THORACIC CAVITY LUNGS and PLEURA Pleura Visceral pleura: Visceral pleura: Covers and follows indentations of lung. Parietal pleura: Parietal pleura:

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  • THORACIC CAVITYLUNGS and PLEURA

  • PleuraVisceral pleura:Covers and follows indentations of lung.Parietal pleura:Lines thoracic cavity.Text: p 113, Fig. 1.23

  • Parietal Pleura DivisionsCostal pleura lines the ribs.Diaphragmatic pleura covers the diaphragm.Mediastinal pleura lies against the mediastinum.Cervical pleura extends above the level of the first rib.Text: p 115, Fig. 1.24

  • Pleural ReflectionsCostodiaphragmatic recess (space):Space where costal and diaphragmatic pleura meet.Costomediastinal recess (space):Space where mediastinal and costal pleura meet.Pulmonary ligament:Transition between visceral and parietal pleura at root of the lung.

  • Pleural Lines of ReflectionCervical dome of pleura:Level with neck of the first rib.Anteriorly, 1.5-2.5 cm above the sternal end of the clavicle.Anterior margin extends obliquely behind the sternoclavicular joint.At sternal angle, the pleura is at the median line and two sides stay in contact until the fourth costal cartilage.Text: p 115, Fig. 1.24A

  • Pleural Lines of ReflectionRight side:Leaves sternum at 7th costal cartilage.At 8th costal cartilage at midclavicular line.At 10th rib at axillary line.At 11th rib at scapular line.Extends to level of body of T12 and then ascends.

  • Pleural Lines of ReflectionLeft side:Leaves sternum at IC space 5.1.5 cm from sternal margin at 6th costal cartilage.Follows same landmarks as right side from this point.

  • Right Lung ProjectionsFollows rib 1 to sternoclavicular joint.Located at median plane at sternal angle.Extends along median plane from 2nd costal cartilage to 4th costal cartilage.Leaves sternum at 6th costal cartilage.At 6th rib at midclavicular line.

  • Right Lung ProjectionsAt 8th rib at axillary line.At 10th rib at scapular line.Ends opposite T11.

  • Left Lung ProjectionsSame as right lung except:Cardiac notch begins at 4th costal cartilage.Horizontal at parasternal line.Medial to costochondral junction at 6th cartilage.

  • Right Lung MorphologyOblique fissure :Separates superior and inferior lobes.Begins at base of scapular spine.At 5-6th rib at midaxillary line.Ends at 6th costochondral junction.Text: p 122: Fig. 1.27

  • Right Lung MorphologyHorizontal fissure :Separates superior and middle lobes.Begins at axillary line.Follows rib 4.

  • Left Lung MorphologyOblique fissure:Same as for right lung.No horizontal fissure.

  • Lobes of the LungsLobes3 on right2 on leftSupplied by secondary bronchi

  • Lobes of the LungsLobules (bronchopulmonary segments)10 on right8 on leftSupplied by tertiary bronchiText: p 125 and 126, Fig. 1.28

  • Lobes of the Right LungSuperior lobe:Apical lobulePosterior lobuleAnterior lobuleMiddle lobe:Lateral lobuleMedial lobule

  • Lobes of the Right LungInferior lobe:Superior lobuleAnterior basal lobuleMedial basal lobuleLateral basal lobulePosterior basal lobule

  • Lobes of the Left LungSuperior lobe:Apicoposterior lobuleAnterior lobuleLingular lobule:Homologous to middle lobe of right lung.Superior lobule.Inferior lobule.

  • Lobes of the Left LungInferior lobe:Superior lobuleAnterior basal lobuleMedial basal lobuleLateral basal lobulePosterior basal lobule

  • Bronchopulmonary TreeTracheaSupported by cartilaginous ringsPrimary bronchiSupported by cartilaginous ringsSecondary bronchiSupported by cartilaginous ringsTertiary bronchi

  • Bronchopulmonary TreeRespiratory bronchiAlveolar sacsAlveoli

  • TracheaSupported by C-shaped cartilage segments.In superior mediastinum.Anterior to esophagus.Bifurcates into primary bronchi at sternal angle.Carina.Text: p 125, Fig. 1.28

  • Right Primary BronchusShorter, straighter, and larger than left:Aspirated objects more commonly follow right bronchus.Gives off three secondary bronchi:Superior to superior lobe of right lung.Middle to middle lobe of right lung.Inferior to inferior lobe of right lung.

  • Left Primary BronchusTwice as long as right primary bronchus.Gives off two secondary bronchi:Superior to superior lobe of right lung.Inferior to inferior lobe of right lung.Angle between primary bronchi is 62 degrees.

  • Bronchopulmonary TreeSecondary bronchi:Supply lobes.Tertiary bronchi:Supply lobules (bronchopulmonary segments)Respiratory bronchiAlveolar sacsAlveoli

  • Lung Vascular SupplyOne pulmonary artery to each lung:Part of root of lung:Lobar arteries:One to each lobeSegmental arteries:To segmentsIntrasegmental

  • Lung Vascular SupplyTwo pulmonary veins from each lung:IntersegmentalText: p 129, Fig. 1.30

  • Bronchial ArteriesSupply bronchiIntrasegmentalSupply tissues of lungsTwo left bronchial arteries from thoracic aortaRight bronchial artery origin is variable but usually from first aortic intercostal artery.Text: p 127, Fig. 1.29

  • Bronchial VeinsRight to azygos vein.Left to accessory hemiazygos vein or left superior intercostal veins.

  • Innervation of the LungsAnterior and posterior plexus:Lie anterior and posterior to roots of lungs.Contain parasympathetic fibers:From vagus nerve (CN X).Contain sympathetic fibers:From T1-4.Related to esophageal and aortic plexuses posteriorly.Text: p 133, Fig. 1.33

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