Rib cage

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Bones of the thorax
Clearly visible thorax in a youth gymnast on the rings .

The thorax or thorax ( ancient Greek θώραξ , breastplate ' , plural thoraces ) of vertebrates is a section of the trunk in anatomy . The wall of the thorax is formed by the thoracic spine , sternum and ribs (bony thorax) as well as muscles . It encloses the thoracic cavity ( Cavum thoracis ) and, due to the dome shape of the diaphragm , also the upper (in animals, front) part of the abdominal cavity . The respiratory muscles attached to the outside and inside of the thorax enable breathing in terrestrial vertebrates .

anatomy

In humans, the sternum angle ( angulus sterni ) is at the level of the 2nd rib. The cartilaginous tip of the 11th rib can be felt laterally, that of the 12th rib behind. The lower angle ( angulus inferior ) of the shoulder blade ( scapula ) is at the level of the 7th rib and the 7th intercostal space .

Inside the rib cage ( intrathoracic ) is the chest cavity . It is divided into two pleural cavities by a septum ( mediastinum ) . In the mediastinum are the heart , the thymus , large blood vessels (chest part of the aorta , vena cava , pulmonary vessels), trachea and esophagus , various nerves ( phrenic nerve , vagus nerve , trunk ), lymph nodes , the dexter lymphatic duct and thoracic duct . The lungs lie to the side of the mediastinum . Due to the curvature of the diaphragmatic dome , some organs of the upper abdomen are also still within the thorax (“intrathoracic”).

Clinical Aspects

Normal finding of an M-mode of the thorax: Seashore sign

The inside of the chest is examined by percussion , chest x-ray and other imaging techniques or thoracoscopy .

Injuries to the chest lead to hemothorax (accumulation of blood), pneumothorax (accumulation of air), tension pneumothorax, or chylothorax (accumulation of lymph). Severe compression of the chest can lead to traumatic asphyxia . It is difficult to differentiate between chest pain that is not caused by heart disease and real angina pectoris . The suction of fluids from the thorax is called thoracentesis .

To malformations of the thorax include vertically extending input or protuberances ( Kiel breast , funnel chest ), transverse constrictions ( bell thorax , Harrison-groove ), and chest asymmetries, such as a rib hump in scoliosis or twists of the breastbone ( expectation stone deformity ). An incomplete closure of the thorax in the embryo is called a thoracoshisis .

The term chest fever , which can be found in older documents as the cause of death, describes various febrile diseases of the thoracic organs, such as pneumonia and pleurisy .

Thoracic surgery

The thoracic surgery ( chest surgery ) includes the prevention and diagnosis , including the instrumental investigation procedures and post-operative treatment of surgical diseases and malformations of the lung , the pleura , the bronchial system , of the mediastinum and the chest wall, especially in the context of tumor treatment . She used to deal with the now independent field of cardiac surgery . It is mostly performed as a thoracotomy , i.e. with opening of the thorax, which could be used more frequently with the invention of Sauerbruch in 1904 (a vacuum chamber in which the patient and surgeon were while the patient's head was ventilated outside the chamber). Video-assisted minimally invasive surgical techniques such as thoracoscopy are becoming more and more important : they enable minimal skin incisions, which result in significantly reduced surgical trauma compared to open operations.

Chest drains

As a chest tube , a hose or will cannula denotes that establishes a connection from the inside of the rib cage to the exterior of the body. The drainage of pleural empyema has been known since ancient times . In 1856 the Hamburg pediatrician Gotthard Bülau introduced negative pressure drainage for the treatment of tubercular empyema. This Bülau drainage made a decisive contribution to avoiding postoperative complications in all thoracic opening operations. The term thoracic drainage includes mediastinal drainage, pleural drainage and pericardial drainage. As a rule, these drainages open into collecting vessels that are connected to a suction device, a surge tank or a Heimlich valve. The size varies according to type and function up to 36 charrière .

literature

  • Heinz Pichlmaier , Friedrich Wilhelm Schildberg: Thoracic surgery - the interventions on the chest and in the chest cavity . Springer, Berlin / Heidelberg 2005.
  • Claus Engelmann: The long way to thoracic surgery . Lengerich 2008.
  • Rosa Böttger, Sönke von Weihe, Margret Liehn, Masaki Nakashima: Thoracic surgery. In: Margret Liehn, Brigitte Lengersdorf, Lutz Steinmüller, Rüdiger Döhler : OP manual. Basics, instruments, surgical procedure. 6th, updated and expanded edition. Springer, Berlin / Heidelberg / New York 2016, ISBN 978-3-662-49280-2 , pp. 329-348.

Web links

Commons : Thoraces  - collection of images, videos and audio files
Wiktionary: thorax  - explanations of meanings, word origins, synonyms, translations

Individual evidence

  1. ↑ Marcus Schiltenwolf, Dierk F. Hollo: Assessment of the postural and locomotor organs . Founded by Gerhard Rompe and Arnold Erlenkämper. Thieme, 2013, ISBN 978-3-13-167446-3 , p. 433.
  2. ↑ Chest fever . In: Meyers Konversations-Lexikon . 4th edition. Volume 3, Verlag des Bibliographisches Institut, Leipzig / Vienna 1885–1892, p. 531.
  3. ↑ R. Zenker : Sauerbruch and the development of thoracic surgery. In: Münchner medical Wochenschrift. Volume 117, 1975, pp. 1815-1818.
  4. ↑ Ernst Kern : Seeing - Thinking - Acting of a surgeon in the 20th century. ecomed, Landsberg am Lech 2000, ISBN 3-609-20149-5 , p. 164.
  5. ↑ Christoph Weißer: Thorax surgery. In: Werner E. Gerabek , Bernhard D. Haage, Gundolf Keil , Wolfgang Wegner (eds.): Enzyklopädie Medizingeschichte. De Gruyter, Berlin / New York 2005, ISBN 3-11-015714-4 , p. 1397.
  6. ↑ Ernst Kern : Seeing - Thinking - Acting of a surgeon in the 20th century. ecomed, Landsberg am Lech 2000, ISBN 3-609-20149-5 , p. 165.