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Mudoogo Edgar 2
Objectives
• Review of chest cavity, mediastinum, pleura, trachea, bronchi
• Review lung fissures and lobes• Understand the bronchopulmonary segments• Relate the discussion to the clinic
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Chest cavity • bounded by the chest wall and
below by the diaphragm• extends upward into the root of the
neck about one fingerbreadth above the clavicle on each side
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Mediastinum • though ,thick, movable partition • Divided by an imaginary line into 2 parts
Structures in superior mediastinum A-P• Thymus, large veins, large arteries, trachea, esophagus
and thoracic duct, and sympathetic trunks.Structures in inferior mediastinum A-P• Thymus, heart within the pericardium with thephrenic nerves on each side, esophagus and thoracicduct, descending aorta, sympathetic trunks
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Pleura
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Trachea • mobile cartilaginous and membranous tube• begins in the neck as a continuation of the larynx• descends in the midline of the neck.• trachea ends below at the carina by dividing into right and left principal bronchi at the level
of the sternal angle• During expiration, the bifurcation rises by about one vertebral level, and during deep
inspiration may be lowered as far as the T6• is about 11.25 cm long , 2.5 cm in diameter• kept patent by U-shaped bars (rings) of hyaline cartilage• posterior free ends of the cartilage are connected by smooth muscle, the trachealis
muscle.
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Anteriorly• The sternum • the thymus• the left brachiocephalic vein• origins of the brachiocephalic left
common carotid arteries, • arch of the aorta
Posteriorly• The esophagus • left recurrent
laryngeal nerve
Right side• azygos vein• right vagus nerve• the pleura
Left side• arch of the aorta• left common Carotid• left subclavian arteries• left vagus • left phrenic nerves• the pleura
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Bronchi • right and left principal bronchi • The right principal(main) bronchus is wider,Right principal bronchus• shorter, and more vertical than the left ,about 2.5 cm long. • Before entering the hilum of the right lung off the superior lobar
bronchus. • On entering the hilum, it divides into a middle and an inferior
lobar bronchus.
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Left main bronchi • is narrower, • longer, • more horizontal than the right • 5 cm long. • It passes to the left below the arch of the aorta in front of the
esophagus. • On entering the hilum of L lung, the principal bronchus divides
into superior and inferior lobar bronchus.
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LUNGS• Are soft, spongy and elastic• would immediately shrink to one third or less in volume if
thoracic cavity was opened• Pink in the child , become dark and mottled .
Why??????• because of the inhalation of dust particles that become trapped in
the phagocytes of lungs• Each is conical, covered with pleura & suspended by its root
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• Apex – The blunt superior end of the lung. It projects upwards, above the level of the 1st rib and into the floor of the neck.
• Base – The inferior surface of the lung, which sits on the diaphragm.• Lobes (two or three) – These are separated by fissures within the lung.• Surfaces (three) – These correspond to the area of the thorax that they
face. They are named costal, mediastinal and diaphragmatic.• Borders (three) – The edges of the lungs, named the anterior, inferior
and posterior borders.
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Oblique fissure – Runs from the inferior border of the lung in a superoposterior direction, until it meets the posterior lung border.Horizontal fissure– Runs horizontally from the sternum, at the level of the 4th rib, to meet the oblique fissure.
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Bronchopulmonary Segments• are the anatomic, functional, and surgical units of the lungs• Is pyramid shaped, with the apex at the lung root; • Is the largest subdivision of a lobe; • Is surrounded by connective tissue; • Has separate segmental artery, segmental (tertiary) bronchus, lymph vessels &
autonomic nerves; • Segmental veins lie in the connective tissue b/w adjacent bronchopulmonary segment;• Diseased segment can be removed surgically without affecting the function of other
segments•
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Main characteristics of a bronchopulmonary segment
• It is a subdivision of a lung lobe.• It is pyramid shaped, with its apex toward the lung• root.• It is surrounded by connective tissue.• It has a segmental bronchus, a segmental artery, lymph• vessels, and autonomic nerves.• The segmental vein lies in the connective tissue between adjacent
bronchopulmonary segments.• Because it is a structural unit, a diseased segment can be removed surgically
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RIGHT LUNG BRONCHOPULMONARY SEGMENTS
Upper lobe Apical anteriorposterior
Middle lobe mediallateral
Lower lobe superiorMedial basalAnterior basalLateral basalPosterior basal
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LEFT LUNG BRONCHOPULMONARY
SEGMENTSUpper lobe apical
anterior
posterior
Superior lingularInferior lingular
Lower lobe superior
Medial basal
Anterior basal
Lateral basal
Posterior basal
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R-A PALM Seed Makes Another Little PalmL-ASIA ALPS
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Clinical Notes1. PLEURAL EFFUSION The pleural normally contains 5-
10ml of clear fluid. The formation results from hydrostatic & osmotic pressures. The pleural fluid is normally absorbed by the capillaries of visceral pleura. Any condition that increases the production of fluid result in abnormal accumulation of fluid
2. PLEURISY or PLEURITIS is the inflammation of pleura 3. PNEUMONIA inflammation of lungs4. PLEURAL RUB pleural surfaces become rough & produce
friction & a can be heard with stethoscope5. PLEURAL ADHESIONS visceral & parietal pleura adhere
to each other6. PNEUMOTHORAX air in the pleural cavity (from lungs or
chest wall)7. HYDROPNEUMOTHORAX air in pleural cavity associated
with serous fluid8. PYOPNEUMOTHORAX air in pleural cavity associated pus9. HEMOPNEUMOTHORAX air in pleural cavity associated
with blood
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Clinical Notes EMPYEMA collection of pus in pleural cavity
without air COMPRESSION OF THE TRACHEA bilateral
enlargement of thyroid gland AORTIC ARCH ANERYSM dilation of aortic
arch TRACHEITIS OR BRONCHITIS give rise to a
raw burning sensation felt deep to the sternum instead of actual pain
INHALED FOREIGN BODIES common in children, tend to enter right bronchus instead of left because the right bronchus is wider & more direct continuation of the trachea
BRONCHOSCOPY examination of interior of trachea through bronchoscope
TRACHEOSTOMY cutting the trachea
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