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Aflasof HumanAnatomy

Editedby R.PutzandR.Pabst
Putz
withRenate
in collaboration

13th,revised
Edition
byDr.M.Lutz,K.Kopsieker
Translated
Budowick,
of Michael
Withtheassistance Dietz,
Sarah
Dr.DorotheaHennessen
768colouredplates
76tables

& FISCHER
URBAN . Jena
M unich
Addressesof the editors: This atlas was founded by Iohannes Sobottaf, former Professorof Anatomy
ProfessorDr. med. R. Putz and Director of the Anatomical Institute of the University of Bonn, Germany.
Vorstanddes AnatomischenInstituts
Ludwig-Maximilians-Universitat
PettenkoferstraBe1I
80336 Mtinchen, Germany GermanEditions:
1. Edition: 1904-7907I. F. LehmannsVerlag,Munich
2.-11.Edition:1913-19441. F LehmannsVerlag,Munich
frofessor Dr. med. R. Pabst
Leiter der Abteilung fiir Funktionelle und 12.Edition: 1948and following editions Urban & Schwarzenberg,Munich
Angewandte Anatomie 13.Edition:1953
MedizinischeHochschule,Hannover 14.Edition:1956
Carl-Neuberg-StraBe 15.Edition:1957
I
30625 Hannover.Germanv 16.Edition:1967(ISBN3-541{2816-5)
17.Edition:1972(ISBN3-541{2817-3)
18.Edition:1982(ISBN3-541-02818-1)
19.Edition:1988(ISBN3-541-02819-X)
This atlas consistsof two volumes: 20. Edition:1993flSBN3-541-1736GX)
Vol. 1: Head,neck, upper limb 21. Edition: 2000 (ISBN 3-437-4194U41

Vol. 2: Thorax, abdomen,pelvis, lower limb


Foreign Editions:
Arabic Edition
Translation: Dr.M. Lutz Modern TechnicalCenter,Damascus
K.Kopsieker ChineseEdition
Editorial staffat Dr. med. DorotheaHennessen HoChi Book Publishing,Taiwan
Urban & Fischer: AlexanderGattnarzik
CroatianEdition
Producer: RenateHausdorf Naklada Slap,Jastrebarsko
Coverdesign: CarctenTschirner
Coverillustration: MichaelBudowick Dutch Edition
Bohn Stafleu van Loghum,Houten
English Edition (with nomenclaturein English)
Lea& Febiger
previous English Edition (with nomenclaturein Latin)
Urban & Schwarzenberg,Munich
French Edition
Atlas dAnatomie Humaine
Tec& Doc Lavoisier,Paris
Greek Edition
GregoryParissianos,Athens
Hungarian Edition
az ember anat6miiijiinakatlasza
SemmelweisKiad6
IndonesianEdition
Nomenclaturein Latin
Atlas Anatomi Manusia
Vol. 1 Head,Neck, Upper Limb. - l3th Engl. ed. - 2001 PenerbitBuku KedokteranEGC.Iakarta
Vol. 2 Thorax, Abdomen,Pelvis,Lower Limb. - 13th Enel. ed. - 2001 Italian Edition
Atlante di AnatomiaUmana
UTEI Torino
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Igaku Shoin Ltd., Tokyo
Korean Edition
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Polish Edition
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Atlas de AnatomieHumana
Editoria GuanabaraKoogan,Rio de Ianeiro
All rights, including that of translation, reserved.No part of this publication PortugueseEdition (with nomenclaturein Latin)
may be reproduced, stored in a retrieval system, or transmitted in any other Atlas de AnatomieHumana
form or by any means,electronic,mechanical,recording,or otherwisewithout Editoria GuanabaraKoogan,Rio de Ianeiro
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Atlas de Anatomia Humana
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Preface
Following the extremely good illustrations in the last edition of R.Pabst:Head,neck, thoracicwall, abdominalwall, thorax,
the Atlas which was brought into being by I. Sobottain 1903,the abdomen,
Pelvis.
editors and publishers askedthemselveswhat could be improved
upon in such a classic work. It became clear from the many The followingartists haveearnedour thanks for the many new
letters and discussions with students and colleaguesthat the drawingswhich they have producedin their alreadyproven
concept obviously still fits into the panoramaof study, and that manner:Ulrike Brugger,RtidiSerHimmelhan,SonjaKlebe,and
the macroscopic anatomy remains without question, together Horst RuB.It is due to their effortsthat the tried and tested
with other basic sciences,one of the fundaments of medicine. "sobottaStyle"hasbeenmaintained. Thefreeelectronicprocess-
Although the Atlas is primarily directed at those studying pre- ing of the photographs aswell as the production of the printswas
clinical medicine, it has neverthelessas "The Book for life as a carriedout by MichaelBudowick.We are also gratefulto our
doctor" all that is necessary to be a companion through the colleagues in the variousclinicswho put the illustrationsat our
clinical studies and a reference book during working life. In disposalfor this editionaswell (seeAcknowledgements).
accordancewith the most importan/urgent wishes, the new
edition has a series of alterations. We wouldlike to thank the colleaguesfrom the instituteswho
were involvedmost sincerelyfor their understanding and for
In the new edition we have the very importantstimulus.Dr. N. Sokolovand A' Buchhorn
- a total of 133 new illustrations drawn based on original prepareddissectionsmeticulouslyto serveas a basisfor many
dissections,e.g.the series of sectionsof the brain and thorax, S.Fryk andG.Hoppmannassisted
newillustrations; us with our
- replacedthe black and white illustrations, word processing.
- brought illustrations ofclinical applicationup to date according
to the developmentof the technique,e.g.endoscopyor X-ray, The editorswouldfinally like to thank explicitlythe colleagues
- introduced the schematicofjoint strain and of the editorialoffice,especiallyDr. DorotheaHennessen and
- revisedthe tables of musclescompletely. A. Gattnarzik,w-hodespite external turbulence consistently
accompanied the productionof the new edition.The production
As the second important goal we have improved the readability was lookedafter in the initial stagesby P. Mazzettiand finally
by carriedout with greatcommitmentby R. Hausdorf.RenatePutz
- the introduction of conspiciouscolours for the chapters, was responsiblefor the conversionof the NominaAnatomica
- colour coding the labelling of topographicillustrations, and for the standardisation of the references and the texts'A
- the consistent addition of orientation sketches to the cross specialthanksto all the peoplewho devotedthemselves to the
sectionsand line of vision, nerve-rackingproof readingand the putting togetherof the
- the revision and new arrangement of the tried and tested index. If "Sobotta"is able to appearwith new contentsand
tables and by in new splendourthen it is due to the entirely constructive
- the introduction of small "wind mills" drawing your attention collaborationof all concerned. We wouldalsolike to thank our
t0 the surrounding illustrations. familiesfor their understanding of the lack 0f time we had for
them.
Of course, the new nomenclature (Terminologia Anatomica),
which has been valid since October1998,has been included.The Many innovationsin this atlas are basedon the critic and
glossaryaids th0se interestedin the backgroundof our specialist suggestionsmade by studentsand colleagues.The editors
languagc. were and are extremelythankfulfor theseand would ask the
users of this edition not to shy away from sendingus their
The division of the revision of the chapters, apart from the comments.
common discussionsover the conceptand the mutual correction,
was retained and is as follows:
R. Putz: General anatomy upper limb, brain, eye, ear, back, MunichandHannover, 1999
September
lower limb: R. PutzandR.Pabst
Contents(volumel
)
Generalterms of direction and position in
the body VII Cranial Cavity,Cavitascranii, and Dura Mater
Referencesto the colouredillustration of the Brain, Dura mater cranialis 258-259
plates . VII Vesselsof the Head 260-266
A c k n o w l e d g e m e n.t.s. VIII Nerves of the Brain, Nervi craniales 2 6 7- 2 7 7
Dura Mater of the Brain, Dura mater cranialis, and
A r a c h n o i dA,r a c h n o i d emaa t e r c r a n i a l i s. . . . . . . . . 278-281
Vesselsof the Brain 282-285
B r a i n ,C e r e b r u m. . . . 286-293
Diencephalon 294-295
Parts and Regionsof the Body 1-5
PassiveLocomotorSystem
M i d b r a i n ,M e s e n c e p h a l o.n, . . . 296-298
6-10
Active LocomotorSystem
Brain Stem,Truncus encephali 299-300
1l-12
Digestiveand RespiratorySystem
Nuclei of the Cranial Nerves . 301
13
UrinaryTractandGenitalOrgans......
Cerebellum 302-305
14
EndocrineSystem
Ventricular Systemand SubarachnoidSpace 306-315
15
VascularSystem
DeepVesselsof the Brain 316-317
16-21
Fornix . 3lB-319
SurfaceProjectionof the InternalOrgans 22-23
Central and PeripheralNervous System
Associationand CommissuralFibres 320
24-27
Internal Capsule,Capsulainterna, Pyramidal Tract,
Skin and Appendages 28-29
Tractus pyramidalis,and BasalNuclei . 321-323
Frontal Sectionsof the Brain 324-327
Head,Caput, and Neck, Collum
Horizontal Sectionsof the Brain 328-334
30-r 63
Sagittal Sectionsof the Brain 335-338
Magnet ResonanceTomographySectionsof the
Regionsof the Head and Neck, Regiones
B r a i n. . .. 339-340
capitis et colli . . . 30-31
SpinalCord,Medullaspinalis . . . . . . 3 4 1- 3 5 5
Skull, Ossacranii, and TemporomandibularIoint,
Articulatio temporomandibularis 32-71
Muscles,Vesselsand Nervesof the Head 72-88 E y e ,O r g a n u vmi s u s . ..... 356-380
Nose,Nasus externus,and Nasal Cavity,
Cavitasnasi .. 89-91 Eyelid,Palpebrae, andOrbitalCavity,Orbita. 356-360
ParanasalSinuses,Sinusparanasales.. 92-94 LacrimalApparatus 361
Oral Cavity,Cavitasoris . . . 95-96 E x t r a o c u l a r M u s cM l euss, c u lbi u l b i . . ...... 362-365
Maxilla and Mandible,Mandibula 97-98 Eyeball, Bulbusoculi 366
Teeth,Dentes 99-106 Vessels of the Eye 367
Palate,Palatum t07 Iris andPupil. . 368
Tongue,Lingua . l 0 B -1 1 2 LenseandOcularFundus, Fundusoculi . . . . . 368-371
SuprahyoidMuscles,Mm. suprahyoidei, OpticNerve,N.opticus .... 372-373
and Hyoid Bone,Os hyoideum 113 V i s u aPl a t h w a .y. . . . 374-375
LargeSalivaryGlands,Glandulaesalivariae Muscles,Vessels andNervesof the Orbital
maJores 114-117 Cavity. 376-379
Arteries and Nerves of the Tongueand Palate t1B Sections of the OrbitalCavity . 380
Baseof the Skull, Basiscranii ll9
Vesselsand Nerves of the Tongue 120-l2l
Frontal Sectionsof the Head 122-123
Larynx 124-133
Overview 381
Thyroid Gland, Glandulathyroidea 1 3 4 -1 3 5
Auricre .::::::::::.:.::::::::.. 3Bz
Pharynx 1 3 6 -1 4 0
- 159 AuricularMuscles,Musculiauriculares 383
Muscles,Vesselsand Nerves of the Neck 141
ExternalAcousticMeatus,Meatusacusticus externus,
Sectionsof the Head and Neck 160-163
andTympanicMembrane, Membranatympani. . . . 384
AuditoryOssicles,Ossicula auditoria 385-386
TympanicCavity,Cavitastympani . . 387-389
AuditoryTube,Tubaauditiva ...... 390-391
InternalEar,Auris interna . . 392-396
AuditoryandVestibularPathways 397
TemporalBone,Ostemporale 398
SurfaceAnatomy 164
NervesoflnternalEar ...... 399-400
Bones, Ioints,Ligaments 165-185
Musclesof the UpperLimb . 186-222
V e s s e l s a n d N e r v e s o f t h e U p p e r .L.i m b .... 223-250 Appendix 401-417
CrossSections of the UpperLimb . . 251-256
Areasof Distributionof the CervicalPlexusand Index.. 401-417
the BrachialPlexus. 25a
Contents(vrlumc
II)
PleuralCavity, Cavitas pleuralis, and
Generalterms of directionand positionin Mediastinum 1 1 4 1- 1 5
the body VII Aorta.. 116-117
Reference t ost h e c o l o u r e idl l u s t r a t i opnl a t e s. . . . . . . VII Posterior Mediastinum ll8-119
Acknowledeements... VIII i ce r v o uSs y s t e m , P aarus t o n o m i c a . . . . . . .
A u t o n o mN 120-l2l
Sections throughthe Thorax 122-131

Back t47

SurfaceAnatomy 1
VertebralColumn,Columnavertebralis 2-26 Stomach, Gaster. 132-136
Musclesof the Back,Mm. dorsi,Musclesof the Nape SmallIntestine, Intestinum tenue. 137-139
of the Neck,Mm. suboccipitales,
and Neck Muscles, Colon.. 140-141
Mm. colli 27 -40 LiveqHepar,Gallbladder, Vesicabiliaris,and
Sectionsthrough the VertebralColumn 4l BiliaryDucts 142-149
Vesselsand Nervesof the Backand of the Occipital Pancreas 150-152
Region. .. 42-45 Spleen, Splen[Lien] 153
Vesselsand Nervesof the VertebralCanal. 46-47 Peritoneal Cavity,Cavitasperitonealis, Development . 154-155
Positionof theAbdominalViscera,Situsviscerum . . 156-167
Truncuscoeliacus andAa.& Vv.mesentericae
ThoracicandAbdominalWalls . 48-75 superiorandinferior 168-177
Portalvein,V. portae 178-179
SurfaceAnatomy 48 Kidney, Ren[Nephros] 180-186
Ribs,Costae 49-50 a l a n dG, l a n d u lsau p r a r e n a l i.s. . . . . . . . .
S u p r a r e nG 187
Sternum .. 51-52 UrinaryBladder,Vesicaurinaria..... 187-188
Thoracic Cage,Caveathoracis 53 MaleUrogenital Organs 189-193
MammaryGland,Mamma... 54-55 FemaleUrogenital Organs 194-204
Vesselsand Nervesof the Thoracicand Abdominal Rectum ... 205-207
W a l l s. . 56 A. renalis 208
SegmentalSensoryInnervation 57 Vessels andNervesofthe Retroperitoneal Space. ... 209-221
Musclesof the Thorax,Mm. thoracis,and Abdominal PelvisandPerineum, ExteriorMaleandFemale
Muscles,Mm. abdominis 5B-66 GenitalOrgans ... 222-239
InguinalCanal,Canalis
inguinalis .. 67 Sections throushthe AbdomenandPelvis 240-261
Diaphragm,Diaphragma 68-70
LumbosacralPlexus,
Plexuslumbosacralis
. 71
AnteriorAbdominalWall 72-73
throuehtheAbdominal
Sections Wall . 74-75
SurfaceAnatomy 262
Thorax 76-131 Bones,IointsandLigaments 263-307
Muscles of theLowerLimb . 308-347
H e a r tC
, or .. 76-91 BloodVessels andNerves . . . 348-378
Trachea 92-93 Sectionsthroughthe LowerLimb . . 379-386
L u n g sP, u l m o n e.s. . . 94-102 Distributionof the Nervesof the Plexus
OutlineSilhouette of the Heart 103 lumbosacralis .... 387-388
Projection of the Tracheaand Bordersof the Lungs
a n dP l e u r a 104-105 Appendix 389-405
Oesophagus 106-110
Thymus lll-113 Index.. .'..389-40
Generaltermsof directionandpositionin the body
The following terms indicate the relative location of organs
longitudinalis= running lengthways(e.g.Musculuslongitudina-
lis superiorof the tongue)
and parts of the body to each other, partly without taking
into considerationthe position of the body in space as well
sagittalis= lying on a sagittalplane
transversalis = lying on a transversal,/transverse
plane
as the location and direction to the extremities.This concept
=
transversusrunningtransversely (e.g. Processus
transversus
of
is not only acceptable for human anatomy but also for
practical medicine and the comparativeanatomy.
the thoracicvertebrae)

General terms
Terms of direction and position for the extremities

anterior - posterior = from the front - from the back (e.g.


proximalis - dktalis = at the base of the extremity - at the end of
Arteriae tibiales anterior et posterior)
the extremity (e.g. Articulationes radioulnares proximalis et
ventralis - dorsalis = lying ventral - dorsal
distalis)
superior- inferior = above- below (e.g. Conchaenasalessuperior
et inferior) For the upper limbs:
cranialis - caudalis = lying cranial - caudal radialis - ulnaris = relatinS to the radial - relating to the ulnar
dexter - stnister= right - left (e.g. Arteriae iliacae communes side (e.g. Arteriae radialis et ulnaris)
dextra et sinistra)
For the hand:
internus - externus = internal - external
palmaris - dorsalis = relating to the palm - relating to the back of
superficialis - profundus = superficial - deep
the hand (e.g. Aponeurosis palmaris, Musculus interosseus
medius, intermedius = lying in the middle between two other
dorsalis)
things (the Concha nasalis media lies in the middle between
the Conchanasalis superior and inferior) For the lower limbs:
medianus= lying on the middle line (Fissuramediana anterior of tibialis - fibularis = relating to the tibial side - relating to the
the spinal cord).By making a median sagittal sectionthe body fibular side (Arteria tibialis anterior)
is dividedinto two mirror images.
medialis - Iateralis = lying towards the middle of the body, lying For the foot:
towards the side (e.g.Fossaeinguinales medialis et lateralis) plantaris - dorsalis = relating to the sole of the foot - relating to
frontalis = relating to the plane of the forehead (frontal plane), the back of the foot (instep)(e.g. Arteriae plantareslateralis et
(e.g.Processusfrontalis of the maxilla) medialis,Arteria dorsalis pedis)

to the colouredillustrationplates
References
The multi-colouredillustrations of this book are basedon didactic Thefollowingplatenumbersindicatenewlydeveloped platesas
observations:The contrasts should be emphasized.Where it is well as drawingsdueto fundamental corrections:
difficult to differentiatebetweenstructures,they should be made U.Brugger
easily recognizable.The colours used for the different kinds of 3 6 - 3 8 ,5 2 , 5 3 ,6 1 ,1 3 6 ,1 3 7 , 2 3 5 - 2 3 7 , 2 8 4 , 3 9 6 - 349380, ,4 3 1 ,
tissue (such as tendons, cartilage, bone and muscles) and the 532- 534,537,539- 5 41,551,570- 577, 598
tracts (such as arteries, veins, lymphatic vessels,nerves) are M. Budowick
different from those found in a living, dead or preserved body. 449,452,474,486,498,548
Here, arteries are red, veins are blue, nerves yellow, lymphatic R. Himmelhan
vesselsand glands are generally representedas green. 437
In addition to the artists who createdthe basis for the complete S.Klebe
collection of illustrations with Prof. Sobotta and the following 138,460,507,508,511-514
editors Prof. Becher,Prof. Ferner and Prof. Staubesand(K. Hajek, H. Rintelen
Prof. E. Lepier,F. Batke,H. v. Eickstedt,K. Endtresser,I. Kosanke, 604-606
J. v. Marchtaler,I. Dimes, U. Brugger,N. Lechenbauer,L. Schnell- H. RulJ
biicher, and K. Schuhmacher),the following also drew for the 22 (insert),144,338-340,444,445,447,449,477,472,545,687
current edition: Ulrike Brugger, Rtidiger Himmelhan, Sonja
Klebe, and Horst RuR. A series of original photographs were
worked over electronically by Michael Budowick. A number of
computer diagrams were producedby Henriette Rintelen.
Generaltermsof directionandpositionin the body
Iongitudinalis = runninglengthways (e.g. Musculuslongitudina-
The following terms indicate the relative location of organs
and parts of the body to each other, partly without taking
lis superiorof the tongue)
into considerationthe position of the body in space as well
sagittalis= lying on a sagittalplane
transversalis = lying on a transversalplane
as the location and direction to the extremities.This concept
transversus = runningtransversally (e.g.Processustransversus
is not only acceptable for human anatomy but also for
practical medicine and the comparativeanatomy. of the thoracicvertebrae)

Generalterms
Terms of direction and position for the extremities
anterior - posterior= from the front - from the back (e.g.
proximalis - distalis = at the base of the extremity - at the end of
Arteriaetibialesanterioret posterior)
the extremity (e.g. Articulationes radioulnares proximalis et
ventralis- dorsalis= lying ventral - dorsal
distalis)
superior- inferior= above- below(e.g. Conchaenasalessuperior
et inferior) For the upper limbs:
cranialis- caudalis= lying cranid - caudal radialis - ulnaris = relating to the radial - relating to the ulnar
dexter- sinister= right - left (e.g.Arteriaeiliacaecommunes side (e.g.Arteriae radialis et ulnaris)
dextraet sinistra)
For the hand:
internus- externus=internal- external
palmaris - dorsalk = relating to the palm - relating to the back of
superficialis- profundus= superficial- deep
the hand (e.g. Aponeurosis palmaris, Musculus interosseus
medius,intermedius= lying in the middle betweentwo other
dorsalis)
things(the Conchanasalismedialies in the middlebetween
the Conchanasalissuperiorandinferior) For the lower limbs:
medianus = lying on the middleIine (Fissuramedianaanteriorof tibialis - fibularis = relatinS to the tibial side / relating to the
the spinalcord).By makinga mediansagittalsectionthe body fibular side (Arteria tibialis anterior)
is dividedinto two mirror images.
medialis- Iaterdlis= lying towardsthe middleof the body,lying For the foot:
towardsthe side(e.g.Fossae inguinalesmedialiset lateralis) plantaris - dorsalis = relating to the sole of the foot - relating to
frontalis= relating to the plane of the forehead(frontal plane), the back of the foot (instep)(e.g. Arteriae plantareslateralis et
(e.9.Processus frontalisof the maxilla) medialis,Arteria dorsalis pedis)

to the colouredillustrationplates
References
Themulti-coloured illustrationsof this bookarebasedon didactic Thefollowingplatenumbersindicatenewlydevelopedplatesas
observations: The contrastsshouldbe emphasized. Whereit is well asdrawingsdueto fundamental corrections:
difficult to differentiatebetweenstructures,they shouldbe made U.Bruger
easilyrecognizable. The coloursusedfor the differentkinds of 707,923,924,927- 932,934, 936,937,1366,r37I
tissue(suchas tendons,cartilage,boneand muscles)and the R. Himmelhan
tracts (suchas arteries,veins,lymphaticvessels,nerves)are 1367,1368,1370, r372, 1374,1375
different from thosefound in a living, deador preservedbody. S.Klebe
Here,arteriesare red,veinsare blue,nervesyellow,lymphatic 1162,fi74, 1175, 1218,1222,1223,1250,1349
vesselsandglandsaregenerallyrepresented asgreen. H. Ru/)
In additionto the artistswho createdthe basisfor the complete 7 88,798, t28l - 1284,1302- 1304
collectionof illustrationswith Prof.Sobottaand the following
editorsProf.Becher, Prof.FernerandProf.Staubesand (K.Hajek,
Prof.E.Lepier,F.Batke,H.v. Eickstedt, K. Endtresser,
I. Kosanke,
I. v. Marchtaler, K. Dimes,U. Brugger, N. Lechenbauer,L. Schnell-
bdcher,and K. Schuhmacher), the followingalso drew for the
current edition: Ulrike Brugger,Riidiger Himmelhan,Sonja
Klebe,und Horst RuB.A seriesof original photographs were
workedover electronicallyby MichaelBudowick.A number of
computerdiagramswereproducedby HenrietteRintelen.
Acknowledgements
The editors would like to thank the following colleaguesfor Prof. Reiser & Dr. Glaser, Institute of Clinical Radiology,
providing the pictures of ultrasound,computedtomography, Universityof Munich
magneticresonancetomographyas well as endoscopicand (figs.307,578-582,705a, b, 771,1369,1371,1373,1377)
colourphotographs of operationalpractice: Prof.Rudzki-Janson, Polyclinicfor Orthodontics,Universiryof
Munich
(figs.80,B1)
Prof.Altaras,RadiologyCentre,GieBenUniversity Dr. Scheibe,Departmentof Surgery,RosmanHospital,Breisach
(figs.964,979,980) (figs.1233a-c)
Dr.Baumeister, Department of Radiology,FreiburgUniversity Prof.Schillinger, Clinic,Universityof Freiburg
Gynaecological
(fig.1095) (figs.1072-1074)
Prof.Daniel,Departmentof Cardiology, Universityof Medicine, Dr. Dr. Schliephake,Facio-MaxillarySurgery,University of
Hannover Medicine,Hannover
(figs.862-864,935) (figs1 . 67,212,2131
Prof. Galanski & Dr. Kirchoff, Department 1 of Diagnostic Prof. SchliiBer,GynaecologyCenhe, University of Medicine,
Radiology, Universityof Medicine,Hannover Hannover
(figs.924,1144a,b,1154, 1155) (figs.1071a, b, 1080,1082,1083,1130)
Prof. Galanski & Dr. SchZifer,Department 1 of Diagnostic Prof. Schuhmacher, Neuroradiology,Departmentof Radiology,
Radiology, Universityof Medicine,Hannover Universityof Freiburg
(figs.838a,b, 888,933,958, 1139,1147,ll50, ll52l (figs.448a,b)
Prof. Gebef Departmentof Gastroenterology and Hepatology, Dr. Sommer& AssistentProf.Bauer,Radiologists, Munich
UniversityofMedicine,Hannover (figs.650,1234-12361
(figs.253a,b,966,975,976,981,990,991,1026, 1043) Prof.Stotz,Orthopaedic Polyclinic,
UniversityofMunich
Dr.Goei,Radiology, Heerlen,TheNetherlands (fig. 1193)
(figs.1010,101I) Prof.Vogl,Polyclinicfor Radiology,Universityof Munich
(with permissionfrom Radiology173:137-141,19891 (figs.440,442,631,6321
Dr.Greeven, St.ElizabethHospital,Neuwied Prof.Vollrath,ENTClinic,Mtinchengladbach
(figs.166,1182) (figs.246-2481
Prof.von der Hardt,PaediatricClinic,Universiryof Medicine, Prof. Wagner(dec.),DiagnosticalRadiologyII, Universityof
Hannover Medicine,Hannover
(figs.893) (figs.914, 1014,10121020,1023,1090)
Dr. Hennig,Departmentof Radiology, Universityof Freiburg Prof.Wenz,Departmentof Radiology,Universityof Freiburg
(fig.529) (fie.747l
Prof.Ionas,Urology,Universityof Medicine,Hannover Dr. Willftihr, Departmentfor Abdominaland Transplantation
(figs.1050a,b, 1051) Surgery,UniversityofMedicine,Hannover
Prof.Kremers,Polyclinicfor DehtalPreservation and Periodon- (fig. 1001)
tics,Universityof Munich AssistentProf.Wimmer,Department Universityof
of Radiology,
(fig. 182) Freiburg
Prof.Kunze,Paediatric Clinic,Universityof Munich (tig.778)
(figs.15-18)
Dr. Meyeq Department of Gastroenterologyand Hepatology,
Universityof Medicine,Hannover Additionalillustrationsweretakenfrom the followingbooks:
(figs.906.949a,b, 959,1086)
Prof.Pfeifer,RadiologyDepartmentof the SurgicalClinic,Uni- Birkner, R: The typical X-ray of the skeleton,Urban &
versityof Munich Schwarzenberg, Munich-Vienna-Baltimore 1990
(figs.306, 3r9,321,748-751,789-792,1199,1230,1231,1260, (fig.1200)
1261\ Welsch,U. (Editor):Sobotta- Histology,5th Edition,Urban&
AssistentProf. Rau, Departmentof Radiology,Universityof Schwarzenberg, Munich-Vienna-Baltimore 1985
Freiburg (figs.635,646)
(figs.875,SS6,S87) Wicke, L.: Atlas of X-ray Anatomy,3rd Edition, Urban &
Prof.Ravelli,Instituteof Anatomy,Universityof Innsbruck, Schwarzenberg, Munich-Vienna-Baltimore 1985
(tig.746l (figs.905a, b, 1076)
Prof. Reich,Clinic for Facio-Maxillary Surgery,Universityof Wilhelm,K.,R.Putz,R.Hierner,R.E.Giunta:Plasticsurgeryof the
Bonn hand,Urban& Schwarzenberg, Munich-Vienna-Baltimore 1997
(figs.133,134) (fig.s8)
SurfaceAnatomyof theBack

Spinascapulae M.deltoideus
----

M. trapezius

---- M.teresmaior
Angulusinforior- - -
Scapula,

M. latissimusdorsi

M. erectorsoinae- - -

Cristailiaca

-
Arlicufatio sacroiliaca- -

M. gluteusmaximus

VertebralumbalisV,-
Proc spinosus

Fig. 706 The back,.Dorsum;


surfaceanatomy.

Regiocervicalisposterior- - - - - - - Lineamedianaoosteriol

- - -- Lineaparavertebralis

Rogioscapularis- -

R€gio deltoidea - -
-- Linea axillarispoGterior

--f-
Regiovertebralis

Fig.7O7 Regionsand orientation


lines on the back.
Back,
Dorsum
2

Veriebrae
lhoracicae
t-xI

Veriebrae
lumbales
t--v

Os coccygis

Fig. 708 Vertebralcolumn, Fig.709 Vertebralcolumn, Fig. 710 Vertebralcolumn,


Columnavertebralis; Columnavertebralis; Columnavertebralis;
the intervertebraldiscs dorsalview (30%). the intervertebraldiscsare
are indicatedin blue; indicatedin blue;
ventralview (30%). left lateralview (30%).
VertebralColumn,Columnavertebrdlis

Clavicula \ '7 Yedebra


cervicalis Vl
- VertebracervicalisVll
- Verlebra cervicalis Vll [prominensl
-- Vertebra
Iprominens]
lhoracicaI
z Canalis verlebralis
- Clavicula,
Extremitas
sternalis - Scapula
- Manubflum
sterni

- Corpus
)-
slernl

,..';:j

.,.",ii
- Arcuscostalis

:.::':i/ifl C o s t aX l - - r )../ /
CostaXll /
- Costaxl /
\ costa Xll Vertebralumbalis|
!.,,i/',

r;rjarn l .*.qr# -
Vertebra lumbalis lll
f
-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-..-.tv

:?iif-/
!-a
-i,,;rii

-- Spina iliaca
anterior superior

\
Promontorium -Os
sacrum

,l -Os
coccygrs
.\ /
-
Facies symphysialis
Sprna Femur-
ischiadica

'Tuber
ischiadicum

Fig. 711 Vertebralcolumn,Columnavertebralis; Fig.7l2 Vertebralcolumn,Columnavertebralis;


shouldergirdle,Cingulumpectorale;
pelvicgirdle, shouldergirdle,Cingulumpectorale;pelvicgirdle,
Cingulumpelvicum; Cingulumpelvicum;
the vertebralcolumnhasbeensectioned
in the median the vertebralcolumnhasbeensectionedin the median
plane;left medialview (25%). plane;left lateralview (25%).
Back.Dorsum

LamtnaarcusI
Incisura
vertebralis
superior vertebrae
i
I Proc articularis
[Zygapophysis] Foramen. :
supenor costotransversarium Proc spinosus
Foveacostatis
superior i I i I
I
/ Pediculus
arcusverlebrae ArticulatroI Proc articularis
lzygapophysis]
costotransversaria supeflor
;
Costa
I i Proc transversus
Epiphysis.'
t; I
t
anulafls

- Fovea
/ Ptoc
/ costalis
spinosus processus
transversi
Corpus - I uoerculum
vertebrae costae Foramen
vertebrale
/
Epiphysrs '/ - Pediculus
anularis' Collum costae I

/t arcus
verlebrae
/t
Factes /
i Caputcostae
intervertebralis / Fovea
i / _-\ coslalis
Foveacostalisinterior/ Articulaliocapitis
/ supeflor
coslae Epiphysis
lncisuravertebralis
inferior / anularis *
/
Corpusvertebrae,
Faciesinteruertebralis

Fig. 713 Vertebra,Vertebra;the fifth thoracic Fig.7l4 Vertebra,Vertebra;the fifth thoracic


vertebra is shown as an example with the typical vertebra is shown as an example with the typical
structure; lateral view (80%). structure; superior view (80%).
' also, rim ' also. rim of vertebral
of vertebral bodv bodv

Structural characteristics of vertebrae (Atlasand Axis excluded)


7 cervical vertebrae,
12 thoracic vertebrae, 5 lumbar vertebrqp;, Sacralbone, Os sacrum
Vertebraecerviqoleg,
Vertebrae thoracieae Vertebraelumbalest:r:r:fornedby 5 vertebrae
I-vII r-xII I-V r,:.li:l
:ir [Vertebraesacralos]
rI...Vl
Upperand lowersurfaces Rectangular, small, Triangular,becoming Large,bean-shaped
of the vertebralbody with Uncicorporumon roundercaudally
the uppersurfaces
Vertebralforamen, Large,triangular Roundcrosssection Small, triangular Sacralcanal,Canalis
Foramenvertebrale crosssectt0n crosssection sacralis,
ovalcrosssection
Articular surfaces, Obliqueslope Frontalposition,slope Lateral part: Fusedto the Crista
Procc.articulares :1. towardsdorsal towardsdorsal sagittal position; sacralismedialis
:irr l
[Zygapophyses] medialpart:
ftontal position
Procc.transversi Containa Tuberculum Club-shaped,
with Procc.mammillares Fusedto theCrista
anterius,a Tuber- Foveae
costales et accessorii sacralislateralis
culumposterius,a
Sulcusnervispinalis
anda Foramen
transversarlum
Procc.
spinosi Horizontal,
short, Inclination towards Horizontal, Fusedto the Crista
biturcated caudalvaries laterallyflattened, sacralis
mediana
masslve
Rudiments
of ribs Ventralpart of the None,because the Procc.costales Parteslaterales
Proc.transversus and ribs aredeveloped
Tuberculum dorsale
Characteristic
feature Foramen Foveae
costales Procc.mammillares Synostosis
of
transversarium superioret inferior et accessorii vertebrae
Vertebrae {
a-'/

Figs.715a-e Regionalcharacteristics of the vertebrae.Only


in the thoracicregionof the vertebralcolumndo the lateral
parts (colouredred) remainseparatedand form ribs.
a first cervicalvertebra,Atlas
b fourth cervicalvertebra,VertebracervicalisIV
c first thoracicvertebra,VertebrathoracicaI, shownwith
the adjacentribs, Costae;and the sternum,Sternum
d third lumbarvertebra,VertebralumbalisIII
e sacralbone,Ossacrum

Epiphysis
anularis'/

Proc.costalis
Proc.accessoriusl

Fig.716 Vertebraldevelopment. Fig.7l7 Vertebraldevelopment.


Appearanceofthe primary ossificationcentres(Pedicle, Ring-shaped ossificationcentres(*rims) appearin the
secondfetal month;body,3rd to 6th fetal months),as vertebralbodiesduring the 8th yearof life. Theyfuse
exemplifiedin a lumbarvertebra.Thesynostosisof the with the vertebralbodiesuntil the 18thyearof life. The
ossificationcentresof the vertebralarchwith thoseof the centralparts of the epiphysisremaincartilaginous
bodyoccursbetweenthe 3rd and 6th yearsof life. laminae" * throughoutlife. Secondary ossificationcentres
(apophyses) appearin the processes ofthe vertebra.
Back,Dorsum

Tuberculum
anterius.
I Arcusanterioratlantis
Foramen vertebrale
/

Massalateralis
Pars - - /_ atlantis
basilaris
Condylus--
occipitalis
Proc /
Foramen -- lransversus
magnum - Fossa /
condylaris Foramen /
lransversanum - - Sulcus
arteriae
(Crista - - vertebralis
occipitalis
externa) I Arcusoosterioratlantis
Tuberculumoosterius

Fig.718 Theoccipitalbone,Osoccipitale; Fig.719 Firstcervicalvertebra,Atlas;


Segmentshowingthe foramenmagnumandthe superiorview (85%).
joint;
articularsurfacesof the atlanto-occipital Thesuperiorarticularsurfacesof the atlasare
inferiorview (807o). frequentlydivided.
' Canalisarteriae vertebralis as a variation

Tuberculumanterius Arcusanterioratlantis
\
\ Densaxis \
. Facies articularis inferior / Faciesarlicularissuperior
Fovea dentis -_ Facies \
I
I , Massa lateralis articularis \ / Faciesarticularisinferior
| / atlantis anterior

Fovea - -- ArcusPosterioratlantis
dentis

Proc - -
articularis
supenor

I
Foramen / I -
I Corpus
vertebrale vertebrae
I Fora.en \
transversarium Arcusvertebrae
/
Foramen
Arcusoosterioratlantis transversarium \
l'o" Proc,articularisintenor
Tuberculumoosterius transversus

Fig.72O Firstcervicdlvertebra,Atlas; Fig.72l Firstandsecondcervicalvertebrae,


inferiorview185%). AtlasandAxis;
mediansection;
medialview (90%).

/ Apex dentis
,/ Faciesarticularisposterior

,/ Faciesarlicularis Proc articularis\ ,/ Corpusvertebrae


anlerior superior \
/ Foramen
Proc. 1 ,/ transversarium
.
/ Proc arlicularis transversus
supenor

Proc. / Tuberculum /
transversus anterius For^ -
"n
transversarium Foramen
vertebrale
/
I' \
Tubercrlu. I
Proc. I
articularis postenus Proc.articularis Arcusverlebrae
inferior inferior
Arcusvertebrae
Proc spinosus Proc spinosus

Fig.722 Secondcervicalvertebra,Axis; Fig.723 Secondcervical vertebra,Axis;


ventralview (90%). dorsosuperiorview (90%).
vertebrae
7

Uncuscoporis.
lProc.uncinatus] Corpusvenebrae, Coryusvertebrae,.
\ Faciesinterverl€bralis Epiphysisanularis\\
Tuberculum-
antenus , Foramentransversarium
Pediculusarcus
Foramen\ verlebrae
Tuberculum- - Sulcus lransversarium
posl€rius netvl
spinalis

Proc.articularis/
sup€not Ptoc'
arlicularis Foramen
supenor vertebrale
Arcusvertebrae Foramenvertebrale
Arcusvertebrae
Laminaarcus
verEbrae
I Proc.spinosus
Proc.spinosusl

Fig.724 Fifth cervicalvertebra,VertebracervicalisVi Fig.725 7th cervicalvertebra,VertebracervicalisVII;


superiorview (100%). superiorview ( 100%).
Thespinousprocesses of the 2ndlo 6th cervical The7th cervicalvertebracaneasilybe identifiedby its
vertebraeareusuallysplit. prominentspinousprocessandis thereforealsocalled
the prominentvertebra,Vertebraprominens.However,the
spinousprocessof the first thoracicvertebraoften
protrudesevenfurther.

'l
Tuberculum
posterius I
I Proc.transversus
7 TuberculumI
/ amenus ,t

CorDusvertebrae-

I
I
Uncicoporis
lProcc.uncinati]

Fig.726 Secondto seventhcervicalvertebrae,Vertebrae Flg.727 Fifth to seventhcervicalvertebrae,Vertebrae


cervicalesII-VII; ventralview (120%). cervicalesI-VII; dorsolateralview (110%).
Back.Dorsum

Corpus-
vertebrae
Arcus
vertebrae
Foveacostalis -
processus
transversl
Arcusvertebrae/
/
Proc transversus
Foramenvertebrale/

/
Proc.spinosus
Fig.728 Tenth thoracic vertebra,Vertebra thoracicaX; Fig.729 Tenththoracicvertebra,
superior view (90%). VertebrathoracicaX;
ventralview (90%).

Proc accessorius\
,, Proc articularis z proc articularis
/ supet|ol \. / superlor
Foveacostalissuperior\
z - Proc transversus Arcusvertebrae\
-- Ptoc mammillaris
- -
Fovea costalis
processus transversi

Fovea costalis inlerior /


I =-.ryi
lncisuravertebralisinferior
Corpus/ Foveacostalis/
Proc arlicularis
inferior venebrae
Proc spinosus Proc articularis
inferior

Fig. 730 Sixththoracicvertebra,VertebrathoracicaVI; Fig. 731 Twelfth thoracicvertebra,


left lateralview (90%). VertebrathoracicaXII;
left lateralview (80%).
' part of the vertebralarchbetweenthe superior
and inferior articularprocess(sccalledisthmus=
interarticularportion)

Corousvertebrae -

Fig.732 Third lumbarvertebra,VertebralumbalisIII;


medialviewof a mediansection(110%).
Specimenfrom an elderlyperson.
' ossification of ligamentous insertions
Vertebrae

/ Proc articularis
./ superior

/ Foveacostalisprocessus
/ transversi

Pediculusarcus - Foramen verlebrale


-
venebrae

Proc. .-_ / Ptoc.


- accessorius
coslalrs
)- erocc
sprnosl

/
Proc artrcularis \ Proc mammillaris
supeflor
/
Lamina arcus vertebrae '
Lamina arcus vertebrae

accessonus
Proc sprnosus/

Fig.734 Fourthlumbarvertebra,
VertebralumbalisIV;
superiorview(1007o).

*. Proc mammillaris

I
P r o cc o s t a l i s '
I
Proc accessoflus/
\ Proc
ariicularisinferror
articularesinleriores

Fig. 733 Tenth to twelfth thoracic vertebrae,Vertebrae Fig. 735 Fourth lumbar vertebra,
thoracicaeX-XII, and first and secondlumbar vertebrae, Vertebra lumbalis IV;
VertebraelumbalesI-ll; dorsolateralview (70%). ventralview (1007o).

- - Proc articularissuoerior
Pedrculusarcus verlebrae \

Epiphysisanularis ** \

- Proc spinosus
--
Lamrnaarcusvertebrae

\ Proc arlrcularisinferior

(Foramenvenae
basivertebralis)

Fig. 736 Fifth lumbar vertebra,Vertebralumbalis V; ' the regionof the vertebralarchbetweensuperiorandinferiorarticularprocesses
Herein the fifth andlessfrequentlyin the fourth lumbarvertebraa cleft,
medial view of a median section (110%). can be formed.This is probably
bridgedby connectivetissue(spondylolysis)
Note the characteristic wedge shape of the body of the fifth causedby localbendingstress.As a consequence the superiorvertebramay
lumbar vertebra. slip (olisthesis)ontothe inferiorvertebra(spondylolisthesis).
'* In this specimenthe anteriorrim is pathologically oblique.
Back,
Dorsum
1 0

-- Tuberositas
ossissacri

--- Cristasacralislateralis

Cristasacralismediana- -
- Cristasacralismedialis

Foraminasacraliaposteriora

Fig.737 Sacralbone,Ossacrum; Cornusacrale


dorsalview (60%).
I
Apex ossis sacri
Proc.articularis
supenor

-\___ Pars lateralis

Lineae transversae - Foramina sacralia anteriora

Fig. 738 Sacralbone,Ossacrum;


view(60%).
ventroinferior
I
Apex ossis sacri

Promontorium
I

Parslateralis_ _ L -

/
/
Proc.arlicularissuperior
/
Canalis sacralis
Fig.739 Sacralbone,Os sacrum;
the bone has been sectionedat the level
ofthe secondsacral vertebra; superior view (55%).
SacralBone,Ossacrum,and Coccyx,Oscoccygis
11
Proc adicularissupeflor - --;l
T u b e r o s r toasss i ss a c r i- - --.

-
Canalis sacralis

Cristasacralis- - -C-!. -
Foramrnasacralia - - Promontorium
meorana .\ t poslenora

Cnsta sacralis
meorana
Facies pelvica
Facies auriculans

Cornusacrale-- - -
Cornu- - -
coccygeum Apex ossis sacri

-
Apex ossrs sacri

Os coccygis

Fig.74l Sacralbone,Ossacrum;
Fig.740 Sacralbone, Os sacrum; medialviewof a mediansection(45%).
* Even in adults, remnants of intervertebral
lateral view from the right (45%). disc tissue Dersists

Fig.742 Sacralbone, Os sacrum;


Fig.743 Sacralbone,Ossacrum;
genderdifferences,lateralview.
ventralview.
genderdifferences,

/ Cornu coccygeum
7 Yetlebra
z coccygeal

- - Vertebra
coccygeaI

- - Vertebra
coccygeall - Vertebr""
zt-
Jrt coccygeae ll-lv
) vertebrae
coccygeae I v

Fig.744 Coccyx,Oscoccygis; Fig.745 Coccyx,Oscoccygis;


ventrosuperior view ( 105%). view ( 105%).
dorsoinferior
Despitevariationsin the formof the intervertebral
vertebraearejointly termedthe
discs,all postsacral
coccyx.

:. Back, Dorsum
=
-s

Fiamus- / P(oc
mandibulae .' mastoideus

Os occipitale
Atlas, Arcus - / /
anlerior

/ Atlas, Arcus
S i nu s
/ ..a
maxillaris

Palatum -
osseum
- Allas,
A x i s ,D e n s Tuberculum
posterius

- Axis, Proc
sprnosus

Axis,Corpus -
vertebrae Incrsura
vertebralis
inferior

Angulus ---- -- Inctsura


mandibulae vertebralis
supenor

Vertebra ----
cervicalislll,
Corpus
vertebrae

Eprglottis --

Os hyoideum -
- Proc articularis
inteflor

- Proc articularis
Drscus inter - supenor
vertebralis

Cartilago *
cflcoidea, -
Lamlna Proc spinosus

Facies intetr - - Pediculusarcus


vertebrales vertebrae

Vertebra -
ceruicalisVll,
Corpus
vertebrae

Fig.746 Cervical vertebrae, Vertebrae cervicales;


a lateral radiograph of the cervical vertebral column
in the upright position. The beam is directed at the
3rd cervical vertebra; shoulders are retracted inferiorly.
VertebralColumn,Columnavertebralis
13

Proc spinosus

Proc transversus

UncicorDorum
IProcc.uncinatil

VertebracervicalisVl, - - -
Comusverlebrae

Fig.747 Cervicalvertebrae,Vertebraecervicales;
AP-radiograph in an upright position;the beamis focused
on the 3rd cervicalvertebra.
' spacesof the intervertebml discs
Back,
Dorsum
14

Foramen interuertebrale
Facies interuertebrales - --

Proc spinosus

Pediculusarcus verlebrae

Fig. 748 Thoracicvertebrae, Vertebrae thoracicae;


lateralradiographin an upright position;
the beamis focusedon the sixth thoracicvertebra.
* soace of an intervertebral dis6

arcusvertebrae - -
Pedrculus

Corpusvertebrae --

Costa - -

Articulatiocostolransversafla- -

Proc transversus--

capitiscostae - -
Articulatio

Caputcostae - -

Fig.749 Thoracicvertebrae, Vertebrae thoracicae;AP-radiograph in


an uprightposition;the beamis focusedon the sixth thoracicvertebra.
" spaceof an intervertebraldisc
n, Columna
vertebralis {
1 \')

Vertebralumbalis l,
Corpus verlebrae

-- Arcusverlebrae,
Pediculusarcusverlebrae
-- Incisura
vertebralis
Inferior

Faciesintervertebrales -

-- Incisura
vertebralis
superior

-- Proc spinosus

Proc arlicularissuoerior
-- Proc arlicularisinlerior

Os ilium, Crista iliaca -

Basisossissacri --
Cristasacralism€diana
Promontorium --j:-:
-=-'na-----
Os sacrum

Fig. 750 Lumbarvertebrae,Vertebraelumbales; ' spaceofan intervertebraldisc


'*
lateralradiographin an upright position;the beamis focused the regionof the vertebralarchbetweenthe superiorand inferiorarticular
pnocesses (so-calledisthmus- interarticularportion)
on the secondlumbarvertebra.Theobliqueanteriorrims of '" herethe courseof the l2th rib can faintlv be seen
the lowerlumbarvertebraeare a pathologicalalteration.
Back,
Dorsum
16

lumbalisl, --
Vertebra
Corpusvertebrae

superior- -
Proc artrcularis

Articulatiozygapophysialis- -

inferior- *
Proc articularis

Pediculusarcusvertebrae- -

-
Faciesintervertebrales

Foraminasacraliaanteriora - -

Fig. 751 Lumbarvertebrae,Vertebraelumbales;


AP-radiograph in an upright position;the beamis focused
on the secondlumbarvertebra.
r spaceof an intervertebraldisc
ulations
oftheHead
17

Os occipitale,Parsbasilaris
\
/ Membranaatlantooccipilalis
anterior

,z Os occipitale,Parslaleralis

Os occipitale,Parslateralis

Arliculatioatlantooccipitalis Capsulaarlicularis

- Lig.longitudinale
anterius

- Oiscusinterv€rtebralis
Vert€bra cervicalis lll - -

' Vertebracervicalislll,
Corpusverl€brae

Fig.752 Articulationsofthe headand uppervertebral


column;articularcapsuleshavebeenremovedon the right;
ventralview.

Os occipitale posteriol
, Membranaatlantooccipitalis
\

Lig. allanlooccipitale
lalerale

Tuberculumposterius

Axis.Arcusvertebrae/

Fig.753 Articulations ofthe head;


the articularcapsuleof the atlantcaxialjoint,Articulatioatlanto-
axialislateralis,hasbeenremovedon the left;
dorsalview.
Back,
Dorsum
1 8
- Os occioitale.Clivus

Sulcussinussigmoidei - - - Os occipitale

Articulalio atlantooccipitalis, - -
Capsula articutaris
- Atlas

Articulatioatlantoaxialis
lateralis, - Membrana tectoria
Capsulaarlicularis

- - Vertebra ceruicalis lll


Vertebracervicalislll, --
Proc. transversus

Fig.754 Articulations ofthe head;


the foramenmagnumandvertebralcanalhavebeen
openedto exposethe deepligaments. Thearticular
capsuleson the right havebeenpartiallyremoved;
dorsalview.

Fasciculilongitudinales \
7 Os occipitale,
Pars basilaris
Li99, alaria \

- Canalis nerui hypoglossi

* Sulcussinussigmoidei

-
Ariiculatio atlantooccioitalis
Caosulaarticularis

\
r - Atlas,Arcusposterior
Articulatio atlantoaxialis lateralis

-
Axis

Fig.755 Articulations ofthe head;


the foramenmagnumandvertebralcanalhavebeen
openedto exposethe deepligaments. Thearticular
capsuleson the right havebeenpartiallyremoved;
dorsalview.

/ Ligg alatia

- *
Lig. apicis dentis

Axis, Oens

Axis,Corpus

Fig. 756 Articulations ofthe head; The alar ligaments,Ligg. alaria, often insert on the lateral
the foramen magnum and vertebral canal have been massesof the atlas as well.
openedto exposethe deep ligaments.The articular
capsules on the right have been removed;
dorsal view
,/ Duramatercranialis

Os occioitale,Parsbasilaris- -
.,/ Lig apicisdentis

/ Ouramaterspinalis
Membrana atlantooccioilalisanterior - -
/ Mernbranatectoria

Atlas,Arcusanterior- - rascicurilongitudinales I
\ -
Densaxis,Faciesarticularis .-
anterior - - lf Lrg.transversumatlantisI LiS crucilormeatlanlis
- Jasclcuti
tongituoinates,l
-t
- Nn cervicales, Radices
-
Axis.Dens
/
Dens axis, Facies articulafls oosterior

\\ Membranaatlantooccipitalisposterior
\
z
Discus inlervertebralis

Atlas.Arcusoosterior
/
Vertebracervicalislll,
Corpus vertebrae
Axis,Proc spinosus

Fig. 7 57 Articulations of the head;


mediansection;
medial view.

/ Os occipitale
,/ Densaxis,Facies
/ articularis
anterior - - Articulatioatlanto-
Oens axis, Facies \ occipitalis
articularisposterior \ / / Axis,Dens - - Axis,Dens

Atlas,Arcusanteriol

Atlas,Massalateralis
-
Arliculatioatlanto-
axialislaleralis
--
Axis,corpus
/
Membrana
atlanto- Axis,Proc spinosus
occipilalis
posterior -
Aria,
Proc spinosus

Fig. 758 Articulationsof the head; Fig.759 Articulationsof the head;


the occipital bone has been removed; AP-radiograph,
takenthroughthe openmouth.
suDeriorview.
Back,
Dorsum
20
--- Fovea costalis
inferior

--- Foveacostalis
supenor
--- Pediculusarcus
vertebrae

Ligg.costo-
lransv€rsaria

Arcus
Discus verlebrae
inlerverlebralis

--- Verlebra
thoracica
Xll,
Corpus
venebrae

Disci
intervertebrales

Fig.760 Ligamentsof the vertebral Fig.761 Ligaments of the vertebralcolumn


columnin the lowerthoracicregion; in the lowerthoracicandupperlumbarregions;
ventralview. the vertebralcanalhasbeenexposed by a
frontalsectionthroughthe pedicles, Pediculi;
dorsal view.

Lig tlavum 7 Procspinosus / Proc transversus


Proc.arlicularissuperior \ / Lig. costo
/ laletale

-
Tuberculumcostae
Articulatiocoslotransversaria-

-
Collum costae
Lig coslolransversarium
-
Lig costotransversarium

'
Pediculus arcus vetlebrae
\
Foramen ve116brale Articulatiocapitiscostae

Lig capiliscostaeradialum

Corpusverlebrae

Fig.762 Costovertebral
articulations,
Articulationes
costo a crosssectionthroughthe lowerpart of the costovertebral
vertebrales: articulationat the headof a rib;
supenorvlew
ofthevertebrat
cotumn
21
-- Proc articularissuperior

Foveacostalissuperior- -

Corousverlebrae--

- - Ligg @stolransversaria
superiora

-- laterale
Lig coslotransversarium

Lig longitudinale anlerius - -

Lig intertransversarium

Lig capitiscostaeradialum

Fig. 763 Ligamentsof the vertebral column and the costo- the lateralpart of the anteriorlongitudinalligamenthasbeen
vertebral articulations; removed:left lateralview.

Foveacostalis
orocessustransversi

Lagcostotransversarium---
laterale

----
Lig costolransversarium

Laminaarcusvertebrae
/
C o s t a e- - - - ( \

Pediculusarcusverlebrae

Fig.764 Ligaments ofthe vertebral


arches; Theligamentaflavaof the lumbarvertebralcolumnsurround
thevertebral
canalhasbeenopened by a frontalsectionthrough the vertebralarticulationsventrallyas well andtherebyformthe
the pedicles;
ventralview. posteriorwall of the intervertebral
foramina.
Back,
Dorsum
22
_ / Lig.capitiscostaeintraarliculare

- / Forcmen interverlebrale

- -- Lig.costotransversarium
suoenus

Lig.costotransversarium
laterale

--
Lig longitudinaleanterius - Articulatiocapitiscoslae

- Tuberculumcostae

\ Capulcostae

Fig. 765 Costovertebralarticulations,Articulationes


costovertebrales;
obliqueverticalsectionthroughthe jointsat the headsof
the ribs (costovertebral
articulations);
left lateralview.

lArcusvertebrae

- Ligg.intertransvorsaria

Proc spinosus
- costr"
)-

Lig costotransversarium
superius

Lig.costotransversarium
laterale

Lig interlransversarium--

Laminaarcusvertebrae Lig supraspinale

Fig.766 Ligaments of the vertebralarchesandcosto.


vertebralarticulations,
Articulationescostovertebrales;
dorsalview.
Ligamentsof the VertebralColumn
23
Pediculusarcusvertebrae

posterius--
Lig longitudinale

VertebralumbalisV --
Corousverlebrae

Fig.767 Ligaments of the lumbarvertebralcolumn; Belowthe secondor third lumbarvertebrae, the superficial
the vertebralcanalhasbeenopened; layerof the posteriorlongitudinalligamentbecomes a thin
dorsalview. strand.Thedeeplayerinsertslaterallyon the fibrousring of
the intervertebral
disc.

Proc costalis -

- - Capsulaarticularis*
Arliculaliozygapophysialis,

Laminaarcusvertebrae --

-
Lig.ttavum

Fig. 768 Articulationsbetweenthe articularprocessesof the Only in the lumbar vertebral column are the zygapophysialjoints reinforcedby
lumbarvertebralcolumn,Articulationeszygapophysiales strong,transversefibre bundles("transverseligaments").
lumbales;the ligamentaflava havebeenremovedon the left;
right dorsalview.
Back.Dorsum

: pulposus
-Nucleus I
\
Uncuscorooris\
IProc.uncinhtus]

Anuluslibrosus- -

anularis
Epiphysis
Anulusfibrosus
anularis
Epiphysis
N spinalis, - -
Nucleuspulposus
Ganghon
sensonum
nerui spinalis Corpusveriebrae-
/ b
A vertebralis

'
Figs.769a, b Intervertebral discs,Disciintervertebrales. Hyaline cartilaginous covering of the end plates of the vertebral bodies,
a nonossified portion of its epiphyses
a cervicalintervertebraldiscs,Disciintervertebralescervicales; ** Within the first decade of life the sc{alled uncovertebral clefts appear in the
frontal sectionthroughthe middleof the vertebralbody; lateral zones of the cervical intervertebral discs Their progress rnedially in the
ventralview (115%) followins decades varies considerably between individuals

b lumbar intervertebraldisc,Discusintervertebralislumbalis,
mediansection(115%)

Fascia thoracolumbalis- -

Lig longitudinaleanterius Vertebralumbalis l, .- .-


Corpus vertebrae

Proc spinosus--

- *
scusInterverlebralis

- -
Canalisvertebralis;
Caudaequina

--
Spatiumepidurale

-. -
VerlebralumbalisV,
Corpusvertebrae

- -
Canalissacralis

I
N spinatis

Fig.77O Lumbarintervertebraldisc.Discusinter- Flg.77l Lumbar vertebral column;


vertebralislumbalis; magnetic resonancetomography (MRT) in the median plane.
ventrosuperiorview ( 115%).
Segments
of Movement
25
Proc articularissuperior
I
Uncuscorporis.
\a
IProc.uncinaius]
Faciesintervertebralis
\ \
\
Epiphysisanularis t \

Corpusvertebrae-

Lig longitudinale anterius


/ Lig interspinale

Facies interuertebralis -

I
N
ll
ll

| eediculusarcusvertebrae
|
I Lig longrtudinale
posterius

Fig.772 Cervicalsegmentof movement; * Rim ofvertebral body.


*' Hyaline cartilaginous covering
schematic,
mediansection(160%). of the end plate of the vertebral body,
a nonossified portion of its epiphysis.

Foramen interuerlebrale
I Proc articularissuperior
/

Lig. flavum
/

Lig interspinale
/
Lig longitudinaleantenus \\

/ Lig supraspinale

Facies intervertebralis -
_

(Foramen venae --
basivertebralis)

**"*/' i
-r,"0,""'"
?-. I
\
Proc.spinosus

PediculusarcusverlebraeI
I
I
-
Laminaarcusvertebrae' Proc articularisinferior

Fig. 773 Lumbarsegmentof movement; * Rim ofvertebralbody.


schematic, '* Hyaline cartilaginouscoveringof the end plate of the vertebral body,
mediansection(120%1.
a nonossifiedportionof its epiphysis.
Back,
Dorsum
26
, VertebracervicalisVl
Clavicula,Extremitasacromialis.

\ vertebra
thoracicaXll

Fig.774 Thoraciccage,Caveathoracis,
andleft shouldergirdle,Cingulumpectorale;
dorsalview.

Trunk-shouldergirdle muscles(Figs.775, 776l

Insertion

continuation -J p. 28
2l
- - occipitalisexlerna
Protuberantia

sternocleidomastoideus

M splenius
capitis\
- M spleniuscapitis

_- M trapezius
Verlebraprominens,Proc spinosus\

Spina scapulae 1

Fascradeltoidea \

\ Acromion

-
M leres
malor \\
Angulusinferior
Scapula,

M inlraspinatus,
Fascrainlraspinata
/
major /
M rhomboideus - M latissimusdorsi

-
M latissimus
dorsi

lumbalesl; ll, -
Vertebrae
Procc spinosi \ VertebrathoracicaXll, Proc spinosus

--
M obliquusexternus
abdominis

-
Trigonum lumbale
- Fasciathoracolumbalis
/
M latissimusdorsi

\ Cristailiaca

- os sacrum,
Faciesdorsalis

Fig. 775 Musclesof the back,Mm. dorsi;


superficialmusclesconnectingthe trunk with
the shouldergirdle and the upperarm;
dorsalview.
Back.Dorsum

Trunk-shouldergirdle mUSCleS (continuation)

Muscle Origin Insertion Function


Innervatton
2, M. levator scapulae Tuberculaposterioraof the Angulus superior and immediate Shouldergirdle:
Direct branchesof the Processustransversiof the adjacentregion of the scapula androtatesthe scapula
Depresses
Plexuscervicalisand upper4 cervicalvertebrae upwaros
N. dorsalisscapulae
(Plexusbrachialis)
3. M. rhomboidensr\ajor Proccspinosiof the upper4 Medial border of the scapula, Shouldergirdle:
N. dorsalisscapulae thoracicvertebrae (caudalto the Spina scapulae) With M. rhomboideus minor:
(Plexusbrachialis, adduction andelevation of the
Pars supracIavicuIa ris) scapula
With M. serratusanterior:
holdscapulato the trunk
4. M. rhonboideus minor Procc.spinosi of the 6th Medial border of the scapula Shouldergirdle:
N. dorsalisscapulae and 7th thoracic vertebrae (cranial to the Spina scapulae) With M. rhomboideus major:
(Plexusbrachialis, adduction andelevation of the
Parssupraclavicularis) scaDUla
With M. serratusanterior:hold
scapulato the trunk
5. M. serrafus anterior Parssuperior:1stand 2ndribs Parssuperior:Angulussuperior Shouldergirdle:
N. thomcicuslongus , (moderatelyconvergent) of the scapula All parts:adduction of thescapula;
(Platus brachialis, Parsmedia:2ndto 4th ribs Parsmedia:Margomedialisof the with Mm rhomboidei holdingthe
Pars supraclavicularis) (divergent) scapula scapulato the trunk (Scapula
alata:whenoneof the antagonists
Parsinferior: 5th to (8th) gth ribs Pars inferior: Angulusinferior of doesnotfunction)
(veryconvergent). Interdigitates the scapula Parssuperior:elevation
with theoriginof M. obliquus Parsmedia:deuression
abdominis externus Parsinferior:d-epression, exterior
rotation(elevation of the arm
abovethe horizontal)
Thorax:
Whenthescapulais stabilized:
elevation of the ribs (inspiration)

Trunk-arm muscles (Fig.775)


M. latissimusdorsiand M. pectoralismajorbelongto this group.Bothariseon the trunk and passto the arm. Basedon the locationof mostof its
mass,the M. latissimusdorsiis includedin the groupofsuperficialmusclesof the back,and like thosemuscles,it alsoderivatesfrom ventral,
M. pectoralismajorarisesfrom the chestwalland is desiribedin the groupof ventralmusclesof the shoulder. ,
Muscle Origln Insertion Function
Innervation
M. ladssimus dorsi Procc.spinosi of the 6 lower Cristatuberculiminoris(bya flat Shoulderjoint:
N. thoracodorsalis thoracic vertebrae,of the lumbar tendonspiralingaroundthe Adductionandmedialrotation,
(Plexusbrachtalis, vertebrae(by Fasciathoracolum- M. teresmajor;in betweenBursa retroversron
Parcsupmclavicularis) balis), Faciesdorsalis of the 0s subtendineamusculilatissimi
Shouldergirdle:
sacrum. Labium externum of dorsi) Adductsanddepressesthe
the Crista iliaca (dorsalthird),
scapula
ribs (9) 10 to 12; frequently
from the Angulus inferior of the
scapula

Spinocostalmuscles (Fig.776)
Thespinocostalmuscles,M. serratusposteriorsuperiorand M. semanlsposteriorinferior,are locatedon top of the autochthonous
musclesof
the back.
Muscle Origin Insertion Functlon
Innervation
1. M, serratus postedor:,, Procc.spinosiof the 6th and 7th 2nd to sth ribs (lateralof the Elevationof 2ndto sth ribs
superlor l:,'r:r cervicalvertebraeand lst and2nd Anguluscostae) (inspiration)
Ventralbmnchesof thoracicvertebrae
N. cervicafts[C6] to
N. thoraclcus[T2]
2. M, serratus posterior P r o c c .s p i n o s io f t h e 1 1 t ha n d 9th to 12thribs (inferiorrim) Pullsribs 9 to 12caudally
inferior 1 2 t h t h o r a c i cv e r t e b r a ea n d 1 s t (expiration).As an antagonist
Ventralbmncha of and 2nd lumbar vertebrae to the pullingforcesof the
N. thomcicus[TI1] to diaphragma, it is alsoactive
N. lunbalb [L2] duringforcedinspiration.
79
/ M. trapezius

/ M. sternocleidomastoideus

M. splenius
capitis
//

M. rhomboideus
major

l', spleniusceruicis

Fascia delloidea /

---
M. taresmajor

serratusposterior/
supenor

- -.
Scapula,Angulusinferior

-
/ / M. erectorspinae
M latissimusdorsi

- M latissimus
dorsi
M serratusanlerior

M. serratusposterior
inlerior
- Fasciathoracolumbalis

M obliquus
externusabdominis

-
M. obliquusexternus
abdominis
M obliquusinternus
abdominis -
Trigonumlumbale

Cristailiaca

Fig.776 Musclesof the back,Mm.dorsi;


the deepmusclesconnecting the trunk with the shoulder
girdle and the upperarm havebeenexposedby removing
mostof the superficialmuscleson the left side;
dorsalview
Back,
Dorsum
30

Caudaequina
anterius Heorcurus I
R e n- - gfl-s- -- [ Arcrs
vcrtculde
I vertebrae
Lamtna arcus I
M psoasmajor-- veneorae )

Mm
transversospinales*'
Plexuslumbalis- -
M ereclor spinae *

Proc costahs--

M q u a d r a t u-s- (Lamina
tumoorum prolunda)
CostaXll --
M obliquusinternus--
abdominis Fascia
thoracolumbalis
dorsi--
i/t latissimus

Proc spinosus-- (Lamina


superficialis)

Fig.777 Musclesof the back,Mm.dorsi; Thedeepmusclesofthe backlie within an osteofibrous tubewhich is formed
by the dorsal parts of thDvertebraeand the surrounding aponeumticthoracolumbar
crosssectionthroughthe secondlumbarvertebra; fascia.Themusclesaredividedinto a tlateral tract and a * *medialtract.
inferior view

- Aorla

-- Corqusvertebrae

-- N u c l e u s p u l p o s u_s )
Foramenintervertebrale \ I tJtscus
I interuertebralis
- - Anulusfibrosus ,/

-/ N ,s p i n a l i s
Proc articularis
superior-

-- M Psoasmajor

Ariiculatio zygapophysialis -- C a u d ae q u i n a

-- Lio flavum*
Proc articularisinferior

-- M ereclor spinae

--
Mm transversospinales
Proc spinosus

-
Fasciathoracolumbalis

Fig.778 Musclesof the back,Mm. dorsi; * Theareawherethe ligamentaflavainsert is oftencalcifiedor ossified,evenin


youngerindividuals.
computedtomography(CT)at the levelofthe intervertebral ** adipose
deposits
disc betweenthe 3rd and 4th lumbarvertebrae.
inferior view.
3T
M semispinaliscapitis / Lig nuchae
\
\ M sPleniuscaoitis
M splenius
capitis \ i /,/
,J,
t,

Ft' I M sternocleidomastoideus
M longissimus
capilis \
\\
M spleniusceruicis \ ,/ M spleniusceruicis

M scalenusposterior:
/ M levatorscapulae

-
M levator scaoulae Fascia deltoidea

M longissimuscervicis / --
M teresmalor
/
M semrspinaliscervicis --
M tr"p"ri*
-
M iliocostalis
ceruicis -
M. serratusposteriorsuperior
\
M rhomboideusmajor
M infraspinatus,
Fasciainfraspinata
\
M iliocostalis thoracis

/ \
M spinalisthoracis M latissimusdorsi
- \
M rftocostalis
thoracis M longissimusthoracis
-
M serraiusanterior
\
M spinalisthoracis
M longissimus
thoracis
--
M serratusposteriorinferior
M iliocostalislumborum
-
- M obliquusexternusabdominis
M obliquusexternusaMominis
-
Fasciathoracolumbalis
Vertebraelumbales,/
Procc spinosi

\
M obliouusinternusabdominis M erectorspinae

Flg.779 Musclesof the back,Mm.dorsi;


muscleshasbeenexposed
the superficiallayerof the autochthonous
by removalof the thoracolumbarfasciaand the overlyingmuscles
which connectthe trunk with the upperarm and the shouldergirdle;
dorsalview.
nrl
1 I Back,Dorsum
-) 'L/

M spleniuscapitis\

M semispinaliscapitis -- - - caoitis
M. semisoinalis

Lig nuchae --

capitis- -
M longissimus -- M lonoissimusceruicis
M splenius
ceruicis-__
M levatorscapulae \\ :- M longissimuscapitis
M longissimuscervicis : _
M iliocoslalis cervicis \ - - Mm spinales cervicis et capitis
capitis-
M semispinalis
M scalenusoosterior*-
M longissimus
ceruicis\

superior---
M serratusposterior

Mm. levatorescostarum - - - M. iliocostalis ceruicis

--
M longissimusthoracis

Mm semisoinales ceruicis - -
et thoracis
externi - -
Mm intercostales

thoracis--
M, iliocostalis

Mm levatorescostarum--
--
M spinalisthoracis -- M soinalisthoracis
*-
M semispinalisthoracis
interior---
M serratusposterior

--
M. longissimusthoracis
-- lumborum
M, iliocostalis
M iliocostalislumborum

M latissimusdorsi

M serratusposteriorinferior
M obliquusexternusabdominis
M longissimusthoracis

M obliquusinternusabdominis

(Aponeurosis
musculi
latissimi
dorsi)
-
Fasciathoracolumbalis

M erectorspinae

M. gluteusmaximus
,-&-*|-'-n

Fig. 780 Musclesof the back,Mm. dorsi;


musclescan be seenafter the
the long fibres of the autochthonous
removalof the thoracolumbarfasciaand the overlyingmuscleswhich
connectthe trunk with the upperarm and the shouldergirdle;on the
right a diagramshowstheir course;the spinousprocesses of the cervical
vertebraeare outlinedin green,thoseof the thoracicvertebraein red,
and thoseof the lumbar vertebraein blue.II-XII = ribs;
dorsalview.
'
l l t f t t c n r t l i dorsi
a
t
ir,,.^I--
Muscles of the Back,Musculi
^€ thn Dnalz dnr

Lateral autochthonous layer of the muscles of the back, Musculi dorsi (Figs.779, 780)
The lateraltract 0f the autochthonousmusclesof the backcoversthe medialtract and is thereforealsocalledthe superficial
portionof the autochthonous musclesofthe back.Includedhereinare the muscleswhosefibrestakea straight(upward)
The Mm. spleniirun oblique,divergingcranially
course:M. iliocostalis,the M. longissimusand the Mm. intertransversarii.
(spinotransversal). TheMm. levatorescostarumtakea caudo-oblique courseto the ribs.
Muscle/Innervation Origin Insertion Function
1. M. iliocostalislumborum i f t h er i b s5 t o l 2
Togetherwith M longissimus A n g u l o
Rr.posterioresof the thoracisfrom the Procc.
Nn.lumbales spinosiof the lumbar vertebrae,
Faciesdorsalisof the Os
sacrum,Cristailiaca(dorsal
third), Fasciathoracolumbalis
2. M. iliocostalisthoracis 1 2 t ht o 7 t h r i b s ( m e d i a tl o t h e A n g u l io f t h e r i b s ( 6 ) 7 t o 1 .
Rr.posterioresof the Anguluscostae)
Nn.tlrcracici
3. M. iliocostaliscervicis 7 t h t o ( 4 t h )3 r d r i b s ( m e d i a l Tuberculaposterioraof the
Rr.posterioresof the to the Anguluscostae) Procc.transversiof the 6th to
Nn.cervicales (4th) 3rd cervicalvertebrae
4. M. longissimusthoracis Togetherwith M. iliocostalis Medialpalt: Proc.mammillaris
Rr posterioresof the lumborum from the Procc. of 5th lumbar vertebra,Procc.
Nn.spinales spinoso i f thelumbar accessorii of 4th to 1st lumbar
vertebrae,Faciesdorsalisof vertebrae,Procc.transversiof
the Os sacrum;often from the the thoracicvertebrae;
P r o c .m a m m i l l a r i so f t h e Lateralpart: Procc.costalesof
2nd and 1st lumbar vertebrae 4th to 1st lumbar vertebrae,
Blendswith and Procc.transversiof the F a s c i at h o r a c o l u m b a l (i sd e e p
M. longissimus cervicis 12th to 6th thoracicvertebrae layer'),12thto 2nd ribs (medial
andM. spinalis to the Anguluscostae) Acting unilaterally:Latera-
5. M. longissimuscervicis Plocc transversiof the 6th to Tuberculumposteriusof PI'occ. flexion of the Columna
Rn posterioresof the lst thoracicvertebraeand 7th transversiof the 5th to 2nd vertebralisto this side
Nn.spinales to 3rd cervicalvertebrae cervicalvertebrae Acting bilaterally:Extention
of the Columnavertebralis
6. M. longissimuscapitis Procc.transversiof the 3rd Proc.mastoideus, posterior
Rr.posterioresof the thoracicto the 3rd cervical margln
Nn. spinales vertebrae
7. Mm. intertransversarii Tuberositasiliaca,Procc. Proc.costalisof the 5th
lateraleslumborum costalisand accessorius of lumbar vertebra,Procc.
Rr posterioresand ante- 5th to lst lumbar vertebrae, transversusof the I st thoracic
rioresof the Nn. spinales Proc.transversusof the 12th vertebra
thoracicvertebra
8. Mm. intertransversarii Ploc.accessoriusof the 4th to Proc.mammillarisof the 4th
medialeslumborum 1st lumbar vertebrae to 2nd lumbar vertebrae
(cf. to No.7)
9. Mm. intertransversarii Procc.transversiof 12th to Procc.accessorius and
thoracis 10th thoracicvertebrae m a m m i l l a r i so f t h e l s t l u m b a r
(cf. to No.7) vertebrato Proc.transversus
of the 11ththoracicvertebra
10.Mm. intertransversarii Tuberculumposteriusof Procc. Tuberculumposteriusof Procc.
posteriorescervicis transversiof the 6th to lst transversiof the 7th to 2nd
(cf. to No.7) cervicalvertebrae cervicalvertebrae
11.Mm. intertransversarii Tuberculumanteriusof Procc. Tuberculumanteriusof Procc.
anteriores cervicis transversiof the 6th to 1st transversiof the 7th to 2nd
(cf. to No.7) cen,icalvertebrae cerVicalvertebrae
12.M. spleniuscervicis Procc.spinosiof the 3rd thora- Tuberculumposteriusof the Acting unilaterally:
Rn posterioresof the cic to 7th cervicalvertebrae, Procc transversiof the Lateralflexion,rotationof the
Nn.cervicales Lig. nuchae(from 3rd cervical (3rd) 2nd to 1st cervical cervicalspineand headto the
vertebra) vertebrae sameside
13.M. spleniuscapitis Procc.spinosiof the 6th to Proc.mastoideus, Linea Acting bilaterally:
Rr.posterioresof the 3rd cervicalvertebrae, n u c h a l i ss u p e r i o r Extentionof the cervical
Nn.cervicales Lig. supraspinale splne

14.Mm. levatorescostarum Procc.transversiof the 11th 1 2 t ht o 1 s tr i b s ( l a t e r aol f Elevationof the ribs;


Rn posterioresof the thoracicto 7th cervicalverte- Angulus costae) lateralflexionand rotationof
N. cervi.calis brae (Mm. levatorescostarunr the columna vertebralis
[CB]and
Nn.thoracici longi:every other caudalrib,
Mm.levatores costarum Mm. levatoresbreves:to the
longiareabsentin the nearestcaudalrib)
middlethoracicregion
Back,
Dorsum
34
M s e m l s p i n a l i s c a p i l i s- -
M obliquuscapitissuperior
M. rectuscapitisposleriorminor //
M obliquuscapitissuperior / M splenius
capitis
M splenius capitis
/ M longissimus
capitis
rectuscapitisposteriormajor
Atlas,Proc transversus Venterposterior
-- M digastricus,
Atlas,Tuberculum posterius - - M intertransversarius
posterior
cervicis
M obliquus
capitisinferior
M. semispinalis
capitis

Mm muliifidi - Mm intertransversarii
posteriores
ceruicis
)-
M semispinaliscervicis

/ Ligg intertransversaria
M scalenusposlerior -

cervicis -
Mm intersoinales -- Lisg inlerspinalia;
Lig supraspinale

-- thoracis
Mm.rotalores
M. spinaliscapitis--,

- Mm interlransversarii
lhoracis

*- - Mm intercostales
externi
Mm levatorescostarumbreves
Mm rolatoresthoracis
lhoracis -
M semisoinalis - Lig costotransversarium
superius
- Lio,intertransversarium
- Membrana intercostalis
interna
laleralia -
Ligg costotransversaria
- N. thoracicus,
N inlercostalis;
posterior
A ;V intercostalis
externi,Fascia -
Mm,intercostales
- Mm rolatores
lhoracis
Mm levatorescostarumbreves - - Membrana interna
intercostalis

Mm levatorescostarumlongi - Mm intercostales
interni
- Mm inlercostales
externi
Mm intertransversarii
thoracis
CostaXll - M obliouusinternus
abdominis
-
Fasciathoracolumbalis -
M quadratus lumbolum, Fascia
- Mm intertransversarii
medialeslumborum
M obliquusinternus
abdominis
- M transversusabdominis
Mm interlransversarii
laterales
tumoorum - Mm interspinales
lumborum
Fasciatransversalis
-
Lig iliolumbale
/
M obliouusexternusabdominis - Ligg, inlertransversaria

--
Mm multitidi Spinailiacaposterior
superior
M. gluteus maximus

Spinailiacaposteriorsuperior - -
Lio sacroluberale

Fig. 781 Musclesof the back,Mm. dorsi,


and suboccipitalmuscles,Mm. suboccipitales;
after the removalof all superficialmuscles
and the thoracolumbarfasciathe deepestlayer
is exposed.
Dorsalview.
The 9th intercostalspacehasbeenpartly opened.
TheRomannumeralsindicatethe spinousprocesses
of the respectivevertebrae.
Musclesof theBack,Musculidorsi
35
Medialautochthonousmusclesof the back,Musculi dorsi (Figs.780,7Bl)
The mediattract of the autochthonousmusclesof the backis coveredby the lateraltract and is thereforealsocalledthe deep
layerof the autochthonous musclesof the back.Includedhereinare the muscleswhosefibres takea straightupwardcourse:
Mm. interspinalesand the M. spinalis.TheMm. rotatores,Mm. multifidi andthe M. semispinalisrun oblique,convergingcranially
(transversospinal).
Muscle Origin Insertion Function
Innervation
1. Mm. interspinales Procc.spinosiof the sth to Cristasacralis mediana
lumborum lst lumbarvertebrae (superior spinosi
rim),Procc.
Rn posterioresof the of the 5th to 2ndlumbar
Nn. spinales vertebrae
2. Mm. interspinales Procc.spinosiofthe (12th) Procc.spinosiofthe
thoracis llth to 2nd(1st)thoracic (1stlumbarvertebra) 12thto extention
Segmental of the
Rr.posterioresof the vertebrae 3rd (2nd)thoracicvertebrae Columnavertebralis
Nn. spinales
3. Mm. interspinales Procc.
spinosiofthe 7th to spinosiofthe lst
Procc.
cervicis 2ndcervicalvertebrae thoracicto the 3rd cervical
Rn posteriora of the vertebrae
Nn. spinales
4. M. spinalis thoracis Procc.spinosiof the (3rd) Procc. spinosiof the ( 10th)
Rr.posterioresof the 2nd,1stlumbarvertebrae, and 9th to 2ndthoracicvertebrae
Nn. spinales the 12thto 10ththoracic (closelycorrelated with Mm.
vertebrae(closelycorrelatedmultifidi)
with M. latissimusthoracis)
5. M. spinaliscervicis Procc.spinosiof the (4th)3rd Procc.spinosiof the (6th)5th Actingunilaterally:Lateral
Rn posterioresof the to lst thoracicvertebrae,and to 2nd cervicalvertebrae flexion.ofthe spineto the
Nn. spinales 7th to 6th cervicalvertebrae samesloe
procc.spinosiof the 3rd to Extention
6. M. spinalis capitis squamaossisoccipitalis ffjilt:1'::t*llv:
Rn posterioresof the 1stthoracicvertebrae, and7th (between Lineaenuchales
Nn. spinales to 6th cervicalvertebrae supremaandsuperior,close
(inconstant) to Protuberantia occipitalis
extefna;associated with
M. semispinalis capitis)
7. Mm. rotatores Procc.mammillares of the Procc.spinosi(roots)of the
Rnposterioresofthe lumbarvertebrae, Procc.trans- 3rd to 1stlumbarvertebrae,
Nn.spinales versiof the thoracicvertebrae, 12thto lst thoracicvertebrae
Tothe Mm. rotatores Procc.articularesinferiores and7th to 2ndcervical
belong:Mm.rotatores of the cervicalvertebrae(Mm. vertebrae
cervicis,Mm. rotatores rotatores brevesrun to the
thoracisandMm.rotatores adjacenthighervertebrae;
lumborum(inconstant) Mm.rotatores longiskip every Actingunilaterally:Lateral
othervertebra) flexionofthe spine
to the sameside,rotation
8. Mm. nultifidi Facies dorsalis
oftheOssacrum, Procc.spinosiof the 5th to Actingbilaterally:Extentionof
Rn posterioresof the Lig.sacroiliacum posterius, 1stlumbarvertebrae, 12thto the sDine
Nn. spinales Cristailiaca(dorsalpart), vertebrae
lst thoracic and7th
Procc.mammillares of thelum- to 2nd cervicalvertebrae
barvertebrae. Procc.transversi
of the thoracicvertebrae, Proc.
articularisinferiorof the7th
to 4th cervicalvertebrae(The
fibresskip 2 to 4 vertebrae.)
9. M. semispinalisthoracis Procc.transversiof (12th) Procc.spinosiof the (4th)
Rn posteriores
ofthe 11thto 7th (6th)thoracic 3rd thoracicto 6th cervical
Nn. spinales vertebrae vertebrae
10.M. semispinaliscervicis Procc.transversiof (7th) procc.
spinosi 6thto
orthe lffi:lfi.?l,o,T.'iffJ$11?
Rr.posteriores
ofthe 6th thoracicto 7th cervical 2ndcervicalvertebrae andheadto the otherside
Nn. spinalu vertebrae Muscleson bothsidesacting
11.M. semispinaliscapitis Procc.transversiof (8th) Squamaossisoccipitalis Extentionof the
together:
Rnposterioresoftlrc 7th thoracicto 3rd cervical (betweenLineanuchalis spine
Nn. spinales vertebrae supremaandLineanuchalis
superior,medialpart)
Back,
Dorsum
36

Lig.costotrans-
versariumlaterale
Proc.transversus

M. semispinalis
thoracis
M. longissimus
thoracis
M. iliocoslalis
lhoracis
Mm multifidi
- M spinalisthoracis
M. levator
coslaebrevis - Mm.multifidi
- M levator
costaelongus
Membrana
intercostalisinterna - M. levator
Mm. intercostales costaebrevis
externi
M serratus -
posteriorinferior Verlebra
lhoracicaXl,
M. iliocostalis Proc.transversus
lhoracis -
Mm rolatores Lio.
int'ertransversarium
M longissimus
thoracis
V.;4. intercostalis
posterior
N thoracicus,
N intercostalis
Mm.intercoslales -
intimi M. serratus
posteriorinferior
Mm. intercostales
externi
-- lumbalisl,
Vertebra
Mm. intercostales
interni Proc.costalis

M longissimus - - M. obliquus
thoracis internusabdominis
M. iliocostalis
thoracis -- M transversus
/ abdominis
M. intertransversarius
medialislumborum

Fascia
thoracolumbalis
/
Mm intertransversarii
lateraleslumborum - M erectorsoinae

M. longissimus
thoracis
Mm.multitidi

Fig.782 Musclesof the back,Mm. dorsi;


the layerofautochthonous musclesandthe thoracicmuscles
are shownherebetweenthe 8th and 12ththoracicvertebrae
(VIII to XII) and betweenthe lst and 3rd lumbarvertebrae
spacehasbeenpartly opened;
(I to III); the 11thintercostal
dorsalview.
Musclesof theBack,Muscultdorsi
31
M levatorcostae brevis

Lig.interlransversarium

Mm rotatoresthoracis - -

--
M levatorcostaelongus

Lig. interlransversarium

Verlebralumbalisl,
Arcusvertebrae

--
Ligg flava
Verlebraolumbales,
Procc costales

Mm intertransversarii
lateraleslumborum

Fascialhoracolumbalis
(Laminaprofunda)

Mm. intedransversarii
medialeslumborum

Mm. multitidi

M. ereclof spinae

Vertebraelumbales,Procc spinosi

Fig. 783 Musclesof the back,Mm. dorsi;


the deepestlayeris exposedherein the regionof the lower
thoracicand the lumbarvertebralcolumn;the thoracolumbar
fasciahasbeenremoved;
dorsalview.
Back,
Dorsum
3 8

M rectuscapitisposterior
minor lvl trapezius
\ I
/, i,4 semispinaliscaprtis
/ -M- rectuscaprtisposteriormajor
/.
: /, M obhquus
capitrssupenor
/ M spleniuscapitis

M splenius
capitis \ \
// Atlas,Arcusposterior

/ M splenius
ceruicis

t--- Proc maslordeus


--
M longissimuscapitis
- Venlerposterior
l / s p l e n i u s c e r v i c i s- - M digastricus,
- Proc
capitis /
M longissimus styloideus
/ - M obliquuscapitisinferior
capitis /
M semispinalis
-
posterius/
Atlas,Tuberculum M longrssimuscapilrs

Axis,Proc spinosus -
.-
M semispinalis
capitis
Mm interspinalescervicis -

\ Mm multifidi

-
M longissimuscervicrs / M semispinaliscervicis

M iliocoslalis cervicis -

\
Lig supraspinale

capitis /
M semispinalis

thoracrs '
M, semispinalis

Fig. 784 Musclesof the back,Mm. dorsi,and


suboccipital
muscles,Mm. suboccipitales;
varioussuperficialmuscleshavebeenremoved;
dorsalview.
'tt **
r
-f $ ]
Back.Musculidorsi t u{ q -- f , $
.f J'

lvl spleniuscapitis \

M longissimuscapitis -

Lrg nuchae

M trapezius

lvl levator scapulae

- - Vertebraprominens,
Proc spinosus

Fig. 785 Musclesof the back,Mm dorsi,and muscles


o f t h e n e c k .M m . c o l l i :
the superficialmusclesof the back havebeenremoved;
left lateralview.

The deep autochthonousmusclesof the neck (Figs.784,786)


Mm. recticapitisposteriorminorandmajorandMm.obliquicapitissuperiorandinferiorbelong - to the medialtractof the
autochthonousmusclesof the back,while M. rectuscapitii lateialisbelbngsto the lateraltract
Mtuscle/Innervation Origin Insertion Function
1. M. rectuscapitisposterior Proc.spinosusof the axis Inferiornuchalline
mator (middlethird)
Suboccipital n. (dorcal
divisionof lst cervicaln.
tClD
2. M. rectus capitis posterior Atlas,Arcus posterior, Inferiornuchalline
minor Tuberculum Dosterius (medialthird)
Suboccipitaln. (cf. to No.I) Actingin concertduring
3. M. obliquus capitis Atlas,Proc.transversus, Inferiornuchalline subtlepositioningand
superior Tuberculumposterius (lateralthird) kinematicsof the head
Suboccipitaln. (cf. to No.1)
4. M. obliquus capitis Axis,Proc.spinosus Atlas(posterior
rim),
inferior Proc.transversus
Suboccipitaln. (cf. to No.1)
5. M. rectus capitis lateralis Atlas (anteriorrim), Proc.jugularis
Osoccipitale,
N. ceruicalis(ventruldivistotts Proc.transversus
of lst cervicaln. [C(])
(cf. to No.1)
Back,
Dorsum
40

- M rectuscapilisposteriormrnor
M semisDinaliscaoitis

t, l,,H
M. recluscaoitis
- - posterior
caoitis --
M solenius major
- Membrana atlantooccipitalis
obliquus capitis superior - - postelior

- - A. vertebralis,
capitrs- -
M, longissrmus Parsatlantica
- Atlas.Proc,transversus
M digaslncus.Venter posterior --

M rectuscapitislateralis/
-- M obliquuscapitisinferior

M splenius
ceruicis

Articulatio Capsulaarticularis
zygapophysralis,

- Mm multilidi

- M scalenus medius

\\ \ Mm interlransversariiposteriorescervicrs
\
Mm multlfidr
M iliocostalisceruicis / \
\
l\4 longissimuscapitis M semispinaliscapiris

Fig.786 Suboccipital muscles,Mm. suboccipitales;


dorsalview.
I = posteriortuberclesof the atlas
II = spinousprocessof the axis

- M obliquus capitis superior

-- M rectuscapitis
posterior
minor

- M rectuscapitis tt

posteriormajor lr
\ Atlas,Arcusposterior
-
capitisinlerior
M. obliquus

Fig.787 Suboccipital muscles,Mrn.suboccipitales, 53 Centreof gravityfor 3/6 of the bodyweight


F$ Forceof bodyweighton the affectedportionof tho lumbarvertebralcolumn
semischematic drawing, Rr4 Resultingforceon the segmentof movoment
left dorsolateralview. FM Forceof the backmuscles
E, Ventralcomponentof shearingstressthat has to be absorbedby the vertebralioints
F. discsand vertebralcolumn
Pressurethat has to be absorb€dby intervertebral
I, Leverarm of the bodiesweightson the vertebralcolumnin the uprightposition
l, Loverarm of the musclesof the back

Fig. 788 Stresson the lumbarvertebralcolumnin the upright


position.
CrossSectionsof the VertebralColumn
4T

-- Larynx
_ - Cartilagothyroidea
Corpus \
venebrae
M. stemocleido-
- z mastoideus
- - Vert€bra cervicalisV,
Corpusvertebrae
-- Uncus@rporis
-- Ptoc transversus,
Tub€rculumanterius
-- Discus
Foramen- intervertebralis
vertebrale -- N. spinalis
-- Pediculusarcus
Proc articularis-
inlerior verlebrae
- -
Lamrnaarcus ' Vertebracervicalisvl,
verlebrae -- Comusvertebrae
Proi. articularis
Lig flavum' - Laminaarcus
vertebrae
Proc spinosus,- -
Tubercula Proc.spinosus

Fig. 789 Cervical vertebral column; Fig. 790 Cervicalvertebralcolumn;


computedtomography(CT) at the level of the computedtomography (CT)at the levelof the
intervertebral disc betweenthe 4th and 5th cervical intervertebral discbetweenthe 5th and6th cervical
vertebrae; vertebrae;i nferiorview.
' Intubationtubeandendoscopic
instrument
inferior view.

Aorla,Pars - ----
V.e,vainletio(
abdominalis
-- Aorta,Pars
V cavainferior- aMominalis

-- Corpusv€rtebrae
Discus -
interuertebralis -- M. psoasmaior
M Psoas -
Ren -
Foramen- -- P€diculusarcus
interuerlebrale vertebrae
Proc articularis* -- Lig.flavum
supeflor
-- Proc.costalis
Articulatio-
zygapophysialis - - Proc.articularis
Proc articularis- inlerior
inferior --
Proc articularis
Proc mammillaris' sup€nor
--
Mm dorsi - Lig. interspinal€
- -
Proc spinosus- Mm.dorsi

*-
Fascia - Fascia
thoracolumbalis thoracolumbalis

Fig. 791 Lumbarvertebralcolumn; Fig.792 Lumbarvertebralcolumn;


computedtomography (CT)at the levelof the computedtomography (CT)at the levelof the
intervertebral
discbetweenthe 2nd and3rd pedicleof the 3rd lumbarvertebra:
lumbarvertebrae:
inferiorview. inferior view.
Back,
Dorsum
42

- - N aurrculaflsmagnus, R posterior (Plexusceruicalis)


- - N occipitalisminor (Plexus cervicalis)
.L

- - - Nn supraclavrculareslaterales(Plexus ceruicalis)
)

- - N- cutaneus brachrl
laleralissuperior
(N axillaris)

N cutaneus
brachii lateralis
inferior(N radialis)

-
N cutaneus brachil
posterior(N radialis)

(Rr cutanei mediales et laterales)


(Nn spinales C4-L1, Rr posleflores)

- Rr cutanei laterales
(Nn spinales,Nn intercostales)

-- R cutaneuslateralis
(Plexuslumbalis,
N iliohypogaslricus)

-- Nn cluniumsuperiores
( N n s p i n a l eLs1 - L 3 ,
Flr posteriores)

- - Nn clunium medii (Nn spinales


---/ S1-S3, Rr posteriores)
't-
-t'

-- / / - -
_-1 Nn clunium inferiores
(N cutaneus femofls posterior)

- -
N cutaneus lemoris lateralis(Plexus lumbalis)
- -
N cutaneus femoris posterior (Plexus lumbalis)
S3

Fig.793 Segmental cutaneous innervation(dermatomes)


andcutaneousnervesof the back;
dorsalview.
43
N occipitalistertius (C3) / a a N o c c r p i t a l i s m a j o r ( C 2 ) ; Ao;cVc i p i t a l i s

N occipitalismajor (C2) /, magnus(Plexusceruicalis)


N auricularis
\
\ l

N suboccipitalis(C1) \ R posterior
(CO)
\ /

A vertebralis
O -
N occipitalisminor (Plexus cervicalis)
/ R poslerior
(C7)

N auricularismagnus (Plexusceruicalis) //
R posterior(CB)
capitisa /
M longissimus
/ R posterior
(T1)
M levatorscapulaeA / - N supraclavicularislateralis(Plexus cervicalis)

M deltoideus
||
| | N. cutaneus brachii lateralis
I : inlerior

, ,. N radialis;
M serratusposteriorsuperiora \ (V.)Profundabrachii
i o an.;
/ N. cutaneus
r +_a
i brachiiPosterior
M m m u l t i f i d Ii -- \

Nn thoracrci,Rr, posteriores.
mediales et lalerales - a M triceps
brachii,
Caputlongum
M iliocostalisthoracis a - -

lhoracisa --
M longissimus

t, \1M teresminor
t, t
a
\ 1M ".infraspinatus
rhomboideusmajor
M serralusposleriorinleriora - -

\ 1 M. latissimus
dorsi
R posterior
(T12)

| --
M latissimusdorsi

M obliquusexternusabdominisa --

Trigonum lumbale;
N ifiohypogastricus

Crista iliaca -- -- (Bursa subcutaneaspinae iliacae


posteriorissuperioris)
R posterior
(T12)
-- (Bursasubcutanea
sacralis)

Nn cluniumsuperiores

M gluteusmaximusa /

R posterior
(S3) \ R posterior
(Sa;

Fig.794 Blood vesselsand nerves of the back;


the superficial musclesand the shoulder girdle
have been removed on the left side;
dorsal view.
* Blood vessels and nerves of the triangular space
* * Blood vessels and nerves of the quadrangular space
Back,
Dorsum
44

N occipitatismajor
/ O A occipitalis, Rr occipitales
M semispinalis
capitisa \
\ / t M. epicranius;M occipitofrontalis,Venter occipitalis
A; VoccipitalisO*\ I
\ I
/ O A occipitalis

A occipitalis
a \
\
\
V auricularisposterior:r 1
\ N occipitalisminor
A. occipitalis, a \r i
R. mastoideus
N auriculaismagnus
---
N. occipilalisminor
+-- O A auricularisposlerior,R
occioitalis

capitisa ---
M longissimus - aM spleniuscapitis
- a M slernocleidomastoideus
N accessorius
[Xtl \

. V jugularis exlerna
M spleniuscapitis O \\

M levatorscapulae
a \ Rr cutaneiposteriores(Nn cervicaleset
ta- thoracici,Rr posteriores)
N. dorsalisscapulae -
--- W M traoezius
l o -_
qqlu!9y:
(A lransversa
colli)
M levatorscapulaea -

V transversa! --
colli

M rhomboideus * --
mtnor
-
Fascia a
deltoidea

M traoeziusa ---

M. teresmaior a - a M infraspinalus,
Fasciainlraspinata

M. rhomboideus{ -
mapr Rr.cutaneiposleriores
(Nn.thoracici,
Rr posteriores)

M latissimusdorsi | -

Rr cutaneilaterales
pectorales(Nn thoracici,
Nn intercostales)

Fig.795 Bloodvesselsand neryesofthe occipitalregion,


Regiooccipitalis,the nuchalregion,Regiocervicalis
posterior,and the upperpart of the back;
the superficialmusclesof the backhavebeenpartially
removedon the left;
dorsalview.
45
Proluberantia
occipitalisextema

M. semispinalis
capitisa \ 7 O R. muscularis(A. vertebralis)

z o A. vertebralis
M. rectuscapitisposleriormal)r O \\ / I a V. auricularisposterior
,/ a V occipilalis
/' / a Pl€xusvenosus
r // suboccipitalis
N. suboccipitalis -r
o Y. verlebralis
R. masloideus(4. occipitalis)a -- ..
/ O A. occipitalis
R occipilalis (A. occipitalis) O -

A. occipitalis O ---
-- o M. splenius
M. obliquusO ---
capilisSuperior capilis

A verl€braliso -- --
Atlas,Arcus
2
posterior

M. spleniuscapitisO /
-
/ (R. communicans)
M longissimuscapilis o / o M. multifidus
--
M. obliquuscapitisinferiorO Fascianuchae
' -- o A. c€Mcalisprotunda
R. posterior(C 2)
R muscularis(A. vertebralis)O / -- a V. c€rvicalisprofunda
M. semispinaliscapitisa /
--
R. posterior(C 3) / o M. semispinaliscervicis
A. cervicalisprofundaO ---- - ,.
N. dorsalisscapulae
R. musculatis . N. accessorius[XU
(N dorsalisscapulae) -- ..
N accessorius / a Mm. rhomboidei
/ major6l minor

z o M. lraoezius

B.superficialis o / I
(A. transiersacollil I
!
'I I
R. profundus(A transv€rsacolli) O I
N. dofsalisscapulae a Mm. rhomboid€imaloret minor

7ssx

Fig.796 Bloodvesselsand nervesofthe occipitalregion,


Regiooccipitalis,the nuchalregion,Regiocervicalisposterior;
dorsalview.
+ Tuberculaof the Prcc,spinosusof the axrs
46 Back,Dorsum

N occipitalismajor / tertius
N occipitalis

M semisprnahscaprtis a \

\-\
\ i \

M, obliquus capitis supeflor | \


)1 - _z O M rectuscapitisposterior
mrnor

M rectus capitis posteriormajor | \

ParsatlanticaO - -
A vertebralis, , - Proc mastoideus
Os temporale,

N subocciprtalis
N suboccipitalis
* - Atlas,Arcusposterior
M o b l i q u ucsa p i t i Isn f e r i oar - - - K
--- | M o b l i q u ucsa p i t i isn t e r i o r
R posterior(C 2) --- O A vertebralis.Pars lransversaria

N occipitalistertius -
O M rectus capitis posteriormalor

Plexus cervicalis

O Mm interspinalesceruicis

Fig.797 Nerves ofthe nuchal region, Regiocervicalis posterior,and vertebral artery;


dorsal view.

/ Foramenmagnum

N subocciprtalis

Proc transversusatlantis

O A vertebralis

Duramaterspinalis- -

-
malerspinalis- -
Arachnoidea N occrpitalrsmalor

N occipilahstertius

N spinalis,R, posterior

M scalenus medius

Vertebra ceruicalis V,
Proc transversus

N ceruicalis[C7],
Fila radiculariaposleriora
---
a A vertebralis
Medullaspinalis

Fig. 798 Bloodvesselsandnervesof the deepposterior the vertebral arches have been completely removed as well as a
andthe contentsof
cervicalregion,Regiocervicalisposterior, portion of the occipital bone.The meningesof the spinal cord are
the vertebralcanal; shown in several laYers;
dorsal view.
canal
ofthevertebral
47

- Lamina arcusvertebrae
_-
-- Vertebralumbalisll, Proc costalis

,'.,
*,*,'"
Spatiumepidurale- _

I
sensorium'i --
Ganglion --
nervisoinalis o M psoasmajor
-- o Plexusvenosus
R anterior vertebralisinternusposterior
R posterior"r - - Ouramatersoinalis

- O Mm intertransversarii
medialeslumborum

R r d o r s a l e(sA ; V l u m b a l i sO) a - - - - Arachnoidea maler spinalis

- - Pia mater spinalis


Radicesanteriorel oosterior{ --
--
V spinalisposteriora -- Lig intertransversarium
-* Proc articularissuperior

Caudaequina *, --
i-- O M interiransversarius
lateralislumborum
- O M. interlransversarius
medialislumboriJm
Radixanterior. --

Radixposterior
- Lig iliolumbale

Duramaterspinalis--
- Os sacrum,Pars
Arachnoideamater - -
spinalis lateralis

Spatiumepidurale; - - Os coxae,Os rlium


Plexusvenosusa
verlebralisinternus \
anlenor \ Os sacrum,Proc
subdurale)/
(Spatium Pia malersoinalis Spatium
subarachnoideum articularissuperior

Fig.799 Bloodvesselsandnervesofthe vertebral


canalin the lumbarregion,Regiolumbalis;
the vertebralarcheshavebeenremovedand the
meningesof the spinalcordareshownin severallayers;
dorsalview.
48 Thoracicand AbdominalWaIIs

malor --
M. pectoralis

M serratusanterior - -

M obliquusexternusabdominis - -

Spinailiacaant€riorsuperior- - -

Fig.800 Surfaceanatomyofthe thoracicandabdominal Notethe upperlimit of the pubichair.It extendsto the umbilicus
wallsof a youngmale;the prominentmusclesareindicated. andhasa triangularshapein the male.In the female,the upper
limit is horizontal.Theregionsof the thoracicandabdominal
walls are shownin Fig. 7.

Articulatiosternoclavicularis
: Incisurajugularis
\
Clavicula,Corpus

*- Angulussterni

Arcuscostalis -

- Anulusumbilicalis

Spinailiacaanteriorsuperior - -

Fig. 801 Surfaceanatomyofthe thoracicand abdominal


walls of a young female;the prominent bonesare indicated.
Ribs,Costae

Caput costae \

Tuberculummusculi \ - - Sulcus venae subclaviae


scalenranterioris \

Sulcus.arleriae\
subclavrae \

Collum costae, - -
Crista colli costae Corpus costae \

// Anguluscostae

'Tuberositas
musculi
serralranteflofls

F a c i e s a r t r c u l a r i -s- -
lubercuI costae

Tuberculumcostae /

Facies articularis- - -- Cristacaoitrscostae


capilis costae

Crista colli costae - -

Facies articularis - -
tuberculicostae

Fig.802 Ribs,Costae.
RibsI to III, superiorview
RibVIII. inferiorview
Thoracicand Abdominal Walls

Angulicostarum

--t
- Carlilaginescostales

Fig.803 Ribs,Costae;
viewedfrom the right.
Thedistancebetweenthe ribs is as in nature.
Incisuraclavicularis\

Manubrium
slerni-

- Symphysis
Incisura
costalisll -
manubriosternalis lncisuracostalisll

-- costalislll
Incisura
costalislll ---
Incisura

--
costalislV - -
Incisura lncisuracostalislV

costalisV --
Incisura -- lncisuracostalisV

costalisVl ---
Incisura

Incisura - - -
costalisVll

Symphysis
xiphosternalis

Proc xiphoideus

Fig. 804 Sternum, Sternum; Fig. 805 Sternum,Sternum;


ventral view. left lateralview.
Form, length and dorsal or ventral direction of the Orientationof ribs andintercostal spaceson the anterior
xiphoid process,Proc.xiphoideus,differ very much. thoracicwatl is facilitatedby the Angulussterni,which
demarcates the articulationof the 2nd rib.
q{i:r
Thoracicand Abdomi.nal

-
Cartilagocostalis ll

manubriosternalis
Symphysis

-
Canilago costalis lll
Lig sternocostaleintraarticulare

Canilago costalis lV -
\...
\-..
\ Artrculationes
sternocostales

costalisV -
Cartilago

Cartilagocostalis Vll - *

Fig.806 Sternum, Sternum;costalcartilages, Notethat the xiphoid processis not seenin this figure due to
Cartilagines
costales;
frontalsection; the curvatureof the sternumin the sagittalaxis.
ventralview.

Capsulaarticularis--
- Lio sternoclaviculareanteflus
Cartilago
costalisl;
SynchondrosiscoslaeI

/ Lig slernocostale radiatum

\ Cartilagocostalis ll
Symphysis
manubriosternalis

Fig. 807 Sternoclavicular joint, Articulatiosternoclavicularis;


the right ioint has beenexposedby a frontal sectionto show
the articulardisc;
ventral view.
Caveathoracis

/ Vedebta ceruicalisVl

/ vedebta thoracica I

Acromron

C o s t al l

Proc coracordeus

Costalll \
Cavitas glenoidalis

Coslae verae
l-vill

Cosla lV

Costa vl

Costa vlll

Costae spuriae
lvilr-xlll

Cosla Xl

/ \ costa Xll
Venebra lhoracica Xll

Vertebralumbalis | / \ Proc costalis

Fig. B0B Thoraciccage,Caveathoracis;left shoulder


g i r d l e ,C i n g u l u mp e c t o r a l e ;
ventralview.
The thoraciccageis shown in a morlerateinhalation
p o s i t i o nT h e b o n e so f t h e s h o u l d e g
r i r d l ea r e s h o w n
i n g r e e n ,t h e c a r t i l a g e isn b l u e .
The length of ribs XI and XII can var) Sreatl-v
Thoracicand Abdominal Walls

-- M. pectoralis
major
pectoralis
major

Areola
mammae

Papilla
mammana
Glandulae
areolares

-r- M serratus
anterior

Fig. 809 Mammary gland, Mamma; Fig. 810 Mammary gland,Mamma;


ventral view risht lateral view.

Papilla mammaria

Ductuslactiferi t.

Papilla
mammana

Sinuslactilerus/

Lobuli glandulae mammariae

Fig. 811 Mammary gland, Mamma, of a pregnant Fig. 812 Mammary gland, Mamma, of a pregnant woman;
woman; the mammary gland has been sectionedin the the skin of the areola,Areola mammae,has been removed,
sagittal plane; the skin around the nipple has been retracted;
lateral view. ventral view.
Mammarv Gland.Mamma

Fig. 813 Radiographof the mammarygland,


mammographyof a 47-year-oldwoman;
beamdirectedlaterally.

--'";r{
i
Nodrlymphoidei
ceruicales Nodiprotundi- _
anteriores,
/ Nodi lymphoideiparaslernales
Nodilymphoidei -
supraclaviculares
l>_.--. 7\".
Nodilymphoidei -
deltopectorales
l><: _ .-
r .-s-

(Nodr lymphoideisubmammarii)/

Fig. 814 Lymphaticdrainageof the femalemammarygland Notethe communicationsbetweenthe lymphaticvesselsof


and locationof the regionallymph nodes both sidesand lymphaticdrainageinto the intrathoraciclymph
(From BEruNrrvr;uor,r/Gornrrlrn:
Textbookof Human Anatomy. nodes.
19791
Vol. 2, l2th ed. Muni<;h:Urban& Schwarzenberg,
Thoracicand Abdominal Walls

Nn. supraclaviculares,
A ; V cerurcilis suoerfrcialisa a'
l'..
I
/ at V cephalica

Plexus venosus areolaris o I


a I t\

i{\

A ; V t h o r a c i c al a t e r a l i s a, t
N thoracicus[T2],
N intercostalis,
R culaneus lateralis
Pectoralrs --
a A t h o r a c i c ai n t e r n a * ;
o Vv thoracicaeinternae

V thoraco- a Nn thoracici,
epigastrica Nn intercoslales,
Rr cutanei anteriores

T3 - a GA ; V epigastricasuperior
14- /
t5

16- --
Nn thoracici, a M obliquus exlernus abdominis
Nn intercostales,
Rr cutanei

pectorales

Nn thoracici,Nn intercostales,
Rr cutanei anterioresabdominales

Vv paraumbilicales*

Vv subcutaneaeabdomrnrs 5 -

A ; V circumflexarliumsuperlicialis3 g -

- - - Chorda arteriaeumbilicalis"

---
N genitofemoralis, - a o A : V e p r g a s t r i c ian t e r i o r
R femoralis
----,&M pyramidalis
A ; V e p i g a s t r i c aa , -
superficialis

A pudenda externa; O - R- Hi3,?'.???T#i3;


W pudendae externae *
--
oM rectusabdominis
N femoralis,
R cutaneus anterior

V saphena magna $ ,
\ N ilioinguinalis

Fig. 815 Blood vesselsand nerves of the thoracic and branchesofthe


Thearabicnumeralsindicatethe cutaneous
abdominal walls. The superficial layer is shown on the right corresponding nerves.
intercostal
* Clinical: internal mammary artery
side of the body; ventral view.
** The Chorda arteriae umbilicalis protectsinternally as the Plica umbilicalis
medialis
57

Fig.816 Segmental sensoryinnervationofthe anterior


thoracicandabdominal walls(dermatomes).
Lettersand numbersindicatethe cornesponding
segmentsof
the spinalcord.

,/ Diaphragma(c4)

// O€sophagusCf4,TS)

Cor (T3,T4)

T6/
w-
T8 -' - Gasler (T8)

- Hepar;vesica biliaris
( T 8- 1 1 1 )
T10
T11 - lntestinumlenue
(r10)
T12
-- lntestinumcrassum
L1 (r1r)
Ren;Testis
Fig.817 Segmental sensoryinnervationofthe thoracic ( T 1 0- L l )
andabdominalwalls.
- Vesicaurinaria
Theregionson the left half of the bodyarethosewhere ( T 1 r- L r )
pain causedby diseasedinternalorgansis projected
(HE,l,o's
zones).
Thoracicand Abdominal Walls

Mm sternocleidomastoidei\
rj
Plalysma \
,.\

Fascia clavipectoralis\ \

V cephalica \ -<,_.. \

M deltoideus --
\ Fascia axillans

M pectoralismajor, - -
Pars sternocostalis

- M serratusanteflor

M serratusanterior-

dorsi-
M latissimus
- Ligg costoxiphoidea

Nl pectoralis malot, '


Pars abdominalis
\:
externusabdomrnrs
M obliouus
'-
L i n e aa l b a

M obliouus exlernus abdominis -

Vagina musculi recti abdominis,


Anulus umbilicalis - Lamrnaantenor

- Spina ilracaantenor superior


Spina rhacaanterior -
supeflor

Tela subculanea: - z Fibrae intercrurales


Panniculusadiposus

- Crus mediale
M obliquusexternus- -
abdominis, - -
Aponeurosis M cremaster

---
Funrculus
spermaticus Lig retlexum

- Lrg suspensonumpenls
Lrg lundiforme penis

Fig. 818 Musclesof the thoracicandabdominalwalls;


superficiallayer;
ventralview.
( ThoracicMuscles,Musculithoracis

M sternocleidomasloideus
/ M pectoralis major, Pars sternocostalis
M pectoralismajor, Pars claviculafls
\

Mm intercoslalesinterni \ V axillaris
/
/ . M pectoralisminor
M deltoideus \

/ Plexus brachialis,
M coracobrachialis \
L..' Parsrntraclavicularis

biceps brachii,
Caput breve A axrllaris

M pectoralis--
malor

M pectoralis -
mrnor

Costae ll-V --

-
M latrssrmusdorsr -
i/4 serratusanlenor -

\ M serratusanterior

M pectoralrsmaior, Pars abdominalis /


\ M pectoralismajor,Parssternocostahs

M obliquus exlernus abdominis - \ M obliquus€xternus


abdominis

Fig. 819 Thoracicmuscles,Mm. thoracis; On the left side the M. pectoralisminor has beensectionedand
the right M. pectoralismajor has beenpartially'removed. reflected;the Membranaintercostalisexternahas beenremoved;
ventralview.

M serratusanterior- - -
-- posterior
V intercostalis
-- posterior
A intercostalis
--- N intercoslalis(T8)

- - Pleura visceralislpulmonalis]

C o s t al x - - - - Parscostalis
- - - Pleuraoarietalis.
- - - Pleurapaflelalis,
Parsdiaphragmalica

- - - Parscostalisdiaphragmatis

M i n t e r c o s l a l iisn l e r n u s - - - -
M inlercostalisexternus ----

- - - Recessuscosiodiaphragmaticus
--- Hepar

Fig. 820 Thoracicmuscles,Mm. thoracis; During punctureof the liver or aspirationof accumulatedfluid
frontal sectionshowingthe thoracicwall and the thoracic in the pleural cavity,the courseof the intercostalnerves and
and abdominalcavities; vessels,the positionof the diaphragmand the expansionof the
right lateralview. lung into the costodiaphragmatic recessmust be taken into
account.
Thoracicand AbdominaLWalls

Ventral musclesof the shoulder (Figs.81B,819)


TheM. pectoralismajoris a muscleof boththe arm andthe trunk. It definesthe superficialreliefof the upperanteriorthoracic
wa.ll.Underneathit liesthe M. pectoralis girdle.TheM. subclavius
minor,a muscleof the trunk-shoulder is alsoa muscleof the
girdie.Its courseto the clavicleis fromcaudal.Thedeepestmuscleof the shouldergirdleis M. subscapularis,
trunk-shoulder
whichruns fromthe anterior(ventral)surfaceof the scapulato the humerus.
Mtscle I Innervatiort Origin Insertion Function
1. M. pectoralis major Pars clavicularis: Clavicula Cristatuberculimajorisof Shoulder joint:
Nn.pectorales medialiset (sternalhalf) thehumerus adduction(very effectivewhen
Iateralis(Plexasbrachialis, internal
the arm is elevated),
Pars sternocostalis:
Parsinfi'a-/ supraclav
icu- Manubriumand Corpussterni,
r0tanon;
Iaris) costalcartilagesof ribs I -6 Parsclavicularis:
anteversion
Pars abdominalis: Reclus Shoulder girdle:
sheath(aponeurosis of the depression,anteversion
externalobliqueabdominal Thorax:
muscle) elevationof the sternum,en-
largementof the thorax (when
Thefibres convergetowards the arms are supportedit
a flat tendon assistsin extreme inspiration)
2. M. pectoralisminor Ribs (2) 3 to 5 (closeto the Apex of the Proc.coracoideus Shoulder girdle:
Nn.pectorales medi.aliset ^F +L^ ^^^^,,1^
iunctionof boneand cartilage) u l t l l t r s l d P u r d depression,anteversion
Iaterolis (Plexusbrachia lis, Thorax:
Pars infra-/ supraclavicu- elevation o f t h e u p p e rr i b s ,
Iaris) enlargementof the thorax
(when the arms are supported
and the shouldergirdle is
fixed it assistsin extreme
inspiration)
3. M. subclavius lst rib (closeto the junction Clavicula(lateralthird), the Shoulder girdle:
N. subclavius of boneand cartilage) fasciais mergedwith the depression(mild effect),
(Plexusbrochialis,Pars adventitiaof V. subclavia resistanceto lateralpull on
supraclavicularis) the clavicle
4. M. subscapularis Faciescostalis,Fossa Tuberculumminus and Shoulder joint:
Nn.subscapulares ^,,k^^^^,,1^-i^
JUUJUdlrUldl l5 adjacentpart of the Crista internalrotation,abductionin
(Plexusbrachtalis,Pars tuberculiminoris (inferiorto the scapularplane (cranial
infraclavicularis) the insertionof Bursasubten- portion),adductionin the
dinea musculisubscapularis) scapularplane (caudalportion)

Muscles of the thoracic wall (Fig.819)


Theintercostalspacesaretakenup by the Mm. intercostales externiandinterni.Theinner surfaceofthe thoracicwall is covered
by Mm.subcostales andby M. transversus thoracis.An occasionalsuperficialvariantis the M. sternalis.M. pectoralismajor,
which dominatesthe superficialcontourof the upperthoracicwall, is a trunk-armmuscle.It overliesM. pectoralisminor,a trunk-
shouldergirdle muscle.Both are describedwith the musclesof the shoulder.
Muscle/ Innervation Origin Insertion Function
1. M. sternalis R.imof sternum(onthe fascia lntothe fascia Contracts
theskin of the chest
(inconstant,existsin 5%of pectoralis)
the population)
Divisionsof Nn.pectorales
(Plexusbrachialis,Pars
supraclaviculans.)or Nn
inierco states(Nn.'thorci ici)
2.Mm. intercostalesexterni Ribs1 to 1l (lon,erborclerfrom Ribs 2 to 12 (upperborderof Elevatethe ribs,expandthe
Nn.intercostales Tuberculumcostaeto the the rib below) intercostal
spacesduring
(Nn.thoracici) junctionof boneandcartilage) inspiration
3. Mm. intercostalesinterni Ribs2 to 12(upperborder Borderof Mm. intercostales Lowerthe ribs andexpandthe
Nn.intercostales fromsternalendof Cartilago intimi on the inner surfaceby intercostal
spacesduring
(Nn.thoracici) costalisto Anguluscostae) Vasaintercostaliaposteriora expiration
and N. intercostalis
4. Mm. subcostales Lowerribs (upperborder Lower ribs (lower border,
(inconstant) betweenTuberculum and alwaysskippingone rib)
Nn, intercostales Anguluscostae)
(Nn. thoracici) Expandthe thoracicwall
5. M, transyersusthoracis Corpussterni,Proc.xipho- Costalcartilagesof ribs 2 to 6 during expiration
(inconstant) ideus(dorsallateralrim), (closeto the junction of bone
Nn. intercostales Cartilago
costalisof rib (6)7 and cartilage)
(Nn. thotucici)
( Thoracic'Muscles.Musculi thoracis

---
M sternothvroideus
- - Mm intercostalesInterni
Manubrium sterni --

--
M transversusthoracis

- - Diaphragma,
Centrum tendineum
-- Foramen venae cavae
- - Mm intercostalesinternl

Fig. 821 Thoraciccage,Caveathoracis;


internalaspectof the anteriorthoracicwall with
the diaphragmin placeon the right side;
dorsalview.

,- Tuberculumanteflus lcaroticum]
(Verlebra cervicalis Vi)
M scalenusoosterior --

--- M scalenusanlerior
M scalenus medrus - -

M s c a l e n u s a n l e r i o r- -
M longus colh

Membrana inlercostalisinlerna - -

-- Membrana inlercostalisinterna

Fig.B22 Thoracic cage,Caveathoracis;


posteriorpart; frontal section;
the musclesof the neck are partly in place;
ventral view.
Thoracicand Abdominal Walls

l\4 trapezius-- - Clavrcula

Spinascapulae--
---- M pectoralismajor, Pars slernocostalis
M infraspinatus--
M teres minor - -
Corpus mammae,
M teres maior -- Lobi glandulaemammariae

--- P a p i l l am a m m a r i a

-- M serralusanlerior

--- M pecloralismaior, Pars abdominalis

M brachialis /
M biceps brachii /

dorsi-
M latissimus

M obliquus externus abdominis - -


- - Anulus umbilicalis
Fascia thoracolumbalis---

lumbale--
Trigonum
-- Vagina musculi recti abdominis,Lamina anterior

Spina iliaca posteriorsuperior --- -- M obliquus Aponeurosis


exlernusabdominis,

- -
Sp'nailiacaanteriorsuperior

--
M tensorfasciae latae
s a x i m u s- -
M , g l u t e um

walls,
Fig. 823 Musclesof the thoracicandabdominal
Mm.thoracisandMm. abdominis. Themammarygland
hasbeendissected:
lateralview.
AbdominalMuscles,Musculi abdominis

- Ligg costoxrphoidea

M. pectoralis
maior
Parssternocostalis

M. pectoralismajor,
- Pars abdominalis
Vagina musculi recli
abdominis,
Lamrnaanterior

M obliquus
externus
abdominis

M reclus abdominis -
Inlersectiotendinea Mm
intercoslales
interna

M reclus
l\,4rectus abdominis - - abdominis

- M obliquus
internus
abdominis,
Aponeurosis

Anulus umbilicahs -

r1
l
Lrnea alba
T
I"
S p i n ai l i a c a
anlerior superior
-
I M obliquus
internus
abdominis

- -
M obliquus
exlernus

M reclus abdominis. '


-
/r'( abdominis,
Aponeurosis
Tendo
- _-
Anulus lnguinalls( Cruslaterale .
superlicrahsl /
/ - Funiculussoermaticus:M cremasrer
\urus meor3;g
/
M pyramidatrs Lig reflexum

Fig. 824 Abdominal muscles,Mm. abdominis;


on the right side of the body,the anterior layer of the rectus
sheath has been openedto display the M. rectus abdominis
and the M. pyramidalis.On the left side of the body,the
M. obliquus externus abdominis has been sectionedto show
the M. obliquus internus abdominis;
ventral view.
Thoracicand Abdominal

M serratusanterior\

-
M latissimus\ M serralus anterior
dorsl

M obliquus
externus abdomtnis

obliquusexternus-- -
abdominis

[,4m intercostalesexlerni - .-

-
Mm intercostalesinterni

-l
costatisX
Cartitago
- M rectus abdomrnis

obliquus externus
abdominis

M obliquusinternus
abdominis

-
Lig ingurnale

Funiculus - M pyramidalas
spermalrcus;
M cremaster

Fig. 825 Abdominal muscles,Mm. abdominis;


on the left side of the body,the anterior layer of the rectus
sheath has been opened.On the right side of the body,the
M. obliquus externus abdominis has been sectioned;
the Membrana intercostalisexterna has been removed;
ventrolateralview.
(
AbdominalMuscles,Musculiabdominis

M rectus abdominis \
,, M pectoralis major

7 M latissimus
oorsl

M obliquus -
exlernus
abdominis

Mm intercostales-
externi

Cartilagines - - M obliquus
costales
externus
abdominis
- Intersectiones
Costaelx; x - lendineae

- Vaginamusculi
rectiabdominis,
Laminaanterior

Vagina musculi recti - -- M rectus


abdominis, abdominis
Lamina posteflor
-- M obliquus
internus
-
Lineasemilunaris abdominis
- M transversus
abdominis

- Intersectio
lendinea

-- M obliquus
internus
M obhquus.- abdominis
internus
abdomrnis

M obtiquus-
inlernusabdominis,
Aponeurosts

Anulus- -
inguinalis
superlicialis,
Crusmedrale

Anulus -
inguinalis
superficialis,
Crus laterale \ M pyramidalis

Fig. 826 Abdominalmuscles,Mm. abdominis;


on the left side of the body,the M. pyramidalis has been
sectioned.On the right side of the body,the M. rectus
abdominis is reflectedupwards and downwards;
the M. obliquusexternusabdominishas beensectioned;
the anterior layer of the rectus sheath has been pulled
to the right over the midline;
ventral view.
Thoracicand Abdominal Walts

Anterior muscles of the abdominal wall (Fig.826)


The anterior muscles of the abdominal wall, M. rectus abdominis and M. pyramidalis, Iay within the rectus sheath.

Muscle Origin Insertion Function


Innervation
1. M. rectus abdominis Ventral surfaceof costal Crista pubica of Os coxae, Flexesthe trunk towards the
Nn. intercostales(Nn. thora- cartilagesof the 5th to Symphysispubica pelvis, compressesthe
cici); rarely ventral divtsions 7th ribs, Proc. xiphoideus, abdomen,abdominal
of upper Nn. Iumbales Ligg. costoxiphoidea breathing (expiration)
2. M. pyramidalis Crista pubica of Os coxae, Linea alba Tensesthe Linea alba
(inconstant) Symphysispubica (ventral of
caudal Nn. intercostales M. rectus abdominis)
(Nn. thoracici)

Lateral muscles of the abdominal wall (Figs.824, 826)

The lateral muscles of the abdominalwall are: M. obliquus internus abdominis,M. obliquus externus abdominis,and
M. transversusabdominis.
In the male the M. cremasterbranchesoff from M. obliquus internus and M. transversus.

Muscle Origin Insertion Function


Innervation
1. M. obliquus externus Ribs 5 to 12 (external surface, Labium externum of Crista Unilaterally acting, rotatesthe
abdominis interdigitateswith M. serratus iliaca, Lig. inguinale, thorax to the oppositeside and
Caudal Nn. intercostales anterior) Tuberculum pubicum, Crista bends the Columnavertebralis
(Nn. thoracici); pubica, Linea alba (part of laterally.Acting bilaterally,
N. iliohypogastricus; the anterior layer of rectus bends the thorax towards the
N. ilioinguinalis(Plexus sheath) pelvis, compressesthe
Iumbalis) abdomen,abdominal
breathing(expiration)
2. M. obliguus internus Fasciathoracolumbalis Inferior border of the costal Uniiaterally acting, rotatesthe
abdominis (superficiallayer),Linea cartilagesof ribs (9) 10 to i2. thorax to the sameside and
Caudal Nn. intercostales intermedia of Crista iiiaca, Linea alba (aboveLinea bends the Columnavertebralis
(Nn. thoracici); Lig. inguinale (lateral tlvo- arcuata it conhibutes to the laterally.
N. iliohypogastricus; thirds) anterior and posterior layer Acting bilaterally,bends the
N. ilioinguinalis (Plexus of the rectus sheath; inferior thorax towards the pelvis, com-
Iumbalis) of Linea arcuataall fibres pressesthe abdomen,abdo
contributeto the anteriorlayer). minal breathing (expiration).
In the male the inferior fibres M. cremasterdraws the testis
becomeM. cremasterand and its tunics up towards the
extend to the spermatic cord. superficial inguinal ring.
3. M, transversus abdomtris Inner surfaceof the costal Linea alba (aboveLinea Compressesthe abdomen,
Caudal Nn. intercostales cartilagesof ribs (5, 6) 7 to 12. arcuatathis muscle contrib- abdominal breathing
(Nn. thoracici); Procc.costalesof the lumbar utes to the posterior layer of (expiration)
N. iliohypogastricus; vertebrae (by way of the the rectus sheath; inferior to
N. ilioinguinalis thoracolumbarfascia),Labium Linea arcuata all fibres con-
(Plexuslumbalis); internum of Crista iliaca, tribute to the anterior layer).
N. genitofemoralis Lig. inguinale (lateral third) In the male the inferior fibres
becomeM. cremasterand
extend to the spermatic cord.

Posterior muscles of the abdominal wall (Fig.829)

Thefoundationof the musclesof the posteriorabdominalwall is formedsuperiorlyby Parslumbalisof ttre diaphragm,inferiorly


by M. quadratuslumborum,and with participationof the M. psoasmajor medially.
Muscle Origin Insertion Function
Innervation
M. quadratuslumborum Labiuminternumof Crista 12thrib (medialpart),Procc. Depresses the ribs
Rn musculares (Plexus iliaca(posteriorthird),Lig. costalesof the lumbar (expiration),
laterallyflexes
lumbali.s);
N. tntercostalis iliolumbale vertebrae4 to one. the lumbarvertebralcolumn
(N, thoracicus[T12])
( Inguinal Canal,Canalisinguinalis

M oblquus--
e x l e r n u sa b d o m r n r s ,
Aponeurosrs

-- M oblquus
i,4ob|quus-- exlernusabdominis.
i n t e r n u sa b d o m r n r s Aponeurosis
zi:'
z :y'".

- - Fibrae intercrurales

-- Crus l
lateraleI Anulus,
l In9urnars
-.- Crus I superfrcialis
mediale
J
- -
Funiculusspermalicus

F i g . 8 2 7 S u p e r f i c i ai ln g u i n a lr i n g ,A n u l u si n g u i n a l i s T h ea p o n e u r o s iosf t h e r i g h t M . o b l i q u u se x t e r n u sa b d o m i n i si s
s u p e r f i c i a l i st h; e r i g h t s l l e r m a t i c o r r l ,F u n i c u l u ss p e r m a t i c u s , openerl;ventralview.
is retractedbv a hook C o m p a r et o F i g 8 3 5 .

Lrg falcilorme
M rectus abdominis
/ Lrg teres hepatis:V umbrftcalis
)

Fossa supravesrcalis
Linea arcuata

F o s s ai n g u i n a l i sm e d r a l r s
\ Plica umbilicalismediana

F o s s a I n g u r n a I sl a l e r a l i s Plica umbilicahsmedialis
\

Pftcaumbilicahslateralis

/ Plica vesicalistransversa

A ; V t e s t i c u l a r i-s- - -
M iliacus

A ; V i l i a c ae x l e r n a - -
---- Osilium
/
A u m b i l i c a t i/s / \ \ A,V tltacaexterna
Ampulla duclus delerentis/ \ Ureler, Pars pelvica

F i g . 8 2 B A n t e r i o ra b d o m i n aw
l allin a newborn; The \'. umbilicalisobliteratesafter birth. In portal hypertension
drlrsalview this vein can onceagainenlargeCompareto Fig 1029,portocaval
anastomosls.
Thoracicand Abdominal Walls

Oesophagus,Pars abdominahs \ , - Pars slernahsdiaphragmalrs

Foramen venae cavae \ / / Pars costalisdiaphragmatis

/ N4 transversusabdominis

- - Centrum tendineum

- - Hiatusaorticus

- - Pars abdominalisaortae

- - Pars lumbalisdiaphraomatis,
Crus dextrum
Lig arcuatum --
mediale

Lig arcuatum lalerale - - - - - i,4 quadratus


lumborum

-- - Fascralransversalrs
( M p s o a s m i n o r.)- -
- -- Vertebraelumbales lll: lV
M. quadratus-
lumborum
- - Crista iliaca

M transversus-
abdominis
-- (M psoasminor),
Tendo
M psoas - --
malor M psoas
malor
M iliacus - --
M iliacus

- -
Promontorium

Periloneum .- - .- Lacuna
parietale vasorum

- - A temoralis
Rectum -
- -
V femoralis

Pecten ossis --
pubrs Lig inguinale

Lig lacunare -

Fig. 829 Diaphragm,Diaphragma;


abdominalmuscles,Mm. abdominis;
ventral view.
Diaphragm,Diaphragma i't-E

Proc.xiphoideus
- - - - --.
Parssternalisdiaphragmatis

/ Hiatusoesophageus
- - - - z
Centrumtendineum

Foramen venae cavae - -

- -
Parscostalisdiaphragmatis

Parslumbalis
diaphragmatis,-
Crusdextrum,(Parslateralis) | . Parslumbalisdiaphragmatis,
Crussinistrum,(Parslaleralis)
Lig arcuatum mediale -

Lig arcuatumtaterate

C o s t ax l l - - -
-- M quadratuslumborum
lumbalis,. ,ro" .or,",," r')[-
Vertebra
-\
Parslumbalisdiaphragmatis,
Pars lumbalis diaphragmatis, Crus dexlrum, // Crussinistrum,
(Pars medialis) (Parsmedialis)
M. psoasmaior
\ VerlebralumbalislV

Fig.830 Diaphragm, andposteriorabdominal


Diaphragma, TheCrusdextrum,Parsmedialisoftenconsistsof threeparts
wall; andreachesfurthercaudallvthanthe Crussinistrum.
inferiorview. ' Clinical:Bocuo,r.r-tx's
triangle

Foramenvenaecavae

Mm intercostales
interni
Parssternalisdiaphragmatis

Parscostalisdiaphragmatis

- - Vaginamusculirecliabdominis,
Laminaposlerior

--- Inters€ctiotendinea

M lransversus
abdominis
--- - - Linea alba
M obliouusexternus
abdominis
---
M obhouus
inlernusabdominis
---
,-- Anulusumbilicalis

-- Lineaarcuata

--_ M transversusabdominis

&- - - Lig. intertoveolare


7Z
-- -- profundus
Anulusinguinalis
Adminiculumlineae albae --- ----
Os pubis,Ramussupenor

Fig. B3l Anterior abdominal wall and parts of the


diaphragm,Diaphragma;
dorsal view.
Thoracicand Abdominal

V cava inferior,Vv hepalicae \


Pars sternalisdiaphragmatis \ \
Pericardium y
Pleura parietalis,Pars diaphragmatica - -
\
l\,1latissimus dorsi - - -
- Gaster, Pars cardiaca
c o s t av l l l - -
Pars lumbalisdiaphragmalis,
C o s t a V l-l - - - --
Crus sinrstrum,(Pars lateralis)
serratusanleflor - -

Costa Vl - -
- - Hiatus aorticus

_-- tig arcuatum laterale"

M rectus abdominis --- C o s t aV l l l


--*
CoslaXll

M obliquus transversusabdominis
externus abdominis
- .-
Lig arcuatum mediale**

-
Pars lumbalisdiaphragmatis,
Crus sinistrum,(Pars medialis)
' -
M psoas majot ' Lig lumbocostale
-
M quadratus lumborum
-
Vertebralumbalis lll, Proc
(i,4 psoas mtnot) -- - M iliacus

Fig. 832 Diaphragm,Diaphragma,with its aperturesand the ' Clinical: BocHDALEK's triangle, Trigonum lumbocoslalediaphragmatis,
a region free of muscles
musclesof the posteriorabdominalwall; the trunk has been *
" also psoasarch, Arcus musculi psoatis,and quadratus arch {also called Hnllrn's
sectionedat the levelof the 1Oththoracicvertebra: a r c h ) ,A r c u s m u s c u l iq u a d r a t i ;
ventralview \ ' , \ ' 1 ,\ ' l l - r i b s 5 , 6 , 7

Diaphragm, Diaphragma (Fig.832)


Thediaphragmseparatesthe thoracicfrom the abdominalcavides.Its domesform the floor of the right andleft pleural cavities,
TheParslumbalisbordersthe retroperitoneumdorsallyand,in a strict sense,representsa portion of the posteriorabdominalwall.
Muscle Origin Insertion Function
Innervation
Diaphragma Parssternalis:Proc. All partsuniteat the central Respiratorymuscle,
N. phrenicus(Plestus
cervicalis) xiphoideus(innersurface), tendon,Centrumtendineum diaphragmatic breathing
rectussheath(aponeurosis of Weakpointsand (inspiration),
increases
M. transversus abdominis) diaphragmatic openings: abdominalpressure
Parscostalis:costalcartilages Trigonumsternocostale,
of ribs 12to 6 (innersurface, Trigonumlumbocostale,
connected to the originof M. Foramenvenaecavae,Hiafus
transversus abdominis) oesophageus, Hiatusaorticus
Parslumbalis, Crus dextrum,
- Parsmedialis:bodiesof
lumbarvertebrae 1 to 3,
Disciintervertebrales
- Parslateralis:Ligg.arcuata
mediale(archof the psoas
muscle)andlaterale(archof
the quadratuslumborum
muscle)
Parslumbalis, Crus sinistrum,
- Parsmediaiis:bodiesof
lumbarvertebrae1 to 4,
Disciintervertebrales
- Parslateralis:Ligg.arcuata
mediale(archof the psoas
muscle)andlaterale(archof
the quadratuslumborum
musclel
Lumbosacral
Plexus,Plexusfumbosacralis

Pars lumbalisdiaphragmatis,Crus dextrumO

Lig arcuatum laterale - - -

i,4 ouadratus lumborumO

N iliohypogastricus--

N ilioinguinalis

M psoasmaloio --
M o b l i q u u s o- -
externusabdominis
M obliquuso --
internusabdominis

M lransversusa --
abdominis
N cutaneus
femoris lateralis

N g e n i t o f e m o r a l,i s - ' 1 : '


Fl. femoralis ,
,;i
-)*+'
- e n i t o t e m o r a l.i s - ' 7 - -
N o
R genitals ,t': ,t N culaneus
femons laleralis
-'
N obturatonus \
i-1;i -
8"nn",,. N.
N cutaneus l-t- I ] femoraris
senito_
remorisiaGririi
" -

';'i:ilfi-;;ril*]j] :!-mw'.llidt 0,
ilE ,lBX4 l- [,no,"ri",,J

/
-
V saphena magnaa
I
N genitofemoralis,Rr genitates / I Funiculusspermaticus

Fig. 833 The lumbosacralplexus,Plexuslumbosacralis;


the psoasmajor,the pectineusand the adductorlongus
muscleshavebeenremovedon the left;
ventralview

Diaphragmaticopenings
Name Position Structures
Hiatusaorticus Parslumbalis, Aorta;
betweenCrusdextrumandCrussinistrum Ductusthoracicus
Hiatusoesophageus Parslumbalis,Crusdextrum Oesophagus; Nn.vagi;N. phrenicus,
R.phrenicoabdominalis sinister
Foramenvenaecavae Centrumtendineum V. cavainferior;N. phrenicus,
R.phrenicoabdominalis dexter
[.lnnry's fissure betweenParssternalisandParscostalis A. andV. epigastrica
superior
Unnamed Parslumbalis, N. splanchnicusmajorand minor;
betweenCrusdextrum,/sinistrum,
Parsmedialis Y. azygos;V. hemiazygos
Unnamed Parslumbalis, Truncussympathicus
betweenParsmedialisandParslateralis
Thoracicand Abdominal

Manubrium
sterni / aA thoracicaintef,na'
A thoracicainterna' O --
:.i
I
;<
/ aV thoracica interna
a --
A pericardiacophrenica

a --
Rr pertorantes

/ a {A( intercostales
anleriores

thoracist --
M transversus

z O o A ; V musculophrenica

A thoracica interna,
Rr intercostales
anteriores
a $A ; V, epigaslrica
suPeflor

a --
A musculoohrenica - o Diaphragma

A epigastricaO --
supeflor

* --
M rectusabdominis

Vaginamusculi--
rectiabdominis,
Laminaposterior

-- epigastricainferior
oA

--
* V epigastricainferior

--
aA iliacaexlerna
interiora -
A epigastrica

Fig. 834 Bloodvesselsof the anteriorthoracicand abdominalwalls;


the right transversethoracicmusclehas beenremoved;
dorsalview.
* Clinical:internalmammaryartery
Antenior
AbdominalWallandInguinal'Canal,
Canalisinguinalis

O\
M rectusabdominis
M transversus a \
abdomrnrs
s 8], O. \
. N .t h o r a c i c u[ T \
N inlercostalis;
A I V. intercostalis \ \ / aM serratusantsrior
N thoracicus [T 9], O O ..
N intercostalis; \ ' Cartilago
A : V Intercoslalis costalisVlll

Vaginamusculi\
rectiabdominis,
Laminaanterior

N t h o r a c i c u sO o : - a M obliquus
rr 101, enernus
N intercostafts; aMominis
A; V intercostalis
- a V umbilicalis
N t h o r a c i c u so o :
[r 11],
N intercostalis;
A : V intercostalis
- aAa umbilicales'*
M obliquus O :
exteinus \
abdomrnrs
- Cutis
Lrnea arcuata \

N thoracicus
[T 12],
N intercostalis

Vagina musculi recti - -'


abdominis,
Lamina posterior
- Urachus

Peritoneumu'.""r"t" - -
OA umbilicalisd6xtra
\r*_\
t. t-
aA vesicalissuperior
A n u l u s- - - - - - -
inguinalis
superlicialis
-----.4
--
0 ,A'
Il l/l Vesicaurinaria
M obliquus
a
internus
abdominis
M cremaslera - / tl\
---
l'--- sp"tirrretropubicum
Fasciaspermaticainterna-' t4.
- -
externaa '-'-4F
Fasciaspermatrca -
aW.vesicales

M obliquus
externusabdominis.a - \
Aponeurosis aM rectusabdominis
A testicularis /
o
- o Mm.pyramidares
= /
Plexuspampiniformis

\ Duclusdefersns
o /
M cremaster

testis,Laminaparielalis/
Tunicavagrnalis

Fascia soermatica inlerna / '


/ a Fasciaspermaticaexterna
Tunica dartos, M darlos o / I
lGubernaculumtestrs;

Fig. 835 The anterior abdominalwall of a newborn. ' bulge caused by looping of the umbilical blood vessels
The rectus abdominis muscle has been retractedsuperiorly and (also called false umbilical cord knot)
'* blood clot, thrombus in the umbilical arteries
the abdominalcavity has been openedin the median plane to
show the urinary bladder and the urachus.The right inguinal
canal has been dissected;
ventral view.
Thoracicand Abdominal Walls \

I M rectus abdominis
I Linea alba
I I I A;w epigastrica(e)superio(es)
I I M obliquus externus abdominis,Aponeurosis
| / Vaoina musculi recti abdominis,Lamina anterior

/ M obliauus internusabdominis

// M. obliquus externus
- t aDoomrnrs
V paraumbihcalis Lig f"l"iforr" M transversusj
i
Lig teres hepatis abdominis,
UmbilicusI Aponeurosis _ - Mm intercostales

- M transversus
M reclus abdominis
/ abdominis

\
/ Fascia transversahs
Anulusumbiticalis pri
I mediana;
L's
".bir,fdl""f,:til"rr{i] / M. obliquus externus
/ abdominis

-- M obliquus
internus
abdominis
--
fvl transversus
abdominis
i
Fasciatransversalis \\ Chorda arteriae umbilicalis
//
\ /
Plica umbilicalismedialis

M transversusabdomlnts --

M obliquus internus -
Vertebralumbalis; -
abdominis
Corpus vertebrae /
M obliquus externus
abdominis

\ (M psoas minor)

- M psoas major

quadratus lumborum
/ M

\
Ala ossis ilium

I \
M iliocostals M gluteus medius
I
/ lumborum
Fasciathoracolumbalis
Fascia \
M iri".r.
M longissimusthoracis thoracolumbalis

Figs. 836 a-c Abdominalmuscles,Mm. abdominis;


horizontalsections.

a abovethe umbilicus
b at the levelof the umbilicus
c belowthe umbilicusand the arcuateline
AbdominalMuscles.Musculi abdominis

Draphragma,Pars costalis a - -
a Diaphragma,
Centrumtendineum
- -
Costavll

- -
C o s t aV l l l
ooA;V intercostalis;
(T8)
N intercostalis
C o s t al X - -

N subcostalis

- - Fascratransversalis
- - Peritoneum parietale

N iliohypogastricus
M obliquus externuS
aor
abdominis
-
rusinlernus
M obliquu us abdominis N ilioinguinalis

M transversus
us abdominrs

Crista ilii
N cutaneus femoris lateralis

M lensor lasciae latae


N femoralis

M iliopsoas --- aA temoralis


--*.
a V femoralis

Fig. 837 Abdominalmuscles,Mm. abdominis;


froiltal section;
ventral view.
Compareto Fig. 1134

M obliquus externus abdominis,Aponeurosis


I M obliquus externus abdominis,AponeurosrsI
M obliquus internusabdominis,Aponeurosis, I
M obliquus internusabdominis,Aponeurosis:, I
M transversusabdomrnrs,Aponeurosrs I i
' M. transversusabdominrs,Aponeurosis I I

M.rectusabdominis, jii M. rectus abdomrnis


I

M quadratusl I M. transversusabdominis' I I |' M transversusabdominis


lumborum I ,' l I
M. obliquus internusabdomrnrs I M obliqura internusabdominis
M erector spinael
M obhouusexternus abdominisr obliquus externus abdominis

Figs.B3Ba, b Abdominalmuscles,Mm. abdominis; Theparticipation of the aponeurosisin formingthe rectus


computedtomography(CT). sheathis clearlydiscernible(cf.to Figs.B3Z1148).
a at the levelof the umbilicus
b at the level of the fifth lumbar vertebra
ThoracicViscera

A carotis communis sinistra

\ \
Truncusbrachiocephalicus A subclaviasinistra

,- Arcus aorlae

V cavasuperior- - - - Lig arteriosum*

// A pulmonalissinistra

- - Truncuspulmonalis
A, pulmonalisdexlra --

serosum,\ \ \
Pericardium - Pericardium
serosum,
Lamrnaparietalis Laminaparietalis

'- - Auriculasinistra

-- V cardiacamagna
Auricula
dextra
.-.-
A coronariasinistra
R circumflexus
Conusarteriosus

- -
Atriumcordisdexlrum- - A. coronaria sinistra,
R intervenlricularis
anterior
- V,interventricularis
' anterior
V cardiaca media
.-
Ventriculuscordis
sinister
-
A coronariadextra

Ventriculus cordis dexle( /

Apex cordis
Pericardium Laminaoarietalis/
serosum,

Fig.839 Theheart,Cor;
the pericardiumhasbeenopenedand mostof its
parietallayerhasbeenremoved;the major branches Pericardiumfibrosum
of the coronaryarterieshavebeendissected; Pericardium
serosum pericardium
and on the
the epicardiumon the Aorta ascendens
Laminaparietalis
Truncuspulmonalisis not shown;
ventralview. Laminavisceralis epicardium
* Bor^Iro's ligment, a remnantof the fetalductusarteriosus.
Heart,Cor

V brachiocephalica sinistra / V vertebralis


A carotiscommunis srnrstra
\ V brachiocephalica dextra
/,
A subclaviasinislra\ \,
/, Truncus brachiocephalicus

Arcusaortae \

posteriores\
Aa intercoslales

/, V. azygos

Pars descendens aortae lAorta descendens] Parsascendensaortae


IAortaascendens]

Lig arteriosum't' - -- V cavasuperior

- - truncipulmonalis
Bilurcatio

-- A oulmonalisdextra

T r u n c u s o u l m o n a-f-t-s

V v D u l m o n a l e s r n r s l r a e- - - -

Auflcula sinistra ---

{i::--- - - Atriumcordissinistrum
V cardiaca magna

- - Sinusvenarumcavarum

A coronana sinrslra, -
R crrcumflexus -- Peflcardiumserosum,

Vzt Lamina parietalis

- -.
Vv airiales sinistrae
'/-,
Vv ventriculi - - .-
sinistriposteriores - Atriur cordrsdextrum

- --
Pericardiumserosum, - Sulcusterminalis
Lamina visceralisIEpicardium]

\ V cava inferioP
-
Ventriculuscordrs sinister / t sinuscoronanus
\
Sulcuscoronarius
APexcordis /
'A coronaria posterior
dextra,R interventflcularis
' Ventriculus
V interuentncularisposlerior / cordisdexter

Fig. 840 The heart,Cor,and adjacentvessels; ' arrow in the transversepericardialsinus,Sinustransversuspericardii


'* doublearrowsin the obliquepericardialsinus,Sinusobliquuspericardii
the pericardiumhas beensectionedcloseto the reflected
" " BorALLo's ligament,a remnantof the fetalductusarteriosus
foldson the great vessels;the major coronaryarterieshave
beendissected;
dorsal view.
ThoracicViscera

- Aorta

_- Truncuspulmonalis
V cava .--
supenor

- - Sinustruncipulmonalis
_ - Auricula sinislra

- Venlriculuscordis sinrster

cordis-
Venlriculus
dexter

Sulcus Fig. 841 Musculature of the heart,


interventricularis
anlerior Myocardium;a part of the superficialmuscle
layer has been removedfrom the wall of the
right ventricle to exposethe deep layer;
ventral view.

A pulmonalis
dextra
truncipulmonalis
Bifurcatio - -
--- V cavasuoerior

W pulmonales dextrae

Vv pulmonalessinistrae --- A t r i u mc o r d i s
dextrum

Atriumcordissinistrum----
-- V cava inferior

Sulcuscoronarius - - Sinus coronarius

-- Ventriculus
cordis
dexter

Fig. 842 Musculature of the heart, Sulcusinteruentricularis


Posterior
Myocardium;
a part of the superficial muscle layer
has been removedfrom the wall of the
Ieft ventricle to exposethe deep layer;
dorsoinferiorview.
(
Heart,Cor

Sulcusinteruentricularis
anterior

Apex cordis

oosterior/
Sulcusinterventricularis

Fig.843 Musculature of the heart,Myocardium;


viewedfromthe apexof the heart.

Valvulasemilunaflsdextra \

Valva trunci Valvulasemilunaris \


pulmonalis anleflor \ / Valvulasemilunarissinistra

/ Valvulasemilunarisdexlra

Trigonum
fibrosumsinistrum\

Tflgonum
librosumdextrum\

Anulusfibrosussinister

Cusprs/
commissurahs
Srnrstra
Valva I Valva
/
atrioventriculars Cuspisposterior
I Cuspisanterior alrioventricularis
sinistra dextra lvalva
IValva mrtralis] tricuspidalisl
Cuspisanterior/ I cuspisseptatis
/
Cuspis commissuralisdextra /

Fig. 844 Musculatureof the heart,Myocardium;


valves,Valvaecordis:
the dissectionplane after removalof the atrial septum
as well as the point of entry of the bundleof Hrs are
not shown.
Systolicphasewith atrial valvesopenand
atrioventricularvalvesclosed;superiorview.
ThoracicViscera

Ostium atrioventricularedextrum r
- - Pars ascendens aortae
Septum interatriale\
\

V cava supenor
- Auriculadextra

Foraminavenarum - --- A coronariadextra


mtntmarum

-- Alriumcordisdextrum

Limbus fossae ovalis -

- - - Valva atrioventricularisdextra.
Cuspisanterior
Tuberculum
Interyenosum
-- M papillaris
septalis
-
Fossa ovalis
-- M papillarisanlerior

V cavainlerior / - -
Valva atrioventricularisdextra,
Cuspis septalis
Valvulavenae cavae inlerioris* /

Osliumsinuscoronarii
/
sinuscoronarii/
Valvula
-- -
Septuminteruentnculare,
Parsmuscularis
Valva atrioventricularisdextra, Cuspis posterior /

Mm papillaresposteflores \ Trabecula
/ septomarginalis'*
Fig. 845 Right atrium, Atrium cordis Ventriculuscordis dexter /
dextrum, and right ventricle, Ventriculus I
/
Myocardium
cordis dexter; I
the heart has been openedby a longitudinal Pericardiuma"roarr, / \ Apex cordis
Lamina visceralisIEpicardium]
section;the right atrioventricular valve is open;
ventral view.
* also:EusrlcHtan valve
* * also: Moderator band
Fig. 846 Right atrium, Atrium cordis
dextrum,of a newborn;
the anterior wall of the atrium has been
V cava superior retracteilto show the oval foramen;
right ventral view.
Auriculadextra For the significanceof the oval foramen
beforebirth seeFig. 41.

Septum interalflale

V v p u l m o n a l e-s- (
dextrae 1:; - - - Valva atrioventricularisdextra
IValvatricuspidalis]

Ostiumvenae cavae
supeflofls" Ostium alrioventriculare
oextrum

Foramen ovale -

Ostiumsinus
- coronaflr
Limbusfossaeovalis -

-
V cava inlerior -
Heart,Cor

V oulmonalis
srnislra - - - -
suoerior Myocardium
/

Auncula sinistra Vv oulmonalesdextrae


\

V cardiaca magna \
/, Alriumcordis
,/ srnrstrum,
Septum
Anulusfrbrosus
srnisler\ interatriale

Ostium atfloventricularesinistrum -

- V pulmonalis
sinistra
inferior
- Valvulatoraminis
M papillarisanterior - ovalis(Falxsepti)

\ Anulusfibrosussinister

- Valva
atrioventricularis
sinistra,
Cuspis
Pericardiumserosum..- posterior
Laminavisceralis
IEpicardium]
Chordaelendineae

M papillarisposterior
Venlriculuscordis sinister -

Fig. 847 Left atrium, Atrium cordis \ Myocardrum


sinistrum,and left ventricle,Ventriculus \ Seolum interventriculare. Pars muscularis
cordissinister; \ Trabeculae carneae
the heart has been openedby a Apexcordrs-
longrtudinalsection;
lateralview.
I Lunula valvulae semilunaris

Bulbusaortae-__

Sinus aortae -

Truncuspulmonalas
\

/ / M papillaris
,.\ Posterlor
L:r
Valvula semilunarissrnislra - -
\
A coronaria dexlta -'
\\,

Nodulus valvulae semilunaris -

Auriculadextra -
/
Valvulasemilunarisdextra /

Valvulasemrlunarisoosteflor /
\ Ostiu. atrioventriculare
sinistrum

Valvaatrioventricularis
sinistra,
Fig. B4B Left ventricle,Ventriculuscordissinister. Cuspisanterior
ascendingpart of the aorta,Aorta ascendens;
longitudinalsectionthrough the middleof the left ventricle
-
and in the anteriorinterventricularsulcus;the aorticvalve M papillarisanterior
(arrow)is shownduring the filling phase(diastole)of the
heart: Ventriculus
cordissinister
lateral view.
ThoracicViscera

/ Valva aortae, Valvula semilunaris sinistra


Atriumcordissinistrum

Pars ascendens aortae --

Valva aortae, Valvula -- 7 Cuspisanterior


/ vatvaatrioventricularis
sinistra
semilunarisposterior z Cuspisposterior )

Sinusaorlae --

Auriculadextra - -

A coronariadextra - -

Septumintervenkiculare,
Parsmembranacea"
posterior
papillaris

Valvaatrioventricularis -
dextra,
Cuspisposlerior

Valvaatrioventricularis
dextra,
Cuspisseplalis
.-*
M papillarisanteriot

M papillarisanterior
/

M papillaris
posterior

I
SeDtuminteruentriculare.
Parsmuscularis

Fig.849 Leftandright ventricle,Ventriculuscordissinister Note the differencein thickness of the myocardiumof the right
and dextra; and left ventricle.
longitudinalsectionthroughthe longaxisof the heart; * Plane of section of Fig 850

left ventrolateralview.

anterior
/ V interventricularis
,/ 7 Pericardiumserosum, LaminavisceralislEpicardium]
A coronariasinistra,
R interventricularis
anterior /, Myocardium
anterior--
Sulcusinterventricularis / Endocardium
/ Ventriculuscordis dexter

/ Trabeculaseptomarginalis

--- A coronaria dextra,


M. papillarisanterior -
R marginalis dexter

- - Myocardium
A. coronariasinistra,- -
R marginalissinister -- M papillarisposterior

- Trabeculae carneae
cordissinister-
Vontriculus

- Seotuminterventriculare,
Mm papillaresposleriores- Parsmuscularis
\ Valvaatrioventricularis
dextralvalvatricuspidalis],
- Cuspisseptalis
Chordaetendineae \- \ posterior
Sulcusinterventricularis
/ \ A coronaria posterior
R interuentricularis
dextra,
V interventricularis.Dosterior

Fig. 850 Leftandright ventricle,Ventriculuscordissinister Note the differencein thickness of the myocardium of the right
and dextra; and left ventricle.
to the longitudinalaxisof the heart;
crosssectionperpendicular
supenorvlew.
Heart,Cor

Valva atrioventricularissinistra,
Cuspis poslerior

Chordae tendineae

M papillarisanterior

M papillaris posterior

Fig. 851 Left ventricle,Ventriculuscordissinister.


A segmenthas been removedto show the papillary
musclesand the Chordaetendineae;
left ventrosuperiorview.

Valva alrioventricularisdextra,
Cusois anlerior

/ Arcusaortae
>
r'l
I

-- Atriumcordisdextrum

Sulcus-
interuenlricularis cordis
Ventriculus
posterior dexter

Trabecula -
septomarginalis

Fig. 852 Right ventricle, Ventriculus cordis dexter.


A segmenthas been removedto show the papillary
musclesand the Chordaetendineae;
dorsal view.
" outline of removedsegment
ThoracicViscera

Parsascendensaortae / Truncuspulmonalis
V cavasuperior\
sinislra
,/ A coronaria
/
z Sinus lrunci pulmonalis
Ostiumvenaocavaesuperioris /
-- Yalvalruncrpulmonalis,Valvula semilunarissinistra
Atriumcordisdextrum\
- - Sinusaortae
- Valva aortae, Valvulasemilunarissinistra

- - Ostium sinus colonarii


-
Nodussinualrialis*
.-- Fasciculusatrioventricularis'**

- Ciusdextrum

Ostiumvenaecavae -
inferioris

Valvula venae cavae


inferioris

Valvulasinuscoronarii
.*-
M papillaris
anterior

-
Valva atrioventricularis dextra,
Cuspis anterior
Ventriculus
cordisdexter

Fig. 853 Rightatrium,Atrium cordisdextrum,andright ' Clinical:Krrru-FLAcKnode,sinus node


't Clinical:AscttoFF-TAwARA node,atrioventricular (AV) nod€
ventricle,Ventriculuscordisdexter,with the conductingsystem; t * * Clinicalb: u n d l eo f H I s
the atrium,the ventricleandthe arterialorificeshavebeen
opened,the conductingsystemis displayed in yellow;
ventralview.

Parsascendensaortae -
/ Sinusaortae
'l
-- Valv.ula
semilunaris
A coronariadexlra - 'Poslerlor I
I Valvaaortae
. - - Valvulasemilunaris
I
t dextra )
- -- septumatrioventriculare
- - -
Valva atriovenlricularissinistra,
Cuspis anterior
Truncuspulmonalis/

A. coronariasinistra

/
Fascrculus
atrioventricularis,
Crussinistrum -
M papillarisanterior

Fig.854 Leftventricle,Ventriculuscordis ' Venkiculus


cordissinister
sinister;the ventriclehasbeenopenedby
a longitudinalsection;the left branchof the
conductingsystemis displayedin yellow;
left ventralview.
Heart,Cor

Arcus aortae - - / Lrg artenosum Fig.855 Coronaryarteries,


Aa.coronariae;cardiacveins,Vv.cordis;
/ Pericardium
serosum
,/ Laminapafletals semischematic;
V cava supenor -
/ A pulmonalissinislra ventralview.
Pericardrumserosum,- Thearrowis in the transversepericardial
Lamina parielalis
t// Iruncus Pulmonalis sinus,Sinustransversus pericardii.
A pulmonalis -
dextra
Parsascendens -
aortae / A coronariasinistra
Sinuslransversus- -
- Atrium cordis sinistrum,Auflcula sinislra
pericardii
/ V cardracamagna

A coronaria- - I- A coronar,a R circumflexus


srnistra,
dextra

- -
Conusarteriosus
Atrium cordis dextrum - - -
A coronaria sinistra, R interuentricularis anterior

- V interuentricularis
anterior
Vv ventriculidextri
anleriores

R atrialis -

R marginalisdexter - Apexcordis

Incisura cordis
aoicis

/, Truncuspulmonahs
Valvaaortae:
Fig. 856 The cardiacvalves,Valvaecordis,
/ Valvulasemilunaris
sinistra
and coronary arteries,Aa. coronariae;
Valvulasemilunaris
dextra
/ the atria have been removed;the pulmonary
/ Valv.ulasemrlunaris trunk and the ascendingpart of the aorta
// posteflor
have been sectioned;the valvesare shown
anteflor A coronaria
' , during filling of the ventricle (diastole);
A coronaria sinistra - - J: dexl'a
suoerior view.
R crrcumflexus - - Anulus
librosus
Trigonum - 1 dexler
fibrosum _.- Trigonum
srnrslrum fibrosum
Y cardraca-- dextrum
magna
-- Fasciculus
Anuluslrbrosus/ atriovenlricularis
sinister
- R maroinalisdexter
R m a r g i n a l i s/
sinisler

Valvulasinus coronarii
/
Ostiumsinuscoronarii \ V cardaacamedia
posterior,'
V interyentricularis \ A coronariadextra,
R intervenlricularisposterior

Fig. 857 Variability of the coronary arteries.


The conusarteriosusbranch,R. coni arteriosi,
originatesfrom the aortaas an independent
A coronaria de)dra,
artery with a frequency of approximately37o/o. R interuentricularis poslerior
ThoracicViscera \

/ A coronaria sinistra
A coronariadextra \
7 Fl crrcumtlexus
R nodi sinuatrialis - / R interuentricularis
anterior
/ Rr interventriculares
seotales
R coni arleriosi - -- R lateralis
-- R m a r g i n a l i ss i n i s t e r Fig. 858 Coronaryarteries,Aa. coronariae;
R atrialis - --*
R lateralis posteriorarterial branchesare shownin pink.
R nodi -_ The posteriorinterventricularbrancharises
- Rr atriales
atrioventricularis \
from the right coronary artery (balancedsupply);
R marginalis - - - Rr intervenlriculares
dexter ventral view.
seplales
(R posterolateralis --- Compareto Fig. 861 a.
dexter) \
R posterior
\ ventncultsrnrstrl
I \
R Intervenlricularisposterior I Rr atrioventriculares
I
Rr interuentriculares
septales / A coronariasinislra

/ B circumllexus
A coronariadextra \
/ R interuentricularis
anterior
-
R nodi sinualriafts .-.- - R atrialis
- R lateralis
R coni arteriosi -
-- R marginalissinister
- - Rr Interuentriculares

Fig. 859 Coronaryarteries,Aa. coronariae; --


R lateralis
the posterior interventricular branch arises from
the left coronaryartery (left dominantsupply);
ventral view R marginalisdexter -

Compareto Fig. 861 b.


ll\
\ Rr.interventriculares
septales
I I
I posterior
R interventflcularis
' (R nodiatrioventricularis)
A coronariadextra \ / A coronaria sinistra

R nodi sinuatrialis \ / R circumflexus


\ J/
_/ R intervenlricularisanterior
R coniarteflosi -\ ' R alflalis
- R lateralis
Rr atrioventriculares-
-- R marginalis inister
--
R atrialis -* Rr interventriculares
seprares
.- R laleralis Fig. 860 Coronaryarteries,Aa. coronariae;
R nodi -
alrioventriCularis the posteriorwall of the ventriclesis mainly
- R posterior
(R posterolateralis - suppliedby branchesof the right coronary
dexter) ventriculi
sinrstri
artery (right dominantsupply);
R marginalisdexter / ventral view.
Compareto Fig. 861 c.
t
R interventricularisposterior /
/
Rr. interuentricularesseptales

1 A coronaria
sinistra,
R circumflexus
2 A coronaria
sinistra,
R poslenor
ventriculisrnrstrl
3 A coronariadextra,
R Interuentricularis
posterior
4 A coronaria dextra

Figs. 861a-c Variationsin the arterial supply of the posterior a balancedsupply


wall of the heart; b left dominantsupply
dorsal view. c right dominant supply
Heart,Cor

A coronaraa
sinistra,
R marginalis
sinister

A coronariasrnislra,
Rr interventriculares
septales
A coronana srnistra,-
R crrcumflexus

A coronariasinistra,
R intervenficularis
anterior
A coronaria sinislra, -
R inlerventricularis
poslerior, Var
* Catheterin the aorta and in the
orifice of the right coronary artery
Diaphragma

Fig.862 Leftcoronaryartery,A. coronariasinistra.Coronaryarteriography (radiograph injection0f a contrast


afterselective
medium);the beamis directedobliquelyfrom right anteriorto left posterior(MO).

A coronariasanislra

A coronariasinistra,
R. marginalis
sinister

A coronariasinistra,
R circumflexus

A coronariasinislra,
Rr intervenkicularesseptales

A coronariasinistra,
posteflor,Var
R interventricularis
* Catheterin the bulb of the aorta
and in the orifice of the left
Oiaphragma coronary artery
'* Shadowof the catheter in the
descendinSthoracic aorta, Aorta
thoracica,Pars descendens

Fig. 863 Left coronary artery, A. coronaria sinistra. Coronary arteriography(radiographafter selectiveinjection of a contrast
medium); the beam is directed obliquely from left anterior to right posterior (LAO).Samepatient as in Fig. 862.

* Catheterin the aorta and in the


orifice of the right coronary
artery
^' Shadowof the catheterin the
descendinBthoracic aorta, Aorta
A coronafla dextra, - thoracica.Pars descendens
R coni arleriosi
A coronaria dextra, -
R atrioveniricularas
A coronaria dexlra -

A coronaria dexlra, -
R marginalisdexter

Diaphragma -
A. coronariadextra,
posterior
R interveniricularis
A coronariadextra,
(R posterolaleralis
dexter)

Fig. 864 Right coronary artery, A. coronariadextra. Coronary arteriography (radiographafter selectiveinjection of a contrast
medium); the beam is directed obliquely from left anterior to right posterior (LAO).Samepatient as in Figs. 862 and 863.
ThoracicVi.scera

/ Arcusaortae

/, A pulmonalisdextra

Pericardium \ / V cava superiol

truncipulmonalis\
Bifurcatio
\ / Pericardium

A pulmonalis
sinistra- \

Atriumcordissinrstruri\\
/ Vv pulmonalesdextrae

sinistrae- -
W pulmonales - Srnusvenarum cavarum

Auriculasinistra- -
v oblrquaatflr srnrstra .- -

V cardiaca magna ..-.-


- - Sulcus terminaliscordis
A coronariasrnrstra,---
R circumflexus

-
Srnuscoronarius- - - Atrium cordis dextrum

--
V cava interror
-
Sulcuscoronarius

- V cardracaparua

\ A coronariadexlra

cordissinister-
Ventriculus
\
Ventriculuscordis dexter

V cardiaca media [V interuentricularisposlerior]

Apex cordis
I Incisuraapicis cordis

Fig. 865 Cardiacveins,Vv. cordis;


the pericardium has been removeddown to the
pericardial reflections around the great vessels;
dorsoinferiorview.
The coronary sinus is often coveredby thin strands
of muscle(compareto Fig. 840).
Hearrcor
E9

al--
t'

,, V. obliqua attii sinistri

V. cardiacamagna \
Sinus coronarius

V ventdculisinistriposterior--
-- valvula sinus coronatii
r
I
\
anterior /
v. inlerv€ntricularis - -
- u. inteNentricularisposlerior

V marginalissinistra / .\
\.

v-;-4
Flg. 866 Cardiacveins,Vv.cordis;
the diagramshowsthe branchesof the largecardiacveins
(afterv. LUottcH.l,usEt);
left inferior view.
Thesizeand courseof the cardiacveinsvary considerably.

W. atrialesdextrae

t,

/ Vv.ventriculidextri anlo.iores

,' \ V. cardiaca media

v. ventriculisinistriposterior-

Fig. 867 Cardiacveins,Vv. cordis;


the right atrium hasbeenremovedto showthe
orifice of the cardiacveins (afterv. LUolndnusrx);
superior view.
* Oriflces of the anterior atrial veins - I^ANNELoNGUE'S
crypts.
The orifices of the cardiac veins vary considerably.
ThoracicViscera

A; V thoracica
internaoa V thyroideainferioro

N vagus[X] \ aaA;Vaxillaris

Plexus brachialis
N phrenicus \

N. phrenicus
sinisler
--- O a A; V. Pericardiaco-
(Nodi lymphoidei: pnrenrca
mediaslinales
anteriores) N vagus [X]

Bronchus: N. laryngeus
principalis dexter recurrens

Lig arteriosum**
Nodi lymphoidei-
tracheobronchiales
superiores'
Nodi lymphoidei
tracheobronchiales
superiores'

-
A pulmonalisdextraa -
0 V pulmonalis
sinistrasuperior

-
a A pulmonalis
V pulmonalisa- sinistra
dextra

Nodilymphoidei/
tracheobronchiales \ 1, V pulmonalis
inferiores' sinistrainterior

\ Nodilymphoidei
tracheobronchrales
*
interiores
/
(Noduslymphoideus
ligamenti
artenosi)

Nodi lymphoadei
Nodi lymphoidei/ phrenici superiores
phrenici superiores

Fig. 868 Positionof the heart in the thorax, Situs cordis;


the thymus has been removed;the Manubrium sterni
retractedsuperiorly; the pericardium partially removedand
the hilum of the lungs dissectedto exposethe mediastinal
lymph nodes;
ventral view.
* Clinical: lymph nodes of the hilum
" liSamentousremnant of the fetal ductus arteriosus (BorALLo)

Aorta

V cava superior -
Valva trunci
pulmonalis
Valva aortae - Valva
Valva - atriovenlflcularis
atrioventriculans sinistra
dextra
Apex cordis

Proc xiphoideus -

Fig. 869 Projectionof the contour ofthe heart and the


cardiac valves onto the anterior thoracic wall.
( Heart, Cor

V thymicaa , N laryngeusrecurrenssinister

Trachea
V thyroidea inlerior o I
dextra a - - _ il.
V brachiocephalica vagus[X] ra \
_ \
V thoracicainterna a --- - N phrenicus
)
- aaA.;Vpericardiaco-
a -.-t'.:
Truncus phrenica
brachiocephalicus ;

- - Pulmosinister
v c a v a s u p e r i o-r-"- f :
Plexusaorticus
thoracicus
N vagus[Xl
Pleura oaflelalis. - --
Pars mediastinalis
N laryngeusrecurrens

Pulmodexter - -

Sinus - -
Iransversus
pericardii

V pulmonaliso -- --
dexlrasuperior Pleuraparietalis,
Parsmediastinalis

is --
V p u l m o n a lO --
dexlraInlerior o V.pulmonalis
sinistrasuperior
--
o v pulmonalis
sinistrainterior
- -
Sinusobliquus
pericardii

Pleura parielalis, -
Pars diaphragmatica - -
Pericardium
fibrosum
V cava inferior a -
(z'
1
Pericardium/
serosum,
Lamrna
parietalis

Fig.870 Pericardium,Pericardium;
the anteriorpartsof the pericardiumandthe heart
with its greatvesselshavebeenremoved;
/ V brachiocephalica dextra ventralview.
V lugularis interna dexlra \ ' reflection of the visceral layer, Lamina visceralis
lEpicardium],
into the parietal layer, lamina parietalis, of the serous pericardium,
Pericardium serosum.
V subclaviadexlra -- V brachiocephalica
sinistra

V cavasuoerior

Vv pulmonales
dexlrae

Vv heoalicae

ofthe greatveinsinto the heart;


Fig. 871 Openings
\ Atrium ventralview.
1 cordrs
V cava inlerior I \ Slnlslrum 'Venouscross':the pulmonaryveinsform the horizontalarms,the
' Atriumcordisdextrum
superiorand inferiorVenaecavaethe verticalbranches.
ThoracicViscera

Bronchus principalis dexter


Bronchus lobaris supetior dexter
01 = Bronchussegmenlalis apicalis[B l]
O2= Bronchus segmentalis posteriorIB ll]
O3= Bronchus segmentalis anteriorIB lll]
Cartilagolhyroidea, - Bronchusloba.ismediusdexter
Lamina dextra
E4 = Bronchus IB lV]
lateralis
segmentalis
05 = Bronchus medialis
segmentalis IB V]
Lig cricothyroideum
medianum Bronchus lobaris inferior dexter
DO= Bronchus segmentalis superior[B Vl]
- E 7 = Bronchus
segmentalis basalismedialis [B Vll]
Arcus cartilaginiscricoideae o 8 = Bronchus
segmentalis basalisanterior[B Vlll]
E9 = Bronchussegmentalis IB lX]
basalislateralis
1o = Bronchus
segmentahs basalisposteriorIB X]

Bronchusprincipalissinister
Bronchuslobarissuperiorsinistet
Cartilagines tracheales - 1,2= Bronchus
segmentahs apicoposteflor [B | + ll]
E 3 = Bronchus
segmentalis anterior[B lll]
O 4 = Bronchus superior[B lV]
lingularis
0 5 = Bronchus Inferior
lingularis [B Vl

Bronchuslobarisinteriorsinister
E 6 = Bronchus
segmentalis superior[B Vl]
E 7 = Bronchus
segmentalis basalismedialis [B Vll]
o 8 = Bronchus
segmentalis basalisanterior[B Vlll]
E 9 = Bronchus
segmenta[s basalislateralis
[B lX]
1o = Bronchus
segmentafis basalisposterior[B X]

Bifurcatio tracheae \

1
Bronchusprincipalisdexter\
Bronchus
1 princrpalis
sinister
lobaris\
Bronchus
super|or

z Bronchus
lobarissuoeriorsinister

3
-
bronchiales
Cartilagines

lobaris-
Bronchus
mediusdexter lobarisinferiorsinister
Bronchus

Bronchus lobaris
inferiordexler
8

Fig.872 Larynx, Larynx;trachea,Trachea;


bronchi. Bronchi:
ventral view.
The Bronchus segmentalisbasalis medialis
[B VII] is often missing on the left.
Bronchiand Trachea

/ Cartilagothyroidea,Lamina dextra

- Carlilaoocornrculata

- - Carlilago aMenoidea

- Lamina carlilaginiscricoideae

Bifurcatiotracheae
\

Bronchus\
principalis
sinister

-- lobarisinleriordexter
Bronchus
/ Bronchus lobaris medius dexler

\
Bronchus lobaris 4
Inferiorsinister

Fig.873 Larynx,Larynx;trachea,Trachea;
bronchi.Bronchi:
belowthe arrow,the superficiallayerof the membranous
wall has been removedto show the musclesof the trachea:
dorsal view.
The numbersindicatethe segmentalbronchi(seepage92).
ThoracicViscera

Fig.874 Lungs,Pulmones,bronchi,Bronchi;
the lobar and segmentalbronchi have been projectedonto
the lung in different colours;ventral view.
The numbersindicatethe segmentalbronchi(seepage92).
On the left side the segmentsI and II frequently arise
from a commonprimary bronchus;the mediobasalsegment
S VII is often absent.
Bronchi

- - - Bronchussegmentalis
apicoposterior
[B | + ll]

principalis
Bronchus
sinister

Bronchus lobaris - - --- Bronchus segmentalis


suDerior sinistgr anteriorIB llll

Bronchuslobarisinferior -- -
stntsler

Bronchussegmentalis- -
superior[B Vll

- Bronchus lingularis
Bronchus inferior[B V]
segmentalis
basalislateralis
[B lX]

Bronchussegmentalis
basalisposterior[B X]
-- Bronchussegmentalis
basalisanterior[B Vlll]

Fig.875 Bronchi,Bronchi;
AP-radiograph; bronchography
(the divisionsof the bronchialtree are madevisibleby
inhalationof powdercontainingcontrastmedium);
left ventralview
* Bronchographic catheter in the trachea
ThoracicViscera

- - Lobussuoerior,
Faciescostalis

Fissura horizontalispulmonis dextrr

- - Lobus medius PUlmonisdextri, Facies coslalrs

Lobus inferior
- Margo interior

Fig. 876 Right lung, Pulmo dexter; Apex pulmonis


/
lateral view.
Note the grey-blackspottedpattern of the lung.
This is due to depositsof inhaled dust particles Lobus suoerior,Facies costaiis
under the pleura ("anthracoticpiSment").

Fissura obliqua

Margo anterior

Lobus superior

Lobus Inferior,
Facies costalis

Incisuracardtaca oulmontssinistrl

Lingula Pulmonrssrnrstrl

Fissuraobhqua I
Fig.B77 Left lung,Pulmosinister;
I
lr4argoinferior
lateral view.
Lungs,Pulmones

,, Fissuraobliqua
Lobussuperior\
-- Bronchuslobaris
superiordexler
A pulmonalis
dextra--
---- Bronchus
principalisdext6r

_-- Bronchuslobaris
Margoanterior- - mediusdexter
et inferiordexter
--- Noduslymphoideus
VV oulmonales dextrae - - -
tracheobronchialis
inferior
--- Pleuraparietalis,
--- Parsmediastinalis
lmoressiocardiaca

- ---
Fissurahorizontalis dextri-
pulmonis Lobusinferior

--- Lig.pulmonale
-
dextri-
Lobusmediuspulmonis

Facies
diaphragmatica;
Basispulmonis
Margoinferior
- Fissuraobliqua

Fig.878 Rightlung,Pulmodexter;
medialview.
In olderpeopleor personsexposed to dust,the lymph
Fissuraobliqua\
nodesof the hilum areoftenblackened by depositsof
sootor otherparticles("anthracotic
lymphnodes").
A pulmonalissinistra \

Pleuraparietalis,
Parsmediastinalis

Facies---
costalis .-.--
Nodi lymphoidei
tracheobronchiales

Lrg ---
pulmonale
- -
lmpressio cardiaca
Lobus -'-
Inlerioa

- Incisuracardiaca pulmonis sinistri

t
- Lingula pulmonis sinistri

\ Fissura
Fig.879 Leftlung,Pulmosinister;
obliqua medialview.
rhoracicviscera
9 8
Pulmo dexter
Pulmo dexter, Iobus superior

lt apicale[SI]
Segmentum

I posteriusISII]
SeSmentum

I anterius[S III]
Segmentum

Pulmo dexter, Lobus medius

I Segmentumlaterale[s IV]

t mediale[SV]
Segmentum

Pulmo dexteq Lobus inferior

I superius[SV!
Segmentum

I basalemediale[cardiacum][SvII]
Segmentum

ffi segmentumbasaleanterius[S vlll]


basalelaterale[SIX]
Segmentum
W
basaleposterius[SX]
Segmentum
f

Fig. 880 Rightlung, Pulmodexter;


bronchopulmonal segments,
Segmenta bronchopulmonalia.
Lateralview.

Pulmo sinister
Pulmosinister,Lobussuperior

,r*r"n*. [S I + II]
apicoposterius
)
I Segmentum
anterius[SIII]

I irnguiaresuperrus[S lvi
Segmenrum

I Segmentum inferius[s V]
lingulare

Pulmo sinister,lobus inferior

I superius[SVI]
Segmentum

I basalemediale[cardiacum][SVII] -
Segmentum

ilffi basaleanterius[SVIII]
Segmentum

W basalelaterale[SIX]
Segmentum

r basaleposterius[SX]
Segmentum

Flg. 881 Ieft lung, Pulmo slnister;


bronchopulmonalsegments,
Segmentabronchopulmonalia,
Lateralview.
r Ttls segmentls generally not lndependentbut ls fusedwith the
antedor basal seepent, Segmentumbasaleanterius lS VIU.
Lungs,
Pulmones
99

Fig. 882 Right lung, Pulmodexter;


bronchopulmonal segments,
Segmentabronchopulmonalia.
Medial view.
For colourcodesand segmentnamesseepage98.

Fig. 883 Left lung, Pulmosinister;


bronchopulmonary segments,
Segmentabronchopulmonalia.
Medial view.
Forcolourcodesand segmentnamessee
ThoracicVtscera

Pericardium

Trachea
Truncusbrachioceohalicus
W brachioceohalicae / Arcusaorlae
dextraet sinistra
I ,A carotiscommunis
V thoracica interna
I i /Asubclavia
Apexpulmonis '
/ // / APexPulmonis
Pulmodexter,Lobussuperior\
\ / A pulmonalissinistra
V. cavasuperior1
A. pulmonalisdextra,Aa. lobaressuperiores\ t..
Pulmosinister,
Lobussuperior
.z

- / A. Dulmonalis
sinistra.
Aa. lobaressuoeriores

Bronchus lobaris
' /
superior sinister

- V pulmonalis
Pulmodexter,- sinistrasuperior,
Lobusmedius V apicoposlerior

A pulmonalis- -- Nodi
dextra, lymphoidei
A. lobarismedia tracheo-
bronchiales
V. pulmonalis-
dextrasuperior,
V lobi medii

A. pulmonalisdextra, z
Aa. lobaresinferiores,
Parsbasalis,A. segmentalis
basalisanterior
/ \
Auriculadextra / A oulmonalissinislra.
/ Aa lobares inferiores
A coronariadextra /
\ Bronchus lobaris
inlerior sinisler

\ A oulmonalissinistra.
Truncuspulmonalis, / Aa lobares infeflores,
Sinuslruncipulmonalis Pars basalis,A segmenlalis
basalis anterior
\ Pulmo sinisler,
Lobus rnferior
\ Auriculasinistra
\ V oulmonalissinistra inlerior

'A coronaria
sinislra,Fl interuentricularis
anterior
Ventriculus
cordissinister

Fig.884 Heart,Cor;lungs,Pulmones;
the arteries,veinsandbronchiof the lungshavebeen
dissectedfreeto the externalsurfaceof the lungs.
Theapexof the hearthasbeenretractedto the right to
permita betterview of the structuresof the left lung;
ventralview.
(
Lungs,Pulmones

A. carotiscommunis
Apexpulmonis
I
Pulmosinister,
Lobussuperior - -l Trachea,Pariesmembranaceus
\ ,l
A s u b c l a v i a\ . , \ ,/ Truncusbrachioceohalicus
""
,/t
Fissuraobliqua\ -
\ T / Arcusaortae
Pulmosinister,Lobusinferior\ _ \;
7 V cavasuperior
Lig arteriosum\
Bronchuslobarissuoeriorsinister- ,, Bilurcatiotracheae
sinistra-
A Dulmonalis
7 V. azygos
Bronchusprincipalissinister-. / Bronchuslobarissuperiordexter

Bronchi segmentales -
4i-
- - - - M. bronchooesophageus
_ _ - :
A segmenlalis - ; - Nodi lymphoidei tracheobronchiales'
basalis lateralis
- - V pulmonalisdextrasuperior
A segmentalis -
basalis medialis
\
A pulmonalisdextra
\
V pulmonalisd€xtrainferiol

\ Atrium
cordissinistrum

V pulmonalis sinistra -
\
suPenor Atriumcordisdextrum
V pulmonalissinistra/
interior \ V cavainferior
\
F \ Pericardium
lsinuscoronarius
Pulmosinister,/ \ \\
Lobusinferior i V cardiacamedia
posleriol
V interuenlricularis
Ventriculus
cordisdexter

Fig.885 Left lung,Pulmosinister;


the largebronchi,pulmonaryveinsand arteriesas
well as the lymph nodesof the hilum are dissected.
" Clinical: hilum lymph nodes
ThoracicViscera

Fig. 886 Arteries of the right lung, Fig. BB7 Veinsofthe right lung,
Aa. pulmonalesdextrae; Vv. pulmonalesdextrae;
AP-radiograph(pulmonary angiography),contrast AP-radiograph(pulmonarv angiography),reflux of contrast
media injected into the right ventricle; media iniectedinto the right ventricle;
ventral view. ventral view.
Note the similar course of the arteries and the Note the different courseof the pulmonary veins compared
bronchi (seeFigs. 874,875l'.The numbers indicate to the arteries(seeFig. 886).
the arterial segmentalbranches(compareto p. 9B)
Cage,Caveathoracis

Trachea

Corpus costae l: lV, V \ Bronchus pflncipalisdexier


I

C l a v r c u l a-

-
Scapula

Angulus
costae V

Truncus
p u l m o na l i s

Alflum cordts
srnrslrum

Ventflculuscordis
srntster

A pulmonalisdexlra, .--
Aa lobares inleriores Diaphragma
Apex cordis

Flecessuscosto-
draphragmalicus

Fig. BBB Thorax, Caveathoracis, and thoracic viscera;


PA-radiographof a 27-year-oldman; the beam is directed
sagittally onto the middle of the sternum.
The position and size of the heart, the lungs, and the
bony parts of the thoracic cageas well as the vertebral
column and ribs can be identified.
1 = aortrcknob"
2 = pulmonaryarch
3 = left atrial contour
4 = letl ventncularcontour
5 = right vascular arch
6 = right atrial contour

v cava -
superior (5) - -
Truncus pulmonalis(2)

- -
Auricula sinistra (3)

Atnum cordis -
+ - -
Ventriculuscordis sinister (4)
dextrum (6)
__-\ Fig. 889 Diagramof the outlinesilhouetteof the heart
v cava--_ in a radiograph
inlerior
Dt = transversediameter(Diametertransversa),
Diaphragma
a b p l u s c d = 1 3 -1 4c m
L = longitudinalaxis of the heart (from the superiorborder
of the right atrium to the apexof the heart)= 15- 16 cm
M = medianplaneof the body
ThoracicViscera

Fig. 890 Positionof the heartin the thoraxduring Fig. 891 Positionof the heartin the thoraxduring
expiration; inspiration;
ventralview. ventralview.
Theheartis moreelongated, the cardiacapexis directed
mediallyandcaudallY.

Clavicula
I Bronchuslobarisinteriorsinister
I I Bronchus princiPalissinister
/ Bronchus
principalis i | | Biturcatiotracheae,Carinatracheae
sinister i ; | | Bronchuslobarisinleriordexter
Bronchus
lobaris
suPenor - Bronchus
dexter lobaris
supenor
sinister
Bronchus
principalis -
Carlilagines
dexter -- tracheales
Bronchus
lobaris
- inferior
Bronchus srnrster
lobaris -
Bronchus
meorus - lobaris
dexler Corpussterni superDr
/ dexter
Bronchus
lobaris .*
Bronchus
inferior principalis
dexter dexter
- Trachea,Paries
membranaceus

Fig. 892 Trachea, Trachea, andbronchi,Bronchi; Fig.893 Endoscopicimage(bronchoscopy)


projectionontothe anteriorthoracicwall. of the bifurcation of the trachea'
Pulmonaryand PleuralBoundaries

VertebracervicalisVll lprominensl\\
Cupulapleura€ - - Lobussuperior\

Spinascapulae -

Lobussuoerior

- Lobus
supenol
Lobusm€dius
pulmonisdexlri

Lobusinferior -
Lobus
inferior

/
Recessuscoslo-
diaphragmalicus

/
Incisuracardiacapulmonissinistri Cristailiaca

Fig. 894 Projection ofthe pulmonary(solidline) Fig. 895 Projectionof the pulmonary(solidline)
and pleural(brokenline) boundariesontothe anterior and pleural(brokenline) boundariesontothe back;
thoracicwall; dorsalview.
ventralview.

Fig. 896 Pnojection of the pulmonary(solidline) Fig. 897 Projectionof the pulmonary(solidline)
andpleural(brokenline)boundaries ontothe right andpleural(brokenline) boundariesontothe left lateral
lateralthoracicwall; thoracicwall:
viewedfrom the right. viewedfrom the left.
ThoracicVtscera

I Membran€
/ fachea
o'
l..1

A subclavia

Glandula thyroidea, - --M


brachioceohalicus - Lobus dexler
Arcusaortae
zl<
rl.
-
Lig arteriosum - -
Oesophagus,
Parscervicalis - At
der
- .- /A
Bronchus Bifurcatio tracheae
principalis
dexter sln
-
Bronchus
Bronchuslobaris principalissinister
superiordexter

-
Pars thoracica aortae

----
oesophagus,
Parsthoracica
Diaphragma,\ ,, Hiatus
Centrumtendineum'.\ oesophageus
/\ ,,

Foramen --
venae
cavae --- Oesophagus, intercostales
Pars posleriores tJroncl
abdominalis superlr

Pars- Cartilago
thoracrca
-
Pars lumbalis -- -- Gaster,
diaohraomatis. Parscardiaca
Cius d-exkum

Aa phrenicae -
inleriores

-
Hiatus aorticus

-
Truncuscoeliacus
-
Pars lumbalis
draphragmatis,
Crus sinislrum

Fig. 898 Oesophagus,Oesophagus;trachea,Trachea; Fig.899 Oesophagus,OesoPhagus;tr


thoracic aorta, Pars thoracica aortae; aortae;
thoracicaorta,Parsthoracica
parts of the diaphragm have been preservedto show viewedfrom thc right.
the openingsfor the aorta, the inferior vena cavaand
the oesophagus;
ventral view.
/ Mm pharyngeiffunica muscularispharyngisl

Glandulathyroidea,Lobussinister \
/ Glandulathyroidea,Lobusdexter

A carotiscommunis\
\\
,/ A carotiscommunis
interna--
V jugularis

A subclavia - ,/ V jugularis
interna

/ A. subclavia
V subclavia -
/ V subclavia

V brachioceohalica sinistra -
-- V brachiocephalica dextra
A subclavia
/ - Truncus brachiocephalicus
Cartilagines tracheales

Arcusaortae - - - - v. cavasuperior

-- v azygos

R bronchialis
- - -
Bronchusprincipalisdexter
- -- A pulmonalisdextra
sinistra-
A pulmonalis

- -
principalis
Bronchus sinister .J
--
t W oulmonal€sdextras

Vv.pulmonalessinistrae-

Ventflculuscordissinister -

Aa intercostales
oosteriores

- Parsthoracicaaortae

Diaphragma Hiatus oesophageus vusuPrrcgus' rdrs ururduru

Fig.900 Oesophagus,Oesophagus;thoracicaorta,
Parsthoracicaaortae;pericardium,
Pericardium;
dorsalview.
ThoracicViscera

- - - - -91=
Glandulaeoesophageae - --: --..
Epithetium- - - - - \ __-P1...
_ _a
Tunicamucosa Lamrnapropnamucosae\\
mucosae- -
Laminamuscularis ;

-
Telasubmucosa
D
Stratumcirculare- - -\- -
Tunica muscularis
--\\
Stratum longitudinale

Tunica adventitia \\
--
Fig.901 Oesophagus,Oesophagus;
crosssectionshowingthe layersof
wall (ca.400%).
the oesophageal

V thyroideainferior\ Parsceruicalis
Oesophagus,
A. thyroidea
inferior\ ,, A thvroidea inferior, V vertebralis \
,'- Br obsophageales
internaq t
V jugularis / V brachiocephalica
sinistra

/ M intercoslalis
-- A verlebralis V subclavia-- // externus
- dextr€
A subclavia
/ V hemiazygos
-- A carotis
accessofla
communis sinistra
V cava -- - M intercostalis
supenor tnlernus

-- Pars thoracica aorlae, --


Vv intercostales
Rr bronchiales posteriores - Vv. oesophageae

Oesophagus,-
Parsthoracica

/ A gastricasinistra,

- Diaphragma,
Diaphragma,- Cenlrum
Foramen venae tendineum
cavae
Parslumbalis-
diaphragmatis, - Oesophagus,
Crusdextrumet Pars
Crussinislrum abdominalis
-
V phrenica inferior - V.gaskoomentalis
A gastrica srnrstra
sinistra Y cavainlerior/
/
V,gastricasinistra

Fig.902 Oesophagus,Oesophagus; Fig. 903 Veins of the oesophagus,Vv. oesophageae;


arterialsupply; parts of the diaphragm and stomachhave been removedto
ventralview. show the oesophagealveins; the anterior wall of the lower
thoracic oesophagushas been excised.
* Veins in the mucous membrane of the oesophagus
* * Branch connectingthe veins of the stomachand the veins of the oesophagus

Venousdrainage of the oesophagus


The abdominaloesophageal veins providecommunicationbe- lowerthoracicoesophagus. However,this causesnot only expan-
tweenthe tributary veins of the portal venoussystemand the sionofthe Vv.oesophageae in the adventitiabut dilationof the
V. cavasuperior(portocavalanastomosis). In portalhypertension veinsof the mucosa(-) as well (oesophageal varices).Rupture
they areof considerable
clinicalsignificanceas they allowblood varicescanleadto massivebleeding
of the seralled oesophageal
drainagevia the veinsof the stomach(. . ) andthe veinsof the in the oesophagus. Portocaval
anastomoses - seeFig. 1029.
ThoracicLymphNodes,Nodilymphoideithoracis

/ Glandulalhyroidea,Lobusdexter
Oesophagus,Parscorvicalis\ 7 A carotiscommunis

A. carotiscommunis\

A subclavia\

Nodi lymphoidei Juxtaoesophageales \

- - Trachea,Pariesmembranaceus
Arcusaortae \

Parsdescendensaortae \
/ Nodilymphoidei sup€riores
tracheobronchiales
V pulmonalis
sinistrasuperior\
\\ _- v. azygos
Nodilymphoideitracheobronchiales
sup€riores\ - Bifurcatiotracheae
\t

A oulmonalis
sinistra-
- - Bronchusprincipalisdexter
Nodi lymphoidei -
)hiales inferiores -- Nodi lymphoidei
superiores
tracheobronchiales

Bronchilobares - -( -- A oulmonalis
dextra

V oulmonalissinistrainlerior-
-- Bronchilobares

-
(Nodi lymphoidei mediastinales posteriores) - -
- V pulmonalisdextrainferior

Oesophagus,Parsthoracica--
- posteriores)
(Nodilymphoideimediastinales

Pericardium fibrosum -

- V. cava inferior

- Diaphragma
Hiatusoesophageus-

Fig. 904 Thoracic lymph nodes,


Nodi lymphoidei thoracis;
the bronchi have been removedbeyondthe branching of the
lobar bronchi while the great vesselsof the mediastinum
remaln.
The lymph nodes in the healthy adult are usually smaller
than shown here.
ThoracicViscera

Scapula -

Clavicula,-
Extremilasslernalis - Recessus
pirilormis

Manubrium slerni -

Oesophagus,
*
Parsthoracica

Oesophagus, -
Pars thoracica**

Oesophagus,
Pars thoracica

Diaphragma -

Figs. 905 a, b Oesophagus, Oesophagus; b) Left anterioroblique(LAO)position,obliquediameterII


radiograph (after swallowing contrast medium). (beam directed from right anterior to left posterior)
a) Right anterioroblique(RAO)position,obliquediameterI ' Oesophagealnarrowing causedby the aortic arch
*" Retrocardiacportion
(beamdirected from left anterior to right posterior) * . * O e s o p h a g e anla r r o w i n ga t t h e b e g i n n i n go f t h e o e s o p h a g u s

Gaster,Parscardiaca,
Tunicamucosa

Oesophagus, Pars abdominalis,


I unrca mucosa

Fig.906 Oesophagus,Oesophagus;
the mucous membrane is viewed through an
endoscope(oesophagoscopy);
suDerlorvlew.
Thymus

1'
}..
,)

),i
.J

Fig. 907 Thymus,Thymus,of a 2-yearoldchild;


ventral view.

Fig. 908 Thymus,Thymus,of a 24-year-old.


Thesurroundingfat hasbeenextensively
removed;ventralview.
' Parathymic adipose tissue
The shape and size of the thymus in this specimen are
unusually well preserved.
ThoracicViscera

V thyroidea inferiora . Glandula Trachea


\a thyroidea\,
Truncusbrachiocephalicus
o \ N laryngeusrecurrens
tt I
Vsubclaviaa\ /, aA carotiscommunis
A subclavia a -
- a V brachiocephalicasinislra
Plexusbrachialis

V thoracica
internaa --

N vagus [X]
Vv. pericardiacophrenicaea --t

--
V brachiocephalica dexta a - - 1A. subclavia

N phrenicus - --
Pleuraparietalis,
Parsmediastinalis

Vcavasuperiorl -- N phrenicus
i:i
tl. - - Lobussinister
'\
)z*.
Pulmo dexler, -
Thymus
Lobus superior
-- I
Lobusdexter
/

- - librosum
Pericardium

Pleura parietalis,-
Pars diaphragmatica

\\
(Nodi lymphoidei / d, Pars sternallsdiaphragmatis
mediastinales anteriores)

\ st"rnu.

Fig.909 Thymus,Thymus,ofan adolescent;


the anterior thoracicwall has been removed,the pleural
cavity openedand the left Iung retractedlaterally;
ventral view.
Comparethe size of the thymus of a newborn
child (Fig.907).
(Fig.999) to that of a 2-year-old
(
ThoracicCavity

/ a M sternohyoideus
Carlilagothyroidea\
\ / laMthyrohyoideus
(Lobus pyramidalis,Var )
\
/, t M omohyoideus, Venter superior

/ a A thyroideasuperior

_/ a V thyroideasuperior

/ Fascra ceruicalis, Lamina superficialis


- I M sternocleidomastoideus
Vv thyroideae infeflores a \
/ a A carotiscommunis
Arcus venosus;ugularisa \
- Plexuscaroticus
communis
N phrenicus
)!r". .> a v. iugularis
interna
--
M scalenus anteriora -
- a Vv brachioceohalicae
C l a v i c u l a- - - _
a V thoracica
M s u b c l a v r u s O- - - Interna

Apexpufmonls -----
.

C o s l al l - - - -
malor
Pleura oarietalis. -
Pars costalis Pulmosinister,
Lobussuperior
Pulmo dexler,
Margo anteflor
- Margoanterior

--'!1
i
-- lncisuracardiaca
pulmonis sinistri
- - Lingulapulmonis
sinistri
- - -
Pleuraparietalis, Pulmosinister,
Parsdiaphragmatica Lobusinferior

\ Margoinferior
Recessus-
costodiaphragmaticus
\ o M obliquus
externus
abdominis

A thoracicainternao' / t, \ a M transversusthoracis
V thoracrcainternaa / \
1 Parssternalisdiaphragmalis
M rectus abdominis al
Recessuscostomediastinalis

Fig. 910 Thymus, Thymus; pericardium, Pericardium;


lungs,Pulmones;
the anterior thoracic wall has been removed,the pleural
cavity opened;
ventral view.
Note the size of the thymus in the young adult. In older
individuals the thymic tissue is almost completelyreplaced
by adiposetissue.
ThoracicViscera \

Plexusbrachialis,
Parsintraclavicularis\ / oA subclavia

/ Clavicula
Truncussympathicus, thoracicum
Ganglion ll \
eM subclavius
,' z/
N vagus[Xl, N laryngeusrecutrens --

N vagus [Xl, Rr. cardiaci thoracici -- -' NoM scalenusanterior

N vagus[Xl,Plexuspulmonalis -- -- - {V subclavia

V azygos * -
-- aA thoracicainterna
principalis
Bronchus dexter -
N phrenicus
R bronchialis(Aortd; a $ \\
v, oroncnrails --- $ V brachioceohalicadextra

N. vagus [X], - a *A ; V pericardracophrenica


Rr cardiaci ihoracici
- Thymus

V intercostalisposterior { -- - sV cava superior

- OAa oulmonales
N thoracicusff 71, -
N intercostalis O * N p h r e n i c u sA; ; V
pericardiacophrenica

Truncussympathicus, - *w pulmonales
Br communicantes
- Pericardium
fibrosum;
Pleura parielalis,
N splanchnicus Pars mediastinalis
maJor - Lig pulmonale

* N vagus IXl,
Aa intercostales o -- Plexus
poslenores oesophageus
-- Pleura parietalis,
Pars costahs

Pleura parietalis, --
Pars costalis - Oesophagus

\ parietalis,Pars draphragmatica
6 Oraphragma;Pleura

Fig. 911 Pleuralcavity,Cavitaspleuralis;mediastinum,


Mediastinum;
the right lateral thoracic wall and right lung have been
removed;partsrofthe mediastinaland costal pleura have
been dissectedto exposethe vesselsand nerves;
viewed from the right.
The xxx indicate the reflection of the visceral pleura into
the parietal pleura at the root of the lung and the pulmonary
ligament.
PleuralCavity,Cavitaspleuralis,and Mediastinum

I R cardiacusthoracicus
Truncussympathicus,
Plexus brachialis.Pars inlraclavicularis
I
I / N. vagus[Xl, Fl.cardiacusthoracicus
ClaviculaI I

M subclavius 7 Oesophagus,Parsthoracica

A axillarisO: Ductusthoracicus,Parsthoracica
\
V axillaris. \ / N. laryngeusrecurrens(N vagus)
\
A caroliscommunis
a \\ Lig.arleriosum
,z

/ Nodi lymphoidei
/ tracheobrochiales

V brachioceohalica: -- | Y. hemiazygosaccessoria
--
N vagus[X]
N phrenicus oesophagus'
--
i,ars tnoractca
Plexusaorticusthoracicus.
Plexuscardiacus N. vagus [X],
-z-
Plexuspulmonalis Plexus pulmonalis

A pulmonalissinislraI - - -- o Parsthoracicaaortae

Plexusaorticus
thoracicus
-- Oa A;V intercostalis
posterior

R communicans

sinistra. - -
V pulmonalis N splanchnicus
maJor
fibrosum--
Pericardium
aoA;V intercostalis
posleflor
V pericardiacophrenica 6 -
N intercoslalis
A pencardiacophrenica O -

- Truncus
sympathicus,
Ganglion
thoracicumlX

\ Pleura
pariotalis,
Parscostalis

- Pleuraoarietalis.
Parsdiaphragmatica
/
Centrumtendineum

Fig.9l2 Pleuralcavity,Cavitaspleuralis;mediastinum,
Mediastinum;
the left lateralthoracicwall and left lung havebeen
removed; partsof the mediastinal andcostalpleurahave
beendissected to exposethe vesselsandnerves;
viewedfromthe left.
ThoracicViscera

A carotis exlerna dextra \ carotis exlerna sinislra


A carotis \ / A carotis interna sinislra
inlerna dexlra

A vertebralisdexlra - ' A verlebrahssinistra


- A carotis communis
A carotis -r sinistra
communrsdexlra
- A subclavia
sinislra

- Lig arteriosum
V cava superior -

-- Atriumcordis
Pars ascendens -
aortae
sinistrum,
Auriculaatrii

Atrium cordis - 1 Arcus aortae 9 Trachea


dextrum 2 A thoracrcainterna 10 A subclaviasinistra
3 Truncusbrachrocephalicus 11 A carotiscommunis sinistra
- Venlriculus 4 A subclaviadexlra 12 Pars descendensaortae
cordrs 5 A carotrscommunis dextra 13 Cor
sinister 6 A- vertebralisdexlra 14 Valva aorlae
7 Rima glottidis 15 Pars ascendens aortae
/ I A vertebralis sinistra
V cava inferior \ Ventriculus
cordis dexter

Fig. 913 Heart,Cor;aortic arch,Arcus aortae, Fig. 914 Aortic arch,Arcus aortae,with its branches;
with origins of the large arteries; AP-radiograph(after injection of contrast medium into
ventral view. the aortic bulb);
ventral view.
* Catheter

A carotis externadextra
\
A carolis Internadextra \ \

A verlebralisdextra \
- A vertebralissinistra
A carolrs -_
communis dextra 13y,
A subclavia - - A subclaviasinistra
0exlra
- A subclaviasinistra
Truncus- -
brachiocephahcus - A carotiscommunrs
srnrstra
Arcus aortae --

Pars ascendens --
aorlae

-- Pars descendensaortae
Pars thoracicaaorlae

Figs.915a-e Variationsin the originsof the main arterial left vertebralartery as an indepenrlentbranchof the aortic
branchesfrom the aortic arch. arch
a "textbookcase"or "normal case" right subclavianartery as the last branchof the aorticarch.
b commonorigin of the brachiocephalictrunk and the left In this variationthe artery usuallypassesto the right, behind
commoncarotidartery the oesophagusThis may causedifficultiesin swallowing
c commonstem from the left commoncarotidartery and the (dysphagialusoria).
trunk
brachiocephalic
(
Thoracicand AbdominalAorta, and Mediastinum

Truncusbrachioceohalicus
N vagus [X] Trachea
/
A cervicahs prolunda a \ N laryngeusrecurrens
\ .-
N vagus[X]
a \\
Truncuscostoceruicalis
t_ N phrenicus
suoremaa --
A intercostalis
--. _-- OA subclavia
A subclavia a
-- aA thoracicainterna
N laryngeus
recurrens
_- aArcusaonae

-- a Pars thoracicaaorlae,
Rr bronchiales
Pars ascendens aorlae O --
IAorta ascendens] N laryngeusrecurrens
N vagus[X],
Bronchus principalis - *. Rr bronchiales
dexler
- - Bronchusprincipalis
sinister
V azygos a ---
-- a Parslhoracica
aortae,
Rr oesophageales
Truncussympalhicus

recurrens,
N laryngeus
Mm intercostales* Br oesophageales
lnternl
-- Pars
Oesophagus,
a --
Vv intercostales thoracrca
posteriores

* -- --
Nrminlercostales aAa intercostales
exlerni posleriores

Truncus sympathicus,
Ganglion

Nn thoracici,
Nn intercostales

N splanchnicus N splanchnacus
mrnor malor

--
P a r s l u m b a l i sa - - 1V azygos
diaphragmatis

N splanchnicusmaior - --
CostaXl

Costa Xl, -
Carlilagocostalis --
j Truncuscoeliacus
N splanchnicusminor

V lumbalisascendens a --
\ a A mesenlerica
supenor

A ; V s u b c o s t a l i s aa - - \
o Pars abdominalis
aonae
subcostalis N iliohypogaslricus

Fig.916 Thoracicand abdominalaorta,Parsthoracica


aortaeand Parsabdominalisaortae;
posteriormediastinum,Mediastinumposterius;
the pleurahas beenremovedto exposethe intercostal
nervesand the sympathetictrunk;
ventralview.
ThoracicViscera \

V thyroidea inferior
lTrachea / f V brachiocephalica sinistra
V brachiocephalica dextra ' \
\ a V subclavia
\ t
Arcusvenaeazygos \ / Oesophaous, Pars lhoracica

V cavasuperior \ . / Ductusthoracicus,Parsthoracica
i'/

posteriores
/ aAa inlercostales

_ - aMm intercostales
interni
V. azygos

-- ''Y. hemiazygos
accessoria

-- *V, hemiazygos

Truncussympathicus,
Ganglia

N. splanchnicus
major

Vv. intercostales
posteriores

- - Cisterna
chyli
A :V subcostalisO --

CostaXl

--
nPars lumbalis
diaphragmatis,
N subcostalis Crusdextrum
et Crussinistrum

\ rV
V lumbalisascendens lumbalisascendens
qV cava inferior

Fig.9l7 Blood vesselsand nerves of the posterior


mediastinum,Mediastinum posterius:
the pleura, the aorta and the oesophagushave been
removedto exposethe thoracic duct, the azygosvein and
the blood vesselsand nerves in the intercostalspaces;
ventral view.
/ Ganglioncervicothoracicumlstellaluml
A. carotiscommunis
a \
/, f@chea
N vagusIXI .. ,,
'
, o M scalenusantetior
Truncussympathicus,
Ganglion
ceruicale
medium / N laryngeusrecurrens
M scalenus
anleriort / a A. subclavia'
Ansasubclavia Ansa subclavia

A s u b c l a v i a o- - _ N vagus[Xl
Truncussympathicus,
Ganglion
thoracicum ll Plexusaorticusthoracicus;
Plexuscardiacus
N vagus[X]
N laryngeusrecurrens

N laryngeusrecurrens

- N. vagus [Xl, Rr bronchiales

Parsascendensal - Bronchusprincipalissinister
aortae
N. vagus(X),
Rr.bronchrales
Nn intercostalgs
Bronchus--
principalisdexter

Truncus
sympathicus

-- o Parsthoracica
aortae

N vagus[Xl,
Plexus
Truncus oesopna9eus
sympalhicus,
Gangliathoracica

splanchnicus
malor

splanchnicus
mrnor

*
Oiaphragma

- Gaster
Pars pylorica -

Duodenum- N. iliohypo-
gasrncus

N subcostalis Pars abdominalis aodaea / \ Truncusvagalisanterior,


Rr.gastricianteriores

Fig.918 Oesophagus, Oesophagus; aorta,Aorta;thoracic


autonomicnervoussystem,Parsthoracicaautonomica;
stomach, Gaster.
Thedorsalportion0f the diaphragmhasbeenretained.
Thepleurahasbeenremoved to exposethe sympathetic
trunk
and its connections
with the intercostalnerves.
Ventralview.
ThoracicViscera

N phrenicus \
N cervicalis
[C 4], R anterior \
N ceruicalis
[C 3], R anterior ,4,
z B communicans
N ceruicalis[C 5], R anleflor \
' - - Cartilago thyroidea
R communicans a.
N ceruicalisIC 61.R anlerior
Ganglion ceruicothoracicumIstellatum] - Truncussympathicus,
Ganolion medium
ceruicale
N cervicalis[C 7], R anterior
tr. -- * M cricothyroideus
N cervicalis[C 8], R anterior /
\ .-
' Rr tracheales
N thoracicus[T1], .
N. intercostalis \ N laryngeus
recurrens
-.- Oesophagus
N cardiacus cervicalismedius
Plexusbrachialis - - -i ,
Truncussympathicus, thoracicum
Ganglion I
N laryngeus
recurrens
Ansa subclavia
R cardiacusceruicalisinferior

N laryngeus
recurrens
N thoracrcus[T 2],
N inlercostalis N vagus[X]
Ganglion thoracicumll --
.- O Truncus
N cardiacuscerurcalisinferior brachiocephalicus

N thoracicus[T 3], Ganglion cardiacum


N intercostalis
Rr bronchrales
Ganglion thoracicum lll o V cava superior

Rr oesophageales
R trachealis
Rr bronchiales
N thoracicus[T 4],
N intercostalis

Ganglion thoracicum lV Rr bronchiales


- Bronchus principalis
dexter, Pafles
memoranaceus
N thoracicus[T 5],
N intercostalis - Bronchus lobarisinferiordexter

Ganglion thoracicumV - -
Plexuspulmonalis

Truncusvagalis
posterior
N thoracicus
[T 6],
N intercostalis

- o Vv.pulmonales

N thoracicus[T 7],
N intercostalis \ oesophagus

Ganglion thoracicumVll / major


N splanchnicus

l./
4-
920
Fig. 919 Lowercervicaland upper thoracicparts of the
autonomic nervous system,Pars thoracicaautonomica;
the vagus nerve and the right lung have been retractedto
exposethe oesophagus;
viewed from the right.
Oesophagus N vagus [X]
/,
V azygos a \ / O
R blonchialis - Bronchuslobaris
\ // / mediusdexter
N vagus [X],
Truncussympathicus,
^' Rr bronchiales
Ganglion
lhoracicum
V
- Bronchus lobarls
interiordexter

N. vagus[X],
Plexuspulmonalis

-- avv pulmonales
Ganglion thoracicumVl
dextrae

Br interganglionares - Pulmo dexter

Ganghon thoracicumVll

- Pericardium
fibrosum

Rr interganglionares

- Plexusoesophageus

- Truncusvagalis
Poslerior
Ganglion thoracicum lX
- OV cavainferior

N phrenicus
Ganglion thoracicum X
ii{
.- Oesophagus
N thoracicus[T 101,
N intercoslalis

Duclus thoracicus /

N splanchnicusmaior

N splanchnicusminor

\
lDiaphragma

919
-t
/l

Fig. 920 Lowerthoracicpart of the autonomic


nervoussystem,Parsthoracicaautonomica;
the dissectionis similar to Fig. 919,but the aorta,
the thoracicduct and the azygosvein havebeen
retained anteriorly;
viewed from the rieht
ThoracicViscera

O
Truncusbrachioceohalicus
Glandula thyroidea
V, brachiocephalicasinistras
N laryngeus recurrens
V jugularis interna4i!\
/ a A. carotiscommunis
N laryngeusrecurrens \ | N phrenicus
/
tt / l*M scalenusanterior
N. vagus[X] r
* a tt \
V subclavia
V brachiocephalica dextra € \ \
\\
N ohrenicus \
'
\ -_---!::

M pectoralisminor * :- .'-\..
\\

N vagqg [X]l
Hr car0racrlnoracrcl

Pulmosrnister,
ArcusaortaeO Lobussuperior

V cavao N phrenicus
supenor

Plexus - -- a I A ; V PericardiacoPhrenica
caroracus
I

-'t' costa lv
A ; V p e r i c a r d i a c-oa a
phrenica :

N phrenicus,
R pericardiacus

- -
Pulmo dexter,
Lobusmedius

--
Pulmo dexter,
Lobus inferior N, phrenicus

N phrenicus

Recessus
costodiaphragmaticus
/
Pleuraparietalis,
Pars I Pericardium \
diaphragmatica \
\
N phrenrcus,Rr phrenicoabdominales

Fig. 921 Thoraciccavity,Cavitasthoracis,in an adult.


The anterior thoracic wall has been removed;
the right and left lung have been sectionedin the frontal plane;
the mediastinaland diaphragmaticpleura have been removed
t0 exposethe pericardiacophrenicartery, A. pericardiacophrenica,
and the branchesof the phrenic nerve;
ventral view.
(
Median Sagittal Sectionof Neck and Thorax

M arytenoideus *, \
transversus / Cavitas Infraglotlica
Cartilago Lamina\ \\
cricordea, .t z Lig. vocale
Oesophagus,Parscervicalist tr't / / cartitago thyrordea
.r'
Trachea, Paries membranaceus \ l,'./
').," / * M sternothyroideus

VertebraceruicalisVll \ /. Glandula thyroidea


/
LpromtnensJ \ , Fascia cewicalis, Lamina superficialis
V jugularis anlerior
. . Ngdi lymphoidei \ /.
tracneooroncntatessuoeflores \

Bronchus principalissrnisler
\ /, * M sternocleidomastoideus
VerlebraceruicalisVll _ -- Carlilaginestracheales
.
uroc. sptnosus
IpromrnensJ, - Articulatiosternoclavicularis
-- Manubrium sterni

ft
Lrgg interspinalia\
-- O Truncus brachiocephalicus
-- *M pectoralismaior
Bifurcatiotracheae, -
Carina tracheae .-- $ V brachioceohalicasinistra
Vv basivertebralesi \\ -- O Arcusaortae
Bronchus principalis -_
oexler -- Corpussternl
i'<-
;1 i,. -- a Parsascendens
aortae
Nodus lymphoideus -
'.acheobronchialisinf Thymus
erior r-{ _ -

Plexus venosus * .-
vertebralis
J- _ - Valva aolae, Valvulae semilunares
sinistra, posterior et dextra
exlernus posleriOr
M Inlerspinalis& - - - a A coronaria
sinistra
A pulmonalisdextra O - -J _- Myocardium
Oesophagus,Pars - :) , I
lhoracica l/
L,- - Valva atrioventricularis
V pulmonalissinistra s - dextra lvalva tricuspidalisl
Sinus transversus - :,- ii
pericardii
V hemiazygos ,, - u'l - C o s t a eV l ; V l l

Atrium cordis sinistrum -


L-
- Cavitas
pericardiaca
SePtum inleratriale -
- Sternum,
A coronariadextra: O Proc xiphoideus
V cardiaca media
Medulla -- ' \ t - aMabdominis
rectus
spinalis
\ a Parssternalis
diaphragmalis
lLaminavisceratis
oura materspinatis/ // I i I
/ i i lEpicardium] | Pericardium
serosum
Spaliumsubarachnoideum
/ Laminaparietatrs
Tunicamuscularis
Oesophagus, 'i,H,e D a r )
Pars lumbalisdiaphragmatis a
phrenicus
Noduslymphoideus superior
Atrium cordis dextrum
Hepar,Area nuda

Fig.922 Thoraciccavity,Cavitasthoracis;mediastinum, Due to the close topographicalrelationship betweenthe left


Mediastinum; atrium and the oesophagus, an enlargementof the left atrium
mediansagittalsectionthroughthe neck and thorax, can be assessedby a displacementof the oesophagusin a
becauseof the slight asymmetryof this thorax,the sternoclavicu- radiograph.
lar joint has beensectionedabovethe Manubrium sterni; The heart can-beexaminedwith ultrasound from the oesophagus
risht lateralview. (transoesophageal sonography).
ThoracicViscera

I Oesophagus
Trachea
A vertebralis
a I r Nodilymphoidei laterales.
ceruicales
profundr
Inferiores
Nodi lymphoideithoracis, I i Nodi
Nodi paratracheales
Plexus brachi
I
A thoraco- a \\A suprascapularis , - Clavicula
acromialis I i
& M subclavius
---
A subclavia O Coslal
---
dextra
-- O A axillaris
N vagus sinister [X]

.-- € V axillaris
V cavasuperior': .-
.-- a Arcus aortae

- - & t\4 pectoralisminor


V pulmonalis
dextrasuperior,* .-
V anterior,
Parsintrasegmentalis
A intercostalisO ---- -- Costalv
--- a Pars ascendens aortae

- - 6$N4 serratus anterior


Fissura horizontalis .- --
pulmonis dextri - - * N4 intercostalisinternus
Atrium cordrsdexlrum -'-
-- a A coronaria srnistra
Fissuraobliqua
*- Bronchus inlrasegmentalis
Pleura parietalis,Pars costalis - - Ventnculuscordis sinister

Pleura visceralis -- Lamina visceralisIEpicardium]*

D i a p h r a g m a6 - - -t -
Lamina parietalis'

/
Recessus costodiaphragmaticus z
\ Peritoneumparietale
Hepar, / t !
I Peritoneum \ Flexuracoli
Lobussinister V n"0",,""s* /,/ i,l
Uhepatrca I
viscerale sinistra
i i coronariadextra
Valvaaorlae / in-r"lt6ni,iiJi"iis'po.r"'io'
i ri F u n
Truncuspulmonalis a I astricus
I Venlriculuscordis dexter

Fig. 923 Thoraciccavity,Cavitasthoracis;


frontal section;
ventral view.
* Pericardium serosum

- A carolrscommunis
Trachea -

- Truncus brachiocephalicus
V cava supeflor -

Pars ascendens aortae - - Truncus pulmonalis

- Pulmo sinister

Pulmo dexter

Atrium cordis dexlrum


- Ventnculuscordis sinisler
Draphragma
-- Ventriculuscordis dexler
Hepar
.- Valva atrioventricularisdextra

Fig.924 Thoraciccavity,Cavitasthoracis;
magneticresonancetomography(MRT);
frontal sectionat the levelof the superiorvena cava;
ventral view.
Compareto Fig. 913.
Frontal Sectionsof the Thorax

Mediastrnumposterius\
\ \ Vertebra
-l
thoracical / Pars thoracicaaortae

Fissura obhqua \ O
t::ii,'r

- Pulmo sinisler

-
,s Cavilas pleuralis
it\ \^a- I
,'o\

"d'!,'q
Diaphragma - - - Pleura parietalis,
Pars coslalis

Hepar -
- Corpusgastricum

V hepalica dexlra -

\ Recessuscoslo-
diaphragmaticus
Recessus -
phrenicomediastrnalis

\ Omentum majus
V cava nletio( /

Gasler Pars cardraca /

Fig.925 Diaphragm,Diaphragma;oesophagus,Oesophagus; frontal sectionthroughthe lowerpart of the thoraciccavityand


with transitioninto the stomach.Gaster: the upper part of the abdominalcavity;
ventralview.

___ A carotiscommunis sinistra


-_ V jugulafls inlerna
-- V subclavia
Truncusbrachioceohalicus- - -

Pars ascendens aortae- -

- - Truncus pulmonalis

Atflum cordis dexlrum_ _


_ _ Ventriculuscordis srntster
_ _ Ventflculuscordrsdexler

Fig.926 Thoraciccavity,Cavitasthoracis;
magneticresonancetomography(MRT);
frontalsectionat the levelof the aorticvalve:
ventralview.
C o m p a r et o F i g s .9 1 3a n d 9 2 3 .
ThoracicViscera \

I/ trapezius@| l* M..setratus
I anreilor
Clavicula,
.-.l Extremitas / * M supraspinatus
acromialis Articulatioacromioclavicularis
M erector* -- /
sprnae a / I M subscapularis
z Scapula, Cavitas glenoidalis

M s p l e n i uas - - / Caput humeri


caprtrs

/ E M deltoideus
Venebra thcracica ll - -

/ (Recessusaxillaris)

- N axillafls

-- a A circumflexahumerl
posterior

M l n l e r c o s l a l r sn l e r n u s -- a M teresmajor

qT, Plexus brachialis,


Fasciculusposterior
:- o A axillaris
I
I
I Plexus brachralis,
I Fasciculusmedialis

V anterior,* Plexus brachialis,


Pars intrasegmentalis Fasciculuslateralis
/ -
Bronchussegmentalis / N thoracodorsalis | lvl coracobrachralis
a n t e r i o rI B l l l ]

anleriof scapulae

Fig.927 Neck,Collum;left axillary region,Axilla;


thoraciccavity,Cavitasthoracis;
frontal section;
ventral view.

M s c a l e n um
s e d i u ss l*Viugularisinterna
I
I

lClavrcula / aM subclavius /, aV cephallca


,, Proc. coracoideus
- - 7 -,' ---.1= /
a M. biceps brachii,Capul longum, Tendo
,/ -rl _/
," / Acromion

/ -:- ,- C a p u th u m e r i

-- * M deltordeus

A c a r o l i s c o m m u nai s - - -
sinister *-
J o V axillaris
Noduslymphoideus- - -.r-.-
tracheobronchralis -a
--
l} M teres major

Arcusaortaeo -- N thoracicuslongus

--
aM serralusanterior
Pulmo sinister -
---
c o s t al V

Fig.928 Neck,Collum;Ieft axillary region,Axilla;


thoraciccavity,Cavitasthoracis;
frontal section;
ventralview.
CrossSectionof the I'horax

M scalenusanterior N | * M sternocleidomastoideus
M pecloralismaior * 1 ,,
N vagus dexler [X]

M subclaviust \
\ -t oA caroliscommunis
Plexus brachialis \

Capul humeri \ -- OA subclavia

- -
Pulmo dexter,Apex

* -
Pleura visceralis

- -
Pterra panelalis

-
Vertebrathoracicalll. Proc soinosus

tl
M rnfraspinatus4 / | *M serratusanterior | &M lrapezrus

Clavicula subclavia
I I av

/ fM deltoideus

Plexus venosus vertebralisinlernus __


a

Spalium sulrarachnoideum z-

lMedullasplnalis /

aM infraspinatus

N suprascapularis
lSpina scapulae

Figs.929a, b Thoraciccavity,Cavitasthoracis; a rightside


transversesectionshowingthe pleuraldomeand the apexof b leftside
the lung;
inferior view.
ThoracicViscera

Manubriumsterni O Truncus brachiocePhalicus


I

)A s u b c l a v i as i n i s t r a
--
N vagussinister[X]

_- Pulmosinister,
Lobussuperlol
V Pulmonahs * .--
dextrasuPerior N thoracicus
rongus
longus
N thoracicus
.--- Plexus brachialis
! syillsris #
-$
Humerus --
--
)eo O Arcus aorlae
A a x i l l a r i sO - - :

- -
Nodus lymphoideus
axillaris,
Nodus apicalis

C /
M subscapularis
/ --
M leresmajora / a M serratusanterior
\\ -
- N. intercostalis
O /
M intraspinatus .\ \ \ Pleura visceralis
Pleura parietalis,
Scapula / Costa lll /
Pars costalis

Ld trapeziusC
\ TruncussymPathicus
V azygost Ductusthoracicus
Lig longitudinaleanterius Vertebrathoracrcall, Proc spinosus

Fig.930 Thoracic cavitY,Cavitasthoracis;


transversesectlon at the level of the aortic arch;
inferior view.

Corpus sterni, , O Truncus brachiocephalicus


Recessus costomediastinalls
\
A thoracica internao \
N phrenicusdexler \
V cava superiora \
- Bronchus segmentalisanterior [B lll]
Nodi lymphoideiparatracheales--_

sinistra,
A. oulmonalis o - -- a M Pectoralismlnor
anterior
A. sbgmentalis Lobussuperlor
.- -. Pulmosintster,
V azygosa --

N intercostalis
-- -- I M serratusanterlor
intrasegmentalis
Bronchus
longus
N thoracicus N lhoracicuslongus
-
Pulmodexter,-
Lobussuperior .-.- Oesophagus
externusa--
M Intercostalis
.-- A thoracodorsalis
a
N vagusdexter[X] -
.-.-
O M leresmajor
M subscapulansa- -- N vagussinister
[X]
V azygosa /
/
M infraspinatusa Fissuraobliqua/ i '\ t Pulmo sinister,Lobus inferior
costa lV / t
\
Truncussympathicus I a Pars thoracica aortae
M trapeziust Recessus vertebromediastinalis
I Ductus thoracrcus
Vertebrathoracica lVl

Fig.93l Thoracic cavity, Cavitasthoracis;


transversesectionat the level of the 4th thoracic vertebra;
inferior view.
CrossSectionsof the Thorax

Corpusslerni
A pulmonalisdextraa

N p h r e n t c u sd e x l e r
\
V cava superior '. \
N4 pecloralismajor \
\ N phrenicus
sinister
A l o b a r i s s u p e r i o r O:
,,

.. V pulmonalis
sinistrasuperior
Pulmo dexler, Lobus superior :
- - Bronchus principahssinister

N o d i l y m p h o i d e i- -
bronchopulmonales - -. Bronchuslobarissuoerior

L4 serratusanteflor

N lhoracicuslongus
N thoracicuslongus
-
Fissuraobliqua .-
- aA
lobarissuperior
Bronchus principalis -
dexler
M serratusanterior
-
Pulmo dexter, -
Lobus inlenor
\ Fissura
obliqua
M teres major ," -
l\\\
7/ \. -
/ v / I \.oParedescendens Scapula
N vagus [X] I runcus arygos aonae N vagus [X]
sympalhrcus \
M trapezius I o""opt"gr.
Vertebralhoracica V ' Ductus thoracicus

Fig.932 Thoraciccavity,Cavirasthoracis;
transversesectionat the levelof the bifurcationof the
T r u n c u sp u l m o n a l i s :
inferior view.

B r o n c h u sp n n c t p a l i d
s e x t e r\

- Slernum

- Pleura parietalis,
Bronchus segmentalis-
anteflor lB llll Pars mediaslinalis
- M pectoralismajor

- Pars ascendens aortae

Bronchus segmentalis - V cava superior


p o s l e r i o rI B l l ]
Bronchus orinciDalissinister

Pars descendensaonae
- -
Bronchus lobals superior--
._--- Scapula
dexter
\
B i l u r c a l r ot r a c h e a e \ ---- M intraspinatus
vc-uP, rcgus

VertebrathoracicalV, -
Corpus vertebrae

Vertebralhoracica lV, '


Proc transversus
I \\\
Foramen vertebrale / M erector sprnae
I l M t r a p e z i u s\ c o s r a e \ M s e r r a t u s a n r e n o r

Fig. 933 Thoracicca\,it)',Cavitasthoracis; I)rocessing of the CT,either the lungs or the skeletalsystemcan
computedtomography(CT)at the levelof the bifurcationof the be emllhasized;
trachea.Dependingon the electronlc inferior view
ThoracicViscera

A\
V cava supeflor l C c - ; . : 3s t e r n i
A thoracrcainterna O
V p u l m o n a l i sd e x l r as u p e r i o ra \
tt
N phrenrcusdexter t
tt \
M pectoralismajor a \

Bronchus lobaris medius \ / N phrenicussinister

z Auriculaalrii sinislri
Pulmo dexter. Lobus medius \

- - Pulmo sinister,Lobus supenor


B r o n c h u sl o b a r i sm e d i u s - \

Bronchus lobaris inferior - -

-- Nodilymphoidei
N lhoracrcuslongus bronchopulmonales

- -
Aa lobares inferiores O - - F i s s u r ao b l i q u a

* -
- Cavitas pleuralis
Pulmo dexter. .-
Lobus inleraor
- -
Bronchus segmentalis
basahsposteriorIB Xl
M serratus anlerior C
"
- aV pulmonalis inistra
M latissimusdorsr a - inlenor

\ OPars descendens aortae


\
Ductus thoracicus
'
Recessusvertebromediaslinalis
s
V rntercostalis *V azygos
M trapezius a acica vl

Fig. 934 Thoraciccavit),Cavitasthoracis;


transversesectionat the levelof the left atrium;
inferior view.

- Atrium cordis sinistrum

- Ostium atriovenlricularesrnlstrum
- -

-- cuspis anlenor I Valva atrioventrrcularrs


i -srnistra[Valva milrahs]
C u s p r sP o s t e r r oJr
| _--
Valvula semilunaflssrnrslra - - -
- -1
Valva Valvulasemilunaris - / Ventriculuscordis sinrsler
aortae Oosteriol
-/
Valvula semilunaris -
dextra

Seplum interuentriculare

Venlriculuscordis dexler

F i g . 9 3 5 H e a r t ,C o r ; heart and its valvescan be depicted.


sonographicimage;the transducerhas been introducedinto The positionof the transduceris at the apexof the triangle;
the oesophagus using this techniquethe left
by an endoscope; left superiorview.
AtriumcordrsdextrumI

CarlilagocostalisI
I
I
Proc xiohoideus
Sternum.
O A coronanasinistra A \
I I / o Sinusaortae
N phrenicus I l l/ Valva aorlae
dexter I
/ Ventriculus
Pulmodexler,Lobusmedius\ .t cordisdexter
\
-- a A coronaria
Papilla mammafla - sinistra,
B interventri-
cularisanterior
- - - Ventriculus
cordissinister
Glandula mammaria - -
-- Valvaatrioventricularis
sinistra [Valva mitralis]

- - Pulmosinister,
Frssuraobliqua -
Lobussuperior
-- Atriumcordissinistrum
M serratusanteriorl -'
N phrenicus
sinister
V basalis rnferror,o --
V pulmonahsdexlra
inlerior - o V cardiacamagna
Nodus lymphoideus-- l\
bronchopulmonalis ,
\ Costa Vl
N vagusdexter[X] /
-
M latissimusdorsio / \ Pulmosinister.
//,/l Lobusinferior
Pulmo dexter./ Verlebra thoracica Vll / i' a v i n t e r c o s t aat i sP\ a r s d e s c e n d e n s a o r t a e
Lobus inferior
N rntercostatis
I ' Truncussympathicus
Oesophagusl I Ductusthoracrcus

Fig.936 Thoraciccavity,Cavitasthoracis;
transversesectionat the levelof the 7th thoracicvertebra:
inferiorview.
A
M pectoralis majora Sternum. Proc xiohoideus
V pulmonalissiniska inleriora Valva atrioventricularis
\ dextra
M transversusthoraciso \ [Valva tricuspidalis]
Pulmodexler,Lobusmedius\ / Ventriculus
cordisdexter
Fissuraobliqua\
\\ / Ventriculus
cordissinister
Cosialll -_ Pulmosinister,
/ -- Lobussuoeror
N inlercostalis

_- Mamma
Recessus- - -
costomediastinalis
-- Fissuraoblioua

--- O M serratusanterior
Nodr lymphoidei---
tracheobronchiales
interiores N phrenicus

- --
Pulmodexter,- O A coronariadextra
Lobusinterior
---
Pulmosinister,
externusf /
M intercostalis Lobusinlerior

Bronchussegmentalis/ \ O Parsdescendensaorlae
basalislalerafts
IB lX]
\ a M latissimusdorsi
Noduslymphoideus/ }4_l--i-i
juxtaoesophagealis /' I t.. --.
,/ i II
N. vagusdexter[X] / 7' Oesophagrsl i Trun"ra ayrpathicus\ o A intercostalii Duclusthoracicus
Vertebra lhoracica Vlll / V azygosa | | VerrebrathoracicaVll, Proc.spinosus

Fig. 937 Thoraciccavity, Cavitasthoracis;


transversesection at the level of the Bth thoracic vertebra;
inferior view.
Abdominatviscera
I32

Incisuracardialis \ - Fundusgastricus

Parsabdominalis-
Oesophagus,

Ostiumcardiacum--
CardialParscardiacal,

- Corpusgastricum

Curvaturaminor \ _

Plicaegastricae\\

angularis\
Incisura

I I
j 'Pars pylorica, Antrumpyloricum
Canalispyloricus,
'Pvlorus

Fig. 938 Stomach, Gaster;duodenum,Duodenum;


the anteriorwall hasbeenremovedto showthe foldsof
the mucosaof the stomachandthe intestine;
ventralview.
is particularlywell
Thecircularlayerof the musculature
developed in the pylorus.
' C l i n i c a l :B u l b u sd u o d e n i

Areae gastncae \

Foveolae gastricae \\

Epithelium r...
Tunicamucosa
propria
Lamina --\
T1"o"""-
Noduluslymphoideus
solitarius - _
Glandulaegastrica" -- - ----
Laminamusculansmucosae- -

Telasubmucosa

str"tur circulare----
Tunicamuscularis
{
\ Stratumlongitudinale \-

Telasubserosa

Tunicaserosa

Fig. 939 Diagramof the wall of the stomach;


the wall has been dissectedlayer by layer;
microscopicenlargement.
stomach,Gaster
I33
:----- Fundusgastricus

Oesophagus,
Tunicamuscularisr

-- Tunicamuscularis,
Stralumlongitudinale

Tunicamuscularis,Stratumlongitudinale--

- - Tunicamuscularis.
Stralumcirculare

Fig. 940 Stomach,Gaster;


the peritoneumhasbeenremovedto showthe external
muscularlayerof the anteriorwall of the stomach;
ventralview

Tunicamuscularis,Fibraeobliquae. Tunicamuscularis,
Stralumcircular€
Oesophagus.
Tunicamuscularis
\

Tunicamuscularis,Stralumcirculare- -

Tunicamuscularis.Fibraeobliouae---

Fig.941 Stomach,Gaster;
the peritoneumhasbeenremoved;
the externalmusculrr layerhasbeenpartially dissected
to shbwthe internalobliquemuscularlayer;
ventralview.
Abdominatviscera
I34
/ Fornix gastricus
Incisuracardialis
\
A ;V gastricasinislra, Rr oesophageales \\

- Fundus gastflcus
Oesophagus. Pars abdominalis -

A , V gastricasinistra \\
A ; V gastricadextra
\
A hepaticacommunis \. t,

Cardia lPars cardiaca] /

Curuaturaminor
\ )-Aa; Vv gastncae
breves
Ouctus hepaticuscommunls - -
\
\
Lig hepatoduodenale -1 \ Curvatura
maior

-\
Omentumminus,
Duodenum, Pars - Lig hepatogastncum
Ampulla
superior,
- \A ; V gastroomentalis
Pylorus - sinistra
Duodenum, Pars
descendens " \ Corpus gastricum

Tunrcamuscularis, --
Stratum longitudinale
- \ Omentummajus
Pars pylorrca, /
Antrum pyloricum
/
A t V g a s t r o o m e n t a/l i s
dexlra lA V gaslroomentallsdextra, Flr omentales
;
Flexura duodeni inlerior /

view'
Fig.942 Stomach,Gaster;duodenum,Duodenum;the peritonetlmhas beenpartiallyremoved;ventral

Nodt
lymphoidei
gastrici
sinistri

Nodi ---
lymphoidei
hepatici - Gaster

-- Nodr lymphoidei
gastricidextri

--
Nodi lymphoidei
pylorici
--. Nodi lymphoidei
gast;oomenlales
sinistrl

- - omenlum malus
--
Nodi lymphoidei
gastroomentales dextri

Fig. 943 Stomach,Gaster,and liver,Hepar,with lymph nodes' of the stomachto show the lymph nodes;
Nodi lymphoidei; ventralview.
the left lobeof the liver has beenretractedsuperiorly;the The number and sizeof the gastriclymph nodesvary
omentum has beenremovedfrom the greaterand lessercurvature considerablY.
stomach,
Gaster
1 35

're1*{ii:
.w',

1 = Oesophaguswith contrast medium


In the transitionalregion between lhe
o e s o p h a g u sa n d l h e l u n d u so l t h e
stomach (1a) lhe grooves between the
folds can be seen as dark striations
2 = Fundus ol the slomach wilh air bubble
3 = Body of lhe stomach, Corpus gastricum
3a = Lesser curuatureof stomach, Curuatura
mrnor
3b = Greatercurualureof stomach,Curvalura
malor
In the border between 3a and 3b
nolches correspondinglo the conlour ol
the mucous lolds are vrsible
4 = Perislalticconstrictionsat the Incisura
angularis
5 = Pars pyloflca pflor lo lhe progressronof
a portion of slomach's contenl
6 = Ampulla duodeni
7 = Pars descendensduodeni with Plicae
crrculares
8 = Jeiunum
9 = Len dome ol diaphragm
1 0 = F l e x u r ac o l i s i n i s l r a( fi l l e dw i l h a i r )

F i g . 9 4 4 S t o m a c h(,i a s t e r ; D u n n g r a d i o g r a p hoy f a s t a n d i n gp a t i e n t a , g a sb u b b l ea p p e a r s
r l u o r l e n u mI ), u o t l t ' n t r m ; i n t h e f u n r l u sr r h i c hi s b o u n d e db y t h e l i q u i d b e l o w
A [ ) r a r l i o g r a p ah f t e ro r a l a r l m i n i s t r a t i oonf a c o n t r a s m
t erlium; t h e s t r i p e si n t h e t r a n s i t i o n arle g i o nb e t w e e nt h e o e s o p h a g u s
t h e p a t i e n ti s s t a n r l i n gL r p r i g h t ; a n r lt h e s t o m a c ha n d i n t h e p y l o r u sa r e c a u s e db y l o n g i t u d i n a l
\ e n t r a l\ l e \ \ . l i r l r l so f t h e m u c o u sm e m b r a n e

F i g .9 { 5 S t o m a r ; h( i,a s t e r ; Fig. 946 Stomach,Gaster;


o u t l i n e( l r a \ ri n q o f t h e m u c o u sm e m l r r a n e topugraphr o u t l i n ed r a w i n go f t h e m u c o u sm e m b r a n et o p o g r a p h y
b a s e rol n a n A P r a r l i o g r a l rohf a s t a n t l i n gp a t i e n t : baserlon an AP-radiograllh of a standingpatient;
r e n t r a lr t e u v e n t r a lv i e w
'f '
h e 1 r lyo r i cy r a r ot f t h e s t u m a r ; ihs c 0 n s t r i c t eadn ( lt h e \ ! a l l C { } n s tir( t i o n d t t h ( ' a n g u l a rn o t th
* * C r ) n s t n t(r o n d l t h ( ' l o r i ( :a n t r u m
o f t h e p l l o r i ca n t r u m i s r e l a x e r l I)\
I ] o t ha r c s i g n so l a l ) r o g r o s s i \ rl x ' r i s t a l t i (u a \ ( '
Abdominatviscera
136

z Slernum,
Proc
xiphoideus
Gaster,
CardiaIPars
cardiacal

CostaX - Fornix
gastricUS

Gaster,
Gaster, Parsovlorica
Parspylorica --
corpus
gastricum
--
Spinaitiaca
anteriorsuperior

Fig. 947 Stomach,Gaster; Fig. 948 Stomach,Gaster;


a projectionof a "normal"stomachontothe anteriorabdominal projection of a "long" stomachonto the anterior abdominal wall
wall in the uprightstandingposition. in the upright standingposition.
The stomachis fixed at its inlet and outlet. The size and the
position of the other segmentsvary considerablydependingon
the amount of contents and the position of the body.In addition
there are considerablevariations amone individuals.

Gaster, - Gaster,
Pariesanterior
Pariesanterior

Plicae gastricae

- Pylorus

- Gasler,
Pars pylorica,
Antrum pyloricum

Gaste( - Gaster,
Pariesposterior Pariesposterior

Figs.949a, b Stomach, Gaster; a view of the body with the distinct longitudinal mucosalfolds
endoscopicviewinto the stomach(gastroscopy); (Plicaegastricae)
superiorview. t> view of the antrum with predominantly smoother mucosa
SmallIntestine.Intestinumtenue
r37
- Mesenlerium

z Tela submucosa

- Lamina muscularis
mucosae runrcamucosa
I'Tunica serosa
H e n t o n e u mI _. - Villiinleslinales
viscerale I lela
\ suoserosa

Noduluslymphoideus
solitarius

Fig.950 Smallintestine,Intestinumtenue;
crosssectionthroughthe uppersmallintestine.

Villusintestinalis

Epilhelium \

Lamina propfla mucosae \

Tunicamucosa Vas lymphaticum centrale \

Glandulaeintestinales-

Laminamuscularismucosae
\

Fig.951 Smallintestine,Intestinumtenue;
layerby layer;
the intestinalwall hasbeendissected
microscopic enlargement.

Mesenlerium

- Mesenterium
diverticuli
Fig.952 Mscrel's diverticulum(Diverticulum ilei).
- (Diverticulumilei) Thisremnantof the Ductusomphalo-entericus occursin 1-3%
In 90%ofthecasesit is I to 10cm longand
ofall individuals.
situatedbetween30 and70 cm oralto the ileocaecal valve.
Abdominat
138

Telasubmucosa \

Glandulae
duodenales'

Tunica muscularis Stralum longiludinale \


Tunica muscularis,
Stratum circulale

Fig. 953 Superiorpart of the duodenum,Parssuperior


duodeni;the duodenalwall has beendissectedlayerb1'
layerto show the tluodenalglands.The glandson the right
sideare near the pylorus.
' r l i n i c a l :I l n u r r r t r ' s g l a n d s

Tela subserosa

- T u n i c am u s c u l a r i s Tunica serosa

- Tunica serosa

Plicae
crrculares

Noduli
lymphoidet
solitarii

F i g . 9 5 4 l e j u n u m ,l e j u n u m ; F i g . 9 5 5 T e r m i n a il l e u m ,P a r st e r m i n a l i si l e i ;
t h e w a l l a t t h e m e s e n t e r i icn s e r t i o nh a s b e e n the u'all at the mesentericinsertionhas been
partiallyopenedto show the mucousmembrane. partialll openedto shou'the mucousmemllrane.
Comparethe number of folds to Fig 955 C o m p a r et o F i g 9 5 4 .

- Plicae circulares

Noduli lymphoideisolitarii --

Fig. 956 Terminalileum, Parsterminalisilei; PLvr:n'sllatchesare alsofound in the tluodenumantl the


portion of intestineopeneda t t h e m e s e n t e r i icn s e r l i O n i e j u n u m ,a n d a r e n o t 0 h a r a c t e r i s toi cf t h e i l e u m .
* r : l j n i ra l : l ) t , v t , H
s p a t th t ' s
Duodenum
I39
Duodenum, Pars superior,Ampulla' \ / N4 sphincterpyloricus

- - Pylorus,Ostium pyloflcum

-- Canalis pyloricus I -
Plicae circulares \ -- I Fars ovronca
Anrrum pyroncumJ

Ouodenum, Pars descendens \

Ampulla hepalopancreatca --

Papllladuodenr major "a -'

-
Tunicamuscularis-

-
Duodenum. Pars horizonlalis -

Fig.957 Duodenum,Duodenum;
the anteriornall has beenremovedto show the mucousmembrane:
v e n t r a lv i e u .
The sulleriorpart coursesto the right dorsosuperiorly
from the
stomachan(l s\4ingsventroinferiorlyat the duodenojejunalflexure.
' r I i n i ra l : [ ] u l l r u sr l u r x l c n i
't r I i n i ra l : I R u r z ' sn l u s c l ( ,
Flexuraduodeno,ejunalis * * * r I i n i t a l :l ) a l i l l ao f \ r r l H

VertebrathoracrcaXll Gaster Curuaturaminor


Duodenum,, Gaster. I
P.rc t
IncisuraanqularrsI
CostaXll , trperioi \ Pylorus
'\ Ampulla \ I i

Duodenum, Pars I Plicae circulares i i D u o d e n u m .Jl e l u n u m l


descendens lPlicae circulares
I I Pars ascendens
lv".r"Or" lumbatis ttl
I
'
Duodenum, Pars horizonlahs

Fig. 95ti l)uodenum,Duorlenum; Fig.959 Duodenum,Duodenum;


AP-rarliograph after oral administrationof a contrastmedium; endoscopicview of the mucousmembranewith the circular
l ) o s i t i o ns:t a n ( l i n gu l ) r i g h t ; folds;
ventralview supenorvtew.
Abdominat
I40

/ Plicae semilunarescoli
Omentummaius
I

/ Taeniaomentalis

/ Taenia mesocolica
/ - Mesocolonlransversum
a--

Fig. 960 Transverse colon,Colontransversum;


the greateromentumhasbeenretractedsuperiorly
in orderto showthe freetaenia;the mucousfolds
in the openedpart of the intestinecanbe clearlyseen;
view.
ventroinferior
Appendices '
omentales
[epiploicae]
- Colon ascendens

Taenia omenlalis
I

Plicae -
semts
tunates
coll

Oslium-
ileale

Frenulumostii/
ilealis

Fig. 961 Caecum, Caecum; vermiform Fig.962 Ascendingcolon,Colonascendens; caecum,


appendix,Appendixvermiformis; Caecum;vermiform appendix,Appendix vermiformis;
terminalpart of the smallintestine, sectionof intestine openedby a frontal section to show
Parsterminalisilei; the ileocaecalvalve;hooks hold the orifice apart;
dorsalview. ventral view.
* clinical: PEYER's
Datches

Glandulae inlestinales \

Epithelium
\
Tunicamucosa
Laminapropriamucosae- -.--
Noduluslymphoideus
solitarius-
Laminamuscularismuoosae

Telasubmucosa - -s
\-

Fig.963 Colon,Colon; Telasubserosa


\\
the intestinalwall hasbeen
Tunicaserosa
dissectedlayerby layer;
microscopic enlargement.
cotonI4
Flexuracoli dextra -
-
Flexura coli sinistra

Caecum
Appendix vermilormis Colontransversum
Haustracoli

Colon sigmoideum
- Colon descendens

- Rectum

Fig. 964 Colon,Colon;rectum,Rectum; (doublecontrastmethod).


AP-radiograph
after filling with contrastmedium and air Comparethe topographyof the colon in Figs.1005and 1008.

Figs.965 a-d Transversecolon,Colontransversum; The positionof the transversecolonalsodependson the


f r e q u e n vt a r i a t i o n si n p o s i t i o n . amountof contentsand on the positionof the body;
a normal position,b serpentine,c U-shaped, d V-shaped ventralview.

Flexuracoli
sinrslra

----- Colon
transversum

---- Colon
descendens

- - Colon
sigmordeum
-- Rectum

F i g . 9 6 6 A s c e n d i n gc o l o n ,C o l o na s c e n d e n s ; Fig.967 Colon,Colon;
vieu'throughan entloscope rvhichhas beenintr<lduced projectiononto the anteriorabdominalwall;
t h r o u g ht h e r e c t u m ,t h e s i g m o i d t, h e d e s c e n d i ncgo l o n ventralview.
and the transversecolon (coloscopy). The positionsof the transversecolonand the sigmoid
vary considerably(seeFig. 965).
Abdominatviscera
I42
/ Lrg coronanum

/ Lig lalcilotme
/ Diaphragma

-
Lig triangularedextrum
Lrg tnangulare
sinislrum

Lobus hepatis sinister,


Lobus hepatis dexter, Facies draphragmatrca
Facresdiaphragmatica

Lig talcrlorme

Lig teres hepatrs


'
i' V e s i c ab i l i a r i s
Margo inferior

Fig.968 l.iver,Ileptrr;
lrartsof the diallhragmhavelleenpresenetlto sholr the
hepatisand the round
attachmentto the liler; the l.ig.falcifrrrme
ligament(Lig.tereshellatis)havebeensectionetl;
ventralvie\4
lmpressiooesophagea \ f Parssuoerror;
,
\ ,, //
Facresdiaphragmatica
I Areanuda
nepatls--1,
tiOrosa
Appendix i \ V cava rnfeflor\
\
\ / lmpressiosuprarenalts

Lrg venosum ---

Lobus caudatus - -

- V portae hepatrs
lmpressro-
gastflca
-- lmpressio renalis
Tubet'-
omentale
-- Ductus
-- choledochus
Proc papillaris
lbiliarisl

- - A lobicaudatl
Proc caudatus
- lmpressio
/ duodenalis
Lobus hepatis sinistet
- A cystica
/
Margo inferior
-
propfla
,,-- lmpressrocolrca
A neparrca j
/ --
Frssura
ligamenti
teretrs Lobus hepatis dexler
I
Incisuraligamenli
terelis' Lig teres
hepatis Lobus Vesica biliaris
quadratus

Fig.969 Liver,I{epar;hepatichilum, Portahepatis;


ligamentousattachmentsof the liver vesselshavebeensectioned;
dorsalview.
* ( : l i n i ( : a l :L i g v c n a t , r : a v a c
** lx)rd(!rofth(f sut)orior re(rssus (lfthe om(!ntal l)ursa
Liver;Hepa,
I43

- - Lobus heoatis dexter.


Tunicaserosa

Lig coronarium -

/
Lobus I
caudalus I
I
Appendix fibrosa hepatis - I
Vv hepaticae/ Peritoneum
'
V cava inlerior

Fig. 970 I.irer,hellar; The peritoneum-free areaof the liver surface,Area nuda,
the peritonealreflectionshaveheense(:tione(l; is rlist;erniblehl its rougherte\ture.
sulleriorview. * r l i n i ra l : I i , . {r r , n a cr a r a c

Lrg coronanum

/ V cava inferior
_-- Areanuda

V umbilicalis - - Facies visceralis


V porlae hepatis

Fig. 971 Liver,Hepar,of a fetus;


the oxygencontentsof the bloodis shownby.colours,
arrows indicatethe directionof bloorlflow:
dorsalview.
The liver parenchymais bl,llassedby wal of the Ductus
venosuswhich directshighly oxygenizetlblootlfrom the
yrlacentato the inferior venacava.
* a l s ot a l k ' r l l ) u (
tus i\RANill

Fig.972 Liver,Hepar;
sagittalsectionthroughthe right lobe to show the
branchesof the hepaticand the portal veins.
' intrahepati(;bran(:h()sof the hepati(:veins
* * intrahepati(:branchosof thc portal vein and the hepatic artery
Abdominat
I44
Fissura portalisPrinciPalis
Seomentumoosterius.'r Segmentum mediale sinistrumllvl
me-diale
dextium[Vlll] /
Fissuraumbilicalis

Fissuraportalisdextra\ _

Seomentum oosterius ---


laieraledexirum[Vlll

Seomentum anlerius
latelalesinistrum
lltl
Segmentum anterius ---
laterale dextrum [Vll

Segmentum anletius -" \ Lig teres hepatis


mediale dextrum [V]
Vesica biliaris

Fig.973 Liver,Hepar; From a surgical point of view, SegmentumIV is subdividedinto


segmentsof the liver lobes are emphasizedin colour; an upper segment (IVa) and a lower segment (lVb).
ventral view.

Lig. venosum V cava inlerior


/
Lig lriangularesinistrum- _
_

Segmenlumfll - -

Segmentumposterius- -
laleralesinistrumul Seomentumposteraus
latiale dextrum[Vlll

Seomentumanterius
ladrab dextrum[Vl]

-- Seomentum anterius
dextrum[Vl
me-diale

Lig teres hepatis/


Vesica biliaris/

Fig.974 Liver,Hepar;
segments of the liver lobesareemphasized
in colourasin Fig.973;
dorsalview.

Parts of the liver,


Parsposteri0rhepatis,Lobuscaudatus Segmentum[]
Divisiolateralissinistra SegmentumposteriumlateralesinistrumIll]
anteriuslateralesinistrum[III]
Segmentum
Divisiomedialissinistra medialesinistrum[lVl
Segmentum
Divisiomedialisdextra anteriusmedialedextrumffi
Segmentum
posteriusmedialedextrumfvlll]
Segmentum
Divisiolateralisdextra anteriuslateraledextrum[VI]
Segmentum
posteriuslateraledextrum[VII]
Segmentum
considerations,i.e. the requirements of surgical resection,
and, moreover, takes into account developmental stand-
points. The individual sections are separatedby fissures
which are not, howeveq discernible by external visible
clefts.
Liver,Hepa,
I45

Diaphragma ---

Pulmo dexter. ---


Lobus intenor

Fig.975 Hepatic veins, Vv. hepaticae;


ultrasound image of the confluenceof the hepaticveins
into the inferior vena cava:
inferior view.
* abdominal wall

V portae hepatis, \-
R. dexter

- - Parsabdominalis
aortae

- - Parslumbalis
diaphragmalis

Pars costalis - -
diaphragmatis

Fig. 976 Portal vein, V. portae hepatis;


ultrasound image of the division of the portal vein
into its main branches;
inferior view.
Compare to Fig. 982.
I abdominalwall
Abdominatviscera
146
/, Lig falciforme
Vesica biliaris

/ Lobushepatrs
Lobus hepatis / r sinisler
dextel

i.-Lig hepatoduodenale

Ductus hepaticusdexler

Collum vesicae biliaris 1


-Paprlla duodeni major

Plicae mucosae \

Tunica - -

Fundus vesicae biliaris

/Ductus
pancrealicus

-(Orificium ductus
pancrealrcr)

-Papilla duodeni major "

Fig.977 Gallbladder,Vesicabiliaris [fellea],


andbiliaryducts;
partsof the anteriorwall of the gallbladder,the biliary
ductsand the duodenumhavebeenremovedto showthe
mucousmembrane;
ventralview.
* clinical: Hrtsten's valve
* * clinical: Papilla ofVrrrn

Figs. 978 a-c Variations of the biliary ducts;


common hepatic duct, Ductus hepaticuscommunis,
and common bile duct, Ductus choledochus.
a high union of the common hepatic duct with the
cystic duct
b low union of the common hepatic duct with the
cystic duct
c low union with crossingof the common hepatic
duct and the cystic duct
vesicabitiaris
I47

Ductushepaticus
srnrster

Ductushepaticus
dexler

Ductushepaticus
communrs

- Ductus cyslrcus

- Vesica biliaris

- Ductus choledochus
Ibiliaris]

- Ouodenum

Fig.979 Biliaryducts;
AP-radiographin the uprightpositionafter
administration
of a contrastmedium:
ventralview.

- Duclusheoaticus
communrs
Duclus cysticus,Plica spiralis

Collum vesicae biliafls

Fig.980 Gallbladder, Vesicabiliaris[fellea],


andbiliaryducts;
AP-radiograph in the uprightpositionafter
administration of a contrastmedium;
the patientis standingupright;
ventralview.
Abdominatviscera
L48

Draphragma -.

Fundus vesicae biliaris -

Colon transversum - - Hepar, Lobus dexter

Omentum maius -

Fig. 981 Liver, Hepar; gallbladder,Vesicabiliaris; Insufflation of gas into the abdominal cavity createsa space
through an endoscope,the liver can be assessedin terms of betweenthe liver and the diaphragm,which enablesa thorough
colour,the surfaceand the shape (laparoscopy); examinationof the liver and the sallbladder.
left ventroinferior view.

- - Ductus hepaticussinister

- V portae hepatis, Fl sinister

A hepatica propria, - A hepatrcapropria, R sinister


R dexter
V portae hepatis, R dexter -

Ouctus hepaticusdexter -

-- A hepaticapropria
-- V porlae hepatis

Fig. 982 Liver, Hepar; portal vein, Vena portae hepatis;


diagram of the branchesof the portal vein projectedonto
the surfaceof the liver;
ventral view.

-- V cava rnlerror

Vv heoaticaedexlrae --
- Vv hepaticaesinistrae

W heDaticaeintermediae --

Ductus choledochus -
lbiliarisl

Fig. 983 Liver, Hepar; hepaticveins, Vv. hepaticae;


diagram of the branchesof the hepatic veins projected
onto the surfaceof the liver;
ventral view.
Positionof the UpperAbdominalOrgans
r4g

Hepar,Lobussinister --

Hepar,Lobusdexter -

Vesicabiliaris

Fig.984 Liver,Hepar; cycle.During inspiration,the diaphragmflattensout and the


projectionontothe anteriorabdominalwall; domedescendsdistinctlycaudally.Thereby,the healthyliver is
mid-respiratoryphase. pressedinferiorly down to the costalarch and the lower border
Thepositionofthe liver dependsessentiallyon the respiratory becomespalpable.

Duodenum.Parssuoeriol Pancreas,Cauda
--

Duodenum.Parsdescendens-- -- Pancreas,Corpus
-- Flexuraduodenoiejunalis
Pancreas. CaDut -
--
Duodenum,Parsascendens
Duodenum.Parshorizontalis--

Fig.985 Duodenum,Duodenum;
pancreas,Pancreas;
projectionontothe anteriorabdominalwall.
Abdominatviscera
150
pyloricus
/ Canalis
M sphincler pyloflcus \
Corpus pancrealrs
/

Ductus Pancreaticus'
/
Ductus choledochuslbiliaris] \_

nuctus oancrealicusaccessorius"'
Incisurapancreatts

Papilladuodenr mrnor

= - - - - - - - M susoensortusduodeni'tt'
Ouctus choledochuslbihansl - -
D u o d e n u m ,P a r s d e s c e n d e n s - -

- FlexuraduodenojeJUnalis
Plica longitudinahsduodeni -
P a p i l l ad u o d e n im a i o r . . t -
=---- D u o d e n u m ,P a r s a s c e n d e n s

Plicae circulares /

caputpancreatisi
i i
Parshorizontalis
Duodenum, i
I
P r o c u n c i n a t uIs

Fig.9B6 Duodenum,Duodenum;pancreas,Pancreas; The formation and size of the accessorypancreaticduct vary


parts of the anterior wall of the duodenum have been removed considerably(in about 30%in the form of an accessorybranch,
to show the entry of the pancreaticduct; the pancreaticduct in less than 10%in the form of a major excretoryduct)'
* clinical: WtnsuNc'sduct
has been dissected;
clinical: SANToRINI's duct
ventral view. *"* clinical: Papilla ofVArER
* " * * c l i n i c a l :T R E l r z ' sm u s c l e

t\

9 7\
9
7 7
I 5/
5 5
7
7 7

5-

d f

Figs. 9B7a-f Variations in the confluenceof 1 = Duodenum


2 = Ouctus choledochus(biliaris)
the common bile duct and the pancreaticduct. 3 = Ductus oancreaticus
4 = Pancreas
a long common segment 5 = Papilladuodeni major
b ampullary expansionof the terminal part 6 = Pabilla duodeni minor, Duclus pancreaticus accessorlus
7 = M. sohincter ampullae hepatopancreaticae
c short common segment 8 = Ducius oancreaiicus(on "Papillabipartita")
9 = Ampulla hepatopancreatica
d separateorifices confluence
e single orifice with a septatedcommon duct
f additional duct, Ductus pancreaticusaccessorius
Pancreas
151
V cava inlerior\ gastricasinistrl pars
I v thoracicaaorlae
A hepaticapropria,
\ \ i / Hiatusaorticus
V portaehepatis\ / A gastricasinistra
\
/ Glandula
suprarenalis
Diaphragma \\

Glandula \
suorarenalis / A ;V splenica0ienalisl

-
Ductushepatrcus
communrs
Oucluscystrcus-

A gastro-- Cauda oancreatis


duodenalis
Ben - - Truncus coeliacus

mesenteflca - A hepatica
superDr communts
(V gaslro- - - A. renalrs
duodenalis)
-
Caputpancreatis
- V renalis
Ouodenum,-
Parsdescendens
\ Ureter
A : V c o l i c a-
medra
\ M suspensorius
duodeni
A : V c o l i c a- < - :
dexlra '-l

Duodenum, - -- \ Jejunum
Parshorizonlalis
M ouadratus /
lumborum
\ Ureter
Ureler/
':
M psoasmalor/ i \ inferior
v mesenterica
A ; V ovarica,/testicularis' \ A mesenterica
inferior
Aa ; W jeiunaleset ilealest

Fig. 988 Retroperitoneal


organsandvesselsof the upper ventral view.
abdomen: Lymph nodes not depicted.

Duodenum,Parssuperior
\
V.portaehepatis\ \ Ductusheoaticus
communis
-- Ouctuacysticus
V splenicalienalisl\
(Sulcusarteriaesplenicae) \, -- Flexuraduodenisuoerior
,
-- Ouctuscholedochus
[biliaris]
Corpuspancreatis\

-
Duclusoancreaticus

Duodenum,
Parsdescendens
superiot-1
V mesenterica
A mesenlerica supeflor Caputpancreatis

Proc uncinalus'

-- Flexuraduodeniinferior

--
Duodenum, Pars horizontalis

Fig.989 Duodenum,Duodenum;pancreas,Pancreas; Thecommonbile ductpassesthroughthe pancreas; the headof


the bodyof the pancreas
hasbeensectioned
to showthe the pancreasreachesaroundthe superiormesentericvein.
pancreaticduct;
dorsalview.
Abdominatviscera
I52

- Ductus pancreaticus:
Cauda pancreatis

Ductushepalicus
communrs
Ouctuscysticus

- Je,unum
Vesica biliaris -

Ductus choledochus
lbitiarisl

Duodenum, Pars descendens I lvertebra lumbalis ll


A m p u l l ah e p a t o p a n c r e a t i c a '
Duclus pancrealicus

Fig.990 Pancreaticduct, Ductus pancreaticus;common bile Clinical: ERCP(endoscopicretrogradecholangio-pancreaticG


duct, Ductus choledochus;gallbladder,Vesicabiliaris; graphy).The whole extent of the pancreaticduct up to the hilum
AP-radiograph;the patient is in the supine position; a cannula of the spleenis visible. It shows a typical oblique course to the
has been introduced endoscopicallyinto the common orifice of Ieft and superiorly.Someof the contrast medium has entered
the pancreaticduct and the common bile duct and a conrrasr the small intestine and thereforeparts of the duodenum and the
medium has been injected; jejunum can be seen.If the contrast medium is inlected under
ventral view. higher pressure,the branchesofthe pancreaticduct may also be
demonstrated(compareto Fig. 986). A danger exists however,
that the pancreascould be damaged.

V porlae hepalis, R sinister

Hepar, Lobus sinisler \

Lig teres hepatis \ mesentencasuperior


/A
/A splenrca
Corpus pancrealis -
V portae hepalis \

Hepar, Lobus \
cauoatus

V renalis sinislra -

V cava inlerior --

Pars abdominalisaortae - - - Cauda pancreatis

-Flen sinister

Fig. 991 Pancreas, Pancreas; the tail of the pancreasextendsquite far posteriorly;
ultrasoundimageto showthe pancreas andthe adjacent inferior view.
greatvesselsduringdeepinspirationof the patient; ' abdominalvall
teen,
spten
[Lien]1 53

Margosuperior
/ V splenica [ienalis]

/ Facies visceralis,Facies colica


A splenica lrenatis; --_

/ Hilum splenicum

/ Lig splenorenale
Lig gaslrosplenicum --

- Extremitasanlerior
Exlremrlas -
poslerior
- -
Facies vrscerahs,
Facies renalis

Fig.992 Spleen,Splen[Lienl;
the vesselsat the hilum of the spleen
Margo interior
havebeendissected;
ventromedialvieu'.
I Margo superior

Facresdiaphragmatica

- -
Extremitas
anleflor

lMargo rnferior
Fig. 993 Spleen,Splen[Lien];
vien'.
superolateral

Tunrcaserosa:
Tunrcalibrosa

Facies renalis --

- - rtabeculae splenicae

Fig.994 Spleen,Splen [Lien];


crosssectionshowingthe structure and the
hilum of the spleen;
medialsuperiorview.
V splenrcalienalisl )
In this crosssection no lymph nodes can be
A splenrcalienalisJ / seen at the hilum. Horever, they regularly
occur here and drain parts of the stomach
and the tail of the pancreasas well.
I54 Abdominat

Pars abdominalis
aorlae

-- Pars abdominalis
aorlae

-- Pancreas

-- Duodenum,
Pars
horizontalis

Omentummajus--

Figs.995a, b Development and topographyof the


peritonealcavity,Cavitasperitonealis;
schematic mediansection:
lateralview.
a earlydevelopment
b development of the greateromentum

Pars abdominalisaortae ---_


' 1--l----

H e P a r- - -

B u r s a o m e n l a l i s- - -
Lig hepatogastricum---

l l e u m- - - -

--
Colonsigmordeum

Fig. 996 Development andtopography ofthe peritoneal


cavity,Cavitasperitonealis,in the female:
schematicmediansection;
lateralview.
The smallwhite arrow marksthe positionof the omental
foramen[epiploicor WIrsLow'sforamen].Thearrow-head
is locatedin the vestibuleof the omentalbursa.
PeritonealCavity,Cavitasperitonealis
155
Pars abdominalis aortae \
Oesophagus \
Hepar \

Diaphragma \

Lig hepatogastracum-,

Pancreas --_.

Bursa omenlalis --_-

Cavitas peritonealis --_


Gaster ---
Mesocolontransversum-- -

Lig gastrocolicum --

----
Colontransversum
-
Duodenum-

Jejunumz'

/
Omentummaius/
/
Cavitas peritonealis/

/
lleum /

/
Colonsigmoideum

Excavatiovesicoulerina/ \ Excavatioreclouterina'

Fig.997 Development andtopography ofthe peritoneal


cavity,Cavitasperitonealis,in the female;
final developmentalstagewith the adhesionof the greater
omentumto the transversecolon;
schematic mediansection;
lateralview.
* clinical: DoucLAs's space

Figs.995-997 Thedevelopment of the intestinesis presented Theperitonealfluid amountsto only a few milliliters.
schematically. In realitymany developmental stagesoccur Peritonealcavity:red dottedarea;omentalbursa:olive;
concurrently. Theperitonealcavityis enlargedin the drawings originalcourseof the peritoneum: red dashedline.
for didacticreasons. Normallythe visceraarevery closetogether Thearrowis in the omental foramen [Foramen epiploicum].
andareonly separated by a smallcapillaryspace.
L56 Abdominat

Lig lalciforme

Pars pylorica \

Lobus hepalis dexler \

Lig leres hepatis \ ,/ M rectus abdominis

- Lig gastrocolicum

Taeniaomentalis

-- M l r a n s v e r s u sa b d o m r n r s

-
Omentum malus
-- M o b l i q u u sI n t e r n u s
a000mlnls

- M obliquus
externus abdomrnrs
-
Colon ascendens,
Taenia libera

-
Colon srgmoideum

Caecum - Peflloneum
paflerare

\
Plica urnbrlrcalislateral's
(A V eprgaslncdiii.rro')
\
L i n e aa r c . , a t a

\
P l i c au m b i l i c a l i sn r c d r a | s
(Chorda arleriae umbilicalis)

Fig. 998 Positionof the abdominalviscera, Situs viscerum;


greateromentum,Omentummaius;
ventral view.
The lower part of the abdominal cavity is also called the
"intestinal abdomen".
Thoracicand Abdominal Organsin a Newborn
51

// fhymus
Pleura parietalis \ / Pericardiumfibrosum
Pars costalis

{.
Pulmo sinisler.
Pulmo dexter - -- Lobus superior
Lobus supenor

- -
Pleura oarietalis.Pars mediastinalis
Pulmo dexler Lobus rnferior--

Pleura Pars mediastinatis - - Lobusinferior


Pulmosinister,
J
P a r r e t a l r sI parsdiaphragmalrca

D r a p hr a g m a - - SplenILien].Exlremrtas
anterior

-- --
Lig faloforme Lobus heoalis sinister

---
major
Gasler,Curuatura
--
- Colon descendens
Lobus hepatis dexter
- -
omenlum ma;us

l-- u umbrricaris

$ Intestrnumtenue

Plica umbilicalislalerahs
(A : V epigastricaInfeflor)
/ Plica umbilicalismedialis
Vesica urinarra / (A umbrlicalis)

Plica umbilicalis mediana / \


(Urachus) Anulus umbilicalis

Fig.999 Positionof the abdominal viscera,Situsviscerum,


in a newborn;
the anteriorthoracicandabdominal wallsandpartsof the
diaphragmhavebeenremoved;
ventralview.
Notethe sizesof the liver,the greateromentum,the medial
umbilicalfoldsandthe umbilicalvein in comparison with an
adult(Fig.998).
Abdominatviscera
15 8
Lrg coronaflum \
Lig falciforme 1

Lig teres
hepatis

Lobus hepatis dexter, -


Facies diaphragmatica - Fundus

Lobus quadratus -
- Appendrx
Omentum minus, - fibrosa hepatis
Lr9 -
hepatogastricum Cardia
- Recessus
V e s i c ab i l i a r i s- costodraphra9-
maticus
m i n u s -,
Omentum
Lrg Corpus gastricum,
hepatoduodenale Paries anterior
Foramen omentale -
' Splen ILien]
[epiploicum]
Gaster, Curyatura minor
Lobus hepatis .-
dexter. Facies
visceralis Lrg gastrosplenrcum

D u o d e n u m ,-
Pars superior Lig phrenicocolicum
I n c i s u r aa n g u l a r i s
Ren, Extremitas '
supeflor Gasler, Curvaturama,or

Pylorus- - Omentum majus

A ; V gastro
Flexuracoli dexlra / ffill{frH iJi omentalissinistra
t Colon transversum --.
- - **
A;Vgaslflcasinislra a Mesocolon lransversum
Taeniaomenlalis \
Omenlum majus Lig gastrocolicum

Fig. 1000 Positionof the viscera in the upper abdomen; This part of the abdomenis also known as the "glandular
parts of the diaphragm as well as the anterior thoracic and abdomen".
abdominal walls have been removed: * also called WtNstow's foramen
ventral view. " " omental bursa slightly exposed

Gaster, Curualura minor


tt\
/ Corpus gastricum

Gasler, - Gaster, Curuaturamalot


Pars pylorica

Hepar, Lobus
dexter

Vesica brlraris /

*@fi

V gaslroomentalis /
dextra, Flr gastrici
O m e n l u mm a j u s

Fig. 1001 Stomach,Gaster;greateromentum,Omentum majus; surgical drape


surgical retractor
surgical photograph;the viscera are in their natura[ position;
ventral view.
Organsof the UpperAbdomen
159
Lobus hepatis dexler, Facies diaphragmatica I Vestibulum
i bursaeomentalis / Lobushepatissinister,Faciesdiaphragmatica

Lig teres hepalis -

/ Recessus
superiorbursae
omenlalis
Lobus z Splen [Lien],
quadralus Margo superior

- Plica