ANATOMY SERIES

THORAX, ABDOMEN, PELVIS AND PERINEUM

(THORACIC VISCERA)
This series is dedicated to explaining the multiple organs located in the thoracic, abdominal,
pelvic and perianal cavities, using an outline. This outline touches all the necessary criteria
needed for the proper evaluation of the gross anatomy of the various organs located in these
cavities.
 ORGANS IN THE THORAX
 Lungs
 Heart
 Thymus
 Esophagus
 Trachea

 ORGANS IN THE ABDOMEN

 Stomach
 Liver
 Pancreas
 Gall bladder
 Kidneys
 Adrenal glands
 Spleen
 Small Intestine
 Large Intestine
 Appendix
 Bladder
 Ureter

 ORGANS IN THE PELVIS

 Bladder
 Rectum
 Uterus
 Ovaries
 Prostate gland
 Urethra

 ORGANS IN THE PERINEUM

 Penis
  Scrotum
 Testis

The outline that will be used to discuss these organs listed above can be used to attempt
questions regarding these organs in the 2nd MBBS professional exams and in the various in-
courses taken in pre-clinical school and in health-allied courses. The outline is given below;
1. Introduction
2. Location
3. Size and dimensions
4. Surface markings
5. Parts (which includes surfaces etc.)
6. Relations or Boundaries
7. Functions
8. Blood supply
9. Venous drainage
10. Innervation
11. Lymphatic drainage
12. Embryology of the organ
13. Histology of the organ
14. Diagram
15. Clinical correlates
16. Conclusion
It is worthy to note that this outline is subject to change as some organs cannot be sufficiently
discussed using the outline, like the heart which has surfaces, chambers, sides etc.

THORACIC VISCERA
1. LUNGS
INTRODUCTION: The lungs are the vital organs of respiration. Their main function is to
oxygenate the blood by bringing inspired air into close relation with the venous blood in the
pulmonary capillaries. Healthy lungs in living people are normally light, soft, and spongy, and
fully occupy the pulmonary cavities. They are also elastic and recoil to approximately one third
their size when the thoracic cavity is opened. The Right and Left lungs are separated from each
other by the Mediastinum.
LOCATION: The lungs are located laterally to the mediastinum of the thoracic cavity, each lung
lies within its own side of the thoracic cavity and is surrounded by the visceral layer of the
pleural membrane.
SIZE AND DIMENSIONS: Each lung is conical and an adult lung weighs about 1.1-1.3 kg
combined. The lungs has about 4-6 liters in total lung capacity. The right lung is broader and
shorter, while the left lung is narrower and longer to accommodate the heart’s position. These
measurements can vary based on factors such as age, sex, and overall health.
SURFACES: The lungs have the following surfaces: Costal surface, Mediastinal surface and a
Diaphragmatic surface.
LOBES: The lungs have present on their surfaces special lines called FISSURES which divide
the lungs into separate lobes. These fissures are the OBLIQUE and HORIZONTAL FISSURES.
The Right Lung has two fissures, the OBLIQUE and HORIZONTAL fissure which divides it
into THREE LOBES. The Left lung on the other hand has the OBLIQUE fissure, which divides
it into TWO LOBES. (Useful mnemonic in remembering the lobes are R3 L2)
BORDERS: The lungs have three borders, an ANTERIOR BORDER, POSTERIOR BORDER
AND AN INFERIOR BORDER.
PARTS: The parts of the lung will be discussed thus
1. An apex, the blunt superior end of the lung ascending above the level of the 1st rib into
the root of the neck; the apex is covered by cervical pleura.
2. A base, the concave inferior surface of the lung, opposite the apex, resting on the dome of
the diaphragm
3. The hilum of the lung is a wedge-shaped area on the mediastinal surface of each lung
through which the structures forming the root of the lung pass to enter or exit the lung
4. The Lung Root, The lungs are attached to the mediastinum by the roots of the lungs—that
is, the bronchi (and associated bronchial vessels), pulmonary arteries, superior and
inferior pulmonary veins, the pulmonary plexuses of nerves (sympathetic,
parasympathetic, and visceral afferent fibers), and lymphatic vessels.
BRONCHOPULMONARY SEGMENTS: The bronchopulmonary segments are the anatomical
and functional units of the lungs, these units are also very important in surgery too. Each lobar
(secondary) bronchus, which passes to a lobe of the lung, gives off branches called segmental
(tertiary) bronchi. Each segmental bronchus passes to a structurally and functionally independent
unit of a lung lobe called a bronchopulmonary segment, which is bounded by connective tissue
walls. The main bronchopulmonary segments are as follows:
RIGHT LUNG:
 Superior lobe: Apical, posterior, anterior
 Middle lobe: Lateral, medial
 Inferior lobe: Superior (apical), medial basal, anterior basal, lateral basal, posterior basal
LEFT LUNG:
 Superior lobe: Apical, posterior, anterior, superior lingular, inferior lingular
 Inferior lobe: Superior (apical), medial basal, anterior basal, lateral basal, posterior basal

(There are 10 bronchopulmonary segments for each lung)

RELATIONS: The relations of the lungs are not limited to the relations listed below, there’s
always room for your own research.
1. Anterior Relations; Pleural membrane, ribs, anterior intercostal muscles and
neurovasculature, pectoral muscles, clavicle, _____
2. Posterior Relations; Pleural membrane, ribs, posterior intercostal muscles and
neurovasculature, scapula, ______
3. Medial relations; structures that forms the lung roots, the heart and its great vessels,
trachea, esophagus, ______
4. Inferior relations; diaphragm,______
FUNCTIONS: As stated earlier, the primary function of the lung is respiration.
BLOOD SUPPLY: The lung receives its arterial supply from two vessels: The Pulmonary artery
(which carries de-oxygenated blood to the lungs for oxygenation) and The Bronchial vessels
(which supply oxygenated blood to the lung tissue).
VENOUS DRAINAGE: The lung is drained by two vessels: The Pulmonary veins (which carry
oxygenated blood from the lungs to the heart) and The Bronchial veins (which carry
deoxygenated blood away from the lung tissue).
INNERVATION: The sympathetic and parasympathetic supply to the lungs comes from the
pulmonary plexus.
LYMPHATICS: Lymph from the lungs drain into the bronchopulmonary, or hilar, nodes in the
hilum of each lung, Efferent from bronchopulmonary nodes run to tracheobronchial nodes.
EMBRYOLOGY OF THE LUNGS: Each lung develops from a bud at the lower end of the
laryngotracheal tube that grows down from the floor of the primitive pharynx. These endodermal
buds form the epithelial part of the lung; the connective tissue, cartilage and muscle of the
bronchial tree are derived from the surrounding mesoderm. By the fifth month the lung has a
glandular appearance, with clumps of epithelial cells and hardly any recognizable lumina. The
cell groups proliferate, become canalized and lie adjacent to capillaries so that by the seventh
month there are sufficient alveoli to sustain a viable infant following premature birth at this time.
Surfactant begins to be secreted about the sixth month
HISTOLOGY OF THE LUNGS: Each alveolus has a very thin wall. The wall is lined by an
epithelium consisting mainly of flattened squamous cells. The epithelium rests on a basement
membrane. Deep to the basement membrane there is a layer of delicate connective tissue through
which pulmonary capillaries run. Studies have shown that the cells forming the lining epithelium
of alveoli (pneumocytes) are of various types. (1) the most numerous cells are the squamous cells
already referred to. They are called TYPE 1 ALVEOLAR EPITHELIAL CELLS. Except in the
region of the nucleus, these cells are reduced to a very thin layer (0.05 to 0.2 µm). The edges of
adjoining cells overlap and are united by tight junctions (preventing leakage of blood from
capillaries into the alveolar lumen). They form the lining of 90% of the alveolar surface. (2)
Scattered in the epithelial lining there are rounded secretory cells bearing microvilli on their free
surfaces. These are designated TYPE II ALVEOLAR EPITHELIAL CELLS. Their cytoplasm
contains secretory granules that appear to be made up of several layers (and are, therefore, called
multilamellar bodies). These cells are believed to produce a secretion that forms a film over the
alveolar epithelium. This film or PULMONARY SURFACTANT reduces surface tension and
prevents collapse of the alveolus during expiration. Surfactant contains phospholipids, proteins
and glycosaminoglycans produced in type II cells. (A similar fluid is believed to be produced by
the cells of Clara present in bronchial passages).
DIAGRAM:

CLINICAL CORRELATES:
1. Atelectasis: secondary atelectasis is the collapse of a previously inflated lung; primary
atelectasis refers to the failure of a lung to inflate at birth. Secondary atelectasis can be
caused by Bullet puncture through thoracic wall and parietal pleura, admitting air and
causing lung to collapse, thereby causing PULMONARY COLLAPSE.
2. Pneumothorax, Hydrothorax, and Hemothorax: Entry of air into the pleural cavity
(pneumothorax), The accumulation of a significant amount of fluid in the pleural cavity
(hydrothorax) may result from pleural effusion, With a chest wound, blood may also
enter the pleural cavity (hemothorax).
3. Pleuritis (Pleurisy): inflammation of the pleura, pleuritis (pleurisy), makes the lung
surfaces rough. The resulting friction (pleural rub) is detectable with a stethoscope. It
sounds like a clump of hairs being rolled between the fingers. The inflamed surfaces of
pleura may also cause the parietal and visceral layers of pleura to adhere.
4. Pulmonary Embolism: Obstruction of a pulmonary artery by a blood clot (embolus) is a
common cause of morbidity (sickness) and mortality (death). An embolus in a pulmonary
 artery forms when a blood clot, fat globule, or air bubble travels in the blood to the lungs
from a leg vein.
5. Pneumonia: The term pneumonia includes any inflammatory condition of the lung in
which some or all of the alveoli are filled with fluid and blood cells. A common type of
pneumonia is bacterial pneumonia, caused most frequently by pneumococci.
6. Chronic Pulmonary Emphysema: The term pulmonary emphysema literally means excess
air in the lungs. However, this term is usually used to describe complex obstructive and
destructive process of the lungs caused by many years of smoking.

HEART
INTRODUCTION: The heart, slightly larger than one’s loosely clenched fist, is a double, self-
adjusting suction and pressure pump, the parts of which work in unison to propel blood to all
parts of the body. The right side of the heart (right heart) receives poorly oxygenated (venous)
blood from the body through the SVC and IVC and pumps it through the pulmonary trunk and
arteries to the lungs for oxygenation. The left side of the heart (left heart) receives well-
oxygenated (arterial) blood from the lungs through the pulmonary veins and pumps it into the
aorta for distribution to the body.
SIZE AND DIMENSIONS: The heart, slightly larger than one’s loosely clenched fist, the heart
is somewhat pyramid shaped. Its long axis is about 12cm and its weight is about 300gram in
males and 250gram in female.
LOCATION: The heart is located in the middle mediastinum.
SURFACE MARKINGS: The heart is aligned obliquely within the thorax, with an apex (pointed
end) directed downward, forward, and to the left. About two thirds of the heart lies to the left of
the midline and one third to the right of the midline. The left ventricle forms the apex of the
heart. It lies at the level of the fifth left intercostal space, 3.5 in. (9 cm) from the midline. The
apex beat can usually be seen and palpated in the living patient.
PARTS/CHAMBERS: The heart is divided into two halves, physiologically called the RIGHT
and LEFT hearts. The heart is also divided into four chambers, a RIGHT and LEFT ATRIUM
and a RIGHT AND LEFT VENTRICLE.
SURFACES: The heart has three surfaces namely, an ANTERIOR OR STERNOCOSTAL
SURFACE, an INFERIOR OR DIAPHRAGMATIC SURFACE, and a POSTERIOR SURFACE
also referred as to the BASE.
The STERNOCOSTAL SURFACE is formed by the Right ventricle and Right atrium
The DIAPHRAGMATIC SURFACE is formed by the Right and Left Ventricles
The BASE is formed by the Left Atrium
BORDERS: The heart has the following borders; THE RIGHT BORDER consists entirely of the
right atrium. THE INFERIOR BORDER is made up mostly of right ventricle with a small
portion of left ventricle, which forms the APEX, at the junction of the inferior and left borders.
THE LEFT BORDER is mostly left ventricle, with the auricle of the left atrium forming the
uppermost part of this border. THE SUOERIOR BORDER, formed by the right and left atria and
auricles in an anterior view; the ascending aorta and pulmonary trunk emerge from this border
and the SVC enters its right side.
RELATIONS: The relations of the heart are not limited to the relations listed below, there’s
always room for your own research
1. Anterior Relations: remnants of the thymus gland, sternopericardial ligament, internal
mammary artery, anterior borders of the lungs and pleura, posterior part of the sternum,
costal cartilages of Ribs 2-6.
2. Posterior Relations: thoracic vertebra T1-T4, esophagus, azygos vein, thoracic duct,
descending thoracic aorta, inferior vena cava
3. Inferior Relations: diaphragm
4. Superior Relations: aorta, superior vena cava, pulmonary arteries
FUNCTIONS: Its major function is basically to propel blood throughout the body.
BLOOD SUPPLY: The heart receives arterial blood from the RIGHT and LEFT coronary
arteries and their branches
VENOUS DRAINAGE: The heart is drained by the cardiac veins listed below; The
CORONARY SINUS and its tributaries, The ANTERIOR CARDIAC VEINS and The VENAE
CORDIS MINIMAE.
INNERVATION: The heart gets its autonomic supply from the CARDIAC PLEXUS
LYMPHATICS: The lymphatics of the heart drain back along the coronary arteries, emerge from
the fibrous pericardium along with the aorta and pulmonary trunk, and empty into the
TRACHEOBRONCHIAL and BRACHIOCEPHALIC lymph nodes.
EMBRYOLOGY: The embryology of the heart involves several key stages;
1. Formation of heart tube, this stage begins around week 3 and it starts with the formation
of the primitive heart tube from mesodermal cells.
2. Formation of heart chambers, begins around week 4-5, here the heart tubes begins to
divide into four chambers; two atria and two ventricles.
3. Formation of septa, septa within the heart develop to separate the atria from the ventricles
and to separate the left and right sides of the heart.
4. Development of the Heart valves, valves within the heart develop to ensure one-way
blood flow
5. Formation of Coronary arteries which supply the musculature of the heart
6. Maturation and Finalization.
HISTOLOGY: There are three layers in the wall of the heart. (a) The innermost layer is called
the endocardium. It corresponds to the tunica intima of blood vessels. It consists of a layer of
endothelium that rests on a thin layer of delicate connective tissue. Outside this there is a thicker
subendocardial layer of connective tissue. (b) The main thickness of the wall of the heart is
formed by a thick layer of cardiac muscle. This is the myocardium. The structure of cardiac
muscle has already been described. It has been shown that atrial myocardial fibres secrete a
natriuretic hormone when they are excessively stretched (as in some diseases). The hormone
increases renal excretion of water, sodium and potassium. It inhibits the secretion of renin (by
the kidneys), and of aldosterone (by the adrenal glands) thus reducing blood pressure. (c) The
external surface of the myocardium is covered by the epicardium (or visceral layer of serous
pericardium). It consists of a layer of connective tissue that is covered, on the free surface, by a
layer of flattened mesothelial cells. The valves of the heart are folds of endocardium that enclose
a plate like layer of dense fibrous tissue.
DIAGRAM:

CLINICAL CORRELATES:
1. Septal Defects; ATRIAL SEPTAL DEFECTS A congenital anomaly of the interatrial
septum, usually incomplete closure of the oval foramen, is an atrial septal defect.
VENTRICULAR SEPTAL DEFECTS The membranous part of the IVS develops
separately from the muscular part and has a complex embryological origin.
Consequently, this part is the common site of ventricular septal defects (VSDs).
 2. Stroke or Cerebrovascular Accident; Thrombi (clots) form on the walls of the left atrium
in certain types of heart disease. If these thrombi detach, or pieces break off from them,
they pass into the systemic circulation and occlude peripheral arteries. Occlusion of an
artery supplying the brain results in a stroke or cerebrovascular accident (CVA), which
may affect vision, cognition, or the motor function of parts of the body previously
controlled by the now-damaged (ischemic) area of the brain.
3. Valvular Heart Disease Disorders involving the valves of the heart disturb the pumping
efficiency of the heart. These disorders produces either stenosis (narrowing) or
insufficiency. Stenosis is the failure of a valve to open fully, slowing blood flow from a
chamber. Insufficiency or regurgitation, on the other hand, is failure of the valve to close
completely, usually owing to nodule formation on (or scarring and contraction of) the
cusps so that the edges do not meet or align.
4. MYOCARDIAL INFARCTION With sudden occlusion of a major artery by an embolus
(G. embolus, plug), the region of myocardium supplied by the occluded vessel becomes
infarcted (rendered virtually bloodless) and undergoes necrosis (pathological tissue
death).
5. CORONARY ATHEROSCLEROSIS The atherosclerotic process, characterized by lipid
deposits in the intima (lining layer) of the coronary arteries, begins during early
adulthood and slowly results in stenosis of the Lumina of the arteries.
6. ANGINA PECTORIS; Pain that originates in the heart is called angina or angina pectoris
(L. angina, strangling pain + L. pectoris, of the chest). The pain is the result of ischemia
of the myocardium that falls short of inducing the cellular necrosis that defines infarction.

THYMUS
INTRODUCTION: The thymus, a primary lymphoid organ. The thymus may appear to be a
single organ, but in fact it consists of right and left lobes closely applied to each other for much
of their extent. It is usually most prominent in children, where it may extend from the level of the
fourth costal cartilages to the lower poles of the thyroid gland.
LOCATION: The Thymus is located in the anterior mediastinum.
SIZE AND DIMENSIONS: At birth the thymus weighs 10-15 g. The weight increases to 30-40
grams at puberty, it reaches its largest size relative to the size of the body in the newborn infant,
at which time it may extend up through the superior mediastinum in front of the great vessels
into the root of the neck.
PARTS: The thymus is a flattened, bilobed structure.
RELATIONS: In front of it lie the sternohyoid and sternothyroid muscles, the manubrium and
upper part of the body of the sternum and their adjacent costal cartilages. Behind it are the
pericardium, the arch of the aorta with its three large branches, the left brachiocephalic vein and
the trachea.
FUNCTIONS: It is the site for development of T (thymic) lymphocytes,
BLOOD SUPPLY: The inferior thyroid and internal thoracic arteries supply blood to the thymus.
VENOUS DRAINAGE: There are corresponding veins. Frequently a relatively large short
thymic vein is present.
INNERVATION: The autonomic supply to the thymus comes from the Thymic plexus.
LYMPHATICS: The lymphatic vessels of the thymus end in the parasternal, brachiocephalic,
and tracheobronchial lymph nodes.
EMBRYOLOGY: The epithelium of the thymus develops mainly from the endoderm of the third
branchial pouch. Some of the epithelial cells become the thymic (Hassall’s) corpuscles; others
form a network of epithelial reticular cells believed to be the source of thymic hormones
concerned with the differentiation of T lymphocytes. Connective tissue elements are derived
from surrounding mesoderm, but the original colonizing lymphocytes have migrated from the
bone marrow. The developing thymus descends from the neck into the mediastinum in front of
all the major contents. It doubles its weight rapidly after birth and then maintains that level
although the lymphoid content decreases with age, being replaced by fat and fibrous tissue.
However, the secretion of thymic hormones and its influence on lymphocytes that migrate to it
continue throughout life.
HISTOLOGY: The thymus consists of right and left lobes that are joined together by fibrous
tissue. Each lobe has a connective tissue capsule. Connective tissue septa passing inwards from
the capsule incompletely subdivide the lobe into a large number of lobules, Each lobule is about
2 mm in diameter. It has an outer cortex and an inner medulla. Both the cortex and medulla
contain cells of two distinct lineages as described below. The medulla of adjoining lobules is
continuous. In the cortex of each lobule of the thymus the reticulum formed by epithelial cells is
densely packed with lymphocytes, Apart from epithelial cells and lymphocytes the thymus
contains a fair number of macrophages, There are small rounded structures, known as corpuscles
of Hassal, present in the medulla of the thymus. Each corpuscle has a central core formed by
epithelial cells that have undergone degeneration.
DIAGRAM:
ESOPHAGUS
INTRODUCTION: The esophagus is a tubular structure, the esophagus descends into the
posterior mediastinum from the superior mediastinum, passing posterior to and to the right of the
arch of the aorta and posterior to the pericardium and left atrium. The esophagus constitutes the
primary posterior relationship of the base of the heart. It then deviates to the left and passes
through the esophageal hiatus in the diaphragm at the level of the T10 vertebra, anterior to the
aorta.
LOCATION: The Esophagus is located in the posterior mediastinum.
SIZE AND DIMENSIONS: The esophagus is a tubular structure about 10-in. (25-cm) long.
PARTS: The Esophagus can be divided into three parts namely; a CERVICAL PART (at the
level of C6 vertebra), a MEDIASTINAL PART (from T1-T10) and an INTRA-ABDOMINAL
PART (from T10-T11).
CONSTRICTIONS: The Esophagus has three constrictions namely;
1. At its beginning in the neck
2. At the point where it is crossed by the left main bronchus
3. At its lower end, where it passes through the diaphragm
RELATIONS: The relations of the thoracic part of the esophagus from above downward are as
follows:
 1. Anteriorly: The trachea and the left recurrent laryngeal nerve; the left principal bronchus,
which constricts it; and the pericardium, which separates the esophagus from the left
atrium.
2. Posteriorly: The bodies of the thoracic vertebrae, the thoracic duct, the azygos veins, the
right posterior intercostal arteries, and, at its lower end, the descending thoracic aorta.
3. Right side: The mediastinal pleura and the terminal part of the azygos vein.
4. Left side: The left subclavian artery, the aortic arch, the thoracic duct, and the mediastinal
pleura.
BLOOD SUPPLY: The upper esophagus is supplied by the inferior thyroid arteries, the middle
portion by esophageal branches from the aorta and by the bronchial arteries, and the lower part
by the esophageal branches of the left gastric artery.
VENOUS DRAINAGE: Venous return from the upper part is to the brachiocephalic veins, from
the middle part to the azygos system of veins, and from the lower reaches by esophageal
tributaries of the left gastric vein, which empties into the portal vein.
INNERVATION: The Esophagus is innervated primarily by the Vagus nerve (CN V). It receives
both sensory and motor fibers from the vagus nerve which controls peristalsis and initiates
swallowing reflexes.
LYMPHATICS: Lymph channels from the cervical esophagus drain to deep cervical nodes, from
the thoracic esophagus to the tracheobronchial and posterior mediastinal nodes, and from the
abdominal part to left gastric and coeliac node.
EMBRYOLOGY: The embryology of the esophagus will be discussed under the following
headings:
1. Developmental origin; the esophagus develops from the foregut around the 4th week of
gestation
2. Formation; initially, the foregut is a tube that extends from the pharynx to the stomach
region. As the development progresses, the esophagus separates from the trachea,
forming a distinct tube.
3. Structural changes; at approx.. week 4-5, the esophagus undergoes rapid growth and
elongation. By week 7, it starts to differentiates into different layers; mucosa, submucosa,
muscularis externa, adventitial layers.
4. Innervation and Vascularization; the esophagus becomes innervated by branches of the
vagus nerve, which plays a role in the sensory and motor functions of the esophagus.
5. Fetal Period; By the end of week 10-12, the esophagus is structurally and functionally
ready for peristalsis, although it continues to mature throughout the gestational period
and after birth.
HISTOLOGY; The esophagus is a tube, the wall of which has the usual four layers viz., mucous
membrane, submucosa, muscle layer and an external adventitia. The mucous membrane of the
esophagus shows several longitudinal folds that disappear when the tube is distended. The
mucosa is lined by stratified squamous epithelium, which is normally not keratinized. The only
special feature of the submucosa is the presence at some places of compound tubulo-alveolar
mucous glands. They are most frequently seen at the level of the bifurcation of the trachea. Small
aggregations of lymphoid tissue may be present in the submucosa, especially near the lower end.
Some plasma cells and macrophages are also present. The muscle layer consists of the usual
circular and longitudinal layers. However, it is unusual in that the muscle fibres are partly
striated and partly smooth, the circular muscle fibres present at the lower end of the esophagus
could possibly act as a sphincter guarding the cardiooesophageal junction.
DIAGRAM:

CLINICAL CORRELATES:
1. Esophageal hernia; Herniation of a part of the stomach upwards through the diaphragm
into thoracic cavity, there are two main types; a sliding hernia and a paraesophageal
hernia.
2. Gastroesophageal Reflux Disease (GERD)
3. Esophageal Cancer
4. Endoscopy; direct visualization of the esophagus to detect abnormalities and obtain
biopsies.
TRACHEA
INTRODUCTION: The trachea is a mobile cartilaginous and membranous tube which conveys
air in and out of the lungs. The trachea is the continuation of the larynx and commences in the
neck below the cricoid cartilage at the level of C6 vertebra, 5 cm above the jugular notch. U-
shaped bars (tracheal rings) of hyaline cartilage embedded in the tracheal wall support and
maintain the patency of the trachea. The trachealis muscle (a smooth muscle) connects the
posterior free ends of the cartilages. The posterior discontinuity permits the esophagus to expand
into the trachea during swallowing.
LOCATION: The trachea descends anterior to the esophagus and enters the superior
mediastinum.
SIZE AND DIMENSION: The trachea is about 10-12 cm long and 2 cm in diameter. In the first
year of life the tracheal diameter is only 3 mm and in childhood it is about equal in millimeters to
the age in years. In full inspiration the trachea may stretch to 15 cm and the bifurcation descend
to the level of T6 vertebra. The trachea has 16 to 20 incomplete hyaline cartilaginous rings that
open posteriorly toward the esophagus and prevent the trachea from collapsing.
PARTS: The trachea is divided into two parts, a CERVICAL PART and a MEDIASTINAL
PART specifically the superior mediastinum.
CONSTRICTIONS OF THE TRACHEA: The trachea is constricted at three points throughout
its course before its bifurcation, these points of constrictions are;
1. At its upper end by the thyroid gland
2. At the middle by the innominate artery
3. At the lower end by the arch of aorta
RELATIONS: Relations in the Neck
1. Anteriorly: The skin, fascia, isthmus of the thyroid gland (in front of the second, third,
and fourth rings), inferior thyroid vein, jugular arch, thyroidea ima artery (if present), and
left brachiocephalic vein in children, overlapped by the sternothyroid and sternohyoid
muscles.
2. Posteriorly: Right and left recurrent laryngeal nerves and the esophagus
3. Laterally: Lobes of the thyroid gland and the carotid sheath and contents
Relations in the Superior Mediastinum
1. Anteriorly: The sternum, the thymus, the left brachiocephalic vein, the origins of the
brachiocephalic and left common carotid arteries, and the arch of the aorta.
2. Posteriorly: The esophagus and the left recurrent laryngeal nerve.
3. Right side: The azygos vein, the right vagus nerve, and the pleura.
4. Left side: The arch of the aorta, the left common carotid and left subclavian arteries, the
left vagus and left phrenic nerves, and the pleura.
BLOOD SUPPLY: Branches from the inferior thyroid and bronchial arteries form anastomotic
networks in the tracheal wall.
VENOUS DRAINAGE: Veins drain to the inferior thyroid vein.
INNERVATION: The vagus and recurrent laryngeal nerves carry the sensory nerve supply.
Sympathetic nerves supply the trachealis muscle.
LYMPHATICS: The lymph drains into the pretracheal and paratracheal lymph nodes and the
deep cervical nodes.
EMBRYOLOGY: The trachea develops from the intermediate part of laryngotracheal tube that
lies between the points of its bifurcation into bronchial or lung buds and the larynx. With the
caudocranial extension of tracheoesophageal septum, the trachea elongates. At birth the
bifurcation of trachea lies at the level of lower border of 4th thoracic vertebra.
• Developmental components of trachea: – The endoderm of laryngotracheal diverticulum forms
the lining epithelium and glands of trachea. – The cartilage, muscle, and connective tissue of
trachea develop from splanchnopleuric mesoderm surrounding laryngotracheal tube.
HISTOLOGY: The skeletal basis of the trachea is made up of 16 to 20 tracheal cartilages. Each
of these is a C-shaped mass of hyaline cartilage. The open end of the ‘C’ is directed posteriorly.
Occasionally, adjoining cartilages may partly fuse with each other or may have Y-shaped ends.
The lumen of the trachea is lined by mucous membrane that consists of a lining epithelium and
an underlying layer of connective tissue. The lining epithelium is pseudostratified ciliated
columnar. It contains numerous goblet cells, and basal cells that lie next to the basement
membrane.
DIAGRAM:
CLINICAL CORRELATES:
1. Chronic obstructive pulmonary disease (COPD) is a group of lung diseases associated
with chronic obstruction of airflow through the airways and lungs. It consists of chronic
bronchitis and emphysema, which are the most common forms and is caused primarily by
cigarette smoking.
2. Chronic bronchitis is an inflammation of the airways, which results in excessive mucus
production which plugs up the airways, causing a cough and breathing difficulty.
3. Asthma is a chronic inflammation of the bronchi that causes swelling and narrowing
(constriction) of the airways.

References:
 Keite Moore Clinical Anatomy
 Last’s Anatomy
 Anatomy of the thorax by Dr. Sameh Doss
 Indebir Singh’s Histology
 Indebir Singh’s Embryology
 Frank Netter’s Atlas of Human Anatomy
 Snell’s Clinical Anatomy
 BRS Gross Anatomy

COMPILED BY:
ONYECHERE IKECHUKWU .V