Pleura & Lungs Pleura & Lungs Dr. Sarwar Hossain Dr. Sarwar Hossain

KhanKhan

The PleuraThe PleuraIs a sac on either sides of the mediastinum.Is a sac on either sides of the mediastinum.

Are occupied by the lungs by invagination.Are occupied by the lungs by invagination.

Is a serous membrane, lined by the mesothelium.Is a serous membrane, lined by the mesothelium.

Has 2 layers—parietal & visceral layers.Has 2 layers—parietal & visceral layers.

Is continuous with each other at the hilum of the lung.Is continuous with each other at the hilum of the lung.

The 2 layers enclose between them the pleural cavity.The 2 layers enclose between them the pleural cavity.

This cavity is a site for—pneumothorax, pleural This cavity is a site for—pneumothorax, pleural effusion,empyema & haemothorax. effusion,empyema & haemothorax.

Cont.Cont. Pulmonary pleura—covers the surface of Pulmonary pleura—covers the surface of

lung ,is free at the hilum & along the lung ,is free at the hilum & along the pulmonary ligament.pulmonary ligament.

Cont. with the parietal pleura.Cont. with the parietal pleura. Parietal pleura—divided into Parietal pleura—divided into

costal,diaphragmatic,mediastinal & costal,diaphragmatic,mediastinal & cervical.cervical.

Cervical—covers the apex of the lung & Cervical—covers the apex of the lung & lies about 1 inch above the medial 1/3lies about 1 inch above the medial 1/3rdrd of of the clavical.the clavical.

Is covered by the sibson’s fascia.Is covered by the sibson’s fascia.

PULMONARY LIGAMENTPULMONARY LIGAMENT Is a fold of the parietal pleura.Is a fold of the parietal pleura. Around the hilum.Around the hilum. Acts as a dead space for the expansion of Acts as a dead space for the expansion of

the veins.the veins. Contains lymphatics & areolar tissues.Contains lymphatics & areolar tissues. RECESSES: are folds of the parietal pleura RECESSES: are folds of the parietal pleura

making room for expansion of the lungs making room for expansion of the lungs during breathing.during breathing.

Costomediastinal & costodiaphragmatic. Costomediastinal & costodiaphragmatic.

CLINICAL IMPORTANCECLINICAL IMPORTANCE

These get filled by pleural effusion These get filled by pleural effusion when diseased.when diseased.

SURFACE MARKING:SURFACE MARKING: Cervical pleuraCervical pleura Anterior marginAnterior margin Inferior marginInferior margin Posterior margin Posterior margin

Nerve supply

• Parietal—intercostal & phrenic nerves

• Is pain sensitive.• Pulmonary pleura—autonomic

nerves—sympathetic nerves.• Not pain sensitive.

BLOD & LYMPHATIC SUPPLYBLOD & LYMPHATIC SUPPLY Parietal—intercostal,internal thoracic Parietal—intercostal,internal thoracic

and musculophrenic arteries.and musculophrenic arteries. Veins drain into azygos and internal Veins drain into azygos and internal

thoracic veins.thoracic veins. Lymphatics—intercostal, internal Lymphatics—intercostal, internal

mammary & diaphragmatic nodes.mammary & diaphragmatic nodes. Pulmonary pleura—bronchial arteries Pulmonary pleura—bronchial arteries

& bronchopulmonary nodes.& bronchopulmonary nodes.

APPLIED

Thoracocentesis Pleurisy Effusion Pneumothorax Haemothorax Hydropneumothorax empyema

THE LUNGS

LUNGSLUNGS

Organs of respirationOrgans of respiration Mediastinum separates the 2 lungsMediastinum separates the 2 lungs Spongy, grey, dark later on.Spongy, grey, dark later on. 600-700gm. R>L600-700gm. R>L Has apex, base, 3 borders, 2 surfaces.Has apex, base, 3 borders, 2 surfaces. Apex—above the level of the anterior end Apex—above the level of the anterior end

of the 1of the 1stst rib—1 inch above the medial 1/3 rib—1 inch above the medial 1/3rdrd end of the clavicle.end of the clavicle.

Covered by sibson,s fascia.Covered by sibson,s fascia.

• Base—lies on the diaphragm.• Anterior border is thin—vertical on the R.• Ant. Border of L lung is notched—cardiac

notch.• Here the heart is not covered by the lung

& the pericardium.• Post.border is thick & corresponds to the

heads of the ribs.• Extend from 7th C vert. to the 10th T vert.

Inferior border—separates the base Inferior border—separates the base from the costal & medial surfaces.from the costal & medial surfaces.

Costal surface.Costal surface. Medial surface—post. & anterior Medial surface—post. & anterior

parts.parts. Has numerous impressions.Has numerous impressions.

Fissures & lobes. R Lung—3 lobes—2 fissures; oblique &

horizontal. L Lung—2 lobes; 1 fissure. Oblique fissure—cuts the whole

thickness of the lung, except at the hilum.

Crosses post. Border, 2-3 inches below the apex.

Crosses inf. Border 2 in. from the medial plane.

Cont.

Horizontal fissure of R lobe divides the middle lobe from the upper lobe.

L lobe has a lingula below the cardiac notch.

No. of lobes may vary.

Structures related to the medial surfaces of the 2 lungs.

ROOTS OF THE LUNG

A pedicle connecting the medial surface of the lung with the mediastinum.

Short & broad. Various structures exit & enter

here from & to the lungs. Lies opposite 5th-7th T vertebra.

CONTENTS

contents

L—1-brochus, R-2-bronchi 1 PA each. 2 PV each. Bronchial art.—2 on L, 1 on R BV Pulmonary plexuses—ant,post. Lymphatics, LN, etc.

relations

Brochial tree

2 bronchi branch out from the trachea.

At the lower end of the 4th T vertebra.

R bronbus is short, wide,straight. Infections are common.

Enters lungs through the hilum. Divides into lobar bronchi—3 on R,

2 on L.

These further divide into—tertiary or segmental bronchi –10 on the R, 8 on the L(10)

These further divide into terminal bronchioles & these into respiratory bronchioles which aerates the pulmonary unit formed by—alveolar ducts,atria, air saccules, & pulmonary alveoli.

Arteries,veins, lymphatics & nerve supply.

Artery—bronchial art.—R side, one art.-either from 3rd post. Intercostal or upper L bronchial art.

L side-2 in no. from desc. Aorta. Pulmonary art. –deoxygenated

blood. PV carry oxygenated blood to the

heart.

veins 2 bronchial veins on each side R bronchial veins drain to azygos

vein, L veins-- into hemiazygos or the

superior intercostal veins. Drain blood from the 1st 1-2 divisions

of the bronchi. Rest of the blood is drained by the

pulmonary veins.

lymphatics Bronchopulmonary nodes.—from

superficial & deep vessels Some connection bet. the 2 groups

exists. NERVES Parasympathetic—vagus—motor,sensory

& secretomotor. Sympathetics—T2-T5—bronchodilation. Form plexuses around the hilum.

Bronchopulmonary segments

Sector of a lung that is aerated by a tertiary bronchus.

Pyramidal in shape with apex towards root.

There are 10 on the R, & 8 on the L. Intersegmental planes—bet. The

segments.

Bronchopulmonary segments

Crossed by the PV. Segments have pulm. Art. With the

bronchus together with the bronchial art.

So the segment cannot be called a bronchovascular segment. –it has no vein.

Clinical

Infections No barrier Surgery Postural drainage Bronchoscopy

MEDIASTINUMMEDIASTINUM

Medium septum of the thorax bet. Medium septum of the thorax bet. The 2 lungs.The 2 lungs.

Ant.—sternumAnt.—sternum Post.—vert columnPost.—vert column Sides --mediastinal pleuraSides --mediastinal pleura Sup.—thoracic inletSup.—thoracic inlet Inf.—diaphragm. Inf.—diaphragm.

Divided into—superior & inferior.Divided into—superior & inferior. Inf.---ant., middle & post.Inf.---ant., middle & post. Middle—contains the pericardium.Middle—contains the pericardium. SUPERIORSUPERIOR Contents: tra, oeso, muscles, Contents: tra, oeso, muscles,

arteries, veins, nerves,thymus, arteries, veins, nerves,thymus, thoracic duct, lymph nodes.thoracic duct, lymph nodes.

Clinical: mediastinitis,site of Clinical: mediastinitis,site of neoplasms,dead space.neoplasms,dead space.

ANTERIOR MEDIASTINUMANTERIOR MEDIASTINUM

In front of pericardium.In front of pericardium. Is cont. with the pretracheal space Is cont. with the pretracheal space

of the neck.of the neck. Contents: ligaments, LN, internal Contents: ligaments, LN, internal

thoracic art. Branches,thymus & thoracic art. Branches,thymus & areolar tissue.areolar tissue.

MIDDLE mediastinum• Contains heart,great arteries &

veins, nerves, LN & bronchi.• POSTERIOR MEDIASTINUM• CONTENTS: oeso, DTA, veins,

nerves, LN & lymphatics.

CLINICAL

Sup. & post. mediastinal infections can spread along each other,s territory.

Mediastinal syndrome.—SVC, TRACHEA, OESOPHAGUS, LRLN, PHRENIC NERVE,INTERCOSTAL NEURALGIA.

Cause: carcinoma, aneurysm, hodgkins.

TRACHEATRACHEA

►Windpipe—organ of respirationWindpipe—organ of respiration► Lower part neck, in the superior Lower part neck, in the superior

mediastinummediastinum►Divides into R & L bronchiDivides into R & L bronchi► Is 4-6 inches long.Is 4-6 inches long.►Dia.—2 & 1.5 in M & F.Dia.—2 & 1.5 in M & F.► Lumen is 12mm.Lumen is 12mm.► Starts from the lower border of cricoid Starts from the lower border of cricoid

cartilage.cartilage.

Structure:--fibroelastic, C-shaped rings Structure:--fibroelastic, C-shaped rings 16 20 in no.16 20 in no.

Post. It is closed by fibroelastic Post. It is closed by fibroelastic membrane & contains the trachealis membrane & contains the trachealis muscle.muscle.

Blood supply—inf. Thyroid art.Blood supply—inf. Thyroid art. Vein: L brachiocephalic veinVein: L brachiocephalic vein Lymph: pre & paratracheal LN.Lymph: pre & paratracheal LN.

Nerve suply---parasympathetic & Nerve suply---parasympathetic & sympatheticsympathetic

APPLIEDAPPLIED TranlucencyTranlucency PalpationPalpation Tracheal tugTracheal tug TracheostomyTracheostomy SwallowingSwallowing Mucus barrierMucus barrier Husky voiceHusky voice

Thoracic ductThoracic duct

Largest lymphatic vesselLargest lymphatic vessel Starts from the upper part of the Starts from the upper part of the

abdomen to the lower part of neck.abdomen to the lower part of neck. Crosses from the R to the L.Crosses from the R to the L. Goes through the post. & sup. Goes through the post. & sup.

Mediastinum.Mediastinum. 18 inch. Long.18 inch. Long. Has valves so looks beaded.Has valves so looks beaded.

Cysterna chyli cont. up as the TD.Cysterna chyli cont. up as the TD. Enters though the aortic opening.Enters though the aortic opening. At level of 7At level of 7thth C Vert., it arches laterally. C Vert., it arches laterally. Ends by opening into the bifurcation of Ends by opening into the bifurcation of

the L brachiocephalic vein into L the L brachiocephalic vein into L subclavion vein & the L IJV.subclavion vein & the L IJV.

RELATION: in theaortic opening, post., RELATION: in theaortic opening, post., sup. Mediastinum & in the neck.sup. Mediastinum & in the neck.

TRIBUTARIESTRIBUTARIES

Receives lymph from below the Receives lymph from below the diaphragmdiaphragm

& also from the L upper half of the & also from the L upper half of the body.body.

Collects lymph from the L jugular Collects lymph from the L jugular trunk, L subclavion trunk, L trunk, L subclavion trunk, L Mediastinal trunk.Mediastinal trunk.

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