Pulmonary Anatomy Flashcards
The inferior thoracic aperture is closed by the ________
diaphragm
What are the three spaces in the chest that make up the thoracic structures?
left pulmonary cavity, right pulmonary cavity, and mediastinum
In the thorax, the blood supply (aorta, vena cava), nerve supply (vagus nerve), thoracic duct and esophagus all penetrate the __________
diaphragm
The superior thoracic aperture has a lot of blood vessels due to vasculature to what three areas?
head, neck, upper extremities
________ results from compression of vasculature and nerve supply penetrating superior thoracic aperture
thoracic outlet syndrome
What does the independence of pulmonary cavities signify?
You can have problems on one side but still maintain respiration on the other.
What two structures are contained within the pulmonary cavities?
Lungs and pleural sacs
The space inside the pleural sac is called the _________ and is empty
pleural cavity
The _______ is space sandwiched in between pleura on both sides
Mediastinum
The ______ pleural lines the lung whereas the ______ lines the body wall
visceral, parietal
What is found within the pleural space?
A tiny bit of fluid that allows the lung to slide back and forth as it expands and deflates
True/False: It is necessary to have positive pressure inside the lung during inspiration
FALSE, negative pressure to draw air in passively
True/False: In COPD, airflow in is compromised
False, can get air in, but can’t get it back out
The ___________ is where the parietal pleura extends further down than the inflated lung. The normal space is about 2 ribs.
costodiaphragmmatic recess
What kind of nerve is the phrenic nerve?
Somatic (that’s why we can control breathing!) with some autonomic fibers
The phrenic nerve is found sandwiched in between what two structures?
Parietal pleura and fibrous pericardium
Phrenic nerve comes from what vertebral levels?
C3-C5 [C3,4,5 keeps the person alive!]
Posteriorly (paravertebrally), the lungs (visceral pleura) go to above vertebral level of ____ whereas the parietal pleura go to vertebral level of ___
10, 12
Anteriorly, when looking at mid-clavicular level, the lungs (visceral pleura) go to about vertebral level of ____ and the parietal pleura to ___
6, 8
If looking from a mid-axillary viewpoint, the lungs (visceral pleura) go to about vertebral level of ___ and the parietal pleura to ____
8, 10
True/False: The cardiac notch has pleura over it and the lung continues into it
FALSE - the lung does not continue into the cardiac notch (does have pleural however)
Why is it important that patient raises their arms for CXR?
to get scapula out of the way
If looking along parasternal line, the lungs (visceral pleural) go to vertebral level of about ___, whereas the parietal pleura go to vertebral level of _____
4, 6
________ are potential spaces which can fill with blood, air and water in pathological states.
Pleural Recesses
This area of the lung consists of mainly pulmonary arteries, bronchi and pulmonary veins but anything entering or leaving the lung could also be considered part of this.
The root
The point where the arteries, bronchi, and pulmonary veins enter the lung is the ______
hilum
Describe the differences in bronchi on each side of the hilum
On the left side. the primary bronchus enters. On the right side, the secondary bronchi for upper and lower lobes enter.
Describe where the phrenic and vagus run in respect to the hilum
The phrenic runs anterior to the hilium and the vagus runs posterior
How many secondary bronchi are there?
2 on right, 3 on left
_______ enter the lobe whereas ______ enter the bronchopulmonary segments
secondary bronchi, tertiary bronchi
The main contribute to the esophageal plexus is the ______
vagus nerve
In the root of the lung, where do the pulmonary arteries lie in relation to the bronchi?
On the right side, the artery lies anterior to the bronchi. On the left side, the pulmonary arteries lie superior to the bronchi (RALS)
In the root of the lung, where do the pulmonary veins lie in relation to the other structures in the root?
anterior and inferior
The branches of the ________ are the most anterior and inferior major structures in the hilum of both lungs
pulmonary vein
What defines a bronchopulmonary segment in a lung?
unit of lung supply by one tertiary (segmental) bronchus and its accompanying artery; each segment separated by connective tissue layer
The tertiary bronchus and its accompanying artery are _____ whereas the pulmonary vein that drains each bronchopulmonary segment is ______
intrasegmental, intersegmental
Pulmonary veins drain intersegmentally. What is the significance of this in terms of loss of blood flow?
One pulmonary vein drains multiple bronchopulmonary segments - so if blood flow obstructed, will affect multiple. When removing a segment, must tie off the tributaries to that vein.
Which primary bronchi is more vertical and wide and what is the significance of this?
The one on the right side. Aspirated objects tend to lodge in the right main or inferior lobar.
At what point does the trachea divide into the primary bronchi?
At the junction of the ascending aorta and the arch.
True/False: The trachea passes from the superior mediastinum to the inferior mediastinum.
FALSE - only superior
Which pleura feel pain?
mediastinal, costal, cervical, and diaphragmmatic. VISCERAL DOES NOT.
True/False: The nerve supply to the lung comes from the same source as the heart and continues into the cardiopulmonary plexus
True
On the costal pleura, where do the pain fiber originate?
intercostal nerves
On the mediastinal pleura, where do the pain fibers originate?
Phrenic nerve
True/False: All lung tissues get their nutrients from the pulmonary circulation
FALSE - structures comprising the root and supporting tissues get nutrients from bronchiole arteries
How many bronchiole arteries are there?
generally two on left and one on right
Why is the pulmonary circulation insufficient to perfuse structures of the root?
Structure is deep in the lung and the fusion across membranes of the lungs is not enough to give these cells nourishment and oxygen
In regards to lymphatics of the lung, the _______ drains the parenchyma and drains to the bronchopulmonary nodes
subpleural plexus
The _______ contains portions of the great vessels, esophagus, trachea, vagus, phrenic and cardiac nerves, thoracic duct and thymus.
superior mediastinum - begins at angle of louis
The inferior mediastinum is divided into what three sections?
anterior, middle, posterior
The ________ contains the heart and ascending aorta, pulmonary trunk and some superior vena cava [everything in pericardial sac]
middle mediastinum
The _______ contains mostly fat, branches of internal thoracic artery and some thymus in children
anterior mediastinum
What are the three superior branches of the aortic arch?
brachiocephalic artery, common carotid artery, subclavian artery
Where does the arch of azygos drain into?
superior vena cava
The right and left brachiocephalic veins, phrenic and vagus nerves, recurrent laryngeal nerves, trachea, esophagus and some thymus are part of the _________. Also includes the extra pericardial part of the pulmonary trunk and right and left pulmonary arteries.
superior mediastinum
Describe the 5 layers of the superior mediastinum from anterior to posterior
glandular, venous (containing brachiocephalic veins), arterial (containing brachiocephalic artery, common carotid, and subclavian), respiratory (including trachea), and digestive (including esopohagus)
The vagus courses onto the esophagus and passes ______ to the root of the lung
posterior
The phrenic nerve runs ______ to the hilum of the lung
anterior
The posterior mediastinum is the area anterior to the vertebral column between levels __ and ____.
T5 and T12
The esophagus and its plexus, the thoracic descending aorta, the azygos system of veins and the greater, lesser, and least thoracic sphlancnic nerves are found in the _______
posterior mediastinum
Between what two structures is the thoracic duct located?
esophagus and aorta
What part of the mediastinum are the sympathetic trunk and roots of the sphlancnic nerves considered to be?
posterior mediastinum - not technically tho
What vertebral levels do the a) greater thoracic splanchnic; b) lesser thoracic splanchnic; c) least thoracic splanchnic
a) t5-t9; b) lesser t10-11; c) least 12
The thoracic duct is sandwiched between esophagus, aorta, and azygos vein on the right and ultimately hooks over to get into the junction of the ________ and _______
internal jugular, subclavian vein
What are the sources of the anterior esophageal plexus? Where do the fibers travel past the this plexus?
The vagus nerves and thoracic sphlancnincs. The left vagus contributes mostly to the anterior esophageal plexus but there is a mixing of fibers from right and left vagus nerves. The fibers then reconvene into the anterior and posterior vagal trunk.
Past the esophageal plexus, the vagal trunks provide parasympathetic innervation to the GI tract as far as the _________
left colic flexure [past this the pelvic sphlancnics take over]
The left vagus gives off the ______ whereas the right hooked behind the ________
recurrent laryngeal nerve; subclavian artery
The ______ contributes mostly to the posterior esophageal plexus [ but there are mixing of fibers from right and left vagal nerves.
right vagus
What happens to the fibers after the posterior esophageal plexus?
reconvene on their way to the stomach as the anterior and posterior vagal trunks
Name the important branches of the thoracic aorta (5)
esophageal arteries, bronchial arteries, posterior intercostal arteries, superior phrenic arteries, subcostal arteries
What three structures does the azygos system drain?
body wall, esophagus, and bronchial veins
How does the azygos drain into the SVC?
arches over the right of the lung on the right
How do the azygos and hemiazygos veins communicate with the abdominal cavity? [major venous connection]
via direct connection to the ascending lumbar veins
The azygos system connects to the portal system indirectly through the __________
esophageal venous plexus
The hemiazygos system usually reached a vertebral level of ____ whereas the accessory hemi reaches ___ [there are a lot of variabilities from person to person however]
T8, T6.
How does liver cirrhosis affect the esophageal plexus?
There is a backup of blood into the portal vein which will head back towards the stomach and esophageal plexus. There is a direction connection with the azygos system. Dump lots of blood into azygos when its not designed to take that much blood
Ruptured vessels in the plexus of veins close to the internal surface of the esophagus can become dilated from ________ and can be ruptured easily and bleed extensively
portal hypertension
If the posterior mediastinum is viewed from the right, the arch of the azygos is found where in relation to the root of the lung
superior
On which side does the diaphragm protrude more highly and why?
on right side because of liver
The thoracic duct receives the lymph from the entire body except where?
the upper right quadrant of the chest and the right side of the head
The thoracic duct passes just inferior to the diaphragm to its point of emptying into the venous system at what junction?
left internal jugular and left subclavian vein
How is flow through the thoracic duct facilitated?
pressure changes during respiration
True/False: Flow through the thoracic duct goes in both directions
FALSE - has valves so that flow only goes in one direction
The thoracic duct passes behind the ______ brachiocephalic vein
right
The oblique fissure runs from what vertebral level? What are the differences between sides? Is it found in the superior or inferior mediastinum?
Starts at T4/T5 and runs anteriorly to pass through hilum. The left is steep than the right. This would be the inferior mediastinum (T4-T9)
The right horizontal fissure runs from the hilum anteriorly. How does the left horizontal fissure run?
trick question there is no left horizontal fissure HAHAHA
Describe tension pneumothorax.
Tension pneumothorax is caused by a wound that creates a “flap” so that air can come in but then flap closes and air cannot escape. This causes a shift of the heart, aorta, and trachea.
What is the biggest issue with tension pneumothorax?
Cardiac output compromised due obstruction of flow to heart
On which view will a tension pneumothorax be better visualized: inspiratory or expiratory and why?
Expiratory because lung naturally pulled back from chest wall
True/False: A silhouette sign can be normal or pathologic and generally refers to the border between lung tissue and any other neighboring tissue (usually the heart)
TRUE
What is a normal silhouette sign?
Heart obscures anterior part of left hemi-diaphragm in lateral film or anterior part of PA film
Rank in terms of most radiolucent to least radiolucent: water and most tissues, spongy bone, fat, air, compact bone
Air, fat, water and most tissues, spongy bone, compact bone
True/False In the costodiaphragmmatic recess, an air fluid level can be normal or pathologic
FALSE - pathologic
On an x-ray, a breast overlapping with the diaphragm would produce a ______
summation shadow
What do the black hole on the chest x-ray signify? Where are the pulmonary arteries in relation?
THe black hole is the left upper lobe bronchus. The left pulmonary artery will be above and the right pulmonary artery will be anterior.
True/False: Posteroinferior lower lobes can only be seen on lateral films
TRUE - diaphragm obscures on PA
