -A nivel de T12 está el hiato diafragmático para la arteria Aorta. Las regiones del tórax son: La Figura Nº 1022: Nivel T3 y T7, que

Región antero-lateral del tórax: Se aprecia el relieve de las clavículas,

pectoral

mayor,

recto

el esternocleidohioideo y el esternotiroideo; adelante de la clavícula Figura Nº 1023: Niveles vertebrales de

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posterior de los cartílagos costales tercero al séptimo (Figura Nº 1024). Por adelante, el pectoral mayor nace

El pectoral menor está detrás del

El músculo subclavio nace en el canal

El músculo recto abdominal nace

El músculo oblícuo externo nace en la

El músculo serrato anterior o mayor

Figura Nº 1024: Vista posterior de la pared anterior del tórax.

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del músculo dorsal ancho y la del El músculo dorsal ancho: nace en las 8

Los espacios intercostales se forman

(intercostal

Los músculos intercostales externos se Figura Nº 1026: Espacio intercostal,

Los músculos intercostales internos se

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un espacio triangular, evidente en el Los

músculos

supracostales

Los músculos infracostales son

Figura Nº 1028: Posición del VAN entre los músculos intercostales.

Las arterias intercostales se forman a

intercosto-cervical, las 8 siguientes nacen de la aorta. Las ramas

Figura Nº 1029: Arterias intercostales.

en

su

espacio

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venas lumbares, las que forman la vena

Figura Nº 1031: Vena ácigos delante de la columna vertebral toráxica.

venas intercostales

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forman la vena intercostal media

Los nervios intercostales nacen de la

intercostales

Los nervios originan los nervios

Figura Nº 1033: Diafragma, se muestra

DIAFRAGMA: Es el músculo respiratorio principal,

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derecho e izquierdo. El pilar derecho se

Figura Nº 1035: Relaciones de los pilares diafragmáticos con las estructuras anatómicas vecinas. Lateralmente se

forman

arcos

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3.-Hiato de la cava inferior: Situado en

4.-Hiato Retroxifoideo (Marfán): Delimitado por los fascículos musculares diafragmáticos-xifoideos. 5.-Hiato Xifo-condro-costal (Larrey): es

mediastínica y el pericardio fibroso,

el

diafragma, emiten

también conduce fibras propioceptivas y sensitivo-protopáticas.

Arterias del Diafragma: - Diafragmática Superior, rama de la

- A nivel del sexto espacio intercostal,

- Debajo del diafragma, la aorta abdominal origina las arterias

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Los músculos de la respiración: Se clasifican en: - Músculo Respiratorio principal. - Músculos Respiratorios Secundarios.

Las relaciones de la pleura mediastínica derecha son: esófago, vago

El músculo respiratorio principal es el Las

relaciones de

la

pleura

del nivel diafragmático: Escalenos, Pectorales, Subclavio, Trapecio, Esternocleidomastoideo,

ancho.

Son

músculos

Proyección de la pleura: La pleura derecha se inicia a 2-3 cm. articulación

TOPOGRAFÍA TORÁXICA: Pleura: Es una membrana serosa, tiene

esterno-clavicular

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hasta el cuarto cartílago costal, de aquí

Figura Nº 1038: Relaciones de la cúpula Pleural derecha, corte parasagital.

Fondos de sacos pleurales:

1.-Fondo Saco Anterior Derecho.

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El espacio de la pared torácica que

al 6º

Figura Nº 1041: Glándulas mamarias. La proyección de la válvula de la

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400-500 g.; cada glándula tiene 15 a 20

glándulas sebáceas

Figura Nº 1043: Irrigación arterial de la

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PERICARDIO: El corazón es el órgano central del

El corazón está rodeado por un saco pericárdico fibroso y un saco pericárdico seroso que tapiza

del

pericardio son: Figura Nº 1045: Proyección torácica del

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Cavidad Pericárdica:

Está delimitada por las dos hojas del

vegetativa parasimpática.

simpática

y

CORAZON: Es una bomba aspirante-impelente, Figura Nº 1046: Corazón, cara anterior. izquierdo

(con

sangre

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1.- Cara Anterior (Esterno-Costal): 1.1.- Sector Atrial: La aorta y la 1.2.-Sector Arterial: Corresponde pedículo arterial y sus orificios,

al

1.3.-Sector Ventricular: En esta cara 2/3

Figura Nº 1049: Proyección de la silueta

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2.- Pared medial o Septal: aquí se

ubicadas

en la pared del atrio; estas

(Aschoff-Tawara) 3.-Pared inferior: aquí desemboca la

4.- Pared superior: aquí desemboca la

Ventrículo derecho:

está

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superior. A la salida del cono de la

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Ventrículo izquierdo: Tiene paredes gruesas (12 mm), la

1.- Cara anterior: se ven (como en el

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Arteria Coronaria Posterior

Derecha

Se origina en el seno de Valsalva de la

o

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La arteria interventricular anterior

atrio-ventricular

anterior

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La inervación para-simpática la dan

Existen dos plexos cardíacos: el superficial y el profundo. Plexo cardíaco superficial: está situado por debajo del cayado aórtico, adelante

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superior y a la cresta Terminal, la

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APARATO RESPIRATORIO

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B) Lóbulo Inferior

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PULMONES:

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Pulmón Izquierdo

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21.-La tráquea, detrás 1.-Restos 15.-Vena delhemiácigos del esternón timo, ysuperior, los cartílagos costales, 2.-Cayado 16.-Venas 22.-El Esófago, por intercostales aórtico, delante demediales, la columna vertebral, 3.-Arteria 17.-Venas 23.-Los nervios tiroideas braquiocefálica, por debajo Neumogástricos, inferiores, del diafragma cérvico-torácico 4.-Carótida 18.-Tronco 24.-Los nervios venoso común frénicos, y costo-cervical, izquierda, por encima del músculo diafragma (Figura Nº 1072).

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braquiocefálica, izquierda distinto, la de del izquierda la pulmón, horquilla lay derecha lallega ysubclavia por esternal, a detrás laal nace vena cuello izquierda. baja de del innominada la de al tronco carótida sexto la 1ª El y tronco arterial común espacio costilla a la vena izquierda, braquiocefálico donde intercostal, braquiocefálico, cava se superior. divide tiene donde trayecto origina Los en siendo secervical troncos divide atóracode laen arteria subclavia trayecto cervical. músculo profunda cervical; frénica para layregión derecha laepigástrica izquierda pre-vertebral y a lase superior. carótida origina y común en Sus la nuca, la ramas parte derecha. yson: la culminante Intercostales intercostal delpósterocayado anteriores aórtico, asciende por el mediastino

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siguientes se izquierda, manubrio conducto diafragmática formanlinfático troncos por ambos y del la lado unión, derecho. troncos tributarios: primer izquierdo envenosos El espacio elprimero El lado (Figura tronco derecho, confluyen intercostal recoge Nº yugular 1077); la izquierdo, de linfa el por derecho; conducto la de detrás vena todas elsu subclavia tronco linfático del longitud lasmanubrio regiones subclavio derecho con es de la 5 yugular esternal, a infra-diafragmáticas lo izquierdo 7 cm., hace2interna a cm. de nivel de las de diámetro; derecha; regiones su borde en desciende derecho, el supralado izquierdo, para por diafragmáticas detrás formar del por la1ºvena la derechas. y 2º unión espacio cavade El superior. la conducto intercostal vena derecho,se torácico línea inicia látero-esternal, en el abdomen llega a nivel al 2º

izquierdos Vago, derechos, los son: troncos Los Esófago, drena mamarios y derechos, lumbares Aorta en yelinternos, Acigos los ángulo derecho premayor venoso y retrolos e en el mediastino yugulo-subclavio izquierdo, traqueo-bronquiales esofágicos los troncos posterior. derecho. subcostales derecho e izquierdo y los troncos intestinales múltiples.

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cricoides, tórax Estructuralmente Contiene por el los adelante mediastino siguientes es de un superior, tubo órganos la columna cartílago:detrás del Esófago fibromuscular 1.vertebral; manubrio baja (Figura esternal mucoso, por detrás Nºytiene 1078). delante de la más tráquea de delas 16 vértebras cartílagos 2.inclinándose Conducto yhialinos del hacia torácico. esófago, la superpuestos izquierda; terminapasa ade nivel de Venas arriba 3.detrás T4,adel aquí bajo, ácigos borde se tienen divide izquierdo y sus forma formantes. en del de bronquio una cayado “U”, con sus que aórtico extremos lo comprime unidos (27 por cm. detrás de la por

longitud medida desde la arcada dentaria.

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segmentos anterior encima del superior arterias acompañan tonodel muscular); esofago-traqueales del es medulares cayado de a cuello, las tipo arterias estriado de delante la luz la T5ácigos es mencionadas, a T9, de yde aórticas, en C6, salen 2ygran adel 2.5 C 7, tieneen cayado cm., parte arterias drenan fibras una depende pre-ganglionares aórtico, en las bronquiales longitud las estrecheces venas de adelante fibras de tiroideas izquierda 4 (blancas) del a es de 5de constrictor T1 cm. inferiores, 1.5 yaderecha, T3, que cm.se mide inferior arterias en unen las(luego de venas esofágicas 4-5 de de del la cm. atravesar faringe, sistema propias, ácigos en susarterias los respectivos y en 2/3la inferioresizquierda esofagico-frenicas gástrica ganglios simpáticos es de tipo(Figura yliso) sin lassinaptar) tiene esofágicas Nº fibras 1081). para inferiores, formar el nervio ramas esplácnico de la mayor, gástrica sus

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su trayecto correspondientes, fibras que sensibilidades. sepre-ganglionares originan en elen Elcanal formando los nervio 31 subcostal que segmentos raquídeo, forman así else plexo el de celiaco, nervio la luego acompañan médula de esplácnico ubicado salir, de espinal; se los delante divide inferior, vasos deen de homónimos, las el una laque aorta astas rama hace y de los pilares sinapsis medulares dorsal mixta con anteriores del las queneuronas diafragma va a la salen región dellas (L1). ganglio dorsal raíces El ganglio renal, anteriores, para inervar junto celiaco aalos las laderecho, músculos astas arteria posteriores renal. seyencuentra la piel.llegan Las delante las ramas raíces anteriores del pilar sensitivas; derecho de ambas los del nervios diafragma raíces se y detrás unen raquídeos a de nivel toráxicos la cava de inferior; los se agujeros ubican el ganglio ende el celiaco o semilunar conjunción canal y emergen izquierdo, como nervio se encuentrala raquídeo; delante raíz posterior del pilartiene izquierdo adjunto del diafragma, el ganglio raquídeo junto a los donde vasos esplénicos. reside la De los segmentos T10- T11 salen fibras primera pre-ganglionares que se orientan hacia los ganglios para-vertebrales simpáticos torácicos de esos niveles, estas se unen para formar el nervio esplácnico menor, cuyas fibras terminan haciendo sinapsis

músculo nervio con el abajo. pericardio, triangular Cada su nervio delcontenido esternón, originaes los una el rama perforante corazón vasos torácicos y las raíces mediales posterior de los y linfonodos (rama grandes dorsal), una rama perforante vasos. torácicos mediales. lateral y una rama perforante anterior. Los seis primeros nervios y sus ramas perforantes se distribuyen en el tórax. Los seis últimos son tóraco-abdominales, el 7º, 8º y 9º llegan al epigastrio y sus perforantes inervan la piel del abdomen. El 10º nervio va al ombligo. El 11º y el 12º (subcostal)