Pulmonary Anatomy Flashcards by Diana Padilla

The inferior thoracic aperture is closed by the ________

diaphragm

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What are the three spaces in the chest that make up the thoracic structures?

left pulmonary cavity, right pulmonary cavity, and mediastinum

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In the thorax, the blood supply (aorta, vena cava), nerve supply (vagus nerve), thoracic duct and esophagus all penetrate the __________

diaphragm

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The superior thoracic aperture has a lot of blood vessels due to vasculature to what three areas?

head, neck, upper extremities

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________ results from compression of vasculature and nerve supply penetrating superior thoracic aperture

thoracic outlet syndrome

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What does the independence of pulmonary cavities signify?

You can have problems on one side but still maintain respiration on the other.

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What two structures are contained within the pulmonary cavities?

Lungs and pleural sacs

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The space inside the pleural sac is called the _________ and is empty

pleural cavity

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The _______ is space sandwiched in between pleura on both sides

Mediastinum

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The ______ pleural lines the lung whereas the ______ lines the body wall

visceral, parietal

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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

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True/False: It is necessary to have positive pressure inside the lung during inspiration

FALSE, negative pressure to draw air in passively

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True/False: In COPD, airflow in is compromised

False, can get air in, but can’t get it back out

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The ___________ is where the parietal pleura extends further down than the inflated lung. The normal space is about 2 ribs.

costodiaphragmmatic recess

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What kind of nerve is the phrenic nerve?

Somatic (that’s why we can control breathing!) with some autonomic fibers

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The phrenic nerve is found sandwiched in between what two structures?

Parietal pleura and fibrous pericardium

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Phrenic nerve comes from what vertebral levels?

C3-C5 [C3,4,5 keeps the person alive!]

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Posteriorly (paravertebrally), the lungs (visceral pleura) go to above vertebral level of ____ whereas the parietal pleura go to vertebral level of ___

10, 12

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Anteriorly, when looking at mid-clavicular level, the lungs (visceral pleura) go to about vertebral level of ____ and the parietal pleura to ___

6, 8

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If looking from a mid-axillary viewpoint, the lungs (visceral pleura) go to about vertebral level of ___ and the parietal pleura to ____

8, 10

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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)

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Why is it important that patient raises their arms for CXR?

to get scapula out of the way

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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

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________ are potential spaces which can fill with blood, air and water in pathological states.

Pleural Recesses

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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

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