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Embryonic region containing the developing dorsal aorta and associated tissues; a site of emergence of definitive haematopoietic stem cells.

The thorax is a mobile osteocartilaginous enclosure with two pleural compartments and a central mediastinum; its visceral boundaries change normally with breathing and posture. The sketch is an anterior projection, with the subject's right on the viewer's left. It distinguishes the lower margin of a lung from the lower reflection of its pleura: those are different boundaries.

The posterior wall is formed by the twelve thoracic vertebrae and adjacent parts of the ribs; laterally the ribs and intercostal muscles form a flexible wall. Anteriorly lie the sternum, costal cartilages and anterior intercostal structures. The superior aperture communicates with the neck, while the respiratory diaphragm closes the inferior aperture. The lower thoracic wall therefore overlaps upper abdominal organs: not every organ under a lower rib is inside the pleural compartment.

Each lung is covered by visceral pleura. Parietal pleura lines the chest wall, upper surface of the respiratory diaphragm and side of the mediastinum, becoming continuous with visceral pleura at the root. The potential pleural space contains a lubricating fluid film; it is not normally an air-filled gap. The right lung has three lobes, the left two, with the cardiac notch and lingula accommodating the leftward projection of the heart. Each apex projects above the first rib into the root of the neck. The roots carry the bronchi, pulmonary vessels, nerves and lymphatic connections.^[ref]

The heart and pericardium occupy chiefly the middle part of the inferior mediastinum, behind the sternum and between the lungs, with most of the cardiac bulk to the left of the median plane. The great vessels approach superiorly. The trachea divides into main bronchi behind the upper central region; the oesophagus descends behind the airway and heart. The descending thoracic aorta lies posteriorly, chiefly left of the vertebral bodies; the azygos venous route lies chiefly on the right. The thoracic duct and sympathetic chains belong to the posterior relations. A frontal projection superposes these structures and must not be mistaken for their order from front to back.

For a conventional quiet-breathing surface description, the lower lung border reaches approximately the sixth rib in the midclavicular line, eighth in the midaxillary line and tenth posteriorly near the scapular line. The pleural reflection descends approximately two ribs farther at corresponding landmarks: eighth, tenth and twelfth. These are orientation points, not immutable lines in every healthy individual. Inferiorly, the extra pleural extent forms the costodiaphragmatic recess. The right diaphragmatic dome usually stands higher, related to the underlying liver; the left is related to the stomach and other abdominal viscera.

In inspiration the respiratory diaphragm descends, the rib cage expands and lower lung margins move into the recesses; in expiration they retreat. The heart also shifts with the diaphragm and changes its surface projection as neighbouring lung expands. Deep inspiration, quiet expiration and forced expiration therefore cannot share a single normal map. The heart's own beat adds smaller cyclic movements.

Posture shifts the diaphragm and mediastinal contents: a supine position generally raises the domes compared with standing, while lateral positioning displaces mobile contents towards the dependent side. Body build, age, abdominal fullness and pregnancy change the available thoracic shape and diaphragmatic level. A distended stomach can raise the left dome and alter the cardiac projection without implying primary cardiac disease. The clinically useful comparison records posture and respiratory phase before judging an apparent difference in organ position.

Both the aorta and a vena cava have an endothelial lining and three broadly corresponding tunics; the aorta is dominated by an elastic muscular media, whereas a caval vein has a relatively thin media and a prominent collagenous adventitia. Their appearance reflects their different mechanical conditions, not simply the oxygen content of their blood.

The tunica intima of each begins with a continuous endothelium on its basement membrane, supported by subendothelial connective tissue. A normal section must be distinguished from age-related or pathological thickening. In the aorta, the intima merges towards a very thick tunica media. Unlike a typical muscular artery with one conspicuous internal elastic boundary, an elastic artery contains so many elastic lamellae that selecting one line as the uniquely dominant elastic membrane is less useful.

The aortic media contains repeated, approximately concentric fenestrated elastic lamellae, with smooth muscle cells, collagen and other matrix components between them. The elastic elements extend during ventricular ejection and recoil between beats; smooth muscle participates in matrix maintenance and regulation of wall properties. The outer tunica adventitia contains collagen, elastic fibres, nerves and vasa vasorum. Those small vessels serve the outer wall, which is too thick to be supplied entirely by diffusion from luminal blood.^[ref]

A vena cava has a wide lumen relative to its wall and is easily distorted or collapsed in a fixed empty preparation. Its intima is relatively thin. The media contains fewer circular smooth-muscle and elastic elements than the aortic media and is much less dominant. Its adventitia is often the thickest coat, with substantial collagen, elastic tissue and conspicuous longitudinal bundles of smooth muscle, particularly in the inferior vena cava. The relative amount varies with the sampled caval region; a thin-walled vein must not be described as a vessel without any muscle. Vasa vasorum and nerves occur in its outer wall too.^[ref]

Ordinary peripheral venous valves are folds of intima, but a valve is not a necessary feature of every large vein or every caval section. The aorta likewise has no series of valves distributed down its wall; the aortic valve is at its cardiac origin. Thus two circular profiles alone should be compared by wall organization, not diagnosed by assuming the vein must display a valve.

An elastic-fibre stain makes the aortic lamellae conspicuous, while ordinary stained sections show nuclei and the relative distribution of muscle and connective tissue. A transverse section cuts longitudinal caval muscle bundles across, whereas a longitudinal section displays their length; recognizing orientation prevents confusing those bundles with glands or isolated cellular nodules. The low-pressure, highly compliant venous reservoir and the pressure-bearing elastic arterial conduit are consequently different uses of the same broad tissue classes.

Arterial recoil, the muscle pump, respiratory movements, venous tone and the mechanics of cardiac filling assist blood circulation. The heart remains its principal continuing source of mechanical energy. These agencies differ in whether they store cardiac work, contribute new muscular work, or direct flow without supplying power.

During ventricular systole, the aorta and other large elastic arteries expand and store elastic potential energy. During diastole, their recoil continues to drive blood towards the peripheral vessels, while closure of the aortic valve limits return into the heart. This elastic reservoir smooths an intermittent cardiac input into a more continuous downstream flow. It does not manufacture extra energy: it releases part of the work performed during the preceding ejection.

Contraction of surrounding skeletal muscles compresses veins. Venous valves favour displacement towards the heart and limit backward flow when the compression is released. Alternating contraction and relaxation therefore produces a muscle pump, especially useful for return from dependent limbs. The added work comes from the contracting muscles; valves guide the displacement but supply no power themselves. Persistent compression without refilling is not equivalent to a series of pumping strokes.

Spontaneous inspiration supplies another assistance. Descent of the respiratory diaphragm raises abdominal pressure while expansion of the thorax lowers intrathoracic pressure. The resulting changes favour a pressure gradient towards the thoracic veins and right side of the heart. The effect depends on posture, the respiratory phase and whether vessels remain open. Positive-pressure inflation does not reproduce the same pressure changes as spontaneous inspiration.^[ref]

Venous smooth muscle can reduce the storage capacity of peripheral veins, transferring blood towards the central circulation. This changes the volume available for cardiac filling; it does not require a travelling wave of venous peristalsis. Relaxation and recoil of the heart, together with movement of the atrioventricular plane, also influence filling pressures. The older expression cardiac suction is therefore best interpreted through specific changes of chamber volume and pressure, rather than a separate force pulling uniformly through every vessel.

Gravity assists a downward column and opposes an upward one. For a complete circuit returning to its initial height it supplies no net gravitational work. Its important effects include hydrostatic pressure differences and dependent pooling. Likewise, the residual pressure gradient across the capillaries is chiefly the downstream consequence of the cardiac pump. Ordinary capillary action at a liquid meniscus is not a universal extra pump inside a closed, fluid-filled vascular network. Local vasodilation can improve perfusion by reducing vascular resistance, but it does not create the necessary pressure source.

With $Q$ the mean volumetric flow rate, $R$ an effective vascular resistance, and $\Delta P$ the driving pressure difference, the useful bookkeeping relation isIt separates an increase of driving pressure from a reduction of resistance. An instructive apparatus compares the outflow of a pulsatile pump through rigid tubing with its outflow through an elastic reservoir feeding the same resistance. Continued outflow between strokes demonstrates stored elastic potential energy. A separately compressed valved flexible tube demonstrates the additional muscle pump principle. Neither observation requires a mysterious attraction of blood by the tissues.

Chyle is intestinal lymph enriched with absorbed dietary lipids; its usual route ends in the venous circulation at the left jugulosubclavian junction. The milky appearance after a fat-containing meal is chiefly due to suspended lipid-rich particles, now called chylomicrons.

Formation begins with lipid digestion in the small intestine. Pancreatic lipase helps hydrolyse dietary triglycerides; bile salts help the digestion products reach the intestinal absorptive surface in mixed micelles. Enterocytes take up the products, reconstruct much of the long-chain triglyceride, and package it with other lipids and apolipoproteins into chylomicrons. These leave the basolateral side of the enterocytes and enter the central lacteals of the intestinal villi. Thus the particles carried in chyle are not simply intact globules of a meal passing through an open hole from the intestinal lumen.^[ref]

From the lacteals, chyle enters lymphatic channels in the intestinal wall and then collecting vessels in the mesentery. These vessels pass through mesenteric lymph nodes, with afferent vessels entering and efferent vessels leaving the nodes. Successive collectors join the intestinal lymphatic trunk or trunks. They usually communicate with the cisterna chyli, an expanded origin of the thoracic duct in the upper lumbar region, near the bodies of L1–L2 and to the right of the aorta. The cisterna chyli also receives lymph from lumbar trunks; the stream beyond it therefore contains material from more than the intestine. A conspicuous sac is not present in every individual.

The thoracic duct passes through the aortic hiatus of the respiratory diaphragm and ascends in the posterior mediastinum, typically between the aorta and azygos vein, behind the oesophagus. It crosses towards the left in the middle or upper thorax, continues to the root of the neck and arches to its terminal venous opening. The usual endpoint is the left venous angle, where the left internal jugular vein joins the left subclavian vein; terminal branches and the precise opening show anatomical variation. It is not normally the right venous angle or a direct entrance into the portal vein.^[ref]

The flow is promoted by intrinsic contraction of collecting lymphatic vessels, movements of surrounding muscles and respiratory changes of pressure. Lymphatic valves limit backward movement. Lymph nodes are interposed biological structures, not pumps that propel every particle independently.^[ref]

This route applies particularly to the long-chain dietary lipids carried by chylomicrons. Most absorbed glucose and amino acids, and much shorter-chain fatty acid material, follow portal vascular routes instead. Confusing these pathways would obscure the reason for asking separately about chyle. In a classical anatomical demonstration, the mesenteric channels of an appropriately fed animal appear white, and an injected or dissected preparation can trace their continuity towards the thoracic duct. The timing after a fatty meal matters: an empty-looking channel in a fasted preparation does not prove absence of a lymphatic vessel. The molecular account of chylomicrons is a modern explanation of the older gross observation.

The heart supplies the principal continuing mechanical input to blood circulation; arterial recoil, respiratory movements and the action of skeletal muscles redistribute and supplement that input. They have different sources of energy and should not all be called independent propulsive powers. The pressure gradient remaining after passage through the capillaries is still a consequence of the upstream pump.

Arterial elasticity. During ventricular systole, ejected blood expands the aorta and large arteries, storing elastic potential energy in their walls. During diastole, recoil continues to drive blood into the peripheral vessels while closure of the aortic valve limits return towards the heart. This reduces the intermittency of flow downstream. The recoil is a temporary store of cardiac work, rather than a fresh source of energy. A vessel that is too rigid provides less of this smoothing; a compliant vessel with an open backward outlet would not provide the same useful result.

The skeletal-muscle pump. Contracting skeletal muscles compress adjacent veins. Venous valves make the displacement preferentially towards the heart; when compression ceases, refilling permits another stroke. Walking therefore aids return from dependent limbs. The source of the added work is muscle contraction, and the valves guide it without producing energy. Merely possessing valves cannot make a stationary column circulate.

The respiratory pump. During inspiration, falling intrathoracic pressure and displacement of the abdominal contents favour a pressure gradient from abdominal and peripheral veins towards the thoracic veins and right side of the heart. The respiratory diaphragm thus participates indirectly in venous return as well as pulmonary ventilation. The exact flow varies with posture, vessel collapse and the phase of the respiratory cycle; positive-pressure inflation does not reproduce the same mechanical circumstances as spontaneous inspiration.^[ref]

Venous tone and cardiac filling. Sympathetic contraction of venous smooth muscle can reduce venous storage capacity and transfer blood towards the central circulation. This alters the volume available for filling rather than requiring a wave of venous peristalsis. Cardiac relaxation, recoil and movement of the atrioventricular plane also affect filling pressure. Some traditionally described cardiac suction is therefore a feature of the cardiac cycle and mechanical coupling, not a separate organ pulling blood through every vessel.^[ref]

Gravity and supposed capillary attraction. Gravity assists a downward column but opposes an upward one. In a complete circuit returning to its original height it supplies no net gravitational work; its important practical effects include hydrostatic pressure differences and dependent venous pooling. Ordinary capillary action in an open narrow tube, driven by a liquid meniscus, is not a general pump in a fluid-filled capillary network. Nor does a vague attraction of blood by tissues replace a measurable pressure gradient. Local vasodilation can increase perfusion by lowering vascular resistance, but that change does not manufacture the necessary pressure source.

For a simple mean-flow description, with $Q$ the volume flow rate, $\Delta P$ the driving pressure gradient and $R$ the effective vascular resistance,This relation distinguishes a source of driving pressure from a change of resistance. In a lumped compliant arterial reservoir with vascular compliance $C$ and no inflow between beats, volume balance giveswhere $P_v$ is the downstream pressure. The exponential decay follows from stored volume leaving through the resistance. It explains continued flow during diastole without claiming that the idealization describes every reflected arterial wave.

A physical demonstration can compare a pulsatile pump feeding a narrow outlet through rigid tubing with the same pump feeding it through an elastic reservoir. Collecting the outflow over the pumping and resting phases reveals the reservoir's smoothing action; a side-arm manometer records its falling pressure. Separately compressing a valved flexible tube shows the role of a peripheral muscle pump. Keeping pump stroke and outlet resistance comparable prevents the apparatus from conflating a smoother flow with creation of extra energy.