Atlas of Sectional Anatomy Understanding the Anatomical
Aspects of the Thorax, Abdomen and Pelvis
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Acknowledgments
The authors would like to thank the National Council for Scientific and Technological
Development (CNPq–Brazil), Coordination of Improvement of Higher Education
Personnel (CAPES-Brazil), and the Rio de Janeiro State Research Foundation
(FAPERJ) for the Urogenital Research Unit Support.
vii
Contents
1 Sectional Anatomy of the Thorax ������������������������������������������������������������ 1
Luciano Alves Favorito and Natasha T. Logsdon
2 Sectional Anatomy of the Abdomen �������������������������������������������������������� 19
Luciano Alves Favorito and Natasha T. Logsdon
3 Sectional Anatomy of the Retroperitoneum�������������������������������������������� 43
Luciano Alves Favorito, Natasha T. Logsdon, and Francisco
J. B. Sampaio
4 Sectional Anatomy of the Male Pelvis������������������������������������������������������ 61
Luciano Alves Favorito, Natasha T. Logsdon, and Francisco
J. B. Sampaio
5 Sectional Anatomy of the Female Pelvis�������������������������������������������������� 79
Luciano Alves Favorito, Natasha T. Logsdon, and Francisco
J. B. Sampaio
Index���������������������������������������������������������������������������������������������������������������������� 95
ix
Contributors
Luciano Alves Favorito, MD, PhD Urogenital Research Unit, Rio de Janeiro
State University, Rio de Janeiro, RJ, Brazil
IDOMED-UNESA, Rio de Janeiro, RJ, Brazil
The National Council for Scientific and Technological Development (CNPq), Lago
Sul, Federal District, Brazil
The Rio de Janeiro State Research Foundation (FAPERJ), Rio de Janeiro, RJ, Brazil
Natasha T. Logsdon, MSc, PhD University Center Geraldo di Biasi, Rio de
Janeiro, RJ, Brazil
Urogenital Research Unit, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil
Francisco J. B. Sampaio, MD, PhD Urogenital Research Unit, Rio de Janeiro
State University, Rio de Janeiro, RJ, Brazil
The National Council for Scientific and Technological Development (CNPq), Lago
Sul, Federal District, Brazil
The Rio de Janeiro State Research Foundation (FAPERJ), Rio de Janeiro, RJ, Brazil
xi
Abbreviations
B Bladder
CMR Cardiovascular magnetic resonance
CT Computed tomography
D Duodenum
H Heart
IO Internal obturator muscle
L Liver
LAM Levator anus muscle
LK Left Kidney
LL Left lung
LV Lumbar vertebra
LT Left Testis
MRI Magnetic resonance images
P Pancreas
PI-RADS Prostate Imaging Reporting and Data System
PM Psoas muscle
RL Right lung
RK Right kidney
RT Right testis
S Spleen
SI Small intestine
SVC Superior vein cava
T Trachea
TV Thoracic vertebra
VS Seminal vesicle
xiii
Chapter 1
Sectional Anatomy of the Thorax
Luciano Alves Favorito and Natasha T. Logsdon
1.1 Introduction
The thoracic cavity is divided into the mediastinum and two pleuropulmonary
regions. In this chapter, we will make a brief anatomical description of the organs of
the thoracic cavity, and we will show a sequence of transverse cuts of the thoracic
cavity demonstrating the relationships between the viscera.
1.2 Mediastinum
The mediastinum is located in the thoracic cavity, being the space between the two
pleuropulmonary spaces. It has a large amount of loose connective tissue that sur-
rounds its elements and supports them. With advancing age, this connective tissue
becomes more rigid, and the viscera of the mediastinum tend to show less mobility
(Netter 1978; Williams et al. 1995).
The limits of the mediastinum are as follows: (1) uppermost—upper opening of
the chest, formed by the first two ribs, the manubrium of the sternum and the first
thoracic vertebrae; (2) inferior—diaphragm muscle; (3) posterior—thoracic spine;
L. A. Favorito (*)
Urogenital Research Unit, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil
IDOMED-UNESA, Rio de Janeiro, RJ, Brazil
The National Council for Scientific and Technological Development (CNPq), Lago Sul,
Federal District, Brazil
The Rio de Janeiro State Research Foundation (FAPERJ), Rio de Janeiro, RJ, Brazil
N. T. Logsdon
University Center Geraldo di Biasi, Rio de Janeiro, RJ, Brazil
Urogenital Research Unit, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil
© The Author(s), under exclusive license to Springer Nature 1
Switzerland AG 2022
L. A. Favorito, N. T. Logsdon (eds.), Atlas of Sectional Anatomy,
https://doi.org/10.1007/978-3-030-91688-6_1
2 L. A. Favorito and N. T. Logsdon
(4) anterior—posterior surface of the sternum; and (5) lateral—parietal pleura
(Testut and Jacob 1926; Williams et al. 1995).
Several diseases (especially tumors and cysts) affect the mediastinum in charac-
teristic locations. Its classic division, in regions, is proposed to facilitate the study
of these diseases that affect the mediastinal organs. We can divide the mediastinum
into four major regions: upper, anterior, middle, and posterior (Netter 1978).
The upper mediastinum is separated from the other portions by an imaginary line
that extends from the sternal angle to the level of the intervertebral disc between the
fourth and fifth thoracic vertebrae (Fig. 1.1). This imaginary line passes at the bifur-
cation of the trachea (called carina), which can also be used as an anatomical point
for the division of the mediastinum (Testut and Jacob 1926; Bergman et al. 1988).
The lower part of the mediastinum is divided into three additional portions, using
the following parameters: (1) anterior mediastinum—located between the posterior
surface of the sternum, anteriorly, and the pericardium, posteriorly; (2) medium
mediastinum—located between the two layers of the pericardium; and (3) posterior
mediastinum—located between the pericardium, anteriorly, and the spine, posteri-
orly (Fig. 1.1).
The upper mediastinum contains the esophagus and trachea (posteriorly), the
thymus or its remnant (anteriorly), and, in an intermediate position, the great vessels
related to the thoracic sympathetic nervous chain of the heart, in addition to the
vagus and phrenic nerves (Williams et al. 1995). Several diseases can affect this
region of the mediastinum. The most frequent are thymomas, teratomas, plunging
goiters (growths of the thyroid gland that reach the chest), adenomegalies, aneu-
rysms, and neurogenic tumors (Nakazono et al. 2019).
The anterior mediastinum has thymus and fatty tissue as its main components
(Fig. 1.2). In adults, the thymus and its remnants occupy, preferably, the upper por-
tion of the mediastinum. The main tumors that affect this region are thymomas,
lipomas, and teratomas. More rarely, the plunging goiter can reach this location.
The main components of the middle mediastinum are the heart and the immedi-
ately adjacent portions of the vessels of the base (Fig. 1.3). Knowledge of cardiac
anatomy is very important to radiological image interpretation. Current cardiovas-
cular magnetic resonance (CMR) examinations require expert planning, multiple
breath holds, and 2D imaging (Moghari et al. 2020). We must emphasize that when
analyzing the sectional images, we must take into account the difference in thick-
ness between the right and left ventricles; as we can see in Figs. 1.3 and 1.4, the left
ventricle is approximately the triple in thickness of the right ventricle. The main
diseases that can affect this region are pericardial cysts, cardiac tumors, broncho-
genic cysts, adenomegalies, teratomas, and lymphangiomas (Nakazono et al. 2019).
In the posterior mediastinum, the esophagus, the descending aorta, the azygos
veins, the thoracic duct, lymph nodes, and the thoracic sympathetic chain are
located. The commonest termination height of the azygos vein in the superior vein
cava (SVC) is at the level of the fifth thoracic vertebrae. The anatomy of the azygos
system is of very importance as a predictor for higher values of SVC diameter and
mediastinum pathology. Such findings can be useful in mediastinal surgery and
mediastinoscopy (Koutsoufianiotis et al. 2021). The main conditions that affect this
region are aneurysms, esophageal lesions, bronchogenic cysts, neurogenic tumors,
adenomegaly, pheochromocytoma, hiatus hernia, and spinal injuries (Fig. 1.5).
1 Sectional Anatomy of the Thorax 3
a b
c d
Fig. 1.1 Mediastinum. (a) Schematic drawing showing the thoracic cavity and the division of the
mediastinum into two compartments by the imaginary line (--------) between the manubrium-
sternal junction and the intervertebral body of the fourth thoracic vertebra in superior and inferior
mediastinum; 1, esophagus; 2, thoracic aorta artery; 3, sternum; 4, imaginary line that divides the
mediastinum; 5, trachea; 6, left main bronchus; 7, left pulmonary artery; 8, left pulmonary vein. (b)
The figure shows a frontal section in a human frozen fetus in the third gestational trimester showing
the relationship between the mediastinum (M) and the right (RL) and left (LL) lungs. (c) The figure
shows a sagital section of a frozen fresh corpus; we can observe the relationship of the heart (3)
with the anterior mediastinal space (1), the lung (4), diaphragm (D), and with the basal vessels (2);
E, sternum. (d) The figure shows an inferior view of a transverse section of a frozen fresh corpus,
at the level of the fourth thoracic vertebra (TV); we can observe some structures of the mediasti-
num and the relationships with the lungs (RL, right lung; LL, left lung); 1, thoracic aorta artery; 2,
esophagus; 3, right pulmonary hilum; 4, left pulmonary hilum; 5, ascending aorta artery
4 L. A. Favorito and N. T. Logsdon
a b
Fig. 1.2 Anterior mediastinum. (a) The figure shows the anterior mediastinum of a fixed human
fetus in the second gestational trimester; we can observe the timus (T) and the relationships
between the heart (H) with the diaphragm (D) and the lungs (RL, right lung; LL, left lung). (b) The
figure shows the anterior mediastinum of a fixed human fetus in the second gestational trimester;
we can observe the timus (T), the pericardium (1), the ascending aorta artery (2), and the tireoid
glans (3); RL, right lung; LL, left lung
1.3 Mediastinal Lymph Nodes
Mediastinal lymph nodes can be divided into four main groups: anterior mediasti-
nal, posterior mediastinal, tracheobronchial, and paratracheal (Williams et al. 1995)
(Fig. 1.6). Knowledge of their disposition is important due to the diseases that affect
them, especially lung cancer.
The posterior mediastinal lymph nodes are located along the esophagus and are
responsible for the lymphatic drainage of the intercostal spaces and the parietal
pleura. Tracheobronchial lymph nodes are located around the bifurcation of the
trachea and along the main bronchi, being divided into the right and left and sub-
carinal tracheobronchial groups. Subcarinal lymph nodes are of diagnostic impor-
tance during the performance of mediastinoscopy and thoracic organ surgeries
(Fujiwara et al. 2019). Paratracheal lymph nodes, located along either side of the
trachea, drain into the lymph ducts (right and thoracic) and lower cervical lymph
nodes (Netter 1978).
1 Sectional Anatomy of the Thorax 5
a c
Fig. 1.3 Medium mediastinum. (a) Schematic drawing of a frontal section of the thoracic cavity
showing some important structures of the medium mediastinum; 1, left ventricle; 2, right atrium;
3, ascending aorta artery; RL, right lung; LL, left lung. (b) The figure shows an inferior view of a
transverse section of a frozen fresh corpus, at the level of the sixth thoracic vertebra (TV); we can
observe some structures of the mediastinum and the relationships with the lungs (RL, right lung;
LL, left lung); 1, esophagus; 2, thoracic aorta artery; 3, left ventricle; 4, right ventricle; 5, ascend-
ing aorta artery; 6, pulmonary artery. (c) The figure shows a thoracic computerized tomography in
the frontal section; we can observe the left ventricle (1), the right atrium (2), and the ascending
aorta artery (3)
1.4 Pleura and Lungs
1.4.1 Pleura
Pleura is a serous membrane that folds back onto itself to form a two-layered struc-
ture that lines the lungs and the inner face of the chest wall. The pleura that sur-
rounds the lungs is called the visceral pleura, and the pleura that is in contact with
the chest wall is called the parietal pleura. The two layers are separated by the
(virtual) pleural cavity, which is filled with a small amount of pleural fluid. This
liquid is essential for sliding between the pleurae and also to prevent the lungs from
moving away from the chest wall (Williams et al. 1995).
6 L. A. Favorito and N. T. Logsdon
a b
c d
Fig. 1.4 Medium and posterior mediastinum. (a) Schematic drawing of a superior view of a trans-
verse section of the thoracic cavity at the level of the sixth thoracic vertebra. We can observe the
esophagus (1), the thoracic aorta artery (2), and the relationships between the left ventricle (3) and
the right ventricle (4) with the lungs (RL, right lung; LL, left lung). (b) The figure shows a thoracic
computerized tomography in a transverse section of the thoracic cavity at the level of the sixth
thoracic vertebra; we can observe the heart (H) and the lungs (RL, right lung; LL, left lung). (c)
The figure shows a superior view of a transverse section of the thoracic cavity at the level of the
eighth thoracic vertebra. We can observe the esophagus (1), the thoracic aorta artery (2), and the
relationships between the heart (H) with the lungs (RL, right lung; LL, left lung). (d) In this figure,
we can observe the posterior view of thoracic viscera of a human fetus in the second gestational
trimester; E, esophagus; LL, left lung; RL, right lung
The visceral pleura follows the divisions of the lungs into lobes, forming pulmo-
nary fissures, and also penetrates the lung parenchyma, dividing the lobes into pul-
monary segments. There is no cleavage plane between the visceral pleura and the
lung tissue itself. The parietal pleura is separated from the structures of the chest
wall by a small amount of connective tissue called endothoracic fascia, and thus the
parietal pleura can be easily removed from the chest wall (Netter 1978).
There are four divisions for the parietal pleura according to the area it covers: (1)
costal pleura, which lines the ribs and costal cartilages; (2) diaphragmatic pleura,
which covers the diaphragm; (3) mediastinal pleura, which is in contact with the
mediastinal viscera; and (4) dome of pleura, which lines the pulmonary apex
(Mouchova et al. 2018) (Fig. 1.7).
1 Sectional Anatomy of the Thorax 7
a c
Fig. 1.5 Heart in medium mediastinum. (a) The figure shows an inferior view of a transverse sec-
tion of a frozen fresh fetus in the third gestational trimester at the level of the seventh thoracic
vertebra (TV); we can observe the relationships between the heart with the lungs (RL, right lung;
LL, left lung). (b) The figure shows a thoracic computerized tomography in a transverse section;
we can observe the heart (H), left lung (LL), right lung (RL), right pulmonary artery (1), left pul-
monary artery (2), and the thoracic aorta artery (3). (c) The figure shows a thoracic computerized
tomography in a transverse section; we can observe the heart (H), left lung (LL), right lung (RL),
and the thoracic aorta artery (A)
The two pleural membranes are continuous in the pulmonary hilum through a
pleura cuff that surrounds the structures that enter and leave the lung. Below the root
of the lung, the two sides come into contact forming the pulmonary ligament
(Williams et al. 1995).
During resting breathing, the expansion of the lungs is not sufficient to fill the
entire pleural space. In this way, they form slit-shaped spaces called pleural recesses.
There are two pleural recesses: costodiaphragmatic and costomediastinal. The cos-
todiaphragmatic recess is formed between the costal pleura and the diaphragmatic
pleura, which are separated only by a capillary layer of pleural fluid. The lower
edges of the lungs occupy this space during inhalation; however, on exhalation, the
lower edges rise and again allow contact between the two pleural divisions (Fig. 1.8).
The same phenomenon is observed in the anterior edges of the lungs that slide in
and out of the costomediastinal recesses, during inhalation and exhalation.
8 L. A. Favorito and N. T. Logsdon
Fig. 1.6 Mediastinal lymph nodes. The figure shows a schematic drawing showing the mediasti-
nal lymph nodes distribution. 1, subcarinal lymph nodes; 2, tracheobronchial lymph nodes; 3,
paratracheal lymph nodes; 4, right lymphatic duct; 5, thoracic duct
1.4.2 Lungs
The lungs are conical organs and occupy the lateral regions of the chest cavity from
the upper opening of the chest to the diaphragm. However, they are very elastic and
reduce their volume to a third or less after opening the chest. They are separated by
mediastinal organs such as the trachea, esophagus, heart and major blood vessels
(Fig. 1.9).
Each lung has a rounded apex that protrudes into the neck by about 3 cm above
the middle part of the clavicle, has a concave base that rests on the diaphragm, and
has three faces (costal, diaphragmatic, and mediastinal), which are separated by the
anterior margin (separates the mediastinal face from the costal surface anteriorly),
posterior margin (separates the mediastinal faces from the costal posteriorly), and
inferior margin (separates the diaphragmatic and costal surfaces) (Netter 1978)
(Fig. 1.9).
The costal face is large, convex, and related to the costal pleura. The costal face
is separated from the ribs, costal cartilages, and intercostal spaces by the costal
pleura. The diaphragmatic face is concave and forms the pulmonary base. This con-
cavity is more pronounced in the right lung compared to the left one due to the
higher position of the diaphragm on the right because of the liver. The mediastinal
face is related to the mediastinal organs, and it is also concave. This concavity is
more pronounced on the left, as the heart is shifted two-thirds to the left.
1 Sectional Anatomy of the Thorax 9
a c
Fig. 1.7 Pleura and pulmonary apex. (a) Schematic drawing showing the pleura (1 and all red
line) distribution in the thoracic cavity; D, diaphragm; T, trachea; RL, right lung; LL, left lung. (b)
The figure shows a frontal section of a frozen human fetus in the second gestational trimester; we
can oberve the relationships of the mediastinum (M) with the lungs (RL, right lung; LL, left lung).
(c) Frontal section of a human frozen corpus showing the relationships of the right pulmonary
apex; RL, right lung; H, pulmonary hilum
Approximately in the middle of this face is the pulmonary hilum, which is the
region where bronchi, vessels, and nerves enter and leave the lung, forming the
pulmonary root (Netter 1978; Williams et al. 1995).
The right lung is shorter than the left due to the elevation of the diaphragm. It is
also wider as a consequence of the displacement of the heart to the left. Thus, the
right lung is heavier, and its total capacity is greater. It has two fissures: horizontal
and oblique, and they separate into three lobes (superior, middle, and inferior). The
horizontal fissure separates the superior lobe from the middle lobe, and the oblique
fissure separates the inferior lobe from the middle and superior lobes. The middle
10 L. A. Favorito and N. T. Logsdon
a b
c d
Fig. 1.8 Mediastinum and lungs. (a) The figure shows a frontal section of a frozen human fetus in
the second gestational trimester; we can oberve the relationships of the mediastinum (M) with the
lungs (RL, right lung; LL, left lung). (b) The figure shows a thoracic computerized tomography in
frontal section; we can observe the heart (H), the right lung (RL), the left lung (LL), and the liver.
(c) The figure shows a posterior frontal section of a frozen human fetus in the second gestational
trimester; we can oberve the lungs (RL, right lung; LL, left lung), the right suprarenal gland (1),
the diaphragm (2), and the left kidney (3). (d) The figure shows an inferior view of a transverse
section of a frozen fresh corpus at the level of the ninth thoracic vertebra (TV); we can observe the
heart (H), the lungs (RL, right lung; LL, left lung), and the liver (L)
lobe is wedge-shaped, as it is limited superiorly by the horizontal fissure that is at
the level of the fourth costal cartilage and bumps into the oblique fissure in the
midaxillary line (Williams et al. 1995).
The left lung has only the oblique fissure, which separates into two lobes: supe-
rior and inferior. The lower part of the superior lobe forms an extension between the
oblique fissure and the cardiac notch, which is called the lingula, that corresponds
to the middle lobe of the right lung.
1 Sectional Anatomy of the Thorax 11
a b
Fig. 1.9 Lungs. (a) Frontal section of a human frozen corpus showing the relationships of the left
lung (LL) with the diaphragm (D); we can also observe the costophrenic recess (1). (b) The figure
shows a transverse section of the thoracic cavity of a frozen corpus at the level of the fourth tho-
racic vertebra (TV); we can observe the left lung (LL), the aortic arch (2), the trachea (2), and the
esophagus (3)
1.4.2.1 Bronchopulmonary Segments
Each lobe is divided internally into smaller parts called bronchopulmonary seg-
ments. The lung is formed by the union of all bronchial branches; thus, the broncho-
pulmonary segment is the portion of the lung where a particular bronchus is
distributed. The pulmonary segments are the anatomical, functional, and surgical
units of the lungs. They are formed by the bronchial tree that begins in the trachea
that divides into two main (pulmonary) bronchi. These are divided into three sec-
ondary (lobar) bronchi on the right and two on the left, each one for a lobe of the
lungs. Finally, the secondary bronchi are divided into tertiary (segmental) bronchi
for the pulmonary segments. Knowledge of the lung segment system is essential for
understanding human anatomy and has great clinical relevance (Netter 1978). The
distribution of the end-branch generation among the five lobes is significantly dif-
ferent. The median branching generation value in the right middle lobe is signifi-
cantly low compared with that of the other four lobes, whereas that of the right
inferior lobe is significantly larger than that of both the right and left superior lobes
(Cai et al. 2020; Fujii et al. 2020).
12 L. A. Favorito and N. T. Logsdon
A bronchopulmonary segment is the largest division of the pulmonary lobe. It
has a pyramidal shape, with the apex pointing to the pulmonary root and the base
facing the costal surface, and it is separated from adjacent segments by septa of con-
nective tissue. It has its own supply through a tertiary bronchus and a segmental
artery, which is a tertiary branch of the pulmonary artery and can be surgically
removed without affecting the anatomy of nearby segments. The drainage of the
bronchopulmonary segment is made by intersegmental veins that drain through the
connective tissue that separates one segment from the other. Thus, venous drainage
does not respect segmentation, as a vein drains adjacent segments (Netter 1978).
Each tertiary bronchus divides into approximately 20 terminal bronchioles that
branch into respiratory bronchioles. These, again, are divided into alveolar ducts,
which end in the pulmonary alveoli. The alveolus is the structural unit where the gas
exchange takes place.
The bronchopulmonary segments are named according to their position in the
lobes. The superior lobe of the right lung has three segments: one apical, one poste-
rior, and one anterior. The right middle lobe has two segments: the lateral and the
medial. The inferior lobe of the right lung has five segments: the upper segment and
four basilar segments (the medial, anterior, lateral, and posterior basilar segments).
The left lung has two segments in the upper part of the superior lobe, the apico-
posterior and the anterior, and in the lingula two more segments called the superior
lingular and the inferior lingular segments. In the inferior lobe of the left lung, there
are the upper segment and three basilar segments, the anteromedial basal, the lateral
basal, and the posterior basal (Williams et al. 1995).
Arterial irrigation of the lungs is done by the pulmonary arteries that take blood
(venous) to be oxygenated and by the bronchial arteries that irrigate with nonrespi-
ratory parts such as the larger caliber bronchi and the pulmonary support tissue with
oxygenated blood. The pulmonary arteries are branches of the pulmonary trunk that
branch into two pulmonary arteries, one pulmonary artery for each lung, that enter
the pulmonary hiluses and branch out following the division of the bronchi (Saha
and Srimani 2019). The left bronchial arteries are branches of the thoracic aorta, and
those on the right are branches of the upper posterior intercostal arteries or a left
upper bronchial artery (Williams et al. 1995).
The pulmonary veins, two for each lung, drain (arterial) blood from the lungs to
the heart. Venous drainage begins in the pulmonary capillaries, with the joining of
smaller veins that drain in the intersegmental septa to larger veins. The venous
drainage is of the intersegmental type and does not accompany the arterial or bron-
chial branching. An intersegmental vein drains adjacent segments.
Pulmonary lymphatic drainage is performed by deep lymphatic vessels and
superficial lymphatic drainage by subpleural vessels. Superficial drainage is
launched in the deep vessels that accompany the bronchi and pulmonary vessels,
towards the pulmonary hilum. The final route is made to the tracheobronchial lymph
nodes on the same side. Sometimes the inferior lobe of the left lung drains into the
lower tracheobronchial lymph nodes on the opposite side (Fig. 1.7).
In Figs. 1.10, 1.11, 1.12, and 1.13, we show a sequence of sectional sections of
the chest showing the main structures that can be visualized.
