3 The pulmonary trunk arises from the right ventricle of the heart and initially progresses anteriorly and then posterolaterally on the left side of the ascending aorta. The bronchi pass in front of the descending aorta, and their positions in relation to the pulmonary vessels are variable based on the laterality. 2 Normally, the trachea is located posteriorly to the great vessels from its start at the level of the C6 cervical vertebra until its bifurcation into the right and left mainstem bronchi at T4-T5 vertebral level. Thoracic structures most susceptible to anatomic and positional variabilities are the airways and the great vessels, pulmonary vasculature in particular. One surgically relevant category is congenital branching abnormalities of the bronchial tree and pulmonary vasculature. 1 The list of congenital defects leading to organ and vessel anomalies is much more extensive and variable in severity. Some examples of acquired pathologies affecting anatomy of the thorax are neoplasms, infections, and trauma. Abnormalities of thoracic organ morphology and arrangement can be caused by both acquired and developmental processes, with the latter leading to the more structurally unpredictable outcomes in patients. Furthermore, since the chest cavity contains many vital cardiovascular and pulmonary structures, it is critical for physicians to be well versed in abnormal anatomy of the region in order to minimize the risk of adverse intraoperative events. Detailed knowledge and understanding of the normal anatomy of the thorax is essential for surgeons and radiologists alike.
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