Thorax anatomy-Thoracic cavity(Snell's Clinical Anatomy By Regions 10th Edition) Flashcards
Discuss the mediastinum
.Definition
Is the area between the:(1)Sternum
(2)Two pleural cavities
(3)vertebral column
.Features
1st/In the living:(1)Thick
(2)Movable
(3)The lungs,heart,and large arteries are in rhythmic pulsation
(4)The oesophagus distends as each bolus of food passes through it
2nd/In the cadaver:Because of the hardening effect of the preserving fluids,the
mediastinum is:
(1)an inflexible structure
(2)fixed structure
.Extension
I)Superiorly to:(1)the thoracic outlet
(2)the root of the neck
a)Mediastinitis:1)The structures that make up the mediastinum are
embedded in loose connective tissue that is
continuous with that of the root of the neck.
Thus, it is possible for a deep infection of
the neck to spread readily Into the thorax,
producing a mediastinitis).
2) Penetrating wounds of the chest Involving the
oesophagus may produce a mediastinitis.
b)Subcutaneous emphysema: In esophageal perforations,
air escapes Into the connective
tissue spaces and ascends beneath
the fascia to the root of the neck,
producing subcutaneous emphysema
II)Inferiorly to:the diaphragm.
III)Anteriorly to:the sternum(the upper border of the sternum is at
level of lower border of T2)
IV)Posteriorly to:the vertebral column.
V)Laterally on either side:Rt and Lt pleura and lungs
.It contains:
(1) the remains of the thymus,
(2) the heart
(3) large blood vessels,
(4) the trachea
(5) oesophagus
(6) the thoracic duct
(7) lymph nodes
(8) the vagus
(9) phrenic nerves
(10) the sympathetic trunks.
.Division:
1st/The mediastinum is divided into superior and Inferior mediastina by an
imaginary plane passing from the sternal angle anteriorly to the lower
border of the body of the fourth thoracic vertebra posteriorly.
This plane is a noteworthy landmark in that it marks several key structures.
From anterior to posterior, these are the:
(1)Joint between the manubrium and body of the sternum
(2)Second costosternal joint
(3)Demarcation between the ascending aorta and the
arch of the aorta
(4)Demarcation between the arch of the aorta and the
descending thoracic aorta
(5)Bifurcation of the trachea
(6)Level of the left primary bronchus
(7)T4 intervertebral disc
2nd/The superior mediastinum
+Boundaries:I)Anteriorly:Manubrium sterni
II)Posteriorly:First four thoracic vertebrae
(T1-T4)
III)Inferiorly:Line joining the sternal angle to the
lower border of T4
IV)Laterally:Pleura
+Contents:(1)Thymus gland and some lymph node
(2)Large veins-(a)Innominate(Brachiocephalic)vein
(b)Superior vena cava(SVC)
(3)Large arteries-(a)Aortic arch
(b)Innominate(Brachiocephalic)artery
(c)Lt common carotid artery
(d)Lt subclavian artery
(4)Nerves-(a)Vagus nerve
(b)Cardiac nerve
(c)Phrenic nerve
(d)Lt recurrent laryngeal nerve
(c)Sympathetic trunks
(5)Tubes-(a)Trachea
(b)Oesophagus
(c)Thoracic duct
3rd/The inferior mediastinum
+Boundaries:I)Anteriorly-Body of the sternum
II)Posteriorly-Lower eight thoracic vertebrae
+Contents in general: (1) Thymus,
(2) Heart within the pericardium with the phrenic nerves
on each side,
(3) Oesophagus and thoracic duct,
(4) Descending aorta
(5) Sympathetic trunks.
+is further subdivided into the:
.Middle mediastinum-Contents: (1)The heart & pericardium.
(2)The ascending aorta.
(3)The superior vena cava with the azygos
vein opening into it.
(4)The pulmonary artery dividing into its
two branches.
(5)The right & left pulmonary veins.
(6)The phrenic nerves.
(7)Some bronchial LNs.
(8)The bifurcation of the trachea & the two
bronchi.
N.B
The site chosen for pericardiocentesis: Left 5th intercostals space.
Posterior inter-ventricular artery is a branch of right coronary, while
anterior inter-ventricu.lar is a branch of left coronary.
.Anterior mediastinum-Location:which is a space between the
pericardium and the sternum
Contents:(1)Loose areolar tissue
(2)Lymph vessels and nodes
(3)Fat
(4)Thymus(prominent in children)
(5)Sterno-pericardial ligaments
.Posterior mediastinum-Location:which lies between the pericardium and
the vertebral column.
Contents:(1)Arteries:Thoracic part of the
descending aorta.
(2)Veins: Azygos & Hemi-azygos vein
(3)Nerves:(a)Vagus nerve
(b)Thoracic splanchnic nerve
(4)Oesophagus
(5)Lymph structures:(a)Thoracic duct
(b)Some LNs.
Define the mediastinum
Is the area between the:(1)Sternum
(2) Two pleural cavities
(3) vertebral column
What are the features of the mediastinum?
1st/In the living:(1)Thick
(2)Movable
(3)The lungs,heart,and large arteries are in rhythmic pulsation
(4)The oesophagus distends as each bolus of food passes through it
2nd/In the cadaver:Because of the hardening effect of the preserving fluids,the
mediastinum is:
(1)an inflexible structure
(2)fixed structure
What are the contents of the mediastinum in general?
(1) the remains of the thymus
(2) the heart
(3) large blood vessels
(4) the trachea
(5) oesophagus
(6) the thoracic duct
(7) lymph nodes
(8) the vagus
(9) phrenic nerves
(10) the sympathetic trunks.
Discuss the division of the mediastinum
1st/The mediastinum is divided into superior and Inferior mediastina by an
imaginary plane passing from the sternal angle anteriorly to the lower
border of the body of the fourth thoracic vertebra posteriorly.
This plane is a noteworthy landmark in that it marks several key structures.
From anterior to posterior, these are the:
(1)Joint between the manubrium and body of the sternum
(2)Second costosternal joint
(3)Demarcation between the ascending aorta and the
arch of the aorta
(4)Demarcation between the arch of the aorta and the
descending thoracic aorta
(5)Bifurcation of the trachea
(6)Level of the left primary bronchus
(7)T4 intervertebral disc
2nd/The superior mediastinum
+Boundaries:I)Anteriorly:Manubrium sterni
II)Posteriorly:First four thoracic vertebrae(T1-T4)
III)Inferiorly:Line joining the sternal angle to the lower border of T4
IV)Laterally:Pleura
+Contents:(1)Thymus gland and some lymph node
(2)Large veins-(a)Innominate(Brachiocephalic)vein
(b)Superior vena cava(SVC)
(3)Large arteries-(a)Aortic arch
(b)Innominate(Brachiocephalic)artery
(c)Lt common carotid artery
(d)Lt subclavian artery
(4)Nerves-(a)Vagus nerve
(b)Cardiac nerve
(c)Phrenic nerve
(d)Lt recurrent laryngeal nerve
(c)Sympathetic trunks
(5)Tubes-(a)Trachea
(b)Oesophagus
(c)Thoracic duct
3rd/The inferior mediastinum
+Boundaries:I)Anteriorly-Body of the sternum
II)Posteriorly-Lower eight thoracic vertebrae
+Contents in general: (1) Thymus,
(2) Heart within the pericardium with the phrenic nerves
on each side,
(3) Oesophagus and thoracic duct,
(4) Descending aorta
(5) Sympathetic trunks.
+is further subdivided into the:
.Middle mediastinum-Contents: (1)The heart & pericardium.
(2)The ascending aorta.
(3)The superior vena cava with the azygos
vein opening into it.
(4)The pulmonary artery dividing into its
two branches.
(5)The right & left pulmonary veins.
(6)The phrenic nerves.
(7)Some bronchial LNs.
(8)The bifurcation of the trachea & the two
bronchi.
N.B
The site chosen for pericardiocentesis: Left 5th intercostals space.
Posterior inter-ventricular artery is a branch of right coronary, while
anterior inter-ventricu.lar is a branch of left coronary.
.Anterior mediastinum-Location:which is a space between the
pericardium and the sternum
Contents:(1)Loose areolar tissue
(2)Lymph vessels and nodes
(3)Fat
(4)Thymus(prominent in children)
(5)Sterno-pericardial ligaments
.Posterior mediastinum-Location:which lies between the pericardium and
the vertebral column.
Contents:(1)Arteries:Thoracic part of the
descending aorta.
(2)Veins: Azygos & Hemi-azygos vein
(3)Nerves:(a)Vagus nerve
(b)Thoracic splanchnic nerve
(4)Oesophagus
(5)Lymph structures:(a)Thoracic duct
(b)Some LNs.
Discuss the imaginary line dividing the mediastinum
The mediastinum is divided into superior and Inferior mediastina by an
imaginary plane passing from the sternal angle anteriorly to the lower
border of the body of the fourth thoracic vertebra posteriorly.
This plane is a noteworthy landmark in that it marks several key structures.
From anterior to posterior, these are the:
(1)Joint between the manubrium and body of the sternum
(2)Second costosternal joint
(3)Demarcation between the ascending aorta and the
arch of the aorta
(4)Demarcation between the arch of the aorta and the
descending thoracic aorta
(5)Bifurcation of the trachea
(6)Level of the left primary bronchus
(7)T4 intervertebral disc
Define the imaginary line dividing the mediastinum
The mediastinum is divided into superior and Inferior mediastina by an
imaginary plane passing
(1)from the sternal angle anteriorly
(2)to the lower border of the body of the fourth thoracic vertebra posteriorly.
What is the extension of the imaginary line dividing the mediastinum?
passing from the sternal angle anteriorly to the lower border of the body of the fourth thoracic vertebra posteriorly.
What is the importance of the imaginary line dividing the mediastinum?
This plane is a noteworthy landmark in that it marks several key structures. From anterior to posterior, these are the:
(1)Joint between the manubrium and body of the sternum
(2)Second costosternal joint
(3)Demarcation between the ascending aorta and the
arch of the aorta
(4)Demarcation between the arch of the aorta and the
descending thoracic aorta
(5)Bifurcation of the trachea
(6)Level of the left primary bronchus
(7)T4 intervertebral disc
What are the structures marked by the imaginary line dividing the mediastinum?
From anterior to posterior, these are the:
(1)Joint between the manubrium and body of the sternum
(2)Second costosternal joint
(3)Demarcation between the ascending aorta and the
arch of the aorta
(4)Demarcation between the arch of the aorta and the
descending thoracic aorta
(5)Bifurcation of the trachea
(6)Level of the left primary bronchus
(7)T4 intervertebral disc
Discuss the superior mediastinum
+Boundaries:I)Anteriorly:Manubrium sterni
(Mnemonic: II)Posteriorly:First four thoracic vertebrae
APIL (T1-T4)
III)Inferiorly:Line joining the sternal angle to the
lower border of T4
IV)Laterally:Pleura
+Contents:(Mnemonic:Thymus IS ABCS VCRP TOT)
(1)Thymus gland and some lymph node
(2)Large veins-(a)Innominate(Brachiocephalic)vein
(b)Superior vena cava(SVC)
(3)Large arteries-(a)Aortic arch
(b)Innominate(Brachiocephalic)artery
(c)Lt common carotid artery
(d)Lt subclavian artery
(4)Nerves-(a)Vagus nerve
(b)Cardiac nerve
(c)Phrenic nerve
(d)Lt recurrent laryngeal nerve
(c)Sympathetic trunks
(5)Tubes-(a)Trachea
(b)Oesophagus
(c)Thoracic duct
What are the boundaries of the superior mediastinum?
I)Anteriorly:Manubrium sterni
(Mnemonic: II)Posteriorly:First four thoracic vertebrae
APIL/MF-LP) (T1-T4)
III)Inferiorly:Line joining the sternal angle to the
lower border of T4
IV)Laterally:Pleura
What are the contents of the superior mediastinum?
(Mnemonic:Thymus IS ABCS VCRP TOT)
(1) Thymus gland and some lymph node
(2) Large veins-(a)Innominate(Brachiocephalic)vein
(b) Superior vena cava(SVC)
(3) Large arteries-(a)Aortic arch
(b) Innominate(Brachiocephalic)artery
(c) Lt common carotid artery
(d) Lt subclavian artery
(4) Nerves-(a)Vagus nerve
(b) Cardiac nerve
(c) Phrenic nerve
(d) Lt recurrent laryngeal nerve
(c) Sympathetic trunks
(5) Tubes-(a)Trachea
(b) Oesophagus
(c) Thoracic duct
What are the veins of the superior mediastinum?
(1) Innominate(Brachiocephalic)vein
2) Superior vena cava(SVC
What are the arteries of the superior mediastinum?
(1) Aortic arch
(2) Brachiocephalic(Innominate)artery
(3) Lt common carotid artery
(4) Lt subclavian artery
What are the nerves of the superior mediastinum?
(1) Vagus nerve
(2) Cardiac nerve
(3) Lt recurrent laryngeal nerve
(4) Phrenic nerve
What are the tube of the superior mediastinum?
(1) Trachea
(2) Oesophagus
(3) Thoracic duct
(4) Thymus
Discuss the inferior mediastinum
+Boundaries:I)Anteriorly-Body of the sternum
II)Posteriorly-Lower eight thoracic vertebrae
+Contents in general: (1) Thymus,
(2) Heart within the pericardium with the phrenic nerves
on each side,
(3) Oesophagus and thoracic duct,
(4) Descending aorta
(5) Sympathetic trunks.
+is further subdivided into the:
.Middle mediastinum-Contents: (1)The heart & pericardium.
(2)The ascending aorta.
(3)The superior vena cava with the azygos
vein opening into it.
(4)The pulmonary artery dividing into its
two branches.
(5)The right & left pulmonary veins.
(6)The phrenic nerves.
(7)Some bronchial LNs.
(8)The bifurcation of the trachea & the two
bronchi.
N.B
The site chosen for pericardiocentesis: Left 5th intercostals space.
Posterior inter-ventricular artery is a branch of right coronary, while
anterior inter-ventricu.lar is a branch of left coronary.
.Anterior mediastinum-Location:which is a space between the
pericardium and the sternum
Contents:(1)Loose areolar tissue
(2)Lymph vessels and nodes
(3)Fat
(4)Thymus(prominent in children)
(5)Sterno-pericardial ligaments
.Posterior mediastinum-Location:which lies between the pericardium and
the vertebral column.
Contents:(1)Arteries:Thoracic part of the
descending aorta.
(2)Veins: Azygos & Hemi-azygos vein
(3)Nerves:(a)Vagus nerve
(b)Thoracic splanchnic nerve
(4)Oesophagus
(5)Lymph structures:(a)Thoracic duct
(b)Some LNs.
What are the boundaries of the inferior mediastinum?
I)Anteriorly-Body of the sternum
II)Posteriorly-Lower eight thoracic vertebrae
What are the contents of the inferior mediastinum in general?
Mnemonic:The HODS
(1) Thymus,
(2) Heart within the pericardium with the phrenic nerves
on each side,
(3) Oesophagus and thoracic duct,
(4) Descending aorta
(5) Sympathetic trunks.
What are the divisions of the inferior mediastinum?
is further subdivided into the:
.Middle mediastinum-Contents: (1)The heart & pericardium.
(2)The ascending aorta.
(3)The superior vena cava with the azygos
vein opening into it.
(4)The pulmonary artery dividing into its
two branches.
(5)The right & left pulmonary veins.
(6)The phrenic nerves.
(7)Some bronchial LNs.
(8)The bifurcation of the trachea & the two
bronchi.
N.B
The site chosen for pericardiocentesis: Left 5th intercostals space.
Posterior inter-ventricular artery is a branch of right coronary, while
anterior inter-ventricu.lar is a branch of left coronary.
.Anterior mediastinum-Location:which is a space between the
pericardium and the sternum
Contents:(1)Loose areolar tissue
(2)Lymph vessels and nodes
(3)Fat
(4)Thymus(prominent in children)
(5)Sterno-pericardial ligaments
.Posterior mediastinum-Location:which lies between the pericardium and
the vertebral column.
Contents:(1)Arteries:Thoracic part of the
descending aorta.
(2)Veins: Azygos & Hemi-azygos vein
(3)Nerves:(a)Vagus nerve
(b)Thoracic splanchnic nerve
(4)Oesophagus
(5)Lymph structures:(a)Thoracic duct
(b)Some LNs.
What are the contents of the middle mediastinum?
(1)The heart & pericardium.
(2)The ascending aorta.
(3)The superior vena cava with the azygos
vein opening into it.
(4)The pulmonary artery dividing into its
two branches.
(5)The right & left pulmonary veins.
(6)The phrenic nerves.
(7)Some bronchial LNs.
(8)The bifurcation of the trachea & the two
bronchi.
N.B
The site chosen for pericardiocentesis: Left 5th intercostals space.
Posterior inter-ventricular artery is a branch of right coronary, while
anterior inter-ventricular is a branch of left coronary.
Discuss the anterior mediastinum
Location:which lies between the pericardium and
the vertebral column.
Contents:(1)Arteries:Thoracic part of the
descending aorta.
(2)Veins: Azygos & Hemi-azygos vein
(3)Nerves:(a)Vagus nerve
(b)Thoracic splanchnic nerve
(4)Oesophagus
(5)Lymph structures:(a)Thoracic duct
(b)Some LNs.
What is the location of the anterior mediastinum?
which lies between (1)the pericardium and
(2)the vertebral column.
What are the contents of the anterior mediastinum?
(1)Arteries:Thoracic part of the
descending aorta.
(2)Veins: Azygos & Hemi-azygos vein
(3)Nerves:(a)Vagus nerve
(b)Thoracic splanchnic nerve
(4)Oesophagus
(5)Lymph structures:(a)Thoracic duct
(b)Some LNs.
Discuss posterior mediastinum
Location:which lies between the pericardium and
the vertebral column.
Contents:(1)Arteries:Thoracic part of the
descending aorta.
(2)Veins: Azygos & Hemi-azygos vein
(3)Nerves:(a)Vagus nerve
(b)Thoracic splanchnic nerve
(4)Oesophagus
(5)Lymph structures:(a)Thoracic duct
(b)Some LNs.
What is the location of the posterior mediastinum?
which lies between (1)the pericardium and
(2)the vertebral column.
What are the contents of the posterior mediastinum?
(1)Arteries:Thoracic part of the
descending aorta.
(2)Veins: Azygos & Hemi-azygos vein
(3)Nerves:(a)Vagus nerve
(b)Thoracic splanchnic nerve
(4)Oesophagus
(5)Lymph structures:(a)Thoracic duct
(b)Some LNs.
Write short notes on deflection of the mediastinum
Symptoms:Shock and breathlessness
This condition reveals itself by the patient being breathless and in
a state of shock.
Signs:Mediastinum displacement
(1)If air enters the pleural cavity (a condition called pneumothorax),
the lung on that side immediately collapses and the mediastinum is
displaced to the opposite side.
(2)On examination, the trachea. and the heart are displaced to the
opposite side.
Discuss mediastinitis
1)The structures that make up the mediastinum are embedded in loose
connective tissue that is continuous with that of the root of the neck.
Thus, it is possible for a deep infection of the neck to spread readily into the thorax
producing mediastinitis
2) Penetrating wounds of the chest Involving the oesophagus may produce a
mediastinitis.
Write short notes on mediastinal tumours or cysts
Because many vital structures are crowded together with the mediastinum, their functions can be interfered with by an enlarging tumor or organ. A tumor of the left lung can rapidly spread to involve the mediastinal lymph nodes, which on enlargement may compress the left recurrent laryngeal nerve, producing paralysis of the left vocal fold. An expanding cyst or tumor can partially occlude the superior vena cava, causing severe congestion of the vetns of the upper part of the body. Other pressure effects can be seen on the sympathetic: trunks, phrenic nerves, and sometimes the trachea, main bronchi, and oesophagus.
Write short notes on mediastinectomy
Mediastinoscopy is a diagnostic procedure whereby specimens of tracheobronchial lymph nodes are obtained without opening the pleural cavities. A small incision is made in the midline in the neck just above the suprasternal notch, and the superior mediastinum is explored down to the region of the bifurcation of the trachea. The procedure can be used to determine the diagnosis and degree of spread of carcinoma of the bronchus
Discuss the pleura
.Def:serous membrane which folds back upon itself to form a two-layered,
membranous structure.
.Location:The paired pleurae and lungs lie:(1)on either side of the mediastinum
(2)within the thoracic cavity
.Division:
1st/Pleural membrane:Each pleural membrane has two parts:
I)a parietal layer:
+Def:The outer pleura (parietal pleura) that is attached to the chest wall.
+Function:
(1)The parietal layer lines the thoracic wall
(2)Covers the(a)thoracic surface of the diaphragm
(b)lateral aspect of the mediastinum
+Extension:
extends into the root of the neck to line the undersurface of the suprapleural membrane at the thoracic outlet.
+Classification: For purposes of description, the parietal pleura is divided according to
the region in which it lies or the surface that it covers:
I)The cervical pleura (cupula)
Features:(1)Extends up into the neck, lining the undersurface of the suprapleural
membrane.
(2)It reaches a level of 1 to 1.5 ln. (2.5 to 4 cm) above the medial third of the
clavicle.
Surface anatomy:(1)bulges upward into the neck and has a surface marking identical
to that of the apex of the lung.
(2)A curved line may be drawn, convex upward, from the
sternoclavicular joint to a point 1 in. (2.5 em) above the
junction of the medial and intermediate thirds of the clavicle
II)The costal pleura lines:(1)the inner surfaces of the ribs,
(2)the costal cartilages,
(3)the intercostal spaces,
(4)the sides of the vertebral bodies, and
(5)the back of the sternum.
III)The diaphragmatic pleura
Df:covers the thoracic surface of the diaphragm.
Variation with breathing-In quiet respiration=the costal and diaphragmatic pleurae are
in apposition to each other below the
lower border of the lung.
In deep inspiration=the lower margins of the base of the lungs
descend into the recesses,and the costal
and diaphragmatic pleurae
separate.
IV)The mediastinal pleura
Location:covers and forms the lateral boundary of the mediastinum.
Function:It reflects as a cuff around the vessels and bronchi at the hilum of the lung
and here becomes continuous with the visceral pleura.
V)Lung root:Each lung lies free except at its hilum, where it is attached to the blood
vessels and bronchi that constitute the lung root.
VI)The costodiaphragmatic recess
Df: This lower area of the pleural cavity into which the lung expands on inspiration is
referred to as the costodiaphragmatic recess
Location: between the costal and diaphragmatic parietal pleurae that are separated
only by a capillary layer of pleural fluid.
Shape: slitlike spaces
Variations with breathing-During full inspiration=the lungs expand and fill the pleural
cavities.
During quiet inspiration=the lungs do not fully occupy the
pleural cavities at four sites,the
right and left costodiaphragmatic
and the right and left
costomediastinal recesses.
V)The costomediastinal recesses
Location:are situated along the anterior margins of the pleura.
Shape:They are slitlike spaces between the costal and mediastinal parietal pleurae,
which are separated by a capillary layer of pleural fluid.
Variation with breathing:During inspiration and expiration, the anterior borders of the
lungs slide in and out of the recesses.
Surface anatomy:The distance between the two borders corresponds to the
costodiaphragmatic recess
II)The visceral layer:
Def:the inner pleura (visceral pleura) that covers the lungs and adjoining structures, i.e.
blood vessels, bronchi and nerves.
Features: It is thinner than the parietal layer
Function:completely covers the outer surface of the lung
Extension:extends into the depths of the interlobar fissures
2nd/Pulmonary ligament
+Df:The two layers are continuous with one another via a cuff of pleura that surrounds
the structures entering and leaving the hilum at the hilum of each lung
This cuff hangs down as a loose fold called the pulmonary ligament
+Function:allows for movement of the pulmonary vessels and large bronchi during
respiration
3rd/Pleural cavity
+Def:The thin space between the two pleural layers
+Shape: a slitlike space
+Function:(1)The parietal and visceral layers of pleura are separated from one another
by, the pleural cavity.
(2)The pleural cavity normally contains only a small amount of tissue fluid,
the pleural fluid.
+Other names:Pleural space
Clinicians are increasingly using the term pleural space instead of the
anatomic term pleural cavity. This is probably to avoid the confusion
between the pleural cavity [slitlike] space and the larger thoracic
cavity
4th/Pleural fluid:
+Function:(1)covers the surfaces of the pleura as a thin film, which causes surface
tension adhesion of the pleural layers and permits them to move on each
other with minimal friction. Thus, the pleural cavity is a potential space
under normal conditions and is discernible only under abnormal
conditions (e.g., when the lung is displaced by air or excess fluid).
(2)lubricates the apposing surfaces of the visceral and parietal pleurae
during respiratory movements.
+Amount:The pleural cavity normally contains 5 to 10 mL of clear fluid
+Formation:(1)Hydrostatic and osmotic pressures stimulate formation of the fluid.
(2)Because the hydrostatic pressures are greater in the capillaries of the
parietal pleura than in the capillaries of the visceral pleura (pulmonary
circulation), the capillaries of the visceral pleura normally absorb the
pleural fluid.
Surface anatomy of the pleura
1st/The lines of pleural reflections
Def: The lines, which indicate the limits of the parietal pleura where it lies close
to the body surface, are referred to as the lines of pleural reflection
Significance:(1)The boundaries of the pleural sac can be marked out as lines on the
surface of the body.
(2)Recognizing the surface markings of the pleural reflections and
the lobes of the lungs is important. The clinician should have a
mental image of the structures that lie beneath the stethoscope when
listening to the breath sounds of the respiratory tract.
2nd/Borders of the pleura
I) The anterior border of the right pleura:runs down behind the sternoclavicular joint,
almost reaching the midline behind the sternal
angle. It then continues downward until it
reaches the xiphisternal joint.
II) The anterior border of the left pleura:has a similar course, but at the level of the
fourth costal cartilage, it deviates laterally and
extends to the lateral margin of the sternum to
form the cardiac notch. (Note that the pleural
cardiac notch is not as large as the cardiac
notch of the lung.) It then turns sharply
downward to the xiphisternal joint
III) The lower border of the pleura:on both sides follows a curved line, which
crosses the eighth rib in the midclavicular line and
the 10th rib in the midaxillary line, and reaches the
12th rib adjacent to the vertebral column that is, at
the lateral border of the erector spinae muscle.
Note that the lower margins of the lungs cross the
6th, 8th, and lOth ribs at the midclavicular lines, the
midaxillary lines, and the sides of the vertebral
column, respectively; the lower margins of the
pleura cross, at the same points, the 8th, l0th,and
12th ribs, respectively.
IV) The costodiaphragmatic recess:The distance between the two borders
corresponds to the costodiaphragmatic recess
Define the pleura
serous membrane which folds back upon itself to form a two-layered, membranous structure.
What is the location of the pleura?
The paired pleurae and lungs lie:(1)on either side of the mediastinum
(2)within the thoracic cavity
Discuss the division of the pleura
.Division:
1st/Pleural membrane:Each pleural membrane has two parts:
I)a parietal layer:
+Function:
(1)The parietal layer lines the thoracic wall
(2)Covers the(a)thoracic surface of the diaphragm
(b)lateral aspect of the mediastinum
+Extension:
extends into the root of the neck to line the undersurface of the suprapleural membrane at the thoracic outlet.
+Classification: For purposes of description, the parietal pleura is divided according to
the region in which it lies or the surface that it covers:
I)The cervical pleura (cupula)
(1)Extends up into the neck, lining the undersurface of the suprapleural membrane.
(2)It reaches a level of 1 to 1.5 ln. (2.5 to 4 cm) above the medial third of the clavicle.
II)The costal pleura lines:(1)the inner surfaces of the ribs,
(2)the costal cartilages,
(3)the intercostal spaces,
(4)the sides of the vertebral bodies, and
(5)the back of the sternum.
III)The diaphragmatic pleura
Df:covers the thoracic surface of the diaphragm.
Variation with breathing-In quiet respiration=the costal and diaphragmatic pleurae are
in apposition to each other below the
lower border of the lung.
In deep inspiration=the lower margins of the base of the lungs
descend into the recesses,and the costal
and diaphragmatic pleurae
separate.
IV)The mediastinal pleura
Location:covers and forms the lateral boundary of the mediastinum.
Function:It reflects as a cuff around the vessels and bronchi at the hilum of the lung
and here becomes continuous with the visceral pleura.
V)Lung root:Each lung lies free except at its hilum, where it is attached to the blood
vessels and bronchi that constitute the lung root.
VI)The costodiaphragmatic recess
Df: This lower area of the pleural cavity into which the lung expands on inspiration is
referred to as the costodiaphragmatic recess
Location: between the costal and diaphragmatic parietal pleurae that are separated
only by a capillary layer of pleural fluid.
Shape: slitlike spaces
Variations with breathing-During full inspiration=the lungs expand and fill the pleural
cavities.
During quiet inspiration=the lungs do not fully occupy the
pleural cavities at four sites,the
right and left costodiaphragmatic
and the right and left
costomediastinal recesses.
V)The costomediastinal recesses
Location:are situated along the anterior margins of the pleura.
Shape:They are slitlike spaces between the costal and mediastinal parietal pleurae,
which are separated by a capillary layer of pleural fluid.
Variation with breathing:During inspiration and expiration, the anterior borders of the
lungs slide in and out of the recesses.
II)The visceral layer:
Features: It is thinner than the parietal layer
Function:completely covers the outer surface of the lung
Extension:extends into the depths of the interlobar fissures
2nd/Pulmonary ligament
+Df:The two layers are continuous with one another via a cuff of pleura that surrounds
the structures entering and leaving the hilum at the hilum of each lung
This cuff hangs down as a loose fold called the pulmonary ligament
+Function:allows for movement of the pulmonary vessels and large bronchi during
respiration
3rd/Pleural cavity
+Shape: a slitlike space
+Function:(1)The parietal and visceral layers of pleura are separated from one another
by, the pleural cavity.
(2)The pleural cavity normally contains only a small amount of tissue fluid,
the pleural fluid.
+Other names:Pleural space
Clinicians are increasingly using the term pleural space instead of the
anatomic term pleural cavity. This is probably to avoid the confusion
between the pleural cavity [slitlike] space and the larger thoracic
cavity
4th/Pleural fluid:
+Function:(1)covers the surfaces of the pleura as a thin film, which causes surface
tension adhesion of the pleural layers and permits them to move on each
other with minimal friction. Thus, the pleural cavity is a potential space
under normal conditions and is discernible only under abnormal
conditions (e.g., when the lung is displaced by air or excess fluid).
(2)lubricates the apposing surfaces of the visceral and parietal pleurae
during respiratory movements.
+Amount:The pleural cavity normally contains 5 to 10 mL of clear fluid
+Formation:(1)Hydrostatic and osmotic pressures stimulate formation of the fluid.
(2)Because the hydrostatic pressures are greater in the capillaries of the
parietal pleura than in the capillaries of the visceral pleura (pulmonary
circulation), the capillaries of the visceral pleura normally absorb the
pleural fluid.
Discuss the pleural membrane
Each pleural membrane has two parts:
I)a parietal layer:
+Function:
(1)The parietal layer lines the thoracic wall
(2)Covers the(a)thoracic surface of the diaphragm
(b)lateral aspect of the mediastinum
+Extension:
Extends into the root of the neck to line the undersurface of the suprapleural membrane at the thoracic outlet.
+Classification: For purposes of description, the parietal pleura is divided according to
the region in which it lies or the surface that it covers:
I)The cervical pleura (cupula)
(1)Extends up into the neck, lining the undersurface of the suprapleural membrane.
(2)It reaches a level of 1 to 1.5 ln. (2.5 to 4 cm) above the medial third of the clavicle.
II)The costal pleura lines:(1)the inner surfaces of the ribs,
(2)the costal cartilages,
(3)the intercostal spaces,
(4)the sides of the vertebral bodies, and
(5)the back of the sternum.
III)The diaphragmatic pleura
Df:covers the thoracic surface of the diaphragm.
Variation with breathing-In quiet respiration=the costal and diaphragmatic pleurae are
in apposition to each other below the
lower border of the lung.
In deep inspiration=the lower margins of the base of the lungs
descend into the recesses,and the costal
and diaphragmatic pleurae
separate.
IV)The mediastinal pleura
Location:covers and forms the lateral boundary of the mediastinum.
Function:It reflects as a cuff around the vessels and bronchi at the hilum of the lung
and here becomes continuous with the visceral pleura.
V)Lung root:Each lung lies free except at its hilum, where it is attached to the blood
vessels and bronchi that constitute the lung root.
VI)The costodiaphragmatic recess
Df: This lower area of the pleural cavity into which the lung expands on inspiration is
referred to as the costodiaphragmatic recess
Location: between the costal and diaphragmatic parietal pleurae that are separated
only by a capillary layer of pleural fluid.
Shape: slitlike spaces
Variations with breathing-During full inspiration=the lungs expand and fill the pleural
cavities.
During quiet inspiration=the lungs do not fully occupy the
pleural cavities at four sites,the
right and left costodiaphragmatic
and the right and left
costomediastinal recesses.
V)The costomediastinal recesses
Location:are situated along the anterior margins of the pleura.
Shape:They are slitlike spaces between the costal and mediastinal parietal pleurae,
which are separated by a capillary layer of pleural fluid.
Variation with breathing:During inspiration and expiration, the anterior borders of the
lungs slide in and out of the recesses.
II)The visceral layer:
Features: It is thinner than the parietal layer
Function:completely covers the outer surface of the lung
Extension:extends into the depths of the interlobar fissures
What are the functions of the parietal pleura?
(1) The parietal layer lines the thoracic wall
(2) Covers the(a)thoracic surface of the diaphragm
(b) lateral aspect of the mediastinum
What is the extension of the parietal pleura?
extends into the root of the neck to line the undersurface of the suprapleural membrane at the thoracic outlet.
What is the classification of the parietal pleura?
For purposes of description, the parietal pleura is divided according to the region in which it lies or the surface that it covers:
I)The cervical pleura (cupula)
(1)Extends up into the neck, lining the undersurface of the suprapleural membrane.
(2)It reaches a level of 1 to 1.5 in. (2.5 to 4 cm) above the medial third of the clavicle.
II)The costal pleura lines:(1)the inner surfaces of the ribs,
(2)the costal cartilages,
(3)the intercostal spaces,
(4)the sides of the vertebral bodies, and
(5)the back of the sternum.
III)The diaphragmatic pleura
Df:covers the thoracic surface of the diaphragm.
Variation with breathing-In quiet respiration=the costal and diaphragmatic pleurae are
in apposition to each other below the
lower border of the lung.
In deep inspiration=the lower margins of the base of the lungs
descend into the recesses,and the costal
and diaphragmatic pleura separate.
IV)The mediastinal pleura
Location:covers and forms the lateral boundary of the mediastinum.
Function:It reflects as a cuff around the vessels and bronchi at the hilum of the lung
and here becomes continuous with the visceral pleura.
V)Lung root:Each lung lies free except at its hilum, where it is attached to the blood
vessels and bronchi that constitute the lung root.
VI)The costodiaphragmatic recess
Df: This lower area of the pleural cavity into which the lung expands on inspiration is
referred to as the costodiaphragmatic recess
Location: between the costal and diaphragmatic parietal pleurae that are separated
only by a capillary layer of pleural fluid.
Shape: slitlike spaces
Variations with breathing-During full inspiration=the lungs expand and fill the pleural
cavities.
During quiet inspiration=the lungs do not fully occupy the
pleural cavities at four sites,the
right and left costodiaphragmatic
and the right and left
costomediastinal recesses.
V)The costomediastinal recesses
Location:are situated along the anterior margins of the pleura.
Shape:They are slitlike spaces between the costal and mediastinal parietal pleurae,
which are separated by a capillary layer of pleural fluid.
Variation with breathing:During inspiration and expiration, the anterior borders of the
lungs slide in and out of the recesses.
Discuss the cervical pleura(cupula)
(1)Extends up into the neck, lining the undersurface of the suprapleural
membrane.
(2)It reaches a level of 1 to 1.5 ln. (2.5 to 4 cm) above the medial third of the clavicle.
Discuss the costal pleura
The costal pleura lines:(1)the inner surfaces of the ribs,
(2) the costal cartilages,
(3) the intercostal spaces,
(4) the sides of the vertebral bodies, and
(5) the back of the sternum.
Discuss the diaphragmatic pleura
Df:covers the thoracic surface of the diaphragm.
Variation with breathing-In quiet respiration=the costal and diaphragmatic pleurae are
in apposition to each other below the
lower border of the lung.
In deep inspiration=the lower margins of the base of the lungs
descend into the recesses,and the costal
and diaphragmatic pleurae
separate.
Define the diaphragmatic pleura
covers the thoracic surface of the diaphragm.
Discuss the variation with breathing of the diaphragmatic pleura
In quiet respiration=the costal and diaphragmatic pleurae are in apposition to
each other below the lower border of the lung.
In deep inspiration=the lower margins of the base of the lungs descend into the
recesses,and the costal and diaphragmatic pleurae separate.
What happens to diaphragmatic pleura in quiet respiration?
the costal and diaphragmatic pleurae are in apposition to each other below the lower border of the lung.
What happens to diaphragmatic pleura in deep inspiration?
the lower margins of the base of the lungs descend into the recesses,and the costal and diaphragmatic pleurae separate.
Discuss the mediastinal pleura
Location:covers and forms the lateral boundary of the mediastinum.
Function:It reflects as a cuff around the vessels and bronchi at the hilum of the lung
and here becomes continuous with the visceral pleura.
What is the location of the mediastinal pleura?
covers and forms the lateral boundary of the mediastinum.
What is the function of the mediastinal pleura?
It reflects as a cuff around the vessels and bronchi at the hilum of the lung and here becomes continuous with the visceral pleura.
Discuss the lung root
Each lung lies free except at its hilum, where it is attached to the blood vessels and bronchi that constitute the lung root.
Discuss the costodiaphragmatic recesses
Df: This lower area of the pleural cavity into which the lung expands on
inspiration is referred to as the costodiaphragmatic recess
Location: between the costal and diaphragmatic parietal pleurae that are separated
only by a capillary layer of pleural fluid.
Shape: slitlike spaces
Variations with breathing-During full inspiration=the lungs expand and fill the pleural
cavities.
During quiet inspiration=the lungs do not fully occupy the
pleural cavities at four sites,the
right and left costodiaphragmatic
and the right and left
costomediastinal recesses.
Define the costodiaphragmatic recess
This lower area of the pleural cavity into which the lung expands on inspiration is referred to as the costodiaphragmatic recess
What is the location of the costodiaphragmatic recess?
between the costal and diaphragmatic parietal pleurae that are separated only by a capillary layer of pleural fluid.
What is the shape of the costodiaphragmatic recesses?
slitlike spaces
Discuss the variation with breathing of the costodiaphragmatic recess
During full inspiration=the lungs expand and fill the pleural cavities.
During quiet inspiration=the lungs do not fully occupy the pleural cavities at
four sites,the right and left costodiaphragmatic and the right
and left costomediastinal recesses.
What happens to costodiaphragmatic recess during full inspiration?
the lungs expand and fill the pleural cavities.
What happens to costodiaphragmatic recess during quiet inspiration?
the lungs do not fully occupy the pleural cavities at four sites,the right and left costodiaphragmatic and the right and left costomediastinal recesses.
Discuss the surface anatomy of the costodiaphragmatic recess
The distance between the two borders corresponds to the costodiaphragmatic recess
Discuss the costomediastinal recess
Location:are situated along the anterior margins of the pleura.
Shape:They are slitlike spaces between the costal and mediastinal parietal pleurae,
which are separated by a capillary layer of pleural fluid.
Variation with breathing:During inspiration and expiration, the anterior borders of the
lungs slide in and out of the recesses.
What is the location of the costomediastinal recess?
are situated along the anterior margins of the pleura.
What is the shape of the costomediastinal recess?
They are slitlike spaces between the costal and mediastinal parietal pleurae, which are separated by a capillary layer of pleural fluid.
What is the variation with breathing of the costomediastinal pleura?
During inspiration and expiration, the anterior borders of the lungs slide in and out of the recesses.
Discuss the visceral pleura
Features: It is thinner than the parietal layer
Function:completely covers the outer surface of the lung
Extension:extends into the depths of the interlobar fissures
What is the feature of the visceral pleura?
It is thinner than the parietal layer
What is the function of the visceral pleura?
completely covers the outer surface of the lung
What is the extension of the visceral pleura?
extends into the depths of the interlobar fissures
Discuss the pulmonary ligament
2nd/Pulmonary ligament
+Df:The two layers are continuous with one another via a cuff of pleura that
surrounds the structures entering and leaving the hilum at the hilum of each lung
This cuff hangs down as a loose fold called the pulmonary ligament
+Function:allows for movement of the pulmonary vessels and large bronchi during
respiration
Define the pulmonary ligament
The two layers are continuous with one another via a cuff of pleura that surrounds the structures entering and leaving the hilum at the hilum of each lung.This cuff hangs down as a loose fold called the pulmonary ligament
What is the function of the pulmonary ligament?
allows for movement of the pulmonary vessels and large bronchi during respiration
Discuss the pleural cavity
+Shape: a slitlike space
+Function:(1)The parietal and visceral layers of pleura are separated from one another
by, the pleural cavity.
(2)The pleural cavity normally contains only a small amount of tissue fluid,
the pleural fluid.
+Other names:Pleural space
Clinicians are increasingly using the term pleural space instead of the
anatomic term pleural cavity. This is probably to avoid the confusion
between the pleural cavity [slitlike] space and the larger thoracic
cavity
What is the shape of the pleural cavity?
A slitlike space
What is the function of the pleural cavity?
(1)The parietal and visceral layers of pleura are separated from one another by,
the pleural cavity.
(2)The pleural cavity normally contains only a small amount of tissue fluid, the pleural
fluid.
Write short notes on the nerve supply of the pleura
The pleural layers are innervated differently despite being a continuous membrane:-
1st/Parietal pleura
Somatic afferent nerves supply the parietal pleura, which is sensitive to pain, temperature, touch, and pressure:
• The intercostal nerves segmentally supply the costal pleura.
• The phrenic nerve supplies the mediastinal pleura.
• The phrenic nerve supplies the diaphragmatic pleura over the dome, and the lower
intercostal nerves supply the periphery of the diaphragmatic pleura.
2nd/Visceral pleura
Visceral afferent nerves supply the visceral pleura, which is sensitive to stretch but is insensitive to common sensations such as pain and touch.
These nerves run in company with autonomic nerves from the pulmonary plexus
What are the specific name of the nerves supplying the parietal pleura?
Somatic afferent nerves
What is the parietal pleura sensitive to?
(1) pain,
(2) temperature
(3) touch, and
(4) pressure
What are the somatic afferent nerves supplying the parietal pleura?
Somatic afferent nerves supply the parietal pleura, which is sensitive to pain, temperature, touch, and pressure:
• The intercostal nerves segmentally supply the costal pleura.
• The phrenic nerve supplies the mediastinal pleura.
• The phrenic nerve supplies the diaphragmatic pleura over the dome, and the lower
intercostal nerves supply the periphery of the diaphragmatic pleura.
What is the role of the intercostal nerves in the parietal pleura?
- The intercostal nerves segmentally supply the costal pleura.
- The lower intercostal nerves supply the periphery of the diaphragmatic pleura.
What is the nerve supply of the costal pleura?
The intercostal nerves
What is the nerve supply of the periphery of diaphragmatic pleura?
Lower intercostal nerves
What is the role of phrenic nerve in mediastinal pleura?
- The phrenic nerve supplies the mediastinal pleura.
* The phrenic nerve supplies the diaphragmatic pleura over the dome
What is the nerve supply of mediastinal pleura?
Phrenic nerve
What is the nerve supply of diaphragmatic pleura over the domes?
Phrenic nerve
What is the nerve supply of diaphragmatic pleura?
(1)The phrenic nerve supplies the diaphragmatic pleura over the dome, and
(2)The lower intercostal nerves supply the periphery of the diaphragmatic
pleura.
Write short notes on the nerve supply of the visceral pleura
Visceral afferent nerves supply the visceral pleura, which is sensitive to stretch but is insensitive to common sensations such as pain and touch.
These nerves run in company with autonomic nerves from the pulmo- nary plexus
What is the specific name for the nerves supplying the visceral pleura?
Visceral afferent nerves
What is the visceral pleura sensitive to?
stretch
What is the visceral pleura insensitive to?
to common sensations such as pain and touch.
What is the other name of the pleural cavity and what is its justification?
+Other names:Pleural space
+Justification:Clinicians are increasingly using the term pleural space instead of the
anatomic term pleural cavity. This is probably to avoid the confusion
between the pleural cavity [slitlike] space and the larger thoracic
cavity
Explain very briefly the nerve in company with the visceral afferent nerves?
The visceral afferent nerves run in company with autonomic nerves from the pulmonary plexus
Discuss the pleural fluid
+Function:(1)covers the surfaces of the pleura as a thin film, which causes
surface tension adhesion of the pleural layers and permits them to
move on each other with minimal friction. Thus, the pleural cavity is a
potential space under normal conditions and is discernible only under
abnormal conditions (e.g., when the lung is displaced by air or excess
fluid).
(2)lubricates the apposing surfaces of the visceral and parietal pleurae
during respiratory movements.
+Amount:The pleural cavity normally contains 5 to 10 mL of clear fluid
+Formation:(1)Hydrostatic and osmotic pressures stimulate formation of the fluid.
(2)Because the hydrostatic pressures are greater in the capillaries of the
parietal pleura than in the capillaries of the visceral pleura (pulmonary
circulation), the capillaries of the visceral pleura normally absorb the
pleural fluid.
Discuss the function of the pleural fluid
(1)covers the surfaces of the pleura as a thin film, which causes surface tension
adhesion of the pleural layers and permits them to move on each other with
minimal friction.Thus, the pleural cavity is a potential space under normal conditions
and is discernible only under abnormal conditions (e.g., when the lung is displaced
by air or excess fluid).
(2)lubricates the apposing surfaces of the visceral and parietal pleurae during
respiratory movements.
What is the amount of the pleural fluid?
The pleural cavity normally contains 5 to 10 mL of clear fluid
How is the pleural fluid formed?
(1)Hydrostatic and osmotic pressures stimulate formation of the fluid. (2)Because the hydrostatic pressures are greater in the capillaries of the
parietal pleura than in the capillaries of the visceral pleura (pulmonary circulation),
the capillaries of the visceral pleura normally absorb the pleural fluid.
Discuss pleural effusion
Df:abnormal accumulation of fluid(i.e.,The presence of excess serous fluid in
the pleural cavity)
Amount:The presence of 300 mL of fluid in the costodiaphragmatic recess in
an adult is sufficient to enable its clinical detection.
Causes:(1)Any condition that increases the production of the fluid
(e.g.,inflammation, malignancy, congestive heart disease)
(2)Any condition that impairs the drainage of the fluid (e.g., collapsed lung)
The clinical signs include:(1)decreased lung expansion on the side of the effusion, with
(2)decreased breath sounds and dullness on percussion
over the effusion
Treatment:Fluid(serous,blood,or pus)can be drained from the pleural cavity through
a wide-bore needle
Define the pleural effusion
abnormal accumulation of fluid(i.e.,The presence of excess serous fluid in the pleural cavity)
How much fluids are there in pleural effusion?
The presence of 300 mL of fluid in the costodiaphragmatic recess in an adult is sufficient to enable its clinical detection.
What are the causes of pleural effusion?
(1)Any condition that increases the production of the fluid (e.g., inflammation,
malignancy, congestive heart disease)
(2)Any condition that impairs the drainage of the fluid (e.g., collapsed lung)
What are the clinical signs of pleural effusion?
(1) decreased lung expansion on the side of the effusion, with
(2) decreased breath sounds and dullness on percussion over the effusion
Discuss surface anatomy of the pleura
Surface anatomy of the pleura
1st/The lines of pleural reflections
Def: The lines, which indicate the limits of the parietal pleura where it lies close
to the body surface, are referred to as the lines of pleural reflection
Significance:(1)The boundaries of the pleural sac can be marked out as lines on the
surface of the body.
(2)Recognizing the surface markings of the pleural reflections and
the lobes of the lungs is important. The clinician should have a
mental image of the structures that lie beneath the stethoscope when
listening to the breath sounds of the respiratory tract.
2nd/Borders of the pleura
I) The anterior border of the right pleura:runs down behind the sternoclavicular joint,
almost reaching the midline behind the sternal
angle. It then continues downward until it
reaches the xiphisternal joint.
II) The anterior border of the left pleura:has a similar course, but at the level of the
fourth costal cartilage, it deviates laterally and
extends to the lateral margin of the sternum to
form the cardiac notch. (Note that the pleural
cardiac notch is not as large as the cardiac
notch of the lung.) It then turns sharply
downward to the xiphisternal joint
III) The lower border of the pleura:on both sides follows a curved line, which
crosses the eighth rib in the midclavicular line and
the 10th rib in the midaxillary line, and reaches the
12th rib adjacent to the vertebral column that is, at
the lateral border of the erector spinae muscle.
Note that the lower margins of the lungs cross the
6th, 8th, and lOth ribs at the midclavicular lines, the
midaxillary lines, and the sides of the vertebral
column, respectively; the lower margins of the
pleura cross, at the same points, the 8th, l0th,and
12th ribs, respectively.
IV) The costodiaphragmatic recess:The distance between the two borders
corresponds to the costodiaphragmatic recess
What is the treatment of pleural effusion?
Fluid(serous,blood,or pus)can be drained from the pleural cavity through
a wide- bore needle
Discuss the lines of pleural reflections
Def: The lines, which indicate the limits of the parietal pleura where it lies close
to the body surface, are referred to as the lines of pleural reflection
Significance:(1)The boundaries of the pleural sac can be marked out as lines on the
surface of the body.
(2)Recognizing the surface markings of the pleural reflections and
the lobes of the lungs is important. The clinician should have a
mental image of the structures that lie beneath the stethoscope when
listening to the breath sounds of the respiratory tract.
Discuss pleurisy
Df:Roughening of the lung surfaces due to inflammation of the pleura (pleuritis
or pleurisy)
Causes: inflammation of the pleura (pleuritis or pleurisy), secondary to inflammation of
the lung (e.g., pneumonia), results in inflammatory exudate coating the pleural
surfaces, which causes roughening of the surfaces.
C/P:Pleural rub-This roughening produces friction, which can be heard with the
stethoscope as a pleural rub on inspiration and expiration.
Complication:Pleural adhesions-Fibroblasts often invade the exudate, resulting in
deposition of collagen and formation of pleural
adhesions that bind the visceral pleura to the
parietal pleura.
Define the lines of pleural reflections
The lines, which indicate the limits of the parietal pleura where it lies close to the body surface, are referred to as the lines of pleural reflection
Define pleurisy
Roughening of the lung surfaces due to inflammation of the pleura (pleuritis or pleurisy)
What is the significance of the lines of pleural reflections?
(1)The boundaries of the pleural sac can be marked out as lines on the surface
of the body.
(2)Recognizing the surface markings of the pleural reflections and the lobes of the
lungs is important. The clinician should have a mental image of the structures that
lie beneath the stethoscope when listening to the breath sounds of the respiratory
tract.
Discuss causes of pleurisy
inflammation of the pleura (pleuritis or pleurisy), secondary to inflammation of the lung (e.g., pneumonia), results in inflammatory exudate coating the pleural surfaces, which causes roughening of the surfaces.
Discuss the surface anatomy of the borders of the pleura
I) The anterior border of the right pleura:runs down behind the sternoclavicular
joint, almost reaching the midline
behind the sternal angle.
It then continues downward until it reaches
the xiphisternal joint.
Discuss C/P of pleurisy
Pleural rub-This roughening produces friction, which can be heard with the
stethoscope as a pleural rub on inspiration and expiration.
Write short notes on the anterior border of the right pleura
runs down behind the sternoclavicular joint, almost reaching the midline behind the sternal angle.
It then continues downward until it reaches the xiphisternal joint.
Write short notes on the anterior border of the left pleura
has a similar course, but at the level of the fourth costal cartilage, it deviates laterally and extends to the lateral margin of the sternum to form the cardiac notch. (Note that the pleural cardiac notch is not as large as the cardiac notch of the lung).It then turns sharply downward to the xiphisternal joint
Discuss types of pneumothorax
Pneumothorax
Def:Air in the pleural cavity
Causes:from the lungs or through the chest wall (pneumothorax) as the result of
disease or injury (e.g., interstitial lung disease, gunshot wounds).
Artificial pneumothorax
In the old treatment of tuberculosis, air was purposely injected into the pleural cavity to collapse and rest the lung. This was known as artificial pneumothorax.
A spontaneous pneumothorax
Def:Is a condition in which air enters the pleural cavity suddenly without its cause
being immediately apparent.
Causes:Investigation usually reveals that air has entered from a diseased lung and
a bulla (bleb) has ruptured.
Open pneumothorax
Wounds that penetrate the thoracic wall (e.g., stab wounds) may pierce the parietal pleura so that the pleural cavity is open to the outside air. This condition is called open pneumothorax.
Tension pneumothorax
Each time the patient inspires, it is possible to hear air under atmospheric pressure being sucked into the pleural cavity. Sometimes, the clothing and the layers of the thoracic wall combine to form a valve so that air enters on inspiration but cannot exit through the wound. In these circumstances, the air pressure builds up on the wounded side and pushes the mediastinum toward the opposite side.In this situation, a collapsed lung is on the injured side, and the opposite lung is compressed by the deflected mediastinum. This dangerous condition is called a tension pneumothorax.
Hydropneumothorax,pyoneumothorax,and haemopneumothorax
Def:Air in the pleural cavity associated with serous fluid is known as
hydropneumothorax, associated with pus as pyopneumothorax, and associated
with blood as hemopneumothorax.
Causes:In hemopneumothorax, trauma to the chest may result in bleeding from blood
vessels in the chest wall, from vessels in the chest cavity, or from a lacerated
lung.
Empyema
A collection of pus (without air) in the pleural cavity is called an empyema.
Pleural effusion
The presence of excess serous fluid in the pleural cavity is referred to as a pleural effusion.
Management of all of the above
Fluid (serous, blood, or pus) can be drained from the pleural cavity through a wide-bore needle
What is the complication of pleurisy?
Pleural adhesions-Fibroblasts often invade the exudate, resulting in deposition
of collagen and formation of pleural adhesions that bind the
visceral pleura to the parietal pleura.
Write short notes on the lower border of the pleura
on both sides follows a curved line, which crosses the eighth rib in the midclavicular line and the 10th rib in the midaxillary line, and reaches the 12th rib adjacent to the vertebral column that is, at the lateral border of the erector spinae muscle.
Note that the lower margins of the lungs cross the 6th, 8th, and lOth ribs at the midclavicular lines, the midaxillary lines, and the sides of the vertebral column, respectively; the lower margins of the pleura cross, at the same points, the 8th, l0th,and 12th ribs, respectively.
Define pneumothorax
Air in the pleural cavity
What causes pneumothorax?
from the lungs or through the chest wall (pneumothorax) as the result of disease or injury (e.g., interstitial lung disease, gunshot wounds).
Discuss artificial pneumothorax
In the old treatment of tuberculosis, air was purposely injected into the pleural cavity to collapse and rest the lung. This was known as artificial pneumothorax.
Discuss spontaneous pneumothorax
Def:Is a condition in which air enters the pleural cavity suddenly without its
cause being immediately apparent.
Causes:Investigation usually reveals that air has entered from a diseased lung and
a bulla (bleb) has ruptured.
Define spontaneous pneumothorax
Is a condition in which air enters the pleural cavity suddenly without its cause
being immediately apparent.
What causes spontaneous pneumothorax?
Investigation usually reveals that air has entered from a diseased lung and a bulla (bleb) has ruptured.
Discuss open pneumothorax
Wounds that penetrate the thoracic wall (e.g., stab wounds) may pierce the parietal pleura so that the pleural cavity is open to the outside air. This condition is called open pneumothorax.
Discuss tension pneumothorax
Each time the patient inspires, it is possible to hear air under atmospheric pressure being sucked into the pleural cavity. Sometimes, the clothing and the layers of the thoracic wall combine to form a valve so that air enters on inspiration but cannot exit through the wound. In these circumstances, the air pressure builds up on the wounded side and pushes the mediastinum toward the opposite side.In this situation, a collapsed lung is on the injured side, and the opposite lung is compressed by the deflected mediastinum. This dangerous condition is called a tension pneumothorax.
Discuss hydropneumothorax,pyoneumothorax and haemopneumothorax
Hydropneumothorax,pyoneumothorax,and haemopneumothorax
Def:Air in the pleural cavity associated with serous fluid is known as
hydropneumothorax, associated with pus as pyopneumothorax, and associated
with blood as hemopneumothorax.
Causes:In hemopneumothorax, trauma to the chest may result in bleeding from blood
vessels in the chest wall, from vessels in the chest cavity, or from a lacerated
lung.
Define hydro pneumothorax,pyopneumothorax and haemopneumothorax
Air in the pleural cavity associated with serous fluid is known as hydropneumothorax, associated with pus as pyopneumothorax, and associated with blood as hemopneumothorax.
What causes hydropneumothorax,pyopneumothorax and haemopneumothorax?
In hemopneumothorax, trauma to the chest may result in bleeding from blood vessels in the chest wall, from vessels in the chest cavity, or from a lacerated lung.
Define empyema
A collection of pus (without air) in the pleural cavity is called an empyema.
What is the treatment of types of pneumothorax and empyema?
Fluid (serous, blood, or pus) can be drained from the pleural cavity through
a wide-bore needle
Discuss the trachea
Def
Is a tube
Location
C6 vertebra to the upper border of T5 vertebra(bifurcation)
Features
(1) mobile
(2) cartilaginous
(3) membranous
Length and diameter
In adults, the trachea is about 4 1/2 in. (11.25 cm) long and 1 in. (2.5 cm) in diameter.
Structure
(1)Tracheal rings:U-shaped bars (tracheal rings) of hyaline cartilage embedded in the
tracheal wall support and maintain the patency of the trachea.
(2)The trachealis muscle (a smooth muscle):connects the posterior free ends of
the cartilages.
(3)The posterior discontinuity:permits the oesophagus to expand into the trachea
during swallowing.
Course
I)In the neck(beginning):(1)It begins in the neck as the continuation of the larynx at the
lower border of the cricoid cartilage at the level of the sixth
cervical vertebra.
(2)It descends in the midline of the neck.
II)In the thorax(ending):(1)The trachea runs through the superior mediastinum, in
approximately the midline.
(2)The trachea bifurcates or ends
+by dividing into the right and left principal(primary or
main) bronchi
+at the level of the sternal angle
+behind the arch of the aorta
+opposite the disc between the fourth and fifth
thoracic vertebrae
+some texts state that the trachea bifurcates at the level of
the 5th thoracic vertebra(T5) or the sixth in tall subjects
(3)During expiration, the bifurcation rises by about one
vertebral level and during deep inspiration may lower as far
as the sixth thoracic vertebra.
Relation
I)The relations of the trachea in the neck are as follows:
(a)Anterior(Superior to inferior):(1)Isthmus of the thyroid gland
(2)Inferior thyroid veins
(3)Arteria thyroidea ima(when that vessel exists)
(4)Sternothyroid
(5)Sternohyoid
(6)Cervical fascia
(7)Anastomosing branches between the anterior
jugular veins
(8)Arch of aorta
(9)Origin of the left common carotid artery
(10)The brachiocephalic trunk ascends at first in
front of and then to the right of trachea
(b)Posterior:Oesophagus
(c)Laterally:(1)Common carotid arteries
(2)Right and left lobes of the thyroid gland
(3)Inferior thyroid arteries
(4)Recurrent laryngeal nerves
II)The relations of the trachea in the superior mediastinum of the thorax are as follows:
(a)Anteriorly: (1)The manubrium,
(2)The sternum,
(3)The remains of thymus,
(4)The left brachiocephalic vein,
(5)The origins of the brachiocephalic
(6)The left common carotid arteries,
(7)The arch of the aorta
(8)The deep cardiac plexus
(b)Posteriorly:(1) The oesophagus
(2)The left recurrent laryngeal nerve
(c)Right side: (1)The azygos vein,
(2)The right vagus nerve,
(3)The pleura
(d)Left side: (1)The arch of the aorta,
(2)The left common carotid
(3)The left subclavian arteries,
(4)The left vagus
(5)The left phrenic nerves,
(6)The pleura
Blood Supply
I)Arterial supply:(1)The inferior thyroid arteries (branches of the subclavian arteries)
supply the upper two thirds of the trachea
(2)The bronchial arteries (branches of the thoracic aorta) supply the
lower third.
II)Venous drainage:Thyroid venous plexus
Lymph Drainage
The lymph drains into the:(1)pretracheal lymph nodes
(2)paratracheal lymph nodes
(3)deep cervical nodes.
Nerve Supply
(1)Branches of the vagus and recurrent laryngeal nerves carry the sensory
nerve supply.The recurrent laryngeal nerves innervate the mucosa lining much of
the trachea
(2)Sympathetic nerves supply the trachealis muscle.
Define the trachea
Is a tube
What is the location of the trachea?
C6 vertebra to the upper border of T5 vertebra(bifurcation)
What are the features of the trachea?
(1) mobile
(2) cartilaginous
(3) membranous
What is the length and diameter of the pleura?
In adults, the trachea is about 4 1/2 in. (11.25 cm) long and 1 in. (2.5 cm) in diameter.
What is the structure of the trachea?
(1)Tracheal rings:U-shaped bars (tracheal rings) of hyaline cartilage embedded
in the tracheal wall support and maintain the patency of the
trachea.
(2)The trachealis muscle (a smooth muscle):connects the posterior free ends of
the cartilages.
(3)The posterior discontinuity:permits the oesophagus to expand into the trachea
during swallowing.
What is the shape of the tracheal rings?
U shaped bars
What is the structure of the tracheal rings?
Hyaline cartilage embedded in the tracheal wall
What is the function of the tracheal rings?
Support and maintain the patency of the trachea
What is the structure of the trachealis muscle?
A smooth muscle
What is the function of the trachealis muscle?
connects the posterior free ends of the cartilages.
What is the function of the posterior discontinuity of the trachea?
permits the oesophagus to expand into the trachea during swallowing.
What does the course of the trachea represent in the neck and thorax?
I)In the neck represents beginning
II)In the thorax represents ending
What is the course of the trachea in the neck?
(1)It begins in the neck as the continuation of the larynx at the lower border of
the cricoid cartilage at the level of the sixth cervical vertebra.
(2)It descends in the midline of the neck.
What is the course of the trachea in the thorax?
(1)The trachea runs through the superior mediastinum, in approximately
the midline.
(2)It ends by dividing into right and left principal (main)bronchi at the level of the
sternal angle (opposite the disc between the fourth and fifth thoracic vertebrae).
some texts state that the trachea bifurcates at the level of the 5th thoracic
vertebra(T5) or the sixth in tall subjects
(3)During expiration, the bifurcation rises by about one vertebral level and during deep
inspiration may lower as far as the sixth thoracic vertebra.
Where does the trachea begin?
(1) begins in the neck
(2) as the continuation of the larynx
(3) at the lower border of the cricoid cartilage
(4) at the level of the sixth cervical vertebra.
Where does the trachea run in the neck?
It descends in the midline of the neck.
Where does the trachea run in the thorax?
The trachea runs through the superior mediastinum, in approximately the midline.
Where does the trachea end in the thorax?
(1)The trachea bifurcates or ends by dividing into right and left principal
(primary or main)bronchi
(2)at the level of the sternal angle
(3)behind the arch of the aorta
(4)opposite the disc between the fourth and fifth thoracic vertebrae
(5)some texts state that the trachea bifurcates at the level of the 5th thoracic
vertebra(T5) or the sixth in tall subjects
What is the location of the tracheal bifurcation during expiration and inspiration?
During expiration, the bifurcation rises by about one vertebral level and during deep inspiration may lower as far as the sixth thoracic vertebra.
What is the location of the tracheal bifurcation during expiration?
the bifurcation rises by about one vertebral level
What is the location of the tracheal bifurcation during inspiration?
May lower as far as the sixth thoracic vertebra.
Enumerate relation of the trachea?
I)The relations of the trachea in the neck are as follows:
(a)Anterior(Superior to inferior):(1)Isthmus of the thyroid gland
(2)Inferior thyroid veins
(3)Arteria thyroidea ima(when that vessel exists)
(4)Sternothyroid
(5)Sternohyoid
(6)Cervical fascia
(7)Anastomosing branches between the anterior
jugular veins
(8)Arch of aorta
(9)Origin of the left common carotid artery
(10)The brachiocephalic trunk ascends at first in
front of and then to the right of trachea
(b)Posterior:Oesophagus
(c)Laterally:(1)Common carotid arteries
(2)Right and left lobes of the thyroid gland
(3)Inferior thyroid arteries
(4)Recurrent laryngeal nerves
II)The relations of the trachea in the superior mediastinum of the thorax are as follows:
(a)Anteriorly: (1)The manubrium,
(2)The sternum,
(3)The remains of thymus,
(4)The left brachiocephalic vein,
(5)The origins of the brachiocephalic
(6)The left common carotid arteries,
(7)The arch of the aorta
(8)The deep cardiac plexus
(b)Posteriorly:(1)The oesophagus
(2)The left recurrent laryngeal nerve
(c)Right side: (1)The azygos vein,
(2)The right vagus nerve,
(3)The pleura
(d)Left side: (1)The arch of the aorta,
(2)The left common carotid
(3)The left subclavian arteries,
(4)The left vagus
(5)The left phrenic nerves,
(6)The pleura
Enumerate relations of the trachea in the neck
(a)Anterior(Superior to inferior):(1)Isthmus of the thyroid gland
(2)Inferior thyroid veins
(3)Arteria thyroidea ima(when that vessel exists)
(4)Sternothyroid
(5)Sternohyoid
(6)Cervical fascia
(7)Anastomosing branches between the anterior
jugular veins
(8)Arch of aorta
(9)Origin of the left common carotid artery
(10)The brachiocephalic trunk ascends at first in
front of and then to the right of trachea
(b)Posterior:Oesophagus
(c)Laterally:(1)Common carotid arteries
(2)Right and left lobes of the thyroid gland
(3)Inferior thyroid arteries
(4)Recurrent laryngeal nerves
Enumerate anterior relations of the trachea in the neck?
Superior to inferior:(1)Isthmus of the thyroid gland
(2)Inferior thyroid veins
(3)Arteria thyroidea ima(when that vessel exists)
(4)Sternothyroid
(5)Sternohyoid
(6)Cervical fascia
(7)Anastomosing branches between the anterior
jugular veins
(8)Arch of aorta
(9)Origin of the left common carotid artery
(10)The brachiocephalic trunk ascends at first in
front of and then to the right of trachea
Enumerate posterior relations of trachea in the neck?
Oesophagus
Enumerate the lateral relations of trachea in the neck
(1) Common carotid arteries
(2) Right and left lobes of the thyroid gland
(3) Inferior thyroid arteries
(4) Recurrent laryngeal nerves
Enumerate relations of the trachea in the superior mediastinum of the thorax
(a) Anteriorly: (1)The manubrium,
(2) The sternum,
(3) The remains of thymus,
(4) The left brachiocephalic vein,
(5) The origins of the brachiocephalic
(6) The left common carotid arteries,
(7) The arch of the aorta
(8) The deep cardiac plexus
(b) Posteriorly:(1) The oesophagus
(2) The left recurrent laryngeal nerve
(c) Right side: (1)The azygos vein,
(2) The right vagus nerve,
(3) The pleura
(d) Left side: (1)The arch of the aorta,
(2) The left common carotid
(3) The left subclavian arteries,
(4) The left vagus
(5) The left phrenic nerves,
(6) The pleura
Enumerate the anterior relations of the trachea in the superior mediastinum of the thorax
(1) The manubrium,
(2) The sternum,
(3) The remains of thymus,
(4) The left brachiocephalic vein,
(5) The origins of the brachiocephalic
(6) The left common carotid arteries,
(7) The arch of the aorta
(8) The deep cardiac plexus
Enumerate the posterior relations of the trachea in the superior mediastinum of the thorax
(1) The oesophagus
(2) The left recurrent laryngeal nerve
Enumerate the relations on the right side of the superior mediastinum of the thorax
(1) The azygos vein,
(2) The right vagus nerve,
(3) The pleura
Enumerate the relations on the left side of the superior mediastinum of the thorax
(1) The arch of the aorta,
(2) The left common carotid
(3) The left subclavian arteries,
(4) The left vagus
(5) The left phrenic nerves,
(6) The pleura
Explain the blood supply of the trachea
I)Arterial supply:(1)The inferior thyroid arteries (branches of the subclavian
arteries)supply the upper two thirds of the trachea
(2)The bronchial arteries (branches of the thoracic aorta) supply the
lower third.
II)Venous drainage:Thyroid venous plexus
Explain the arterial supply of the trachea
(1)The inferior thyroid arteries (branches of the subclavian arteries) supply the
upper two thirds of the trachea
(2)The bronchial arteries (branches of the thoracic aorta) supply the lower third.
Explain the venous drainage of the trachea
Thyroid venous plexus
Explain the lymphatic drainage of the trachea
The lymph drains into the:(1)pretracheal lymph nodes
(2) paratracheal lymph nodes
(3) deep cervical nodes.
Explain the nerve supply of the trachea
(1)Branches of the vagus and recurrent laryngeal nerves carry the sensory
nerve supply.The recurrent laryngeal nerves innervate the mucosa lining
much of the trachea.
(2)Sympathetic nerves supply the trachealis muscle.
What is the sensory nerve supply(i.e.,sensation)of the trachea?
Branches of the vagus and recurrent laryngeal nerves carry the sensory
nerve supply.
The recurrent laryngeal nerves innervate the mucosa lining much of the trachea.
What is nerve supply of the trachealis muscle?
Sympathetic nerves supply the trachealis muscle.
Explain compression of the trachea
Causes
(1)Enlargement of the thyroid gland
In the neck, a unilateral or bilateral enlargement of the thyroid gland can cause
gross displacement or compression of the trachea.
(2)A dilatation of the aortic arch (e.g., an aneurysm)
can compress the trachea. With each cardiac systole, the pulsating aneurysm
may tug at the trachea and left bronchus, a clinical sign that can be felt by
palpating the trachea in the suprasternal notch.
Discuss tracheitis or bronchitis
Tracheitis or bronchitis gives rise to a raw, burning sensation felt deep to the sternum instead of actual pain. Many thoracic and abdominal viscera, when diseased,give rise to discomfort that is felt in the midline. It seems that organs possessing a sensory innervation that is not under normal conditions directly relayed to consciousness display this phenomenon. The afferent fibers from these organs traveling to the central nervous system accompany autonomic nerves.
Discuss the bronchi
Bifurcation:
(1)The trachea bifurcates or ends by dividing into the right and left principal
(primary or main) bronchi.
+at the level of the sternal angle
+behind the arch of the aorta
+opposite the disc between the fourth and fifth thoracic vertebrae
+some texts state that the trachea bifurcates at the level of the 5th thoracic
vertebra(T5) or the sixth in tall subjects
(2)The carina:Def-is a small ridge
Location-at the inferior end of the junction of the trachea and the
principal bronchi
Function-separates the openings of the bronchi
Division
I)The trachea bifurcates into:(a) The right principal (main) bronchus:
Features-(1)wider,
(2)shorter, and
(3)more vertical than the left
Length-about 1 in. (2.5-cm) long.
Division-(1)Before entering the hilum of the right lung,
the principal bronchus gives off the
superior lobar bronchus.
(2)On entering the hilum, it divides into
+middle lobar bronchus
+inferior lobar bronchus.
(b)The left principal (main) bronchus
Features-(1)narrower,
(2)longer,
(3)more horizontal than the right and is
Location-lies at T6
Length-about 2-in. (5-cm) long.
Course-It passes to the left
+below the arch of the aorta and
+in front of the oesophagus.
Division-On entering the hilum of the left lung,
the principal bronchus divides into a
+superior lobar bronchus
+inferior lobar bronchus.
II) Each principal bronchus supplies an entire lung . The principal bronchi next divide
into lobar (secondary) bronchi that supply the individual lobes of the lungs.
III)The bronchi divide dichotomously:
+eventually giving rise to several million terminal bronchioles that terminate in one or
more respiratory bronchioles.
+Each respiratory bronchiole divides into 2 to 11 alveolar ducts that enter the
alveolar sacs.
+The alveoli arise from the walls of the sacs as diverticula (see Bronchopulmonary
segments, to follow).
Discuss the bronchopulmonary segment
Def
the anatomic, functional, and surgical units of the lungs. Each lobar (secondary) bronchus, which passes to a lobe of the lung, gives off branches called segmental (tertiary) bronchi. Each segmental bronchus passes to a structurally and functionally independent unit of a lung lobe called a bronchopulmonary segment, which is bounded by connective tissue walls
A branch of the pulmonary artery accompanies the segmental bronchus, but the tributaries of the pulmonary veins run in the connective tissue between adjacent bronchopulmonary segments. Each segment has its own lymphatic vessels and autonomic nerve supply.
Each segmental bronchus divides repeatedly upon entering a bronchopulmonary segment As the bronchi become smaller, irregular plates of cartilage, which become smaller and fewer in number, gradually replace the tracheal rings. The smallest bronchi divide and give rise to bronchioles, which are <1mm in diameter. Bronchioles possess no cartilage in their walls and are lined with columnar ciliated epithelium.
The submucosa possesses a complete layer of circularly arranged smooth muscle fibers.
The bronchioles then divide and give rise to terminal bronchioles, which show delicate outpouchings from their walls. Gaseous exchange between blood and air takes place in the walls of these outpouchings, which explains the name respiratory bronchiole. The diameter of a respiratory bronchiole is about 0.5 mm. The respiratory bronchioles end by branching into alveolar ducts, which lead into tubular passages with numerous thin-walled outpouchings called alveolar sacs. The alveolar sacs consist of several alveoli opening into a single chamber.
A rich network of blood capillaries surrounds each alveolus. Gaseous exchange takes place between the air in the alveolar lumen and the alveolar wall into the blood within the surrounding capillaries.
The main characteristics of a bronchopulmonary segment are as follows:
• It is a subdivision of a lung lobe.
• It is pyramid shaped, with its apex directed toward
the lung root.
• It is surrounded by connective tissue.
• It has three defining components: a centrally located
segmental (tertiary) bronchus, a segmental artery that accompanies the segmental bronchus, and intersegmental veins located in the connective tissue walls between adjacent bronchopulmonary segments.
• It has its own lymph vessels and autonomic nerves.
• Because it is a structural unit, a diseased segment can
be removed surgically.
The functional flow pattern within each bronchopul-
monary segment is as follows:
• Air enters and leaves the center of each bronchopul- monary segment via the segmental bronchus.
• Deoxygenated blood enters the center of each bronchopulmonary segment via the segmental artery (a branch of the pulmonary artery).
• Oxygenatedbloodleavesthebronchopulmonaryseg- ment via the intersegmental veins located around the periphery of each segment. These veins drain into the pulmonary veins.
Typically, the right lung has 10 bronchopulmonary segments and the left lung has 8 to 10. Although the general arrangement of the bronchopulmonary seg- ments is clinically important, memorizing the details is not essential for anyone not intending to specialize in pulmonary medicine or surgery.
The main bronchopulmonary segments are as follows:
• Rightlung
Superior lobe: Apical, posterior, anterior Middle lobe: Lateral, medial
Inferior lobe: Superior (apical), medial basal,
anterior basal, lateral basal, posterior basal
• Left lung
Superior lobe: Apical, posterior, anterior, superior lingular, inferior lingular
Inferior lobe: Superior (apical), medial basal, anterior basal, lateral basal, posterior basal
Discuss foreign body aspirations
.Incidence
Inhalation of foreign bodies into the lower respiratory tract is common, especially in children.
.Types of foreign bodies
These objects have all found their way into the bronchi:
(1)Pins,
(2)Screws,
(3)Nuts,
(4)Bolts,
(5)Peanuts, and
(6)Parts of chicken bones and
(7)Toys
(8)Parts of the teeth-may be inhaled while a patient is under anesthesia during
a difficult dental extraction.
.Location of foreign body lodgement
Right principal bronchus:(1)Site related-Because the right principal bronchus is the
wider, more vertical, and more direct
continuation of the trachea foreign bodies
tend to enter the right instead of the left
main bronchus.
From there, they usually pass into the middle
or inferior lobar bronchi.
(2)size related-(a)Large aspirated objects:commonly lodge in
the right main
bronchus,
(b)Small aspirated objects:tend to stop in the
right Inferior lobar
bronchus.
Treatment
Removal by a bronchoscopy
What is the incidence of inhaled foreign body
Inhalation of foreign bodies into the lower respiratory tract is common, especially in children.
Enumerate types of inhaled foreign bodies
These objects have all found their way into the bronchi:
(1)Pins,
(2)Screws,
(3)Nuts,
(4)Bolts,
(5)Peanuts, and
(6)Parts of chicken bones and
(7)Toys
(8)Parts of the teeth-may be inhaled while a patient is under anesthesia during
a difficult dental extraction.
Explain briefly location of lodgement of inhaled foreign bodies
Right principal bronchus:(1)Site related-Because the right principal bronchus is
the wider, more vertical, and more
direct continuation of the trachea foreign
bodies tend to enter the right instead of the
left main bronchus.
From there, they usually pass into the middle
or inferior lobar bronchi.
(2)size related-(a)Large aspirated objects:commonly lodge in
the right main
bronchus,
(b)Small aspirated objects:tend to stop in the
right Inferior lobar
bronchus.
Explain the site related lodgement of inhaled foreign bodies
Because the right principal bronchus is the wider, more vertical, and more direct continuation of the trachea foreign bodies tend to enter the right instead of the left main bronchus.
From there, they usually pass into the middle or inferior lobar bronchi.
Explain the size related inhaled foreign bodies
(a) Large aspirated objects:commonly lodge in right main bronchus
(b) Small aspirated objects:tend to stop in the right Inferior lobar bronchus.
What are the indications of bronchoscopy?
Indication
(1)Bronchoscopy enables a physician to examine the interior of the trachea, its
bifurcation, the carina, and the main bronchi
(2)With experience, it is possible to examine the(a)interior of the lobar bronchi
(b)beginning of the first segmental
bronchi.
(3)This procedure also facilitates obtaining biopsy specimens of mucous membrane
(4)Removal of lodged inhaled foreign body in the larynx(even an open safety pin (5)Oedema of the mucous membrane of the larynx secondary to infection or trauma
may require immediate relief to prevent asphyxiation.
(6)Tracheostomy is a method commonly used to relieve complete obstruction
Discuss the lungs
Features
I)During life, the lungs are soft and spongy and very elastic.
II)If the thoracic cavity were opened, the lungs would immediately shrink to one third
or less in volume.
III)In the child, they are pink, but with age, they become dark and mottled because of
the Inhalation of dust particles that become trapped in the phagocytes of the lung.
City dwellers and coal miners show this especially well.
IV)Each lung is conical in shape
V)Covered with visceral pleura
VI)Attached to the mediastinum only by its root
VII)Suspended free in its own pleural cavity
Location
One lung lies on each side of the mediastinum. Therefore, the heart and great vessels and other structures in the mediastinum separate them from each other.
Parts
I) Apex:(1)Shape-Each lung has a blunt apex
(2)Location-(1)The apex projects upward into the neck for about 1 in. (2.5 cm)
above the medial 1/3rd of the clavicle
(2)The apex of both lungs is approximately 4cm superior to the
sternocostal joint of the first rib.
Immediately below this is a sulcus created by the subclavian
artery
II)Base:a concave base that sits on the diaphragm
III)Surfaces:(1)Costal surface-(a)convex
(b)corresponds to the concave chest wall
(i.e., corresponds to the concavity of the chest)
(2)Mediastinal surface-(a)concave
(b)contacts the mediastinal pleura
(c)has the cardiac impression
(d)molded to the pericardium and other
mediastinal structures
(e)above and behind this concavity
(i.e.,the mediastinal surface)is the hilum
(3)Diaphragmatic
IV)Hilum:Def-A depression in which the root of the lung attaches
Location-At about the middle of the mediastinal surface
Shape-Triangular depression
Function-It is the place where the structures which form the root of the lung
enter and leave the viscus.
These structures are invested by pleura,which,below the hilum and
behind the pericardial impression,forms the pulmonary ligament
V)Root:Def: The structures that enter or leave the lung form the root of the lung.
Contents-(1)the bronchi
(2)pulmonary artery and 2 pulmonary veins
(3)bronchial lymph vessels
(4)bronchial vessels
(5)nerves
Structure:The root is surrounded by a tubular sheath of pleura, which joins the
mediastinal parietal pleura to the visceral pleura covering the lungs.
VI)Borders:(1)The anterior lung borders-Feature-are thin
Location-a)overlap the heart.
b)Rt lung:extends from the apex to
1)Sternoclavicular joint
2)Sternal angle
3)then vertically to the
level of 6th costal
cartilage
c)Lt lung: extends from the apex to
1)Sternoclavicular joint
2)Sternal angle
3)then vertically to the
level of 4th costal
cartilage
4)Deviates to the Lt and
descends again 1 inch
lateral to sternal margin
down to the 6th costal
cartilage
(2)The posterior border of each lung-(a)is thick
(b)lies beside the vertebral column.
(3)The inferior border of both lungs-(a)6th rib in mid clavicular line
(b)8th rib in mid axillary line
(c)10th rib posteriorly,close to the
vertebral column
N.B:The pleura runs two ribs lower than the corresponding lung level
V)The cardiac notch:Def-indentation of the anterior margin of the left lung that leaves
the anterior surface of the heart relatively exposed .
Shape-concave
VI)The lingula:Def-projection of the anterior margin of the left lung.
Location-extends from the inferior end of the cardiac notch.
Shape-tonguelike
Lobes and fissures
I)Deep fissures divide the right and left lungs into unequal numbers of lobes.
II)The organization of the lobes and fissures is summarized in Table 5.1 (page233)and
illustrated in Figures 5.16 to 5.18.
1st/Rt lung(slightly larger)
(A)Fissures:(1)Horizontal fissure-Runs along approximately the horizontal line of the
fourth costal cartilage to intersect the oblique fissure
in the midaxillary line.
(2)Oblique fissure-Runs at roughly a T2 (posterior) to T6 (anterior)
angulation.
(B)Lobes: In both lungs, the-(1)upper(superior)lobes-lie more anteriorly, whereas
(2)lower(inferior)lobes-lie more posteriorly.
(3)middle lobe-Size:small
Shape:triangular lobe
Location:1.lays anteroinferiorly,
2.between the other two lobes,
Bounded by the:1.horizontal fissure
2.oblique fissure
2nd/Lt lung
(A)Fissures:Oblique-similar course as in the right lung. No horizontal fissure.
(B)Lobes: In both lungs, the-(1)upper(superior)lobes-lie more anteriorly, whereas
(2)lower(inferior)lobes-lie more posteriorly.
The right lung is different from the left lung in that:
(1) It is heavier.
(2) lt is larger in transverse diameter.
(3) lt has no cardiac notch.
(4) lt usually has two fissures.
(5) lt has 2 bronchi in the hilum.
Blood Supply
Two separate arterial systems supply the lungs.The second system is the respiratory (pulmonary) circuit,
1st/Nonrespiratory Circuit
I)Supplies the tissues of the respiratory tree and lungs.
II)Arterial supply:The bronchial arteries-(a)Types:(1)2 Left branches-branches of the
descending aorta
(2)1 right branch-a branch of the
3rd posterior
intercostal artery
(b) supply the:(1)bronchi, the
(2)connective tissue of the lung,
(3)visceral pleura.
III)Venous drainage:The bronchial veins-(a)which communicate with the pulmonary
veins
(b)drain into the azygos and hemiazygos
veins.
2nd/Respiratory (Pulmonary) Circuit
I)Across which gas exchange occurs.
II)Arterial supply:The segmental arteries-(a)the terminal branches of the pulmonary
arteries
(b)carry deoxygenated blood(i.e.,supply all
the needs except oxygen)into the
1.bronchopulmonary segments
2.alveoli
III)Venous drainage:(1)Intersegmental veins-(a)carrying oxygenated blood from the
alveolar capillaries,
(b)follow the connective tissue septa
bounding the bronchopulmonary
segments to the pulmonary veins
and to the lung root
(2)Two pulmonary veins-leave each lung root to empty into the left
atrium of the heart.
Lymph Drainage
+Origin:(a)The lymph vessels originate in superficial(subpleural)and deep plexuses
(b)They are not present in the alveolar walls.
+The superficial (subpleural) plexus:Location-lies beneath the visceral pleura
Drainage-drains over the surface of the lung
toward the hilum, where the lymph
vessels enter the bronchopulmonary
nodes.
+The deep plexus:Course-(1)travels along the bronchi and vessels toward the hilum of
the lung,
(2)passing through pulmonary nodes located within the
lung substance;
(3)the lymph then enters the bronchopulmonary nodes in
the hilum of the lung.
(4)All the lymph from the lung leaves the hilum and drains
into the tracheobronchial nodes and then into the
bronchomediastinal lymph trunks.
Nerve Supply
+Pulmonary plexuses:Origin-The following nerve fibres intermingle at the root of each
lung and form the pulmonary plexuses:-
(1)Sympathetic nerve fibers (derived from the
sympathetic chains),
(2)parasympathetic nerve fibers (derived from the
vagus nerves), and
(3)visceral afferent fibres
Course-(1)Branches of the pulmonary plexuses:mainly follow the
bronchi into and
within the lungs.
(2)Afferent impulses(a)Origin-derived from:1.the
bronchial
mucous
membrane
and
2.stretch
receptors in
the alveolar
walls
(b)Course-travel with both
sympathetic and
parasympathetic nerves
to the central nervous
system.
+Lung autonomic functions
Table 5.2 summarises lung autonomic functions.
What are the features of the lungs?
I)During life, the lungs are soft and spongy and very elastic.
II)If the thoracic cavity were opened, the lungs would immediately shrink to one
third or less in volume.
III)In the child, they are pink, but with age, they become dark and mottled because of
the Inhalation of dust particles that become trapped in the phagocytes of the lung.
City dwellers and coal miners show this especially well.
IV)Each lung is conical in shape
V)Covered with visceral pleura
VI)Attached to the mediastinum only by its root
VII)Suspended free in its own pleural cavity
What are the features of the lungs during life?
(1) soft
(2) spongy
(3) very elastic
What are the features of the lungs if the thoracic cavity was opened?
If the thoracic cavity were opened, the lungs would immediately shrink to one
third or less in volume.
What are the features of the lungs in relation to the age?
In the child, they are pink, but with age, they become dark and mottled because of the Inhalation of dust particles that become trapped in the phagocytes of the
lung.
City dwellers and coal miners show this especially well.
What is the shape of the lungs?
1) Each lung is conical in shape
2) Covered with visceral pleura
3) Attached to the mediastinum only by its root
4) Suspended free in its own pleural cavity
What is the location of the lungs?
One lung lies on each side of the mediastinum. Therefore, the heart and great vessels and other structures in the mediastinum separate them from each other.
Discuss the parts of the lungs
I) Apex:(1)Shape-Each lung has a blunt apex
(2)Location-(1)The apex projects upward into the neck for about 1 in. (2.5 cm)
above the medial 1/3rd of the clavicle
(2)The apex of both lungs is approximately 4cm superior to the
sternocostal joint of the first rib.
Immediately below this is a sulcus created by the subclavian
artery
II)Base:a concave base that sits on the diaphragm
III)Surfaces:(1)Costal surface-(a)convex
(b)corresponds to the concave chest wall
(i.e., corresponds to the concavity of the chest)
(2)Mediastinal surface-(a)concave
(b)contacts the mediastinal pleura
(c)has the cardiac impression
(d)molded to the pericardium and other
mediastinal structures
(e)above and behind this concavity
(i.e.,the mediastinal surface)is the hilum
(3)Diaphragmatic
IV)Hilum:Def-A depression in which the root of the lung attaches
Location-At about the middle of the mediastinal surface
Shape-Triangular depression
Function-It is the place where the structures which form the root of the lung
enter and leave the viscus.
These structures are invested by pleura,which,below the hilum and
behind the pericardial impression,forms the pulmonary ligament
V)Root:Def: The structures that enter or leave the lung form the root of the lung.
Contents-(1)the bronchi
(2)pulmonary artery and 2 pulmonary veins
(3)bronchial lymph vessels
(4)bronchial vessels
(5)nerves
Structure:The root is surrounded by a tubular sheath of pleura, which joins the
mediastinal parietal pleura to the visceral pleura covering the lungs.
VI)Borders:(1)The anterior lung borders-Feature-are thin
Location-a)overlap the heart.
b)Rt lung:extends from the apex to
1)Sternoclavicular joint
2)Sternal angle
3)then vertically to the
level of 6th costal
cartilage
c)Lt lung: extends from the apex to
1)Sternoclavicular joint
2)Sternal angle
3)then vertically to the
level of 4th costal
cartilage
4)Deviates to the Lt and
descends again 1 inch
lateral to sternal margin
down to the 6th costal
cartilage
(2)The posterior border of each lung-(a)is thick
(b)lies beside the vertebral column.
(3)The inferior border of both lungs-(a)6th rib in mid clavicular line
(b)8th rib in mid axillary line
(c)10th rib posteriorly,close to the
vertebral column
N.B:The pleura runs two ribs lower than the corresponding lung level
V)The cardiac notch:Def-indentation of the anterior margin of the left lung that leaves
the anterior surface of the heart relatively exposed .
Shape-concave
VI)The lingula:Def-projection of the anterior margin of the left lung.
Location-extends from the inferior end of the cardiac notch.
Shape-tonguelike
Discuss the apex of the lung
(1)Shape-Each lung has a blunt apex
(2)Location-(1)The apex projects upward into the neck for about 1 in. (2.5 cm)
above the medial 1/3rd of the clavicle
(2)The apex of both lungs is approximately 4cm superior to the
sternocostal joint of the first rib.
Immediately below this is a sulcus created by the subclavian
artery
What is the shape of the lung apex?
Each lung has a blunt apex
What is the location of the apex of the lung?
(1)The apex projects upward into the neck for about 1 in. (2.5 cm) above the
medial 1/3rd of the clavicle
(2)The apex of both lungs is approximately 4cm superior to the sternocostal joint of
the first rib.Immediately below this is a sulcus created by the subclavian artery
What are the relations of the lung apex?
(1)Clavicle:The apex projects upward into the neck for about 1 in. (2.5 cm)
above the medial 1/3rd of the clavicle
(2)Sternocostal joint:The apex of both lungs is approximately 4cm superior to the
sternocostal joint of the first rib.
(3)Subclavian sulcus:Immediately below this is a sulcus created by the subclavian
artery
What is the relation of the clavicle to the lung apex?
The apex projects upward into the neck for about 1 in. (2.5 cm) above the medial 1/3rd of the clavicle
What is the relation of the sternocostal joint to the lung apex?
The apex of both lungs is approximately 4cm superior to the sternocostal joint of the first rib.
Immediately below this is a sulcus created by the subclavian artery.
What is the relation of the subclavian sulcus to the lung apex?
Immediately below this(i.e.,the apex) is a sulcus created by the subclavian artery
Discuss the lung base
.Shape:concave base
.Location:sits on the diaphragm
What is the shape of the lung base?
Concave
What is the location of the lung base?
Sits on the diaphragm
Discuss the lung surfaces
(1)Costal surface-(a)convex
(b)corresponds to the concave chest wall
(i.e., corresponds to the concavity of the chest)
(2)Mediastinal surface-(a)concave
(b)contacts the mediastinal pleura
(c)has the cardiac impression
(d)molded to the pericardium and other
mediastinal structures
(e)above and behind this concavity
(i.e.,the mediastinal surface)is the hilum
(3)Diaphragmatic
Discuss the costal surface of the lung
(a)convex
(b)corresponds to the concave chest wall(i.e., corresponds to the concavity of
the chest)
What is the shape of the costal surface of the lung?
Convex
What is the relation of the costal surface to the lung?
corresponds to the concave chest wall
i.e., corresponds to the concavity of the chest
Discuss the mediastinal surface of the lung
(a)concave
(b)contacts the mediastinal pleura
(c)has the cardiac impression
(d)molded to the pericardium and other
mediastinal structures
(e)above and behind this concavity
(i.e.,the mediastinal surface)is the hilum
What is the shape of the mediastinal surface of the lung?
Concave
What are the relations of the mediastinal surface of the lung?
(1) Mediastinal pleura:contacts the mediastinal pleura
(2) Heart:has the cardiac impression
(3) Pericardium:molded to the pericardium and other mediastinal structures
(4) Hilum:above and behind this concavity(i.e.,the mediastinal surface)is the hilum
Discuss the hilum of the lung
Def-A depression in which the root of the lung attaches
Location-At about the middle of the mediastinal surface
Shape-Triangular depression
Function-It is the place where the structures which form the root of the lung
enter and leave the viscus.
These structures are invested by pleura,which,below the hilum and
behind the pericardial impression,forms the pulmonary ligament
Define the hilum of the lung
A depression in which the root of the lung attaches
What is the location of the hilum of the lung?
At about the middle of the mediastinal surface
What is the shape of the hilum of the lung?
Triangular depression
What is the function of the hilum of the lung?
It is the place where the structures which form the root of the lung enter and leave the viscus.
These structures are invested by pleura,which,below the hilum and behind the pericardial impression,forms the pulmonary ligament
Discuss the root of the lung
Def: The structures that enter or leave the lung form the root of the lung.
Contents-(1)the bronchi
(2)pulmonary artery and 2 pulmonary veins
(3)bronchial lymph vessels
(4)bronchial vessels
(5)nerves
Structure:The root is surrounded by a tubular sheath of pleura, which joins the
mediastinal parietal pleura to the visceral pleura covering the lungs.
Define the root of the lung
The structures that enter or leave the lung form the root of the lung.
What are the contents of the root of the lung?
(1) the bronchi
(2) pulmonary artery and 2 pulmonary veins
(3) bronchial lymph vessels
(4) bronchial vessels
(5) nerves
What is the structure of the root of the lung?
The root is surrounded by a tubular sheath of pleura, which joins the mediastinal parietal pleura to the visceral pleura covering the lungs.
Discuss the borders of the lungs
(1)The anterior lung borders-Feature-are thin
Location-a)overlap the heart.
b)Rt lung:extends from the apex to
1)Sternoclavicular joint
2)Sternal angle
3)then vertically to the
level of 6th costal
cartilage
c)Lt lung: extends from the apex to
1)Sternoclavicular joint
2)Sternal angle
3)then vertically to the
level of 4th costal
cartilage
4)Deviates to the Lt and
descends again 1 inch
lateral to sternal margin
down to the 6th costal
cartilage
(2)The posterior border of each lung-(a)is thick
(b)lies beside the vertebral column.
(3)The inferior border of both lungs-(a)6th rib in mid clavicular line
(b)8th rib in mid axillary line
(c)10th rib posteriorly,close to the
vertebral column
N.B:The pleura runs two ribs lower than the corresponding lung level
Discuss the anterior borders of the lung
Feature-are thin
Location-a)overlap the heart.
b)Rt lung:extends from the apex to
1)Sternoclavicular joint
2)Sternal angle
3)then vertically to the level of 6th costal cartilage
c)Lt lung: extends from the apex to
1)Sternoclavicular joint
2)Sternal angle
3)then vertically to the level of 4th costal cartilage
4)Deviates to the Lt and descends again 1 inch lateral to
sternal margin down to the 6th costal cartilage
Discuss the posterior border of the lung
(a) is thick
(b) lies beside the vertebral column.
Discuss the feature of the posterior border of the lungs
thick
What is the location of the posterior border of the lungs?
lies beside the vertebral column.
Discuss the inferior border of the lungs
(a)6th rib in mid clavicular line
(b)8th rib in mid axillary line
(c)10th rib posteriorly,close to the vertebral column
N.B:The pleura runs two ribs lower than the corresponding lung level
Discuss the cardiac notch of the lungs
Def-indentation of the anterior margin of the left lung that leaves the anterior surface
of the heart relatively exposed .
Shape-concave
Define the cardiac notch
indentation of the anterior margin of the left lung that leaves the anterior surface of the heart relatively exposed .
What is the shape of the cardiac notch?
concave
Discuss the lingula
Def-projection of the anterior margin of the left lung.
Location-extends from the inferior end of the cardiac notch.
Shape-tonguelike
Define the lingula
projection of the anterior margin of the left lung.
What is the location of the lingula?
extends from the inferior end of the cardiac notch.
What is the shape of the lingula?
tonguelike
Discuss lobes and fissures of the lungs
Lobes and fissures
I)Deep fissures divide the right and left lungs into unequal numbers of lobes.
II)The organization of the lobes and fissures is summarized in Table 5.1 (page233)and
illustrated in Figures 5.16 to 5.18.
1st/Rt lung(slightly larger)
(A)Fissures:(1)Horizontal fissure-Runs along approximately the horizontal line of the
fourth costal cartilage to intersect the oblique fissure
in the midaxillary line.
(2)Oblique fissure-Runs at roughly a T2 (posterior) to T6 (anterior)
angulation.
(B)Lobes: In both lungs, the-(1)upper(superior)lobes-lie more anteriorly, whereas
(2)lower(inferior)lobes-lie more posteriorly.
(3)middle lobe-Size:small
Shape:triangular lobe
Location:1.lays anteroinferiorly,
2.between the other two lobes,
Bounded by the:1.horizontal fissure
2.oblique fissure
2nd/Lt lung
(A)Fissures:Oblique-similar course as in the right lung. No horizontal fissure.
(B)Lobes: In both lungs, the-(1)upper(superior)lobes-lie more anteriorly, whereas
(2)lower(inferior)lobes-lie more posteriorly.
What do fissures do to the lungs?
Deep fissures divide the right and left lungs into unequal numbers of lobes.
Summarise the organisation of fissures and lobes of lungs
I)Deep fissures divide the right and left lungs into unequal numbers of lobes.
II)The organization of the lobes and fissures is summarized in Table 5.1 (page233)and
illustrated in Figures 5.16 to 5.18.
1st/Rt lung(slightly larger)
(A)Fissures:(1)Horizontal fissure-Runs along approximately the horizontal line of the
fourth costal cartilage to intersect the oblique fissure
in the midaxillary line.
(2)Oblique fissure-Runs at roughly a T2 (posterior) to T6 (anterior)
angulation.
(B)Lobes: In both lungs, the-(1)upper(superior)lobes-lie more anteriorly, whereas
(2)lower(inferior)lobes-lie more posteriorly.
(3)middle lobe-Size:small
Shape:triangular lobe
Location:1.lays anteroinferiorly,
2.between the other two lobes,
Bounded by the:1.horizontal fissure
2.oblique fissure
2nd/Lt lung
(A)Fissures:Oblique-similar course as in the right lung. No horizontal fissure.
(B)Lobes: In both lungs, the-(1)upper(superior)lobes-lie more anteriorly, whereas
(2)lower(inferior)lobes-lie more posteriorly.
Summarise the organisation of fissures and lobes of the right lung
Rt lung(slightly larger)
(A)Fissures:(1)Horizontal fissure-Runs along approximately the horizontal line
of the fourth costal cartilage to intersect the oblique
fissure in the midaxillary line.
(2)Oblique fissure-Runs at roughly a T2 (posterior) to T6 (anterior)
angulation.
(B)Lobes: In both lungs, the-(1)upper(superior)lobes-lie more anteriorly, whereas
(2)lower(inferior)lobes-lie more posteriorly.
(3)middle lobe-Size:small
Shape:triangular lobe
Location:1.lays anteroinferiorly,
2.between the other two lobes,
Bounded by the:1.horizontal fissure
2.oblique fissure
What are the fissures of the right lung?
(1)Horizontal fissure-Runs along approximately the horizontal line of the
fourth costal cartilage to intersect the oblique fissure
in the midaxillary line.
(2)Oblique fissure-Runs at roughly a T2 (posterior) to T6 (anterior) angulation.
What is the horizontal fissure of the right lung?
Runs along approximately the horizontal line of the fourth costal cartilage to intersect the oblique fissure in the midaxillary line.
What is the oblique fissure of the right lung?
Runs at roughly a T2 (posterior) to T6 (anterior) angulation.
What are the lobes of the right lung?
In both lungs, the-(1)upper(superior)lobes-lie more anteriorly, whereas
(2)lower(inferior)lobes-lie more posteriorly.
(3)middle lobe-Size:small
Shape:triangular lobe
Location:1.lays anteroinferiorly,
2.between the other two lobes,
Bounded by the:1.horizontal fissure
2.oblique fissure
What is the location of the upper(superior) lobe of the right lung?
lie more anteriorly
What is the location of the lower(inferior)lobe of the right lung?
lie more posteriorly.
Discuss the middle lobe of the right lung
Size:small
Shape:triangular lobe
Location:1.lays anteroinferiorly,
2.between the other two lobes,
Bounded by the:1.horizontal fissure
2.oblique fissure
What is the size of the middle lobe of the right lung?
small
What is the shape of the middle lobe of the right lung?
triangular lobe
What is the location of the right lobe of the right lung?
- lays anteroinferiorly,
2. between the other two lobes,
What are the boundaries of the lobes of the right lung?
Bounded by the:1.horizontal fissure
2.oblique fissure
Discuss fissures and lobes of the left lung
(A)Fissures:Oblique-similar course as in the right lung. No horizontal fissure.
(B)Lobes: In both lungs, the-(1)upper(superior)lobes-lie more anteriorly,
whereas
(2)lower(inferior)lobes-lie more posteriorly.
What is the oblique fissure of the left lung?
similar course as in the right lung. No horizontal fissure.
Discuss the lobes of the left lung
In both lungs, the-(1)upper(superior)lobes-lie more anteriorly, whereas
(2)lower(inferior)lobes-lie more posteriorly.
What is the location of the upper(superior)fissure of the left lung?
lie more anteriorly, whereas
What is the location of the lower(inferior)lobe of the left lung?
lie more posteriorly.
What is the course of the trachea?
I)In the neck(beginning):(1)It begins in the neck as the continuation of the
larynx at the lower border of the cricoid cartilage at
the level of the sixth cervical vertebra.
(2)It descends in the midline of the neck.
II)In the thorax(ending):(1)The trachea runs through the superior mediastinum, in
approximately the midline.
(2)It ends by dividing into right and left principal (main)bronchi
at the level of the sternal angle (opposite the disc between
the fourth and fifth thoracic vertebrae).
some texts state that the trachea bifurcates at the level of
the 5th thoracic vertebra(T5) or the sixth in tall subjects
(3)During expiration, the bifurcation rises by about one
vertebral level and during deep inspiration may lower as far
as the sixth thoracic vertebra.
Discuss the respiratory tract
Def:
The respiratory tract (respiratory tree) is the network of passageways that
supplies air to the lungs.
Classification:
I)The upper respiratory tract-includes(1)the nasal passages and
(2)sinuses,
(3)pharynx,
(4)larynx, and
(5)upper portion of the trachea.
II)The lower respiratory tract(tracheobronchial tree)includes the(1)upper portion of the
trachea,
(2)bronchi,
(3)bronchioles
What the other name for the respiratory tract?
Respiratory tree
Define the respiratory tract
is the network of passageways that supplies air to the lungs.
What is the classification of the respiratory tract?
I)The upper respiratory tract-includes(1)the nasal passages and
(2)sinuses,
(3)pharynx,
(4)larynx, and
(5)upper portion of the trachea.
II)The lower respiratory tract(tracheobronchial tree)includes the(1)upper portion of the
trachea,
(2)bronchi,
(3)bronchioles
Enumerate the upper respiratory tract organs
(1) the nasal passages and
(2) sinuses,
(3) pharynx,
(4) larynx, and
(5) upper portion of the trachea.
What is the other name for the lower respiratory tract?
Tracheobronchial tree
Enumerate the lower respiratory tract organs?
(1) upper portion of the trachea,
(2) bronchi,
(3) bronchioles
