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The knowledge of certain aspects of thoracic anatomical arrangements is of great importance to the thoracic anesthetist. Throughout its course the esophagus lies directly behind the trachea, with the recurrent laryngeal nerves lying in the groove in between. In the upper (extra thoracic) trachea, the isthmus of the thyroid overlies the trachea anteriorly with the thyroid lobes lying laterally. The carina marks the bifurcation into right and left bronchi. The bronchus for each segment divides about 15 times into terminal bronchioles. Blood from each segment is drained by intersegmental veins that lie in the connective tissue around the segment, which generally leads to a single branch from each segment. The borders of the thoracic paravertebral space are imprecise. It is thought that the prevertebral fascia and anterior longitudinal ligament usually form a barrier to communication to the contralateral paravertebral space, breached only by lymphatic channels.
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