Anatomy of the lungs and tracheobronchial tree

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Anatomy of the lungs and tracheobronchial tree

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Lung volumes and capacities
Asthma
Bronchodilators: Beta 2-agonists and muscarinic antagonists
Bronchodilators: Leukotriene antagonists and methylxanthines
Pulmonary corticosteroids and mast cell inhibitors
Emphysema
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Diffusion-limited and perfusion-limited gas exchange
Obstructive lung diseases: Pathology review
Chronic obstructive pulmonary disease (COPD): Clinical
Ventilation-perfusion ratios and V/Q mismatch
Reading a chest X-ray
Regulation of pulmonary blood flow
Restrictive lung diseases
Compliance of lungs and chest wall
Gas exchange in the lungs, blood and tissues
Anatomy of the lungs and tracheobronchial tree
Diffuse parenchymal lung disease: Clinical
Combined pressure-volume curves for the lung and chest wall
Pulmonary hypertension
Pulmonary shunts
Pulmonary embolism
Tuberculosis: Pathology review
Long QT syndrome and Torsade de pointes
Cardiovascular system anatomy and physiology
Lymphatic system anatomy and physiology
Coronary circulation
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Altering cardiac and vascular function curves
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Physiological changes during exercise
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Acyanotic congenital heart defects: Pathology review
Cyanotic congenital heart defects: Pathology review
Atherosclerosis and arteriosclerosis: Pathology review
Coronary artery disease: Pathology review
Peripheral artery disease: Pathology review
Valvular heart disease: Pathology review
Cardiomyopathies: Pathology review
Heart failure: Pathology review
Supraventricular arrhythmias: Pathology review
Ventricular arrhythmias: Pathology review
Heart blocks: Pathology review
Aortic dissections and aneurysms: Pathology review
Pericardial disease: Pathology review
Endocarditis: Pathology review
Hypertension: Pathology review
Shock: Pathology review
Vasculitis: Pathology review
Cardiac and vascular tumors: Pathology review
Dyslipidemias: Pathology review
Choanal atresia
Laryngomalacia
Allergic rhinitis
Nasal polyps
Upper respiratory tract infection
Sinusitis
Laryngitis
Retropharyngeal and peritonsillar abscesses
Bacterial epiglottitis
Nasopharyngeal carcinoma
Tracheoesophageal fistula
Congenital pulmonary airway malformation
Pulmonary hypoplasia
Neonatal respiratory distress syndrome
Transient tachypnea of the newborn
Meconium aspiration syndrome
Apnea of prematurity
Sudden infant death syndrome
Acute respiratory distress syndrome
Decompression sickness
Cyanide poisoning
Methemoglobinemia
Emphysema
Chronic bronchitis
Asthma
Cystic fibrosis
Bronchiectasis
Alpha 1-antitrypsin deficiency
Restrictive lung diseases
Sarcoidosis
Idiopathic pulmonary fibrosis
Pneumonia
Croup
Bacterial tracheitis
Lung cancer
Pancoast tumor
Superior vena cava syndrome
Pneumothorax
Pleural effusion
Mesothelioma
Pulmonary embolism
Pulmonary edema
Pulmonary hypertension
Sleep apnea
Respiratory distress syndrome: Pathology review
Cystic fibrosis: Pathology review
Pneumonia: Pathology review
Tuberculosis: Pathology review
Deep vein thrombosis and pulmonary embolism: Pathology review
Pleural effusion, pneumothorax, hemothorax and atelectasis: Pathology review
Obstructive lung diseases: Pathology review
Restrictive lung diseases: Pathology review
Apnea, hypoventilation and pulmonary hypertension: Pathology review
Lung cancer and mesothelioma: Pathology review
Cholesterol metabolism
Fats and lipids
Chlamydia pneumoniae
Klebsiella pneumoniae
Pseudomonas aeruginosa
Legionella pneumophila (Legionnaires disease and Pontiac fever)
Bordetella pertussis (Whooping cough)
Mycobacterium tuberculosis (Tuberculosis)
Mycoplasma pneumoniae
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Blastomycosis
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Pneumocystis jirovecii (Pneumocystis pneumonia)
Aspergillus fumigatus
Cryptococcus neoformans
Cryptosporidium

Notes

Anatomy of the Lungs & Tracheobronchial Tree

Figure 1. Mediastinal surface of the right lung showing the borders of the lung.
Figure 2. right and left lung showing impressions on the mediastinal surface.
Figure 3. Bronchopulmonary segments of the A right and left lung.
Figure 4. Anterior view of the lungs.
Figure 5. A Anterior view of the tracheobronchial tree and B isolated terminal bronchiole.
Figure 6. A Anterior view of the functional pulmonary circulation. Anterior view of the nutritive circulation.
Figure 7. Anterior view of the lymphatic drainage of the lungs. 
UNLABELLED DIAGRAMS

Transcript

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The lungs are a pair of air-filled organs located in the thoracic cavity, on the left and right side, separated by a central mediastinum, which contains the heart, thoracic parts of the great vessels, thoracic parts of the trachea, esophagus, thymus, and other structures.

It’s also important to notice that the heart is turned and extends towards the left side of the thoracic cavity, imposing on the left lung markedly more than the right so the anatomy of the two lungs is not completely symmetrical.

Each lung is covered by a membrane called the pleura, which is subdivided into the visceral pleura that intimately adheres to the lung and the parietal pleura that lines the pulmonary cavity.

Between them, there’s the pleural cavity, which is normally filled with a thin film of fluid.

Now, on the medial part of each lung, there’s the pulmonary hilum, where the root of the lung passes through.

The root of the lungs is made of structures like the main bronchus arteries, and veins.

The lungs are light, soft and spongy, and each of them has an apex a base, 3 surfaces: costal, mediastinal and diaphragmatic, and 3 borders: anterior, inferior and posterior.

The apex is the blunt superior end of the lung above the level of the first rib into the root of the neck, while the base is the concave inferior surface of the lung that rests on the diaphragm.

Now for the specifics.

The right lung is larger and heavier than the left, but it’s shorter and wider, because the right dome of the diaphragm is higher and the heart and pericardium are more to the left.

The right lung is divided into three lobes, superior, middle and inferior, by the horizontal fissure and the oblique fissure, which can be seen on all the surfaces of the lung.

On the other hand, the left lung has a single left oblique fissure, which can also be seen on all surfaces and divides the left lung into two lobes: superior and inferior.

Also on the left lung, there’s a deep cardiac notch on the anterior border, caused by the deviation of the heart towards the left.

This leaves an impression on the antero-inferior aspect of the superior lobe and also shapes a tongue-like process called the lingula.

The lingula extends below the cardiac notch and goes in and out of the costomediastinal recess during breathing.

Next, there are the lung surfaces.

The costal surface of both lungs is large, smooth and convex and related to the costal pleura, which separates it from the ribs, costal cartilages and the intercostal muscles.

The posterior part of the costal surface is in relation to the bodies of the thoracic vertebrae and sometimes called the vertebral part of the costal surface.

The diaphragmatic surface of the lung, also concave, forms the base of the lung, which rests on the dome of the diaphragm.

The concavity is deeper in the right lung because the right dome is higher due to the liver sitting below.

Finally, the mediastinal surface of the lung is concave because it’s related to the middle mediastinum, which contains the pericardium and heart.

This surface includes the hilum which receives the root of the lung.

On an embalmed cadaver, several impressions can be seen on the mediastinal surface of the lung.

On the right lung, there’s a groove for the esophagus and arch of the azygos vein as it arches superior to the lung hilum to drain into the superior vena cava which may also cause a groove in the right lung.

Both lungs also have a cardiac impression for the heart,where on the left lung, there’s a much larger cardiac impression as the heart apex is directed towards the left.

The left lung will also have a continuous groove for the arch of the aorta, as well as the descending aorta and a smaller area for the esophagus.

And just a few words on borders. The anterior border is where the costal and mediastinal surfaces meet anteriorly.

On the right lung, it’s almost straight, while on the left lung it’s deviated by the cardiac notch.

The inferior border is thin and sharp and bounds the diaphragmatic surface of the lung and separates it from the costal and mediastinal surfaces.

It also projects into the costodiaphragmatic recess of the pleura.

The posterior border is where the costal and mediastinal surfaces meet posteriorly, and it’s broad and rounded, and lies at the side of the thoracic region of the vertebral column.

The lungs are attached to the mediastinum by the roots of the lungs, made up by the bronchi and associated bronchial vessels, the pulmonary arteries, the superior and inferior pulmonary veins, as well as the pulmonary plexuses of nerves and lymphatic vessels.

On a section of the right and left lung root, we can identify the position of the main bronchus, and the pulmonary artery and vein in relationship to one another.

But keep in mind there may be slight variations from person to person. First, the main bronchus is typically against the posterior middle boundary in both lung roots.

Depending on the precise location of the section, you may see the main bronchus dividing into the superior lobar bronchus and intermediate bronchus on the right, and into the superior lobar bronchus and inferior lobar bronchus on the left.

On anatomical dissection, the bronchus is easiest to identify due to its firm cartilaginous structure when feeling it.

Second, the pulmonary artery is the superior most structure on both the left and right roots.

However, on the right side, you may see the first two branches of the pulmonary artery.

Third, the superior and inferior pulmonary veins are typically the anterior most and inferior most structures on both lung roots.

These roots enter and exit the lungs through a doorway that is called the hilum of the lung, similar to how the roots of a plant enter into the ground.

Medial to the hilum, towards the central mediastinum, the lung root is enclosed within the area of continuity between the parietal and visceral layers of the pleura.

Inferior to the root of the lung, this continuity between parietal and visceral pleura forms the pulmonary ligament, which extends between the lung and mediastinum, directly anterior to the esophagus..

The pulmonary ligament consists of a double layer of pleura separated by a small amount of connective tissue. To visualize this, think of wearing a large lab coat.

Your forearm represents the root of the lung, and the sleeve is the pleura, which if it is too large will droop down in a double layer.

Now, let’s play a game and see if you can tell which lung is which based on their external appearance!

Alright, now let's look at the tracheobronchial tree which starts with the trachea, right below the larynx.

Below the larynx, the walls of the trachea are surrounded by C-shaped rings of hyaline cartilage.

The trachea bifurcates into two main bronchi or primary bronchi at the level of the transverse thoracic plane or sternal angle.

They pass inferolaterally to enter the lungs at each hilum.

The right main bronchus is wider, shorter and has a more vertical trajectory than the left one and passes directly into the right hilum.

The left main bronchus passes inferolaterally, inferior to the aortic arch and anterior to the esophagus and thoracic aorta to reach the left hilum.

Now, within each lung, the main bronchi divide to form the branches of the bronchial tree, all of which actually belong to the root of the lung.

Each main bronchus divides into secondary lobar bronchi, each of which supply a lobe of the lung - so on the right, there are three secondary lobar bronchi: right superior lobar bronchus, right middle lobar bronchus and right lower lobar bronchus.

The portion of the right main bronchus that continues inferiorly and gives rise to the middle and lower lobar bronchi is often referred to as the intermediate bronchus.

On the left, there are only two lobar bronchi: the left superior lobar bronchus and left inferior lobar bronchus.

Each secondary lobar bronchus then divides into several tertiary segmental bronchi that supply the bronchopulmonary segments

Each bronchopulmonary segment is independently supplied by a tertiary segmental bronchus, in addition to a branch of the pulmonary artery - so there’s 10 bronchopulmonary segments for the right lung, and 8 to 10 for the left lung as some of the segments may be combined.

These bronchopulmonary segments are functionally distinct segments which is important for surgeons who operate on the lungs.

In both lungs, the superior lobe has an apical, posterior, and anterior segment where the apical and posterior segment may be combined in the left.

Furthermore, the left superior lobe also has a superior lingular and inferior lingular segment.

Because the right lung has a middle lobe, the middle lobe has a lateral and medial segment, which are the counterparts to the superior lingular and inferior lingular sesgments.

Finally, both of the lung’s lower lobes have a superior segment, along with an anterior, posterior, medial and lateral basal segment, where in the left lung the anterior and medial segments may be combined.

Beyond the tertiary segmental bronchi, the tracheobronchial tree branches 20 to 25 more times, resulting in about 20 to 25 generations of branching conducting bronchioles.

Finally, conducting bronchioles end as terminal bronchioles, which are the smallest conducting bronchioles and don’t have any cartilage in their walls.

Each terminal bronchiole gives rise to several generations of respiratory bronchioles, which have scattered alveoli, or thin-walled outpouchings, extending from their lumens.

Sources

  1. "Gray's Anatomy for Students" Elsevier Canada (CDN Editions) (2019)
  2. "SURGERY OF THE LUNG ROOT" The Lancet (1935)
  3. "Gray's Anatomy" Churchill Livingstone (2007)
  4. "Applied Radiological Anatomy" Cambridge University Press (2012)
  5. "Clinically Oriented Anatomy" Lippincott Williams & Wilkins (1998)
  6. "West's Respiratory Physiology" LWW (2015)
  7. "Last's Anatomy" Elsevier Australia (2003)