Lungs and pleura Flashcards
How many lobes does the right lung have
3
How many lobes does the left lung have
2
Where does the horizontal fissure (right lung) run
From T3 vertebra posteriorly to rib 6 anteriorly
Where does the oblique fissure run
From rib 4 to horizontal fissure
What are the surfaces of the lungs
Cervical surface (top)
Mediastinal surface
Diaphragmatic surface
Costal surface (side)
What are pleural reflections
The lines along which the parietal pleura changes direction from one wall of pleural cavity to another
What are the names of the pleural reflections
Sternaline line of pleural reflection
Vertebral line of pleural reflection
Costal line of pleural reflection
What is the sternaline line of pleural reflection
When the costal pleura changes into mediastinal pleura ANTERIORLY
What is the vertebral line of pleural reflection
When the costal pleura changes into mediastinal pleura POSTERIORLY
What is the costal line of pleural reflection
When costal pleura changes into diaphragmatic pleura
How does the right lung compare to the left lung and why
Right lung is larger and heavier than the L but shorter and wider because right dome of diaphragm is higher and heart and pericardium bulge to the left
Which dome of the diaphragm is higher
Right
What is the surface anatomy of the visceral pleura
2-4-6-8-10
Reflections closest at plane of sternal angle (rib 2)
Parallel down to rib 4
L indented by cardiac notch but right continues down to cc6
Cross rib 8 at midaxillary line
Cross rib 10 at lateral border of erector spinae
What is the surface anatomy of the parietal pleura
2-4-6-8-10-12
Asymmetry and close behind sternal angle (rib 2)
Parallel down to rib 4
L indented but R continues down to cc6
Rib 8 at midclavicular line
Rib 10 at midaxillary line
Rib 12 at lateral border of erector spinae mm
Which bronchus is more vertical and wider and so therefore where are foreign objects more likely to enter
R
What do secondary bronchi supply
Lobes
What do tertiary bronchi supply
Segments
How many segments does the right lung have
10
How many segments does the left lung have
8
Where does fluid typically accumulate in the lung if the patient is lying on their back for extended periods of time
Apical and posterior segments of the inferior lobe (both lungs)
What are the borders of the lung
Anterior
Posterior
Inferior
What is the anterior border of the lung
Where costal and mediastinal surfaces meet anteriorly
What is the posterior border of the lung
Where costal and mediastinal surfaces meet posteriorly
What is the inferior border of the lung
Separates diaphragmatic surface from costal and mediastinal surfaces
How is blood supplied to the lung
Pulmonary trunk –> Lobar artery –> segmental artery to each bronchopulmonary segment
What do bronchial arteries supply
Blood to structures comprising the;
Roots of the lungs
Supporting tissues of lungs
Visceral pleura
What drains the visceral pleura
pulmonary veins
What supplies the parietal pleura
Intercostal arteries
How are lungs drained
Pulmonary veins
How are adjacent bronchopulmonary segments drained
Intersegmental veins which then turn into superior pulmonary veins or inferior pulmonary veins
Where do the pulmonary veins drain
Right atrium
What is the role of the bronchial veins
drain part of the blood supplied to the lungs by the bronchial arteries
What do the bronchial arteries supply
Visceral pleura of lungs, connective tissue of lungs, bronchi and oesophagus
Difference between pulmonary arteries and bronchial arteries
Pulmonary arteries supply deoxygenated blood pumped from the right ventricle
Bronchial arteries supply oxygenated blood pumped from the left ventricle
Where does the right bronchial vein drain into
Azygos vein
Where does the left bronchial vein drain into
Accessory hemi-azygos vein
Left superior intercostal vein (which then goes to left brachiocephalic vein)
Where does lymphatic fluid from the lung tissue and visceral pleura drain into (sequence of events)
1- Superficial lymph plexus
2- bronchopulmonary (hilar) lymph nodes
3- inferior and superior tracheobronchial lymph nodes
4ai) Right bronchomediastinal lymph trunks
aii- right lymph trunk (along with other lymph trunks)
aiii- Terminate at venous angle
4bi)Left bronchomediastinal lymph trunks
bii- terminates at thoracic duct
biii- Terminates at venous angle
Where does lymph from structures that form the root of the lung drain into
1) Deep lymph plexus
2) Pulmonary lymph nodes
3) these drain into bronchopulmonary (hilar) lymph nodes
4) Then follow same course as lymph fluid from lung tissue and visceral pleura
Where does lymph from parietal pleura drain into
Lymph nodes of thoracic wall (intercostal, parasternal, mediastinal, and phrenic)
Where does lymph from cervical pleura drain into
Axillary lymph nodes
What is pleuritis and how is it presented
Inflammation of pleura so lung surfaces rub. Can be heard with stethoscope.
Presented with sharp, stabbing pain when there is increased exertion (ie climbing stairs)
When does pulmonary collapse occur
When there is too much air in the pleural cavity
Which structures are affected in pulmonary collapse and how
- Lung
- Diaphragm is elevated in elevated side
- Mediastinum shifts away (can tell because trachea is displaced)
- ICS narrowing
- Pleural sacs are separate so they don’t affect one another
Which pleura is insensitive to pain and why
Visceral pleura because its innervation is autonomous (vagus nerve and sympathetic fibres)
What is the visceral pleura innervated by
Vagus nerve and sympathetic fibres
What pleura is sensitive to pain and why
Parietal pleura
What is the parietal pleura innervated by
Intercostal nerves and phrenic nerve
Which part of the parietal pleura is particularly sensitive to pain
Costal pleura
If there is irritation of the costal and peripheral parts of diaphragmatic pleura, where would there be pain
Local pain and referred pain along intercostal nerves to thoracic and abdominal walls
If there is irritation of mediastinal and central diaphragmatic areas of parietal pleura, where would there be pain
Pain in root of neck and over the shoulder
What are the common pneumonia sites in the lung of patients that are confined to bed
Apical and posterior segments of the inferior lobe
