Book - An Atlas of Topographical Anatomy 13

From Embryology

XIII. Transverse section of the same body at the level of the apex of the heart and ninth dorsal vertebra

Embryology - 23 Sep 2019    Facebook link Pinterest link Twitter link  Expand to Translate  
Google Translate - select your language from the list shown below (this will open a new external page)

العربية | català | 中文 | 中國傳統的 | français | Deutsche | עִברִית | हिंदी | bahasa Indonesia | italiano | 日本語 | 한국어 | မြန်မာ | Pilipino | Polskie | português | ਪੰਜਾਬੀ ਦੇ | Română | русский | Español | Swahili | Svensk | ไทย | Türkçe | اردو | ייִדיש | Tiếng Việt    These external translations are automated and may not be accurate. (More? About Translations)

Braune W. An atlas of topographical anatomy after plane sections of frozen bodies. (1877) Trans. by Edward Bellamy. Philadelphia: Lindsay and Blakiston.

Plates: 1. Male - Sagittal body | 2. Female - Sagittal body | 3. Obliquely transverse head | 4. Transverse internal ear | 5. Transverse head | 6. Transverse neck | 7. Transverse neck and shoulders | 8. Transverse level first dorsal vertebra | 9. Transverse thorax level of third dorsal vertebra | 10. Transverse level aortic arch and fourth dorsal vertebra | 11. Transverse level of the bulbus aortae and sixth dorsal vertebra | 12. Transverse level of mitral valve and eighth dorsal vertebra | 13. Transverse level of heart apex and ninth dorsal vertebra | 14. Transverse liver stomach spleen at level of eleventh dorsal vertebra | 15. Transverse pancreas and kidneys at level of L1 vertebra | 16. Transverse through transverse colon at level of intervertebral space between L3 L4 vertebra | 17. Transverse pelvis at level of head of thigh bone | 18. Transverse male pelvis | 19. knee and right foot | 20. Transverse thigh | 21. Transverse left thigh | 22. Transverse lower left thigh and knee | 23. Transverse upper and middle left leg | 24. Transverse lower left leg | 25. Male - Frontal thorax | 26. Elbow-joint hand and third finger | 27. Transverse left arm | 28. Transverse left fore-arm | 29. Sagittal female pregnancy | 30. Sagittal female pregnancy | 31. Sagittal female at term
Historic Disclaimer - information about historic embryology pages 
Mark Hill.jpg
Pages where the terms "Historic Textbook" and "Historic Embryology" appear on this site, and sections within pages where this disclaimer appears, indicate that the content and scientific understanding are specific to the time of publication. This means that while some scientific descriptions are still accurate, the terminology and interpretation of the developmental mechanisms reflect the understanding at the time of original publication and those of the preceding periods, these terms and interpretations may not reflect our current scientific understanding.     (More? Embryology History | Historic Embryology Papers)


THE section of which the upper surface is here shown was taken two inches below the preceding ; and passed through the lower portion of the sternum and the fifth costal cartilage ; divided the apex of the heart, the diaphragm, and the liver ; and came out posteriorly through the lower portion of the ninth dorsal vertebra, and the corresponding rib.


This plate terminates the series of sections of the thorax ; and the abdominal cavity is already open, showing at a glance how wounds of the liver may involve the lung. Although the left lobe of the liver lies in the section, a very small portion only of the left half of the cupola of the diaphragm has been removed. It rises as high as the lower border of the fourth rib, seen from the front ; whilst the right half, of which considerably more has been removed than of the left, rises as high as its upper border nearly a rib's breadth higher, and almost on a level with the plane of the nipples.


It has been already stated in the last chapter that this position of the diaphragm does not correspond with its relations during life, but that it was so found in the body of a young powerful man, and that it would be pushed higher up in tympanitis.


The position of the heart is in immediate relation with the diaphragm and liver ; and the lowest part of the heart is shown divided behind the fifth costal cartilage of the left side. The absolute apex of the heart is about four fifths of an inch from the plane of section. On the right side, in the apex of the right portion of the heart, is seen the lowest part of the cavity of the ventricle, filled with its columnse carnese. At the apex of the left side the section exhibits the arrangement of the muscular structure.


The heart does not extend downwards beyond the fifth rib, reaching only to its lower border ; the cavity of the pericardium, however, extends about half an inch lower, and contains about a tablespoonful of frozen fluid. In a male fifty years of age I found at the level of the eleventh costal cartilage a portion of the heart corresponding with that here represented, but considerably deeper.


The relations of the pleurae to the front of the heart are of practical importance. The pleuraB appear as folded sacs, which extend from the anterior border of the lungs towards the middle line, leaving in the present instance merely a small interspace between the left edge of the sternum and the fifth costal cartilage, through which the pericardium could be reached by the trocar without wounding the pleurae. Bodies vary considerably in this particular, so that it is readily conceivable why so many different descriptions are given for the position of the point in the introduction of the trocar.


Luschka, however, is right when he maintains that the pericardium presents at the left border of the sternum a narrow strip quite free of pleura, so that it may be safely avoided in paracentesis of the pericardium. The safest method of operating, as I have satisfied myself, is to pass a fine trocar in the upper angle between the left edge of the sternum and the fifth costal cartilage. It does not appear justifiable to depend upon an adhesion of the pleura. Even large collections of fluid in the pericardium may exist for a considerable time without it.


The amount of extension of the liver towards the left appears surprising ; hence the heart seems to be entirely supported by its left lobe, and from its abnormal size one is inclined to assume that some pathological condition was present. Such, however, was not the case, and the viscus was normal both in weight and structure.


It must be borne in mind that the left lobe of the liver shows great varieties of form even under normal relations ; that it reaches down to the spleen ; but that it lies always under the heart, a portion of which projects anteriorly and to the left side over the margin of the liver. Again, it is to be remembered that, in consequence, false notions are formed of the shape and position of the liver ; one having been accustomed to observe it in front as projected on a plane, in which case its entire extent cannot be shown. A good view of the extent and position of the liver is obtained from the diaphragm above ; and this is the easiest method that can be adopted of studying the important relations of the liver to the spleen, stomach, and heart. I have frequently, after the removal of the chest- wall, shown the diaphragm intact, with a portion of the pericardium attached to it, and subsequently removed the diaphragm and introduced the liver into the drawing ; and I always found a similar relation of the heart and liver to that seen in this plate, notwithstanding the variable extent of the left lobe. If the diaphragm be very carefully removed, the peritoneum may be preserved and the individual organs seen through it in their respective relations to each other. If the body be placed in the upright position, the pressure on the surface of the diaphragm is lessened and rupture of the peritoneal sac avoided. I give three plates which were made from the bodies of young powerful men (suicides) which were brought to the anatomical school with the rigor mortis on them.

There is no question that in such operations the position of the diaphragm frequently alters ; and that with the removal of the upper half of the thorax especially the anterior and posterior walls of the lower half somewhat approach each other, and the cupola of the diaphragm rises correspondingly higher in consequence : this alteration of position having, however, but a very slight influence on the subjacent organs. A preparation of this kind may be made on a subject lying on the belly or on the back without any perceptible displacement of the enclosed viscera. Frequent observations show that by means of this method many useful results are obtained in explanation of the topography of this region. I have, then, rested satisfied with the representations obtained, and have refrained from attempting an improvement upon the plates by a previous moulding in plaster of Paris, and from using the drawing apparatus of Lucee. Considering the sources of error which result from the relations in the dead body, an exact definition of the position of the parts must be given up.


Fig. 1 represents the relations of the parts, the stomach being tolerably full. This viscus when full pushes the left lobe of the liver outwards, and lies for the most part covered by it. The portion of the diaphragm that supports the pericardium indicates the position of the heart. If the left ventricle, when full, exceeds the margin on the left side, it is clear that the heart lies, not on the stomach, but on the liver, and only its apex reaches the region of the stomach, and a transverse section would be similar to that represented on Plate XIII. The left cupola of the diaphragm is distended, therefore, by the left lobe of the liver, stomach, and spleen.

Fig. 1. Normal position of the viscera below the diaphragm, viewed from above. J.

1. (Esophagus. 2. Aorta. 3. Inferior vena cava. 4. Liver. 5. Pericardial portion of diaphragm. 6. Stomach. 7. Lobulus Spigelii. 8. Spleen.


Fig. 2 represents the position of the viscera below the diaphragm in still greater distension of the stomach. By simple inspection of the form of the circumference of the liver, it is evident that the figure was taken from another body, and that a body was used in which there was considerable distension of the stomach. This distension was not obtained by mere experiment, which very easily disturbs the relations of the parts : the subject was perfectly fresh, and the examination was made before it was touched in any way. The stomach, which was distended with food, did not extend as far as the left side, but still had against it the fatty portion of the peritoneum, which drags on the left end of the transverse colon, and which is continuous with the greater sac.


The left lobe has a different form from that in Fig. 1, notwithstanding that its relation to the heart is the same, or, at most, so slightly altered that the apex of the heart, in consequence of the greater breadth of the left lobe, has liver substance on the abdominal surface of the diaphragm under it. From observations that I instituted on different subjects, after filling the colon from the anus, or the stomach from the oesophagus, in order to demonstrate the variation in position of the organs in one and the same individual, I was convinced that even by carefully lifting the peritoneum, I obtained no condition of things from which a plate of any value could be made. The stomach was much displaced from its natural position, and was emptied with as much difficulty as the colon ; so that I was forced either to use different subjects for the plate, or to select from them those which showed the organs in the state of distension desired. It appeared in the highest degree remarkable that in a portion of the trunk, to which merely the under half of the thorax was attached, one could inject a large quantity of water through the oesophagus, and leave it any length of time without its escaping. On introducing the finger through the oesophagus into the stomach one could feel its wall between the cardiac extremity and the fundus jutting out so sharply as to form a distinct valve. It must remain for further investigations how far these relations on the subject can be applied to the living body.


IX Normal position of the viscera below the diaphragm, viewed from above, f .

1. (Esophagus. 2. Aorta. 3. Inferior vena cava. 4. Liver. 5. Pericardial portion of diaphragm. 6. Stomach. 7. Great oinentum. 8. Spleen. 9. Lobulus Spigelii.



Fig. 3 shows the stomach empty, and the resulting space filled up on the left side by the colic flexure. The other relations are similar to the preceding. It appears in these plates that the heart always has the left lobe of the liver between it and the stomach, and lies on the stomach by only a portion of its apex, which may vary greatly in size.


Normal position of the viscera below the diaphragm, viewed from above. .

1. (Esophagus. 2. Aorta. 3. Vena cava interior. 4. Liver. 5. Pericardial portion of diaphragm. 6. Stomach. 7. Left flexure of colon. 8. Spleen.


frontal section shows the same condition, and the order of these structures as arranged one above the other can be well studied (compare Henke, ' Atlas der Top. Anat.,' tab. xxxv, xxxvii, and Pirogoff, I A, ii A, ii B).


It will also be seen that, according to the condition of the stomach, the position of the viscera in the left cupola of the diaphragm will be altered. The left flexure of the colon is pushed up if filled with gas and the stomach empty ; and will, as it more often contains air than the stomach, afford especially a full tympanitic percussion note in the lower half of the left side of the thorax ; it may also, by the strong pressure exerted upwards, disturb the functions of the organs within the chest.


The following woodcuts are taken from Pirogoff's atlas to demonstrate the change in the position of the apex of the heart as occasioned by pleuritic or pericardial exudation.


Fig. 4 illustrates the relations of the parts, at the same level, when the pericardium is very much distended with fluid. The section is taken at the same level as mine, and the apex of the heart is pushed strongly backwards and somewhat to the left side.


Male thorax. Hydro-pericarditis. Lungs healthy. Pirogoff, ii, 15, 2. J. 1. (Esophagus. 2. Aorta. 3. Vena cava inferior. 4. Liver. 5. Heart.


The pleurse approach each other in front, leaving only a narrow space at the left edge of the sternum. One would expect a greater separation of the pleurae from each other as the quantity of fluid in the pericardium took up greater space. It is therefore the place to choose for puncture of the pericardium, as has been stated before, so as not to open the pleural cavity. Pirogoff does not mention the age of the individual ; it is merely noticed that the lungs (and very likely the pleurae) exhibited no abnormality.


Fig. 5 is a section showing the relations of the organs in pleurisy and hydropericarditis. It was made on the body of a man of middle age, who died in hospital, and passes deeper than my section by a vertebra. Notwithstanding the mass of exudation, very little of the liver is divided. As regards the position of the apex of the heart, it is dislocated backwards and to the right. The distension of the left pleura is so considerable that it extends forwards to the middle line and posteriorly beyond it.



FIG. 5. Male thorax. Left pleurisy. Hydro-pei'icarditis. Pirogoff, ii, 22, 2. 1. (Esophagus. 2. Aorta. 3. Yena cava inferior. 4. Liver. 5. Heart.


Of the ribs of the left side almost the same are divided as in my case, from which it is evident that the effusion was more considerable, causing a tilting up of their anterior extremities. On the right side, on the other hand, which, according to PirogofTs account, contained very little fluid, the ribs lie wider apart, so that the fourth rib is sawn through.


Fig. 6 shows the relations of the parts in double pleurisy and hydropericarditis. The description is to be found in Pirogoff's atlas, ii, p. 54.


The section, which has passed a vertebra deeper, divided the fifth, sixth, seventh, eighth, and ninth ribs of both sides, and shows almost the same relations of the skeleton as Plate XIII, both halves of the thorax being symmetrical. The man had an encysted empyema of the right side. The right lung was strongly compressed, and appeared polygonal in section


FIG. 6. Male thorax. Partial cystic empyema of right side. Hydro-pericarditis. Pirogoff, ii, 15, 4. 1. (Esophagus. 2. Aorta. 3. Yena cava inferior. 4. Liver. 5. Heart.


in consequence. The left pleura was thickened and very adherent. The heart, it will be observed, is dislocated and drawn to the left. The left lung lies far back, and its pleural sac is firmly adherent for its whole length in front of the heart, so that puncture of the pericardium could be performed without danger of the pleura at the sides. With regard to dislocation and hypertrophy of the heart, some authors have frequently observed a bending in of the inferior vena cava. (Compare Luschka, ' Anat.,' i, 2, p. 445 ; Bartels, * Deutsches Archiv,' iv, p. 269.)


In my opinion the question is not yet decided, and can only be definitely settled by allowing a body to be frozen, and to expose the right auricle with the venae cavaa from behind with hammer and chisel. Transverse sections, like the one under observation, where the vena cava and the entrance of the hepatic vein are cut through immediately below the foramen quadratum, throw little light on the question ; nor can much be expected from experiment or clinical observation. Researches on animals, which I have instituted in Ludwig's laboratory, and published in the reports of the Academy, show that ligature of the inferior vena cava does not set up any considerable disturbance of the circulation, as the blood finds a ready path collaterally by means of the azygos veins and spinal plexus, thus getting into the superior vena cava.



Historic Disclaimer - information about historic embryology pages 
Mark Hill.jpg
Pages where the terms "Historic Textbook" and "Historic Embryology" appear on this site, and sections within pages where this disclaimer appears, indicate that the content and scientific understanding are specific to the time of publication. This means that while some scientific descriptions are still accurate, the terminology and interpretation of the developmental mechanisms reflect the understanding at the time of original publication and those of the preceding periods, these terms and interpretations may not reflect our current scientific understanding.     (More? Embryology History | Historic Embryology Papers)
Braune Plates (1877): 1. Male - Sagittal body | 2. Female - Sagittal body | 3. Obliquely transverse head | 4. Transverse internal ear | 5. Transverse head | 6. Transverse neck | 7. Transverse neck and shoulders | 8. Transverse level first dorsal vertebra | 9. Transverse thorax level of third dorsal vertebra | 10. Transverse level aortic arch and fourth dorsal vertebra | 11. Transverse level of the bulbus aortae and sixth dorsal vertebra | 12. Transverse level of mitral valve and eighth dorsal vertebra | 13. Transverse level of heart apex and ninth dorsal vertebra | 14. Transverse liver stomach spleen at level of eleventh dorsal vertebra | 15. Transverse pancreas and kidneys at level of L1 vertebra | 16. Transverse through transverse colon at level of intervertebral space between L3 L4 vertebra | 17. Transverse pelvis at level of head of thigh bone | 18. Transverse male pelvis | 19. knee and right foot | 20. Transverse thigh | 21. Transverse left thigh | 22. Transverse lower left thigh and knee | 23. Transverse upper and middle left leg | 24. Transverse lower left leg | 25. Male - Frontal thorax | 26. Elbow-joint hand and third finger | 27. Transverse left arm | 28. Transverse left fore-arm | 29. Sagittal female pregnancy | 30. Sagittal female pregnancy | 31. Sagittal female at term

Reference

Braune W. An atlas of topographical anatomy after plane sections of frozen bodies. (1877) Trans. by Edward Bellamy. Philadelphia: Lindsay and Blakiston.


Glossary Links

Glossary: A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z | Numbers | Symbols | Term Link

Cite this page: Hill, M.A. (2019, September 23) Embryology Book - An Atlas of Topographical Anatomy 13. Retrieved from https://embryology.med.unsw.edu.au/embryology/index.php/Book_-_An_Atlas_of_Topographical_Anatomy_13

What Links Here?
© Dr Mark Hill 2019, UNSW Embryology ISBN: 978 0 7334 2609 4 - UNSW CRICOS Provider Code No. 00098G