Topographical and Pathotopographical Medical Atlas of the Chest, Abdomen, Lumbar Region, and Retroperitoneal Space Scrivener Publishing 100 Cummings Center, Suite 541J Beverly, MA 01915-6106 Publishers at Scrivener Martin Scrivener ([email protected]) Phillip Carmical ([email protected]) Topographical and Pathotopographical Medical Atlas of the Chest, Abdomen, Lumbar Region, and Retroperitoneal Space Z. M. Seagal This edition first published 2018 by John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, USA and Scrivener Publishing LLC, 100 Cummings Center, Suite 541J, Beverly, MA 01915, USA © 2018 Scrivener Publishing LLC For more information about Scrivener publications please visit www.scrivenerpublishing.com. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, except as permitted by law. Advice on how to obtain permission to reuse material from this title is available at http://www.wiley.com/go/ permissions. Wiley Global Headquarters 111 River Street, Hoboken, NJ 07030, USA For details of our global editorial offices, customer services, and more information about Wiley products visit us at www.wiley.com. Limit of Liability/Disclaimer of Warranty While the publisher and authors have used their best efforts in preparing this work, they make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of merchantability or fitness for a particular purpose. No warranty may be created or extended by sales representatives, written sales materials, or promotional statements for this work. The fact that an organization, website, or product is referred to in this work as a citation and/or potential source of further information does not mean that the publisher and authors endorse the informa- tion or services the organization, website, or product may provide or recommendations it may make. This work is sold with the understanding that the publisher is not engaged in rendering professional services. The advice and strategies contained herein may not be suitable for your situation. You should consult with a specialist where appropriate. Neither the publisher nor authors shall be liable for any loss of profit or any other commercial dam- ages, including but not limited to special, incidental, consequential, or other damages. Further, readers should be aware that websites listed in this work may have changed or disappeared between when this work was written and when it is read. Library of Congress Cataloging-in-Publication Data ISBN 978-1-11952-6-261 Cover image: Courtesy of Z. M. Zeagal Cover design by Kris Hackerott Set in size of 13pt and Minion Pro by Exeter Premedia Services Private Ltd., Chennai, India Printed in the USA 10 9 8 7 6 5 4 3 2 1 Contents Preface vii Part 1: The Chest 1 Part 2: Abdomen 51 Part 3: Lumbar Region and Retroperitoneal Space 111 Part 4: Pathotography Chest 139 About the Author 179 v Preface Atlas of Human Topographical and Pathotopographical Anatomy Chest, Abdomen, Lumbar Region and Retroperitoneal Space The atlas presents the topographic and pathotopographic anatomy of a person (adult and child). Sections “chest”, “abdomen”, “lumbar region” and “retroperitoneal space” include layered topographic anatomy, vari- ant, computer and MRI topography and pathotopographic anatomy. Surgical anatomy of congenital malformations includes funnel-shaped deformation of the chest, keeled chest, hernia, aplasia, fistula, etc. Individual and age differences, fascia and cell spaces, triangles and vas- cular-neural bundles, and collateral blood supply are presented in case of injury or occlusion of the main arteries. All the pictures are colorful and original. The atlas is written in accordance with the educational program of medical universities of the Russian Federation. The origi- nal graphs of logical structures are presented according to the sections of topography and congenital malformations. This allows an effective study of the subject. The atlas is intended for students of General Medicine, Pediatrics and Dentistry faculties, as well as for interns, residents, postgraduate stu- dents and surgeons. vii Topographical and Pathotopographical Medical Atlas of the Chest, Abdomen, Lumbar Region, and Retroperitoneal Space. Z. M. Seagal, © 2018 Scrivener Publishing LLC. Published 2018 by John Wiley & Sons, Inc. The Chest Topographic Anatomy of the Chest Chest borders. The chest walls (paries thoracis) and chest cavity (cavum thoracis) together compose the chest (thorax). The superior chest border runs along the upper edge of the clavicle and the manu- brium of sternum, and on the back — along the horizontal line drawn through the spinous process of the 7th cervical vertebra. The lower border goes down obliquely from the xiphoid process along the costal arches and on the back along the 12th rib and the spinous process of the 12th  thoracic vertebra. The muscular-fascial layer of the chest is pre- sented at the back with the latissimus dorsi muscle, on the sides with the serratus anterior muscles, and in front with the major and minor pectoral muscles. External and internal intercostal muscles are located in the chest itself; the space between these muscles is filled with cellular tissue with intercostal arteries, veins and nerves. The superior chest aperture (apertura thoracis superior) is bounded by the posterior sur- face of the manubrium of the sternum, the inner edges of the first ribs and the first thoracic vertebra. The inferior chest aperture (apertura 1 2 Atlas of the Chest, Abdomen, Lumbar Region, and Retroperitoneal Space thoracis inferior) is bounded by the posterior surface of the xiphoid process, the lower margins of the costal arches and the 10th thoracic vertebra anteriorly. The prethoracic, thoracic, inframammary, scapular, subscapular and vertebral regions are identified. Chest Cavity Organs Projection and Layers of Chest Pleura projection (Figure 1). Lower pleural margins go on the mid- clavicular line — along the 7th rib; on the anterior axillary line — along the 8th rib; on the midaxillary line — along the 10th rib; on the scapular line — along the 11th rib; on the paraspinal line — until the 12th tho- racic vertebra. Posterior margins correspond to costovertebral joints. The cervical pleura overhang the collar bone and correspond to the level of the spinous process of the 7th clervical vertebra posteriorly and anteriorly it is projected 2-3 cm above the collar bone. Lung projection (Figure 2). The anterior margin of the left lung starts from the 4th costal cartilage. Then, because of the cardiac notch, it slants to the left midclavicular line. The lower margins of the lungs correspond to the 6th costal cartilage on the right sternal line and on the left parasternal line: on the midclavicular line — to the upper mar- gin of the 7th rib; on the anterior axillary line — to the lower margin of the 7th rib; on the midaxillary line — to the 8th rib; on the scapular line — to the 10th rib, and on the parasinal line — to the 11th rib. The lung margin moves down in inhale. The lung apex is identified 3-4 cm above the collar bone. Thymus (Figures 3, 4) is located in the superior interpleural space. Superiorly it borders on the jugular notch of the sternum, above the level of the 2nd rib; on the sides — with the parietal pleura margins. Heart projection (Figure 5). Upper margin of the heart matches a horizontal line, drawn at the level of the 3rd costal cartilage insertion to the breast bone. The right margin is a line, connecting the upper edge The Chest 3 3 2 1 2 125 94 11 12 8 3 "he sintopia of the chest cavity organs is clearly visible onthe computer tomogram: the inferior vena cava (11) andthe esophagus (9) 0re located in front of backbone, to theright of which the aorta (4) is located, to which the heartwith the pericardium (8) are attached. m. 2 1 g 3 a r h p 2 Dia t. s 10 he c 1 e 1 h 5 9 1 gm; of t 74 86 1 – breastbone; 2 – parietal pleura; 3 – intercostal muscles; 4 – aorta; 5 – vertebral body;6 – costal part of diaphragm ; 7 – tendinous center of diaphra8 – pericardium;;9 – esophagus; 10 – costomediastinal sinus; 11 – inferior vena cava; 12 – ribs. e 1 Transverse section r u g i F