Book - An Atlas of Topographical Anatomy 9

From Embryology

IX. Transverse section of the thorax of a male at the level of the third dorsal vertebra

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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
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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)


THIS plate represents a section between the regions of the neck and thorax of a man twenty-two years of age, powerfully built and perfectly normal.


All the sections, as far as to that of the pelvis, in the following series have been made from this subject.


The lamina in this plate was about 1/4 inch thick, and its upper surface is shown, so that the body is viewed from above. The arteries were injected. The section passed just below the upper border of the manubrium sterni, and through the upper margin of the third dorsal vertebra, together with a small portion of its underlying cartilage.


Close to the sternum lie the clavicles in section and their interarticular fibro-cartilages. Laterally, near the sternal ends of the clavicles, are the sections of the first ribs, behind them those of the second, and further backwards and inwards those of the third. These last are not quite symmetrically divided, in consequence of the somewhat higher level of the right side of the chest. On the left side the third rib exhibits in connection with it a portion of the transverse process of the vertebra which articulates with it ; whilst on the right side merely a small portion of the head of the rib is shown.


The scapulae are divided through the glenoid cavities. The heads of the humeri show the greater tuberosities and the lower portion of their articular surfaces.


If the plate which in the large coloured atlas is figured IX be compared with this (the position of the parts in the man of fifty years with that of a man of twenty-two years), it will be seen, that in the former instance the under Surface of the third dorsal vertebra is divided, and in the latter the upper. In the younger subject, also, the plane of section has passed nearly an entire vertebra higher, yet in spite of this the sternum is deeper.


It would follow, then, that although the section was perfectly horizontal the sternum lies higher in the young subject than in the old. If the transverse and antero-posterior diameters of both the sections be compared, the latter diameter is seen to be the larger in the old man, whilst the transverse diameter is less. It is possible that the enlarged thyroid gland invading the cavity of the thorax may be the cause of this difference.


By comparison of the shoulders, we observe that in consequence of the extremely powerful muscular development they stand much higher in the young man ; therefore considerably more is removed by the saw. A glance at the large surface which involves the pectoralis major, the deltoid, and the subscapularis, suffices to show that the muscular development has been great.


The anterior contour is partly owing to these masses of muscle and partly to the different attitude of the shoulders. It may be that the older subject was frozen with the arms slightly raised, and with the shoulders pushed somewhat backwards, whereas in the present instance the arms were laid close against the thorax.


By measuring the sections it is shown that the antero-posterior and transverse diameters of the body differ but little.


The transverse diameter in this plate amounts to nearly an inch more than in Plate IX in the coloured atlas, if both sections be reduced to equal scale, since the bony contours are more regular. In the middle portion of this plate the position of the vessels and nerves is more intelligible than on the section of the body of the older individual, owing to the changes in the relative position of the parts from the presence of the goitre in the other case.


Behind the sternum lie the sections of the sterno-thyroids, and near them and behind the clavicles are the sterno-hyoids. In front of the sternum are the tendinous origins of the sterno-cleido-mastoids. Further in behind the muscle, the sternum, and the clavicles, is the upper portion of the thyroid body. It is separated from the sterno-mastoid by the middle layer of the cervical fascia. Further back is the left innominate vein, which, on account of its oblique course downwards from left to right, is extensively divided. The trunk can be followed towards the right side as far as the lumen of a vein, which is the inferior thyroid vein opening vertically. On the other side of this vein the trunk lies more deeply and is no longer seen through the cellular tissue. The isolated right innominate vein is divided transversely.


On examining the left innominate vein two small openings are seen ; the anterior of these is the internal mammary vein, and the posterior the thoracic duct. The duct in this instance opens more internally than is usual, and into the innominate instead of into the subclavian vein ; and it may be followed on the inner pleural surface of the left lung directly backwards, whence it bends downwards, applying itself along the vertebral column.


On the right side behind the great vein are a series of four large arteries, which pass obliquely towards the middle line. Commencing from the left side they are, the left subclavian, the left vertebral (which in this case sprang independently from the aortic arch), the left carotid, and the innominate. The arch of the aorta is immediately below the plane of section.


Although the length and point of origin of the innominate artery are liable to considerable variations, the vessel, nevertheless, lies so close to the middle line that it should be searched for in the middle line of the jugulo-tracheal space, as Pirogoff recommends. After researches on the dead body, I have convinced myself that this proceeding is the surest guide to the vessel.


The head is to be drawn towards the left side and the right shoulder depressed, and the tissues divided as far as the group of muscles coming from the hyoid bone and larynx. It is a matter of importance to make the incision exactly in the middle line between both sterno-thyroid muscles, and to divide the dense cervical fascia to which the great veins are intimately attached. If this be done the trunk of the artery in the loose cellular tissue can be isolated from the trachea, and the ligature passed. The surgeon must remember that close to it is the left innominate vein, which runs obliquely across its trunk, and that on the right side of the trunk, as is shown in the plate, the vagus nerve passes down. The vagus in this case was met with below the point of origin of the recurrent laryngeal nerve ; it therefore lies further back than it does higher up in its course on the left side ; the recurrent laryngeal nerve is between the oesophagus and trachea, and the trunk of the vagus is in front of the subclavian artery.


From the position of the innominate artery it is clear that burrowing of pus in the mediastinum is likely to follow such an operation as its ligature, whilst the relative shortness of its trunk and the strong pressure in the arch of the aorta are serious obstacles in the way of the formation of a resisting thrombus. It is therefore obvious that however artistically the operation itself may be conducted, it will be followed by serious consequences. The position of this artery must be taken into consideration in the performance of tracheotomy below the thyroid body. The surgeon must be prepared to meet occasionally with an arterial trunk from the innominate[1] running obliquely over the trachea (as Liicke did in one case). The artery is the thyroidea ima.


Ligature of the first part of the subclavian artery and its dangers have already been alluded to. It must be remembered that even in its normal relations -(as in the present instance) the left subclavian artery lies in a niche of pleura, and that it has not been pushed against the pleura by means of the enlarged thyroid gland. (Plate IX in the large atlas should be referred to.) It can be readily seen from the plate that swellings of the thyroid body may push the oesophagus out of position, and displace the trachea backwards. In the superior aperture of the thorax the oesophagus normally inclines to the left side, and attains its greatest deviation in the region of the second or third dorsal vertebra. I have observed exactly the same Pirogoff (tab. i, fasc. ii), in a transverse section made between the first and second dorsal vertebrae in a powerful man, shows the oesophagus placed at the side of the trachea ; and, indeed, unless the oesophagus be much dilated (as in the case from which Plate I was taken), it does not project towards the median line. This fact renders it evident that in the operation of cesophagotomy, if there be no tumour of the thyroid body of the left side, the oesophagus must be looked for on the left side of the trachea ; and from the plate it is clear that the operation is similar to that of finding the left common carotid or vertebral arteries. The close relation of the recurrent laryngeal nerve is to be noticed.condition in another section made on a normal male subject.


Under the pectoral muscles, on the outside of the cavity of the thorax, are the brachial plexus and subclavian vein, and between them is the subclavian artery. If the pectoralis major be removed with the muscular branches of the acromio-thoracic artery, a thin fascia is met with which passes over the short head of the biceps, the coraco-brachialis and the pectoralis minor. It extends inwards as far as the sterno-clavicular articulation, and envelopes the subclavius muscle. The fascia then passes upwards along the first rib, at the line of junction with the sharp edged coraco-clavicular fascia, and terminates in a sickle-shaped margin. An aperture is formed externally and above, resembling the saphenous opening in the thigh, which permits of the passage of the cephalic vein, the acromial axis, and the external anterior thoracic nerve. Below this is Mohrenheim's fascia and the section has so passed that the continuity of this fascia is not interrupted, but is shown by means of a white line. The fascia forms with the posterior lamina a sheath for the pectoralis major and coraco-brachialis, and constitutes at the same time the anterior layer of the sheath of the axillary vessels. Higher up it attaches the vein to the subclavius muscle and clavicle. Wounds of the vein at this spot may be attended by a dangerous entry of air into the heart.


The posterior layer of the sheath of the vessels is formed by the fascia of the serratus magnus and intercostal muscles ; the external layer being derived from the fascia of the subscapularis muscle. The cavity of the shoulder-joint is indicated by the black line which marks out the capsule; the folds are well shown which facilitate rotation of the head of the humerus.


The strengthening of the capsular ligament by the insertion of the tendons of the subscapularis and teres minor are well seen; and on the right side the bursa, which lies between the tendon of the subscapularis and the capsular ligament, is indicated.


Fig. 1. Subject A. Male, aet. 22. Normal. Plate X.

1. Trachea. 2. (Esophagus. 3. Left innominate vein. 4. Bight innominate vein. 5. Innominate artery. 6. Left common carotid artery. 7. Left subclavian artery.


In order to show by plane sections the changes in position which are brought about by pathological conditions of the lungs and pleurae, I have arranged two of Pirogoff's plates so as to exhibit surfaces corresponding with those in my own work, that is to say, viewed from above downwards. They are reduced to half scale, and fig. 1 represents the central portion of my own Plate X.

The surrounding muscles and upper extremity are not represented, in order to make the woodcut clearer.

Fig. 2 represents large tubercular cavities in the upper lobe of the left lung, and is taken from a series illustrating dislocation of the heart and lungs.

FIG. 2. Subject B. Male, set. 18. Tuberculosis, Pirogoff, ii, 2, 3.

1. Trachea. 2. (Esophagus. 3. Left innominate vein. 4. Bight innominate vein. 5. Innominate artery. 6. Left common carotid artery. 7. Left subclavian artery.


The section passes pretty much at the same level as in my own plate, and can therefore be conveniently compared with it. Pirogoff represents both portions of the section, as the saw had removed so much that there was considerable difference in the two sides. Pirogoff in his text, fasc. ii, p. 10, states that after freezing the body the upper extremities were removed with the scapulae. The pulmonary and costal pleurae were closely adherent. The cavities, which are shown by the deeper shading, have attained an enormous size, and the left side of the thorax was considerably more sunken in than the right ; on the woodcut, however, it does not appear very remarkable. Between the first and second ribs only is a slight incurvation of the contour of the chest to be noticed. But the transverse diameter of the left portion of the thoracic cavity is considerably larger than the right. It is unfortunately not stated by Pirogoff whether any encysted pleuritic effusion existed lower down, which might have been the cause of this increase in breadth; consequently there is little of importance to remarl^ as to the cause of this altered form of the mediastinal space. Fig. 3 shows a section which corresponds with mine, but the section has passed nearly a vertebra deeper. It is from the body of an adult male who, shortly before death, had pneumothorax of the left side.



FIG. 3. Subject C. Adult male. Left lateral pneumothorax. Pirogoff, ii, 2, 3, \.

1. Trachea, 2. (Esophagus. 3. Left innominate vein. 4. Right innominate vein. 5. Innominate artery. 6. Left common carotid artery. 7. Left subclavian artery.


The apex of the left lung was so compressed by the mixture of pus and air that it is not visible in this section ; on the right side the lung was divided near its cupola. It is evident that the distension of the left side of the thorax is not due to the elevation of the ribs only, but also to the dragging inwards of the mediastinum ; and in consequence of this the structures in the upper portion of this thoracic cavity appear to be pushed considerably out of their places.


  1. In a case in which I performed tracheotomy on a man, set. 50, I found the innominate artery running obliquely across the trachea below the isthmus. TR.


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.


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Cite this page: Hill, M.A. (2019, December 14) Embryology Book - An Atlas of Topographical Anatomy 9. Retrieved from https://embryology.med.unsw.edu.au/embryology/index.php/Book_-_An_Atlas_of_Topographical_Anatomy_9

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