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GROSS ANATOMY OF LUNGS


SURFACES AND BORDER OF LUNGS
HILUM AND ROOT OF LUNGS
FISSURES AND LOBES OF LUNGS
BRONCHOPULMONARY SEGMENT
BLOOD SUPPLY OF LUNGS
LYMPHATICS OF LUNGS
NERVE SUPPLY OF LUNGS
PLEURA

Texture : spongy

Color
:
young brown
adults mottled black
due to deposition of
carbon particles
Weight :
right lung 600 gram
left lung 550 gram

1. Apex : projects 1 inch above

medial 1/3 of clavicle


2. Base: it is concave, rests on
the copula of diaphragm
3. Surfaces : costal & medial
a. Costal S. : is convex , related
to ribs & intercostal spaces
b. Medial S. : is formed of 2
parts :
A- Anterior mediastinal part
( hilum lies in its posterior)
B- Posterior vertebral part
4. Borders :

1 & 2 -Anterior & inferior :


sharp
3- Posterior : thick & rounded

Blunt
Lies above the level of
anterior end of 1st rib
Reaches 1-2 cm
above medial 1/3rd of
clavicle
Covered by cervical
pleura
Groved by :
- subclavian artery
- subclavian vein

Semilunar and
concave

Rest and dome of


diaphragma

Right sided dome is


higher than left

ANTERIOR BORDER :
1. Corresponds to the
anterior
(costomediastinal) line
of pleural reflection
2. It is deeply notched in
the left lung posterior
to 5th costal cartilage
by the pericardium
and extends vertically
downwards to form
Lingula. This is called
cardiac notched

Thin and sharp

It separates the
base of the lung
from the costal
surface and
extends into
phrenicocostal
sinus

Thick and ill


defined

Fits into deep


paravertebral
gutter

Extend from C7 to
T10

1.

Costal surface :
It is in contact
with costal pleura
and overlying
thoracic wall

2. Medial surface :
a.
Posterior/vertebral
part
b. Anterior/
mediastinal part

1.
2.
3.
4.

Vertebral column
Intervertebral disc
Posterior intercostal vessels
Splanchnic nerves

RIGHT SIDE
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

Right Atrium
Small parts of Right
ventricle
SVC
Right brachiocephalic vein
(lower part)
Azygos vein
Esophagus
IVC
Trachea
Right vagus nerve
Right phrenic nerve

LEFT SIDE
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

Left ventricle
Pulmonary trunk
Arch of aorta
Thoracic of aorta
Left subclavian artery
Thoracic duct
Left brachiocephalic vein
Left vagus nerve
Left phrenic nerve
Left recurrent laryngeal
nerve

It is a large
depressed area
that lies near the
centre of the
medial surface.
Various structures
enter and leave the
lung via its root.

The root is enclosed in


a short tubular sheet
of pleura that joints
the pulmonary and
mediastinal parts of
pleura. It extend
inferiorly as a narrow
fold- The pulmonary
ligament.

It lies opposite of the


bodies of 5th, 6th and
7th thoracic vertebra

1.

2.

3.
4.

5.

Principal bronchus on
the left side
Eparterial and
hyparterial on the
right side
One pulmonary artery
Two pulmonary veins ,
superior and inferior
Bronchial arteries, one
on right side and two
on left side

6. Bronchial veins
7. Anterior and
posterior
pulmonary plexus
of nerves
8. Lymphatics
9. Bronchopulmonary
lymphonodes
10. Areolar tissues

RIGHT SIDE

ABOVE DOWNWARDS:
1.
EPARTERIAL
BRONCHUS
2.
PULMONARY ARTERY
3.
HYPARTERIAL
BRONCHUS
4.
INFERIOR PULMONARY
VEIN

LEFT SIDE

ABOVE DOWNWARDS:
1.
PULMONARY ARTERY
2.

BRONCHUS

3.

INFERIOR
PULMONARY VEIN

Fissures divide the lungs into lobes

Each lung has an oblique fissure, separating


the upper lobe from the lower lobe on the left
and the upper and middle lobes from the
lower lobe on the right

The right lung has a horizontal fissure,


separating the middle lobe from the
upper

runs from the 2nd thoracic vertebra


posteriorly to the 6th costal cartilage
anteriorly, or along the medial border of
the scapula when the arm is raised above
the head.

It extend from anterior margin at level at


level of 4th costal cartilage.
Runs horizontally backwards to meet the
oblique fissure in the mid-axillary line.
Pulmonary pleura extend into the fissure
of the lungs so that the lobes can move
on each other during respiration

The right lung is larger than the left and


has three lobes:
Superior or upper
Middle
Inferior or lower

The left lung has two lobes


Superior or upper
Inferior or lower

Is a pyramidally shaped section of the lung


with its base covered by visceral pleura
Is separated from adjacent segments by
connective tissue septa
Is names for the segmental bronchus that
supplies it
Has its own bronchus and segmental branch
of the pulmonary artery

Each bronchopulmonary segment can be


surgically resected, independent of
adjacent segments

Each segment is surrounded


by a delicate C.T. septum

The ultimate pulmonary unit from


respiratory bronchiole to alveoli is called
Acinus.

There are about 28 ordes of divisions of


tracheobronchial tree.

Total no. of alveoli has been estimated


to between 200-600 million, with a
total surface area of 40-80 meter
square.

Trachea

Right and left principal


bronchus

Lobar bronchi (secondary)

Segmental bronchi (tertiary)

Terminal bronchioles

Respiratory bronchioles

Alveolar duct

Alveolar sacs

Alveoli

ACINUS

Divisions of bronchi

(2ry
bronchus)

(3ry bronchus)

RIGHT BRONCHUS

LEFT BRONCHUS

1.

Shorter

1.

Longer

2.

Wider

2.

Narrower

3.

More in line with


trachea

3.

More olblique than


the right

Right lung

Left lung

Slightly larger , shorter & wider

Slightly smaller , longer &


narrower

No cardiac notch

The anterior border has a cardiac


notch & below it lies tongue like
process
called lingula

It is divided by 2 fissures
( oblique & horizontal ) into 3
lobes ( upper , middle & lower )

It is divided by one fissures


( horizontal ) into 2lobes ( upper
& lower )

: The hilum contains


bronchi ( eparterial & 1-2
Hyparterial )
Pulmonary artery- 2
pulmonary veins 2- 3

:The hilum contains


one bronchus- 1
Pulmonary artery- 2
pulmonary veins 2- 3

It receives one bronchial artery in It receives 2 bronchial arteries in


the posterior part of the hilum
the posterior part of the hilum
It has 3 lobar bronchi & 10
segmental bronchi ( 10
bronchopulmonary segments )

It has 2lobar bronchi & 8-10


segmental bronchi (8-10
bronchopulmonary segments )

RIGHT MAIN BRONCHUS


Upperlobe bronchus:
- Apical segmental bronchus
- Anterior segmental bronc.
- Posterior segmental bronc.

Middle lobe bronchus:


Medial segmental bronchus
Lateral segmental bronchus

Lower lobe bronchus:


Apical segmental bronchus
Anterior segmental bronchus
Posterior segmental bronchus
Medial segmental bronchus
Lateral segmental bronchus

LEFT MAIN BRONCHUS


Upper lobe bronchus:

Upper branch :
- Anterior segmental bronchus
- Apico-psterior seg. bronchus

Lower branch :
Superior lingular seg. Bronchus
Inferior lingular seg. bronchus

Lower lobe bronchus:


Apical segmental bronchus
Antero-medial segmental
bronchus
Posterior segmental bronchus
Lateral segmental bronchus

Bronchopulmonary segments: Apes And


Possums Might Light LAMPS
Upper lobe: Apical, Anterior, Posterior;
Middle lobe: Medial and Lateral;
Lower lobe: Lateral, Anterior, Medial,
Posterior,
Superior)

Each bronchopulmonary segment can be


surgically resected, independent of
adjacent segments . Segmental resection
with minimal destruction to the
surrounding lung tissue.

A.

SYSTEMIC : Vasa privata


ARTERIES BRONCHIAL
ARTERIES (supplies walls of
bronchi & bronchioles)
BRONCHIAL VEIN :
- RIGHT BRONCHIAL VEIN
AZYGOS VEIN
- LEFT BRONCHIAL VEIN
HIGHGEST INTERCOSTAL
VEIN

B.

PULMONARY :Vasa
publica
PULMONARY
TRUNK RIGHT AND
LEFT PULMONARY
ARTERIES .
CAPILARY NET
AROUND ALVEOLI
.. PULMONARY VEINS
LEFT ATRIUM

Lymph from the lungs


drains to
Pulmonary lymph
nodes (along the lobar
bronchi)
Bronchopulmonary
lymph nodes (along
the main stem bronchi)
Superior and inferior
tracheobronchial lymph
nodes (superior and
inferior to the bifurcation
of the trachea)

Innervation is via the pulmonary plexuses


located anterior and posterior to the lung
roots.
The plexuses contain postganglionic
sympathetic fibers from the sympathetic
trunks that innervate the smooth muscle of
the bronchial tree, pulmonary vessels, and
glands of the bronchial tree.
Sympathetic fibers are bronchodilators,
vasoconstrictors, and inhibit glandular
secretion.
The plexuses contain preganglionic
parasympathetic fibers from the vagus
nerve (CN X), small parasympathetic
ganglia, and postganglionic
parasympathetic nerves that innervate the
smooth muscle of the bronchial tree,
pulmonary vessels, and glands of the
bronchial tree.
Parasympathetic fibers are
bronchoconstrictors, vasodilators, and
secretomotor to the glands.
Visceral afferent fibers carry information
involved in cough reflexes, stretch
reception, blood pressure, chemoreception,
and nociception.

Each lung is surrounded by, and covered


with, a continuous membrane, which is
defined as
the visceral pleura, which covers the lungs and
cannot be dissected from the lung
the parietal pleura, which lines the pleural cavities

The visceral and parietal pleura are


continuous at the hilum of the lung where
structures enter and leave the lung
(bronchus, pulmonary vessels, bronchial
vessels, lymphatics)

Subdivisions of the pleura :


1- Visceral pleura
2- The parietal pleura has four named parts:
Costal pleura lining the internal surface of the
thoracic wall
Mediastinal pleura covering the sides of the
mediastinum
Diaphragmatic pleura covering the superior surface
of the dome of each hemidiaphragm
Cervical pleuraa dome of pleura extending
superiorly into the superior thoracic aperture

3- Pulmonary ligament

Cervical pleura

Costal pleura

Left lung

Mediastinal
pleura

Pulmonary ligament
Diaphragmatic pleura

The pleural cavity is the potential space


between the parietal and visceral pleura.
The pleural cavity contains a tin layer of
serous pleural fluid, which lubricates and
allows the pleurae to move smoothly over
each other during respiration.
Surface tension keeps the lung surface in
contact with the thoracic wall.

The lung expands and fills with air when


the thoracic cavity expands.

Thoracocentesis is the insertion of a


needle into the pleural cavity to withdraw
a sample of fluid or blood. To avoid
damage to the intercostal vein, artery,
and nerve that run in the costal groove on
the inferior surface of each rib, the needle
is inserted well below the rib. The needle
also must be placed sufficiently above the
rib below to avoid the collateral branches
of intercostal nerve and vessels that run
along the superior surface of each rib.

SURFACE ANATOMY OF THE PLEURA


Cervical pleura (apex) : lies one inch above the medial 1/3 of the
clavicle.

Anterior border: a line is drawn, passing downwards and medially :


1-From the sternoclavicular joint to a point on the sternal angle close to the
median plane.
2-Then it is extended vertically to the level of the 4th costal cartilage.
a. On the right side, this line is extended vertically to 6th costal cartilage.
b. On the left side, the line deviates for about one inch to the left of the
sternum (for cardiac notch) then it ends at 6th costal cartilage

Inferior border: a line passing round the chest wall. It begins from the
level of 6th costal cartilage close to the median plane . Then it
crossing :
1-The 8th rib in the midclavicular line
2-The 10th rib in the mid-axillary line
3-The it reaching the 12th spine to ends .

Posterior border : along the vertebral column from the apex of the
pleura to the inferior border

Lung : 2 spaces less than pleura below the 6 th rib .

Lines of pleural reflection are lines along which the parietal pleura changes directions from one
wall to another.
The sternal line of pleural reflection is the sharp line along which the costal pleura
becomes the mediastinal pleura
The costal line of pleural reflection is the sharp line along which the costal pleura becomes
the diaphragmatic pleura
The vertebral line of pleural reflection is a smooth reflection of the costal pleura onto the
vertebrae posteriorly.
The lines of pleural reflection on the left side can be remembered as 4-6-8-10-12.
The line of pleural reflection on the left descends in the midline of the sternum to the 4th
costal cartilage, where it deviates to the left margin of the sternum at the 6th costal
cartilage to accommodate the pericardium and the heart (cardiac notch).
This line then deviates to cross the 8th rib at the midclavicular line.
It crosses the 10th rib at the midaxillary line
It then crosses the 12th rib at approximately the neck.
On the right side, the line of pleural reflection descends at the midline of the sternum to the
xiphoid process, and then deviates 8-10-12.
The lungs do not fully occupy the pleural cavities during expiration
There are peripheral areas where the diaphragmatic and costal pleura come in contact and
these are called the costodiaphragmatic recesses.
There are areas posterior to the sternum where the costal and mediastinal pleura come in
contact with each other, and these are called costomediastinal recesses.
The costomediastinal recess is larger on the left, because of the cardiac notch.
During expiration, the lower limit of the lungs is two costal spaces above the line of pleural
reflection:
6-8-10: the sixth rib at the midclavicular line, the 8th rib at the midaxillary line, and the
10th rib at the neck.
Thus the costodiaphragmatic recess is approximately two costal spaces deep.

Surface
Anatomy
Of
Pleura

Cervical pleura

Anterior borde

6th costal
cartilage
12th thoracic spine
10th rib

Inferior border

8th rib

Costomediastinal rece

In full inspiration,
the anterior bord
of the lung extend
into this recess
In full inspiration,
the inferior border
of the lung extends
into this recess

Costodiaphragmatic recess

Visceral pleura does not have any


general sensory innervation and is
insensitive to pain
The parietal pleura is very sensitive to
pain because of its sensory supply by
branches of the intercostal and phrenic
nerves

Mediastinal pleura

Diaphragmatic pleu

Removal of chest
wall revealed the
following :
1-Internal thoracic
A &V
2- Intercostal
nerves
3- Costal part of
parietal pleura
4- Lower border of
lung
5. Costodiaphrag
matic recess of
pleura