Preoperative considerations on the thorax: Anatomy and surgical landmarks

The thoracic wall is the higher part of the thorax consisting of a musculoskeletal structure including the mediastinum, the pleuropulmonary cavities, viscera, lymphatic, vascular, and nervous structures. Its dimensions are influenced by age, gender, and life style including physical training. It changes constantly in shape and size according to respiration: Generally, males show an abdominal pattern while females have usually a thoracic respiration pattern. The anatomy of the chest differs between men and women, with considerable variations among different ages and races. The skin is thicker in male than in female. In the male thorax, hair is frequently present and the mammary glands are underdeveloped. In this area, pathologic scar formation is relatively common. The clavicle and manubrium stern create the upper edge of the thorax, while xiphoid and the synchondrosis joints from seventh to tenth rib form the lower edge. The diaphragm, separating from the abdomen, is attached to the posterior surfaces of the xiphoid process and the lower six ribs and costal cartilages. Lateral limit of the chest is represented by the anterior axillary fold, which is formed by the pectoralis major tendon’s insertions onto the lateral lip of the intertubercular sulcus of the humerus.