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Anatomy Of Tracheo-Bronchial Tree
Dr. Supreet Singh Nayyar, AFMC
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Layout•Embryology•Respiratory Tree
▫Trachea and main bronchi▫Segmental Bronchi▫Bronchopulmonary Segments
•Structure•Vasculature , Lymphatic and Nerve
Supply•Applied Anatomy
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EMBRYOLOGY•Tracheobronchial Diverticulum below
Hypobranchial Eminence – 4th wk IUL•edges – oesophagotracheal septum•fuses caudally•endoderm lining•cranial – Trachea / Larynx• caudal – Bronchi / Lungs
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EMBRYOLOGY17-07-2012
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EMBRYOLOGY
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The Respiratory Tree
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The Trachea•Cartilaginous and Membranous tube•Dimensions
▫Length -10- 12 cm▫Ext Dia – 2.0 cm ( 1.5 cm)
•Extent – C6 – T4•Incomplete rings
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Relations•Cervical
▫Anteriorly Isthmus of thyroid with inf thyroid vessels Pretracheal fascia Sternothyroid & Sternohyoid Investing layer of Deep Cervical Fascia Skin & superficial fascia
▫Posteriorly Oesophagus; longus colli; RLN
▫On each side Thyroid Common Carotid Artery
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11Relation o cervical trachea at C 7
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Relations• Thoracic
▫ Anterior Manubrium Sterni Sternothyroid Thymus Lt Brachiocephalic V Aorta & Lt CCA Deep Cardiac Plexus
▫ Posterior Oesophagus Vertebral Column
▫ Rt Side Right Lung & Pleura Rt Vagus Azygous V
▫ Lt Side Arch of Aorta Lt Common Carotid Lt Subclavian A Lt RLN
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The main Bronchi and Branches •Rt and Lt Main Bronchi – T4 level•Carina•The Right Bronchus (bronchus dexter),
wider, shorter, and more vertical▫5 cm. long▫Enters right lung opposite fifth thoracic vertebra▫Azygos vein arches over it from behind▫Right pulmonary artery lies at first below and
then in front ▫2.5 cm along course- Rt Upper Lobe Bronchus▫At Hilum of Lung – Middle & Lower Lobe Bronchi
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Bronchi, Bronchioles, & Alveoli
•Trachea divides into •Primary bronchii
divide into•Secondary bronchi
divide into•Tertiary bronchi divide
into•Bronchioles divide into•Terminal bronchioles
divide into
•Respiratory bronchioles divide into
•Alveolar ducts end in •Alveoli
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The Respiratory Tree www.nayyarENT.com 17-07-2012
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The Respiratory Tree Structure through the airways1.Trachea 2. Bronchus (Right- or Left- Primary
Bronchus) 3. Lobar Bronchus 4. Segmental Bronchus 5. Bronchus 6. Bronchiole 7. Terminal Bronchiole 8. Respiratory Bronchiole 9. Alveolar Duct 10. Alveolar Sac / Alveolus
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The Respiratory Tree • Rt Upper Lobe Bronchus
▫Rt lat aspect of bronchus▫Superolaterally▫3 segmental Bronchi ( Apical; Post; Ant )▫Apical Segmental – Apical & Ant. Subsegmental Br▫Post Segmental – Lateral & Ant. Subsegmental Br▫Ant. Segmental – Lateral & Ant. Subsegmental Br
• Rt Middle Lobe Bronchus▫2.5 cm beyond Rt Upper Lobe Bronchus▫Ant aspect▫Forwards Downwards and Laterally▫Lateral and Medial Subsegments
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The Respiratory Tree •Rt lower lobe bronchus
▫Apical Segmental – post aspect Medial ; Sup ; Lat
subsegmental br▫Medial Basal ( Cardiac ) – Rt Border of heart▫Ant Basal ▫Lateral Basal▫Post Basal
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The Respiratory Tree
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The Respiratory Tree
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The Respiratory Tree •Left Bronchus (bronchus sinister)
smaller in calibre but longer than the right▫5.5 cm long▫Enters root of the left lung opposite sixth
thoracic vertebra ▫Passes beneath Aortic arch,▫crosses in front of oesophagus, thoracic
duct, descending aorta▫Left pulmonary artery lies at first above
then in front
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The Respiratory Tree • Lt upper Lobe Bronchus
▫Anterolateral aspect 5.5cm from carina▫Curves laterally then divides
Cranial divisions: Apico posterior and Anterior Caudal divisions : anterolaterally Lingular
area of lung Sup and Inf segmental• Lt Lower Lobe Bronchus
▫Apical segmental Originates posteriorly 1cm below upper lobe
orifice▫Anteromedial (Anterior Basal and Medial Basal )▫PosterolateralLateral Basal and Post Basal)
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The Lungs
•Soft, spongy, cone-shaped
•Right lung▫3 lobes
•Left lung▫2 lobes
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Bronchopulmonary segments•Independent respiratory units•Sectors of lung with tertiary/ segmental
bronchus ;separate Br of Pulmonary A•Pyramidal with apex to root of lung•Clinical Significance
▫Restriction of infections▫Segmental resection▫Bronchoscopy
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Structure of Trachea andMajor Bronchi
•Cartilages▫16-20▫Incomplete Rings (4 mm vertically and 1 mm
thick)▫Union of 2 or more rings partially or completely▫Highly elastic▫1st Tracheal Cartilage
•Fibrous Membrane▫Perichondrium of cartilages▫Collgen with elastic fibres▫Non striated mus fibres
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Changes as the Respiratory Tree Branches•As branching of
bronchi becomes more extensive▫Rings of cartilage
become plates▫Smooth muscle
increases▫Columnar
epithelium becomes cuboidal, then squamous (in alveoli
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•Mucous Membrane▫Epith lining – thins and single layered▫Tubulo-racemose glands▫Not present in bronchioles
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Vasculature and lymphatics
•Blood Supply▫Inf Thyroid A ▫Bronchial A – 1 for Rt lung ;2 for Lt▫Lie against post wall of Bronchi▫2 Bronchial Veins
Rt – Azygous V Lt – Lt Sup Intercostal V or HemiazygousV
▫Pulmonary V
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Vasculature and lymphatics•Lymphatic Drainage
▫Pretracheal and Paratracheal groups▫Superficial System- Tissue beneath pleura
vessels round lung borders and fissures to reach hilum numerous Valves
▫Deep System- Bronchial Tree; Pulm Vesselshilum- drain into Bronchopulmonary Nodesless no. of Valves
▫Rt and Lt Paratracheal LN unite with Internal Thoracic and Brachiocephalic LN
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Nerve Supply▫Parasympathetic ( Vagus)
Motor to bronchial muscle – bronchospasm Secretomotor to mucous gland Sensory- stretch and Cough Reflex
▫Sympathetic Cervical Ganglion and Spinal N. T2 – T5 Inhibitory to smooth muscle and glands
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Applied Anatomy
•Tracheostomy•Bronchoscopy•Foreign Body In Respi Tract
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Thank you
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