Anatomy and Function

The terms chest or thorax represent a generic medical term for the upper trunk section in its entirety as well as for its bony-cartilaginous structures considered in isolation. Thorax structure Here, an incision has been made parallel to the forehead (frontal incision), which even affects the intestines. Both lungs are cut, the heart, which was partially covered by the lungs, can now be seen in all its glory. In addition, the tiered structure of the trunk becomes clear: Under the thorax lies the abdominal cavity with liver and stomach, the border is the diaphragm.

Diseases of the thorax

Pathological changes in the area of the chest can affect individual organs, for example the heart (e.g. heart attack, coronary heart disease, cardiac insufficiency), as well as several structures of the ligamentous thorax at the same time and cause thoracic pain. It is also not uncommon for injuries to the chest area to be caused by mechanical accidents, such as after a fall. We have already mentioned a common disease, the collapse of the lung due to the separation of the two leaves of the pleura: the “pneumothorax“.

This occurs when air enters the pleural gap and the adhesive forces of the pleura are not sufficient to hold the lung to the thorax. In addition to accident-related (traumatic) causes, especially traffic accidents or falls, it can develop spontaneously, spontaneous pneumothorax. (especially in young men aged 15-35), when small pathological vesicles of the lung (emphysema vesicles) burst.However, it can also be the result of infections such as tuberculosis, degenerative fiber metabolism (fibrosis) of the lungs or scarring of the pleura (pleura).

Finally, there is even a genetic predisposition (disposition) due to the reduced activity of certain proteins (enzymes). In addition, blood can also enter the pleura (hematothorax) or the combination of blood and air (hematopneumothorax). Finally, serous fluid in the pleural gap can also increase (pleural effusion).

All clinical pictures have in common a shortness of breath (dyspnoea) and mostly breath-dependent pain (only the parietal pleura and the rest of the body wall can perceive pain) or discomfort, which is normally not very dangerous if only one half of the body is affected, one has two lungs, the right one is more powerful. The situation usually becomes threatening only when the pneumothorax is “open”, i.e. with injury to the body wall and a connection of the chest cavity to the external ambient air. In this situation, which can occur for example after a stabbing, a valve mechanism can form on the thorax so that air flows in during inhalation but cannot escape during exhalation.

The pressure within the chest (intrathoracic pressure) therefore increases, all elements of the chest are shifted to the place of lower pressure and finally press on the heart, which can no longer develop (cardiac tamponade). Acute danger to life due to circulatory failure would be the consequence, the unavoidable therapy is a “relief puncture” through the body wall, so that the excess pressure can be released. A single rib fracture is generally not a problem for the well-tensioned chest wall as long as the rib does not penetrate into surrounding tissue, e.g. the pleura (!!).

If more than three ribs are broken (serial rib fracture), breathing is noticeably impaired and the risk of internal injury increases. Due to the continuous anatomy in the area of the upper thoracic aperture, inflammatory processes in the head/neck area have the possibility to spread relatively unhindered as a “subsidence abscess” into the mediastinum and cause damage there. The basic shape of the chest wall is subject to various factors, but above all the constitution, sex and age.

In women, the amount of fat deposited in their “breast” in the narrower sense (mamma) dominates the contour, with this fat being more or less firmly attached to a taut envelope of the body, the large body wall fascia (here: fascia pectoralis), by means of connective tissue pulls. In men, the shape of the large pectoral muscle (Musculus pectoralis major) primarily determines the shape of the chest wall. The thorax of a person with a tendency to be overweight, with a short neck and strong contours (pycniker), is rather barrel-shaped, while in a slender person with long, spindly extremities (leptosome) it is narrow and flat.

Normally, our 12 pairs of ribs swing upwards during inhalation and the lower transverse-oval thoracic aperture widens. As we age, calcium deposits in the cartilage tissue of the thorax (ribs have only cartilage and no bone from the middle of the clavicle, the “medioclavicular line”, towards the front, as in the back), so that its mobility (viscoelasticity) diminishes, “often one runs out of breath”. The lung mediates the import of oxygen and the export of carbon dioxide in relation to the whole organism, which is called “gas exchange”.

The sites of gas exchange are millions of tiny alveoli. These can be damaged by a variety of diseases, a pulmonary emphysema develops and the person affected becomes an emphysemic. Difficulty in breathing in these patients causes the ribs to remain in an almost permanent inhalation position (swung upwards) with widened lower thoracic aperture.

Over time, this leads to a grasping thorax with a simultaneous increase in curvature of the thoracic spine to the back (thoracic kyphosis). The funnel chest is considered a congenital defect of the thorax: the sternum and rib cartilage form a depression towards the inside. Conversely, the clinical picture of a pigeon chest exists if the sternum protrudes forward.