Respiratory: Anatomy - Pleurae, lungs and tracheobronchial tree

Question 1

Four parts of the parietal pleura

Answer 1

1. Costal
2. Mediastinal
3. Diaphragmatic
4. Cervical (pleural cupula; covers apex of lungs)

Question 2

Three pleural reflections

Answer 2

1. Sternal: costal to mediastinal pleura anteriorly
2. Costal: costal to diaphragmatic pleura inferiorly
3. Diaphragmatic/vertebral: costal to mediastinal pleura posteriorly

Question 3

Describe the course of the sternal pleural reflections in the L vs R lung

Answer 3

Both start from cupulae superiorly, pass posterior to SCJ to meet at anterior median line at level of sternal angle
Descend in contact at level of ribs 2-4
R then turns laterally at 6th costal cartilage
L turns laterally at 4th costal cartilage (making space for pericardium) then descends inferiorly at 6th

Question 4

Describe the course of the costal pleural reflections

Answer 4

Pass obliquely from:
- 8th rib in midclavicular line
- 10th rib in midaxillary line
- 12th neck of rib continuous with vertebral lines

L costal begins at midclavicular line (to make space for pericardium)

Question 5

Describe the course of the diaphragmatic/vertebral pleural reflections

Answer 5

Runs in paravertebral places T1-12

Question 6

Two costal recesses

Answer 6

1. Costomediastinal
2. Costodiaphragmatic

Question 7

Describe the divisions of segments by lobe in L vs R lung

Answer 7

Right lung:
- Superior lobe: segments 1-3
- Middle lobe: segments 4-5
- Inferior lobe: segments 6-10

Left lung:
- Superior lobe: segments 1-5 (lingula 4-5)
- Inferior lobe: segments 6-10

Question 8

Describe the course of the oblique fissure

Answer 8

From spine of T3 to 6th rib in midclavicular line

Question 9

Describe the course of the horizontal fissure

Answer 9

From 4th costal cartilage between superior and middle lobes
Meets oblique fissure at 5th costal cartilage in midaxillary line

Question 10

At what vertebral and costal cartilage level are the hila of the lung located?

Answer 10

3rd to 4th costal cartilages
T5-7 vertebrae

Question 11

What are the unique features of the R lung hilum?

Answer 11

Separate R upper and main bronchi
Separate upper lobe pulmonary artery

Question 12

What are the unique features of the L lung hilum?

Answer 12

Pulmonary artery on top with left main bronchus below
2x pulmonary veins: one lying anterior and one inferior to the left main bronchus

Question 13

Surface impressions and hilar contents of L lung

Answer 13

Question 14

Surface impressions and hilar contents of R lung

Answer 14

Question 15

Lung hilum contents

Answer 15

1. Main bronchus (+ upper bronchus on R)
2. Pulmonary artery(s)
3. Pulmonary vein(s)
4. Bronchopulmonary lymph nodes and channels
5. Bronchial vessels
6. Pulmonary ligament (formed from pleural folds)

Question 16

At what level do the R and L pulmonary arteries arise from the pulmonary trunk?

Answer 16

Level of the sternal angle

Question 17

Describe the course of the pulmonary arteries into the L and R lung

Answer 17

R pulmonary artery gives off R superior lobar artery (before entering hilum), then divides into middle and inferior lobar arteries -> segmental arteries

L pulmonary artery gives off L superior lobar artery (before entering hilum), then continues as inferior lobar artery -> segmental arteries

Question 18

How is the thoracic aorta accessed via thoracotomy?

Answer 18

Through L chest at 5th intercostal space

Question 19

How is the oesophagus accessed via thoracotomy?

Answer 19

Through R chest at 5th intercostal space

Question 20

What is the landmark for pericardial aspiration?

Answer 20

Needle inserted just left of xyphoid

Question 21

What are the surface landmarks for aspiration of the pleural cavity?

Answer 21

4th intercostal space in mid-axillary line

Question 22

Describe the venous drainage of the lungs

Answer 22

Superficial venous drainage via bronchial veins
Deep venous drainage via pulmonary veins or directly to LA

Question 23

Describe the bronchial vessels supplying the L lung

Answer 23

2x bronchial arteries, directly from thoracic aorta
1x bronchial vein which drains into accessory hemizygos or L superior intercostal vein

Question 24

Describe the bronchial vessels supplying the R lung

Answer 24

1x bronchial artery, usually from 3rd R posterior intercostal artery
1x bronchial vein which drains into the azygos vein