EXAM3_G21_Lungs_Pleura Flashcards
Pleura that adheres to thoracic wall, mediastinum & Diaphragm and four named regions
Parietal Pleura
- Cervical (cupula)
- Costal parietal pleura
- Diaphragmatic pleura
- Mediastinal pleura
Pleura that adheres to lungs
Visceral pleura
Injuries to the base of the neck can affect lungs and pleura, why?
Cervical pleura extends 2-3 cm above the superior thoracic aperture
What is the edge between costal and mediastinal pleural regions called?
L&R STERNAL lines of pleural reflection
What is the edge between costal and diaphragmatic pleural regions called?
L&R COSTAL lines of pleural reflection
point that changes direction as it changes from parietal pleura to visceral pleura
what is the area of continuity between parietal and visceral pleura called?
Pleural Sleeve
Left sternal line of reflection deviates laterally spanning what ribs? what access does this provide?
ribs 4-6 and exposes an anterior access to the mediastinum
In a radiograph where does the costal and diaphragmatic pleura intersect at the midclavicular line? Midaxillary line? paravertebral line?
rib 8- midclavicular line
rib 10-midaxillary line
rib 12 paravertebral line
Lungs and serous pleural sac are found in the ?
pulmonary cavities
The lungs are engulfed in a balloon called the pleural sac and suspend the lungs within the chest. The space created by the pleural sac is called? and filled with ?
Pleural cavity filled with serous fluid for lubrication (
inflammation of the parietal and visceral pleura is called?
Pleuritis- sounds like walking on snow
The lungs do not entirely fill the pulmonary cavities which leaves two named spaces which can fill with fluid which are called what?
Costomediastinal recess (sternal pleural reflection and cardiac notch)
Costodiaphragmatic recess- (Costal pleural reflection)
2 rib rule of the costodiaphragmatic recess helps you remember the inferior extent of the lungs & Parietal pleura. What rib level does the lung end what level does the pleura end at the midclavicular, midaxillary, and paravertebral lines?
Midclavicular line (Lungs-rib 6, CLPR-rib 8) Midaxillary line (lungs- rib 8, CLPR rib- 10) Paravertebral line (lungs- rib 10, CLPR rib 12)
How do you estimate where the lungs end and where the parietal pleura ends in order to safely insert a needle into the pleural cavity to perform a thoracentesis?
2 Rib rule of costodiaphragmatic recess
- Use:
Midclavicular line intersects (rib 6 lungs, 8 pleura)
Midaxillary line intersects (rib 8 lung, 10 pleura)
Paravertebral line intersects (rib 10 lung, rib 12 pleura)
Dypsnea (difficulty breathing) is seen in a patient who has excess fluid accumulated in the recess of the pleural cavity. This space is called?
Costodiaphragmatic recess-
its’ a potential space
At the midaxillary line where would you insert the needle to perform a thoracentesis?
Between ribs 9 and 10 (9th Intercostal Space) because at the midaxillary line the lungs end at rib 8 and the pleura ends at rib 10
Each lung is surrounded by its own independent pleural sac and cavity. The pleural cavity is under negative pressure which keeps the lungs inflated during inspiration. A breach of pleura releases the suction causing elastic recoil of the lung to collapse. This is clinically called?
Secondary Atelectasis
Entry of air into the pleural cavity is called ?
Pneumothorax (a type of pleural effusion)
Pleural effusion of serous, blood, lymph called respectively? What sign do you look for on the radiograph?
Meniscus sign on radiograph:
Serous - Hydrothorax
Blood- Hemothorax
Lymph- Chylothorax
What are the lungs attached to ?
Mediastinal structures (heart & trachea) via the root of the lungs
Structure forming the root of the lung enter and exit the lung through the “spot” called the?
Hilum
What structure surrounds each root of the lung? what structure forms by the slack inferior to the root of the lungs?
Pleural Sleeve
Pulmonary ligament (anchors the lung)
What three major components of the root of the lung?
Main Bronchus
Pulmonary Artery
Pulmonary Veins
What are the first structure to identify in the root of the lung? why?
left and right main bronchi
(posterior part of the lung) very cartilaginous and easy to identify
just superior to the clavicle the superior border of the lungs extends into the base of the neck. This border of the lungs is called?
APEX and is associated with the cervical pleura (cupula)
What are the identifying borders of the lungs? (how do you determine what your looking at?)
anterior
posterior
inferior
Anterior border is wedge-like
Posterior border is rounded
Inferior border is concave downward
What feature is just inferior to the cardiac notch on the left lung? what lobe is it on?
Lingula- superior lobe of left lung inferior to cardiac notch
Inferior the larynx beginning at C6 and palpable at the jugular notch is what?
Trachea
Where does the trachea begin and end?
What is the surface landmark for where the trachea ends?
begins C6 and ends at T4/T5 IVD
Sternal angle “transverse thoracic plane”
What causes the bumpy anterolateral sides of the trachea?
What is the posterior side of the trachea called?
C shaped hyaline cartilage rings
Trachealis smooth muscle
The keel of a boat . thin ridge of cartilage marking the branching of teh trachea into two main bronchi is called ?
Carina
Describe the difference between the openings of the left and right main bronchi
Right main bronchi is LARGER and more vertical and has higher chance of foreign objects getting in there
The right main bronchus splits into what?
The left?
Right= Three Lobar (secondary Bronchi)
Left= Two Lobar Bronchi
Each lobar bronchus branches into ?
How many left and right?
Segmental (tertiary bronchi)
10 Right
10 (or 8) on left
Each segmental bronchus supplies a wedge-shaped region called a
Bronchopulmonary segment
Describe Bronchopulmonary segments
Each segment has independent vasculature and is separated by connective tissue
Because bronchopulmonary segments have independent vasculature and separated by CT, each segment can be resegmented without interrupting the neighboring segments. This is called?
removing an entire lobe? Entire lung?
Segmentectomy
lobectomy
numectomy
Segmental bronchus branches into smaller airways. Describe from large to small.
- Segmental Bronchus->
- conducting bronchiole>
- Respiratory bronchiole>
- Alveolar ducts and sacs>
- gas exchange in alveolus
What supplies low Oxygenated blood from the heart to the lungs for oxygenation?
Pulmonary arteries
The pulmonary arteries connect to ______ surrounding alveoli where respiration occurs
capillary beds
What supplies blood to the lung parenchyma?
Pulmonary arteries
What supplies nutrients and high oxygen blood to root of lungs, stroma of lungs, and visceral pleura?
Bronchial arteries
The left bronchial artery is derived from ?
Thoracic aorta
Right bronchial artery is derived from ?
Variable origin–
- posterior intercostal artery or,
- thoracic aorta or,
- left bronchial artery
What structures are supplied by the bronchial arteries?
Oxygenated blood to root of lung, stroma of lung, and visceral pleura
What structures are supplied by the pulmonary arteries?
lung parenchyma
Arteries of thoracic wall supply what?
parietal pleura
What mainly drains blood from airway walls & stroma near the root of the lung?
Bronchial Veins
Parietal pleura drains into what veins?
veins of the thoracic wall
The parietal pleura is supplied by what artery?
Arteries of the thoracic wall
right bronchial vein drains where?
Azygous vein then into SVC
The left bronchial vein drains where?
Accessory hemiazygous vein then the SVC
The remainder of blood in the lungs and visceral pleura drains into the?
pulmonary veins
What brings oxygenated blood from capillaries to the heart?
Pulmonary veins
What drains deoxygenated blood from the visceral pleura?
Pulmonary veins
What drains the superficial lymph from the lung parenchyma & visceral pleura ? what does that drain into?
Superficial plexus then drains into the Hilar (bronchopulmonary) nodes
What lymphatic vessels originate in walls of airway and surrounding stroma and drains lymph from structures that form the root of the lung?
Deep plexus
Superficial and deep plexus drain into? then describe how they get all the way to the thoracic duct
Hilar(bronchopulmonary) nodes>
“corina” Tracheobronchial nodes>
paratracheal nodes>
R lymphatic or thoracic duct
What is the general pattern of lymph flow in the lungs?
right lung,
left inferior lobe
Left superior lobe
Lymph in right lung> right venous angle
Lymph in left inferior lobe> right venous angle
Lymph in superior lobe > left venous angle
Cancer that forms anywhere in the lungs is called?
Bronchogenic carcinoma
