3. Thoracic Pulmonology (Olinger)

Question 1

Left lung

Answer 1

Two lobes separated by oblique fissure. Superior and Inferior

Left lung grooves: cardiac impression, aortic arch, descending aorta, 1st rib, subclavian a.

Question 2

Right lung

Answer 2

Three lobes. Superior and middle are separated by horizontal fissure. Oblique fissure between middle and inferior lobes.

Right lung grooves: cardiac impression, azygous v. esophagus, SVC, IVC, 1st rib, and brachiocephalic v.

Question 3

Hilum

Answer 3

houses pulmonary a., pulmonary v., main bronchi, and the pulmonary ligament, which is hanging plura from the root of the lung

Question 4

Lung cancer

Answer 4

Can derive from actual lung tissue, or from the Bronchi (Bronchogenic Carcinoma). Lung cancer can involve the Phrenic N., Vagus N. and Recurrent Laryngeal N. due to the proximity of those nerves to the Lungs.

Tx can include removal of a Lung (Pneumonectomy), a lobe of a lung (Lobectomy) or a specific Bronchopulmonary Segment (Segmentectomy) through Lung Resection.

Question 5

Visceral pleura of the lungs

Answer 5

covers the outer surface of the lungs, and extends into the interlobar fissures. It is continuous with the parietal pleura at the hilum of each lung (this is where structures enter and leave the lung).

Question 6

Parietal pleura of the lungs

Answer 6

Covers the internal surface of the thoracic cavity. Four sections:

• Mediastinal pleura – Covers the lateral aspect of the mediastinum (the central component of the thoracic cavity, containing a number of organ).
• Cervical pleura – Lines the extension of the pleural cavity into the neck.
• Costal pleura – Covers the inner aspect of the ribs, costal cartilages, and intercostal muscles.
• Diaphragmatic pleura – Covers the thoracic (superior) surface of the diaphragm.

Question 7

Plural reflections

Answer 7

1. Sternal Line of Pleural Reflection (Costal Pleura becomes Mediastinal Pleura anteriorly)
2. Costal Line of Pleural Reflection (Costal Pleura becomes Diaphragmatic Pleura)
3. Vertebral Line of Pleural Reflection (Costal Pleura becomes Mediastinal Pleura posteriorly)

Question 8

Pleural cavities

Answer 8

Costodiaphragmatic – located between the costal pleurae and the diaphragmatic pleura. Inferior lobe will expand into this space if needed.
Costomediastinal – located between the costal pleurae and the mediastinal pleurae, behind the sternum. Typically, superior lobe extends into this space if needed.

Question 9

Pulmonary collapse

Answer 9

occurs when enough air enters the Pleural Cavity to break the surface tension between the two layers of Pleura. The elasticity of the Lungs causes them to collapse.

Question 10

Pneumothorax

Answer 10

Entry of air into the Pleural Cavity from a penetrating wound to the Thoracic Wall or a rupture of a pulmonary lesion into the pleural cavity, which results in a collapse of the lung.

Question 11

Hydrothorax

Answer 11

Accumulation of excess fluid in the Pleural Cavity, usually the result of fluid escape into the Pleural Cavity, or Pleural Effusion.

Question 12

Hemothorax

Answer 12

Accumulation of blood in the Pleural cavity, usually the result of a chest wound, usually the result of laceration of an Intercostal vessel or Internal Thoracic vessel rather than laceration of the lung.

Question 13

Difference between bronchi and bronchioles

Answer 13

The difference between bronchi and bronchioles is cartilage.
Bronchi have cartilaginous support in the connective tissue that helps keep them open even if the smooth muscle contracts in response to an irritant.

Question 14

Bronchioles

Answer 14

Smaller than bronchi, have no cartilaginous support, and are at the end of the respiratory conducting system, the tubes that lead directly into alveoli, the gas-exchange epithelium. If the smooth muscle contracts, these tubules can close almost completely, making it very difficult for air to reach the alveoli.

Question 15

Bronchi

Answer 15

Main passageway into the lungs. When someone takes a breath through their nose or mouth, the air travels into the larynx. The next step is through the trachea, which carries the air to the left and right bronchus. The bronchi become smaller the closer they get to the lung tissue and are then considered bronchioles. These passageways then evolve into tiny air sacs called alveoli, which is the site of oxygen and carbon dioxide exchange in the respiratory system. Primary bronchi are located in the upper portion of the lungs, with secondary bronchi near the center of the lungs. Tertiary bronchi are located near the bottom of these organs, just above the bronchioles. No gas exchanges occur in any of the bronchi.

Question 16

Location and course of trachea

Answer 16

The trachea is a cartilaginous tubular structure connecting the larynx superiorly and the main bronchi inferiorly. The lower edge of the cricoid cartilage defines the beginning of the trachea. The end of the trachea is marked by the carina, the steep-angled take off of the right main bronchus, and the take off of the more horizontal left main bronchus. The carina is usually found at the level of the T4 vertebral body but its vertical position in the mediastinum changes with the phases of respiration.

In the adult, the trachea sits anteriorly in the neck and dives posteriorly in the mediastinum as it travels toward the carina, where it divides into right and left main bronchi. This angle of descent is more acute in children and tends to become more horizontal with age due to kyphotic changes in the spine and tethering of the left main stem bronchus under the aortic arch.

Question 17

Right and Left bronchi comparison

Answer 17

The right main bronchus is wider and shorter than the left main bronchus. The right main bronchus subdivides into three lobar bronchi and the left main bronchus divides into two.
Right – 3, Left – 2.
The right main bronchus enters the right lung at roughly the level of the fifth thoracic vertebra, while the left main bronchus enters the root of the left lung opposite to the sixth thoracic vertebra, passes underneath the aortic arch, and crosses in front of the esophagus, the thoracic duct, and the descending aorta.

Question 18

Bronchopulmonary segments

Answer 18

A bronchopulmonary segment is a distinct region of the lung separated from the rest of the lung by connective tissue. Each bronchopulmonary segment forms a discrete functional unit in the lung that is independent of the other segments. This property allows a bronchopulmonary segment to be surgically removed without affecting other segments.

Question 19

Respiratory vs. terminal bonchioles

Answer 19

• Terminal Bronchiole: devoid of cartilage; branches into Respiratory Bronchioles
• Respiratory Bronchiole: devoid of cartilage, capable of gas exchange; branches into Alveolar Ducts)

Question 20

Bronchial asthma

Answer 20

a widespread narrowing of the airways produced by contraction of smooth muscle, edema of the mucosa and mucus in the lumen of the Bronchi and Bronchioles.

Question 21

Bronchoscopy

Answer 21

Insertion of a Bronchoscope into the trachea to visualize the Main Bronchi.