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Lungs and Pleura
Lecture 11 for Anatomy
58
Anatomy
Graduate
09/19/2014

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Cards

Term
Compartments of the thoracic cavity
Definition
Pulmonary cavity- Mediastinum - Pulmonary cavity
Term
Pulmonary cavities contain
Definition
  • Lung
  • Serous plural sac (side of the body)
  • Lung is outside and surrounded by the pleural sac
Term
Pleural sac & cavity
Definition
  • Wall of each pleural sac consists of a continuous serous membrane or mesothelium (pleura)
  • Parietal pleura
  • Visceral pleura
  • Pleural sleeve
  • Pleural cavity
Term
Parietal Pleura
Definition
  • Pleura that adheres to thoracic wall, mediastinum, and diaphragm
Term
Visceral pleura
Definition
  • Pleura that adheres to lungs
Term
Pleural sleeve
Definition
  • Area of continuity between parietal and visceral pleurae
Term
Pleural Cavity
Definition
  • Has a small amount (<10ml) of serous fluid for lubrication
Term
Clinical Correlation (Pleuritis)
Definition
  • Inflammation of visceral and parietal plura (pleuritis) makes them sticky
  • Increased friction between the pleurae creates a pleural rub that is accompanied with sharp pain
Term

Named Regions of parietal pleura 

Palpate: Cervical, costal, mediastinal, diaphragmatic, superior thoracic aperture

Definition
[image]
Term
Cervical Pleura Clinical Correlation
Definition
  • Injuries to the base of the neck can affect lungs and pleura because cervical pleurae extends 2-3cm above the superior thoracic aperture
Term
Lines of Pleural Reflection
Definition
  • Abrupt change in direction between adjacent pleural regions
  • Left & right sternal lines of pleural reflection
  • Left & right costal lines of pleural reflection
  • Left & right vertebral lines of pleural reflection
  • Junction betwen costal and mediastinal parietal pleura at the sternal lines are asymmetric
  • Left sternal line of reflection deviates laterally spanning ribs 4-6
  • Left lateral deviation exposes an anterior access location to mediastinum 
Term
Junction between costal and diaphragmatic parietal pleura
Definition
  • Crosses rib 8 at the midclavicular line
  • Crosses rib 10 at the midaxillary line
  • Ends at rib 12 at the paravertebral line
Term
Pleural Recesses
Definition
  • Gutters
  • During breathing, lungs do not entirely fill the pulmonary cavities
  • Costomediastinal recess
  • Costodiaphragmatic recess
Term
Costomediastinal recess
Definition
  • Associated with sternal pleural reflection and cardiac notch (which is bigger in the left lobe than the right lobe)
Term
Costodiaphragmatic recess
Definition
  • Associated with costal pleural reflection
Term
"2 Rib Rule" of costodiaphragmatic recess
Definition
  • Midclavicular line of lungs is rib 6, parietal pleura is rib 8
  • Midaxillary line of lungs is rib 8, pareital pleura is rib 10
  • Paravertebral line is rib 10, parietal pleura is rib 12
  • Helps to know where to safely put needle
Term
Sampling fluid from pleural recesses (thoracentesis)
Definition
  • Costodiaphragmatic is a potential space that can fill with fluid
  • When upright, excess fluid will accumulate in the recess
  • As patient exhales, clinically a syringe can be put between the ribs 9 and 10 (9th intercostal space)
Term
Lungs
Definition
  • Organs of respiration (gas exchange)
  • Spongy and pink (air polution darkens lungs)
  • Inflates with air during inspiration and elastically recoils during  exhalation
Term
Pulmonary (lung) collapse
Definition
  • Each lung is surrounded by own independent pleural sac (and cavity)
  • Pleural cavity is under negative pressure- keeps lungs inflated during inspiration
  • Breach of pleura releases suction in the affected cavity- elastic recoil causes the lungs to collapse
  • Entry of air into the pleural cavity due to a fractured rib
Term
Secondary atelectasis
Definition
  • Elastic recoil causes the lungs to collapse
Term
Pneumothorax
Definition
  • Entry of air into the pleural cavity
Term
Types of fluid accumulation
Definition
  • Pneumothorax
  • Hydrothorax
  • Hemothorax
  • Chylothorax
Term
Hydrothorax
Definition
  • Excessive serous fluid in pleural cavity
Term
Hemothorax
Definition
  • Blood in pleural cavity
Term
Chylothorax
Definition
  • Lymph in the pleural cavity
Term
If air and fluid accumulation
Definition
  • Start with fluid prefix and then air in the middle, and then thorax
Term
Mediastinum
Definition
  • Between lungs and pleura
  • Contains all thoracic viscera and structures, except for the lungs
  • Leave impressions on cadaveric lungs
  • Root of the lungs
Term
Root of the lungs
Definition
  • Lungs attached to the mediastinal structures by this
  • Major components are
    • Main bronchus
    • Pulmonary arteries
    • Pulmonary veins
Term
Hilum
Definition
  • Structures forming the root of the lung enter and exit this location
Term
Pleural Sleeve
Definition
  • Surrounds the root of the lung
Term
Pulmonary sleeve
Definition
  • Slack in the pleural sleeve forms this
Term
Left and right root of the lungs
Definition
  • Pulmonary arteries are superior
  • Bronchi are posterior
  • Pulmonary veins are anterior-inferior
  • Pulmonary ligaments are inferior to pleural sleeve
Term
Border of the lungs
Definition
  • Apex 
    • Superior end that extends the base of the neck
  • Anterior border is wedge like
  • Posterior border is rounded
  • Inferior border
    • Anatomical base of lung
    • Concave
    • Wedge-like at costodiaphragmatic recess
    • Blunt at mediastinum
Term
Surface anatomy of lungs
Definition
  • Costal
  • Mediastinal
  • Diaphragmatic
Term
Features of the right lung
Definition
  • Has 3 lobes
    • Superior
    • Medial
    • Inferior
  • Has 2 fissures that separate the lobes
    • Oblique fissure (separates superior from inferior and inferior from medial)
    • Horizontal fissure (separates superior from medial
Term
Features of the left lung
Definition
  • 2 Lobes
    • Superior and Inferior
  • Fissure
    • Just the oblique fissure
  • Two unique things
    • Cardiac notch
    • Lingula of superior lobe
Term
Tracheobroncial tree
Definition
  • Begins below the larynx
  • Tree branches into smaller successive tubes
  • Ends at alveoli with capillary beds for exchange
Term
Trachea
Definition
  • Palpable at the jugular notch
  • Begins at the C6 vertebral level
  • Ends at the T4/T5 IVD level (sternal angle or transverse thoracic plane)
  • At end bifurcates into the 2 main bronchi
  • Has C-shape cartilage that is then finished off by smooth muscle called the trachealis
Term
Bronchoscope
Definition
  • Used to examine the inside (lumen) of the airway
Term
Carina
Definition
  • "Keel of boat"
  • Usually at T4/T5 IVD level
  • Thin ridge of cartilage
  • Marks branching of trachea into the main bronchi
Term
Clinical correlation of Carina
Definition
  • Widening or distortion of the carina usually indicates carcinoma of the lymph nodes where the trachea bifurcates
Term
Main Bronchi
Definition
  • Trachea bifurcates into R&L main (primary) bronchi
  • The right main bronchus is wider and more vertical than the left main bronchus
  • Clinically: Forein bodies and objects are more likely to be lodged in the right main bronchus
Term
Lobar and Segmental Bronchi
Definition
  • Each main bronchus branches into:
    • Lobar (secondary) bronchi
      • 2 Left, 3 Right
      • Each lobar bronchus branches into:
        • Segmental (tertiary) bronchi
          • 10 right
          • 10 (or 8) left
          • Each segmental bronchus supplies a wedge-shaped region called a bronchopulmonary segment
Term

Bronchopulmonary Segments

[image]

[image]

[image]

Definition

Right lung down:

  • Apical
  • Posterior
  • Anterior
  • Lateral
  • Medial
  • Anterior Basal
  • Lateral Basal

 

Right lung medial:

  • Superior
  • Medial 
  • Posterior Basal

 

Left lung medial:

  • Superior
  • Posterior basal

 

Left lung down:

  • Apicoposterior
  • Anterior
  • Superior lingular
  • Inferior lingular
  • Anteromedial basal
  • Lateral basal
Term
Clinical Correlations: Lung Resections (Segmentectomy, Lobectomy, Pneumonectomy)
Definition
  • Each segment in BP Segments have independent vasculature and is separated by connective tissue
  • Diseased BP segment can be resected without interrupting neighboring segment
  • Lobectomy is cutting out an entire lobe
  • Pneumonectomy is cutting out an entire lung
Term
Alveoli and path of bronchus->bronchioles
Definition
  • Distal buds of the tree
  • Goes from segmental bronchus to conducting bronchiole (lack supporting cartilage)
  • Conducting bronchiole->terminal bronchiole->respiratory bronchiole->alveolar ducts->alveolar sac->alveolus
  • Alveolus is where gas exchange occurs
Term
Arterial Supply of Lungs (Pulmonary Arteries)
Definition
  • Pulmonary Artery
    • Supply oxygen-deficient blood from heart to lungs for oxygenation
    • Follows branching and course of airways
    • Connect to capilllary beds surrounding alveoli where respiration occurs
    • Mainly supply blood to the lung parenchyma
Term
Arterial supply of lungs (other arteries)
Definition
  • Bronchial arteries
    • Supply high O2 blood to root of lungs, stroma of lungs, visceral pleura, and upper esophagus
    • Left bronchial artery branches off thoracic aorty
    • Right brachial artery is variable and comes from thoracic aorta, left bronchial artery, and posterior intercostal artery
  • Anastomose with pulmonary arteries in walls of bronchioles and visceral pleura
Term
Venous drainage of lungs (bronchial veins)
Definition
  • Bronchial veins
    • Right bronchial veins-> azygos vein
    • Left bronchial veins->accessory hemiazygos vein
  • Remainder of blood in lungs and visceral pleura is drained by the pulmonary vein
Term
Venous drainage of lungs (pulmonary veins)
Definition
  • Drain high O2 blood from capillaries to the heart
  • Drain low O2 blood from visceral pleura
  • Course independently of the arteries and airways
  • Merge into the 2 left and 2 right veins at the hilum
Term

Innervations of Lungs and Pleurae (Pulmonary Plexus)

 

Definition
  • Anterior and posterior to the root of lung
  • Innervates lungs
  • Parasympathetic motor fibers from CN X (Vagues nerve) which is preganglionic
  • Sympathetic motor fibers from sympathetic trunks (postganglionic)
  • Vagus nerve activates bronchoconstriction
  • Sympathetic trunks activate bronchodilation
  • Visceral pleura and parenchyma insensitive to pain from mechanical damage
Term
Innervation of lungs and pleurae (others)
Definition
  • Intercostal nerves and phrenic nerves innervate the parietal pleura and convey localizaed pain
Term
Parietal pleura veins and arteries
Definition
  • Drained by veins of thoracic wall and supplied by arteries of thoracic wall
Term
Superficial and deep lymphatic plexus of lungs
Definition
  • Communicate freely between left and right sides
  • Drain sequentially to tracheobronchial nodes ->paratracheal nodes->right lymphatic and thoracic ducts
Term
Superficial plexus
Definition
  • Subpleural origin (just beneath visceral pleura origin)
  • Drains lymph from lung
  • Parenchyma and visceral pleura to hilar (bronchopulmonary) nodes
Term

Deep lymphatic plexus of lungs

Definition
  • Originates in walls of airways and surrounding stroma
  • Drains lymphs from structures that form root of lung
Term
General flow of lymphatic drainage in lungs and clinical correlation (most lymph, not all)
Definition
  • Lymph in right lung->right venous angle
  • Lymph in left inferior lobe->right venous angle
  • Lymph in left superior lobe-> left venous angle
  • Can be used to determine metastasis of lung cancer using the lymphatic plexuses and access to venous circulation 

[image]

Term
Bronchogenic Carcinoma
Definition
  • General term for any type of lung cancer
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