Pulmonary

Question 1

Visceral Pleura

Answer 1

Portion of the pleura in direct contact with the lung, completely covering it
(Pulmonary pleura)

Question 2

Parietal Pleura

Answer 2

As the visceral pleura reflects off the lungs and onto the inner wall of the thoracic cavity

Question 3

Root of the lung

Answer 3

• transition between the parietal and visceral pleura

- consists of the primary bronchus, pulmonary artery and pulmonary veins

Question 4

Pleural cavity

Answer 4

• in the living body, it’s a potential space and the visceral pleura touches the parietal pleura
• normally the pleural cavity contains only a thin film of serous fluid that lubricates the serous surfaces and allows free movement of the lungs within the pleural cavity

Question 5

Subdivisions of the Parietal Pleura (regionally named)

Answer 5

Costal Parietal Pleura: lines the inner surface of the thoracic wall

Mediastinal Parietal Pleura: lines the mediastinum

Diaphragmatic Parietal Pleura: lines the superior surface of the diaphragm

Cervical Parietal Pleura (cupula): extends superior to the first rib

Question 6

Lines of Pleural Reflection

Answer 6

Parietal pleura is sharply folded where the costal pleura meets the diaphragmatic pleura and where the costal pleura meets the mediastinal pleura
-they are acute and the inner surfaces of the parietal pleurae are usually in contact with one another

Question 7

Pleural Recesses

Answer 7

The potential spaces where parietal pleura contacts parietal pleura

Question 8

Costomediastinal Recess (left and right)

Answer 8

Are located posterior to the sternum between the costal parietal pleura and the mediastinal parietal pleura

Question 9

Costodiaphragmatic Recesses (left and right)

Answer 9

Rate located at the most inferior limits of the parietal pleura between the costal parietal pleura and the diaphragmatic parietal pleura
-during quiet inspiration, the inferior border of the lungs do not extend into the costodiaphragmatic Recesses

Question 10

Pleural Adhesions

Answer 10

May account between the visceral and parietal pleurae

-they’re the result of disease processes

Question 11

Pleural Cavity (in the clinic)

Answer 11

Under pathological conditions, the potential space of the pleural cavity may become a real space. For example if air enters the pleural cavity (pneumothorax), the lung collapses due to the elastic recoil of its tissue

• excess fluid may accumulate in the pleural cavity, compress the lung, and produce breathing difficulties
• the fluid could be serous fluid (pleural effusion) or blood resulting from a trauma (hemothorax)

Question 12

Pleural Effusion

Answer 12

abnormal accumulation of fluid in the pleural space
Normally only a thin layer of fluid separates the two layers of the pleura. Fluid can accumulate in the pleural space as a result of a large number of disorders including infections, injuries, heart failure, cirrhosis or liver failure, pneumonia, blood clots in the lung blood vessels (pulmonary emoboli), cancer and drugs
-symptoms may include difficulty breathing and chest pain, particularly when breathing and coughing
-diagnosis is by chest x-rays, lab testing of the fluid, and often CT scan. Large amounts of fluid are drained with a tube inserted into the chest

Question 13

Pleural Tap (Thoracocentesis)

Answer 13

The aspiration of pathologic material from the pleural cavity (serious fluid, fluid mixed with tumor cells, blood, pus, etc.) may be done thru the intercostal space
-the pleural tap is performed in the midaxillary line or slightly posterior to it. Usually, intercostal space 6, 7, 8 is selected for puncture to avoid penetrating abdominal viscera. A large-bore needle is inserted low in the intercostal space to avoid injury to intercostal nerve and vessels

Question 14

Oblique Fissure

Answer 14

On both lungs

• lies deep to the fifth rib laterally and that it is deep to the sixth costal cartilage anteriorly
• may be referred to as the major fissure*

Question 15

Horizontal Fissure

Answer 15

On the right lung

• lies deep to the fourth rib and fourth costal cartilage
• may be referred to as the minor or transverse fissure*

Question 16

Right Lung Lobes

Answer 16

Superior, middle and inferior lobes

Question 17

Left Lung Lobes

Answer 17

Superior and inferior

Question 18

Apex of the Lung

Answer 18

Occupies the cupula of the pleura and that both rise as high as teh neck of the first rib
-therefore the apex of the lung and the cupula of the pleura lie superior to the plane of the superior thoracic aperture (aperture bordered by the superior border of the manubrium, first pair of ribs, and superior border of the First thoracic vertebra) and are actually located in the neck

Question 19

Phrenic Nerve (course)

Answer 19

Passing inferiorly in the connective tissue between the Mediastinum parietal pleura and the fibrous pericardium anterior to the root of the lung

Question 20

Vagus Nerve (Course)

Answer 20

Passes posterior to the root of the lung (in the same connective tissue plane as the phrenic nerve)

Question 21

Irritation of the Pleura

Answer 21

The Parietal Pleura is richly innervated with pain fibers that originate from either intercostal nerves or the phrenic nerve. Pain resulting from irritation of the parietal pleura can manifest differently depending on which part is involved
-the visceral pleura is innervated by autonomic nerves and has no pain fibers

Question 22

Nerve Fibers along the root of the lungs

Answer 22

Anterior and posterior pulmonary plexuses

-the pulmonary plexus is an autonomic plexus formed from pulmonary branches of the vagus nerve and sympathetic trunk

Question 23

Pleural Sleeve

Answer 23

Portion of the pleura forming the transition between the mediastinal parietal pleura adhering to the fibrous pericardium and the visceral pleura on teh lung surface

Question 24

Root of Lung Structures and position

Answer 24

Pulmonary arteries and veins are anterior to the main bronchus, with the pulmonary artery positioned superior to the pulmonary veins
-begin to divide into their lobar branches as they approach the lungs

Question 25

Position of the Lobes of the Lung

Answer 25

Superior and inferior lobes are separated by the oblique fissure

Most of the inferior lobe lies posteriorly and most of the superior lobe lies anteriorly

Right lung: Horizontal fissure which defines a small middle lobe

Question 26

Contact Impressions of Mediastinal Surface of the Right Lung

Answer 26

Cardiac impression
Esophagus impression
Arch of the azygos vein impression
Superior vena cava impression

Question 27

Contact Impressions of the mediastinal surface of the left lung

Answer 27

Cardiac impression
Aortic Arch impression
thoracic Aorta impression

Question 28

Hilum of each lung

Answer 28

• main bronchus, pulmonary artery and pulmonary vein
• the main bronchus usually lies posterior to the pulmonary vessels and the pulmonary artery is superior to the pulmonary veins

RALS: right side anterior, left side superior (relation of the pulmonary artery to the main bronchus)

Question 29

Superior, Middle, and Inferior Lobar Bronchi (right lung)

Answer 29

-the right superior lobar bronchus passes superior to the right pulmonary artery and therefore is called the “eparterial bronchus”

Question 30

Superior and Inferior Lobar Bronchi of the Left Lung

Answer 30

Main bronchi divide into the Lobar bronchi at the posterior position of the hilum of the left lung

The left pulmonary artery divides into lobar arteries at a superioanterior position

The left pulmonary veins enter the hilum at an inferioanterior position

Question 31

Right Vagus Nerve (position)

Answer 31

Deep (medial) to the mediastinal parietal pleura

Question 32

Arch of the azygos vein

Answer 32

Passes superior to the right main bronchus to drain into the superior vena cava
-right vagus nerve passes medial to this

Question 33

Comparing the Right and Left Main Bronchi

Answer 33

-right is larger in diameter and shorter. It’s also originated more vertically than the left main bronchus

Question 34

Bifurcation of the Trachea

Answer 34

Within or close to the horizontal plane passing thru the sternal angle

Question 35

Carina

Answer 35

Specialized piece of tracheal cartilage.

Question 36

Bifurcation of the Trachea (in the clinic)

Answer 36

During bronchoscopy, the carina serves as an important landmark because it lies between the superior ends of the right and left main Bronchi

• the carina is usually positioned slightly to the left of the median plane of the trachea
• when foreign bodies are aspirated, they usually enter the right main bronchus because of the leftward position of the carina and because of the fact the right main bronchus is wider and more vertically oriented than the left main bronchus