Lecture 3 - Bronchi, pleura, lungs and the diaphragm Flashcards
What vertebral levels does the trachea span?
From C6 to T4/5
Describe the structure of the trachea.
- Held open by cartilaginous (hyaline) C-shaped rings that face posteriorly, allowing for the oesophagus to expand when food passes through it
- Lowest cartilaginous ring has a hook on it, called the carina (looks like the bow of a ship when passing an endoscope down the trachea)
- Posterior wall is composed of mainly smooth muscle
At what level does the trachea bifurcate?
T4/5
Describe the structure of the primary bronchi.
- Known as the right and left bronchus
- Right is wider and more vertical than the left
- Enters and passes through the hilum of the lung
In which bronchus are obstructions more common?
The right bronchus as it is almost a direct pathway from the trachea (more vertical) and therefore foreign objects are more likely to enter into this bronchus.
What do the main bronchi branch into?
Lobar bronchi (secondary), forming in the lungs and supplying the lobes of the lungs.
How many lobar bronchi are there on each side?
2 on the left and 3 on the right
What follows the lobar bronchi and what do they do?
Segmental bronchi (tertiary) which supply the bronchopulmonary segments - 10 segments in each lung
How are segmental bronchi held open?
Discontinuous elongated plates of cartilage that is not present in the bronchioles.
What is the clinical significance of the segmental bronchi?
They are the smallest functionally-independent regions in the lung that can be isolated and removed without affecting other regions.
What are the attachments of the lungs?
Attached to the heart via the pulmonary blood vessels and the to the trachea via the lung root.
How many lobes are in each lung and what are their individual names?
Right lung - 3 lobes (superior, inferior and middle lobes)
Left lung -2 lobes (superior and inferior lobes)
How are the lobes visibly separated in the lungs?
Right - horizontal and oblique fissures
Left - oblique fissure (level T4)
Which lung is larger?
Right
How do the oblique fissures differ in each lung?
The oblique fissure on the left lung runs slightly more obliquely than the right oblique fissure.
Describe the shape and boundaries of the lungs.
- Conical in shape
- Apex rises 3-4cm above first costal cartilage
- Base is concave and rests on the convex surface of the diaphragm
What does the diaphragm separate the lungs from?
Right - right lobe of the liver
Left - left lobe of the liver, stomach and spleen
Describe the mediastinal surfaces of the lungs?
Anterior - deeply concave to accommodate mediastinum/heart. Indent on the left is larger than the right due to increased cardiac muscle.
Posterior - in contact with thoracic vertebrae (T1-12)
Superior and posterior to cardiac impression - hilum of the lung
What is the hilum of the lung?
The lung root which connects the mediastinal surface to the heart and trachea and is formed by structures that enter and leave the hilum.
What are the contents of the hilum?
- Principal bronchi (right or left)
- Pulmonary artery
- 2 pulmonary veins
- Bronchial arteries
- Pulmonary nerve plexus
- Lymph vessels and nodes
What is the pulmonary ligament?
Thin, blade-like fold of pleura that projects inferiorly from the hilum to the mediastinum.