Lung & Pleura PDF

10 L.E D R. H en da wy  Lung & pleura Types of pleura  Visceral pleura: Inner layer covering lung except at hilum  Parietal pleura: Outer layer lining thoracic wall....

10 L.E D R. H en da wy  Lung & pleura Types of pleura  Visceral pleura: Inner layer covering lung except at hilum  Parietal pleura: Outer layer lining thoracic wall. wy  Pleural cavity: space between visceral & parietal layers Parts of lung  Apex: da  Covered by cervical pleura & supra-pleural membrane  Base:  Covered by diaphragmatic pleura.  The diaphragm separates it from: en o liver on right side o liver, stomach, spleen on left side So right lung is shorter than the left one  Borders H  The lung has anterior & posterior & inferior borders th th  Anterior border of left lung only shows cardiac notch opposite 4 & 5 space R. So right lung is wider than the left  Surfaces:  Costal Surface: Related to sternum, ribs & Intercostal muscles. D  Medial Surface: see later. Anatomist “lung” 2  Arterial supply of Lung & visceral pleura  Pulmonary artery: carry deo2 blood from Right Ventricle  Bronchial artery: wy o One for Right lung: from Right 3rd posterior intercostal artery o 2 for Left Lung: from descending aorta Parietal pleura: Internal thoracic & Pericardio-phrenic & Intercostal arteries & Superior phrenic & Musclo-phrenic da Venous drainage of Lung & visceral pleura:  Pulmonary vein: carry o2 blood from lung en  Bronchial vein: o Right lung: drains into Azygous o Left Lung: drains into superior hemiazygous Parietal pleura: H Internal thoracic & Pericardio-phrenic & Intercostal arteries & Superior phrenic & Musclo-phrenic Nerve supply of R. Lung & visceral pleura: Painless “supplied by autonomic nervous system” Parietal pleura: Painful “supplied by phrenic & inter-costal nerves” D Lymph drainage of Lung & visceral pleura: pulmonary & broncho-pulmonary & trachea-bronchial & broncho-mediastinal Parietal pleura: cervical & inter-costal & diaphragmatic & mediastinal lymph nodes Anatomist “lung” 3  Mediastinal surface of both lungs Right Lung Left lung Surface anatomy: Opposite 5th ,6th & 7th thoracic vertebrae wy Content:  Superior pulmonary vein: most anterior structure  Inferior pulmonary vein: most Inferior structure Hilum  Principle bronchus "hyparteial": Most posterior structure  Principle bronchus: Most posterior structure da  Superior Lobar "eparterial": Most superior structure  Pulmonary artery: lies between 2 bronchi  Pulmonary artery: the most superior structure  Broncho-pulmonary LN en  Anterior & posterior pulmonary plexus  Arch of azygous  Aortic arch  Above the arch:  Above the arch: Above hilum H 1. Right BCV with Right phrenic nerve 2. Trachea with Right vagus nerve 3. Esophagus 1. Left common carotid artery 2. Left subclavian artery 3. Esophagus with thoracic duct R. Left phrenic & vagus pass between left common carotid, subclavian Behind  Esophagus hilum  Azygous vein  Descending aorta D  SVC & IVC with Right phrenic nerve  Pulmonary trunk Anterior  Cardiac impression for to hilum “Right Atrium” “Left Ventricle, Left auricle & Right Ventricle” Anatomist “lung” 4  wy da en H R. D Anatomist “lung” 5  Surface anatomy of lungs & pleurae  Apex of lung = cervical pleura : Curved line one inch above medial 1/3 of clavicle wy  Anterior border: o From sterno-clavicular joint to sternal angle level where both borders meet each other o 2 borders descend vertical together till 4th costal cartilage then: da  Right lung: descend vertical till 6th costal cartilage  Left lung: deviate 4 cm to the left then descend to 6th CC  Right pleura: descend vertical till xiphisternal joint  Left pleura: deviate to left to left sternal margin then en descend till 6th costal cartilage  Inferior border of: o Lungs: cuts H  6th rib at mid-clavicular line  8th rib at mid- axillary line R.  10th rib at para-vertebral line o Pleurae:  Cut 8th rib at mid-clavicular line  Cut 10th rib at mid- axillary line D  Cut 12th rib opposite vertebral column  Posterior border: Vertical line from medial end of Inferior border to the apex “lung” or cervical pleura “pleura” Anatomist “lung” 6  Fissures of the lung: o Oblique fissure:  Found in both lungs  Extend from “Posterior border at level of spine of T3, wy inch from midline” till “ Inferior border 3 inches from midline, at 6th costo-chondral junction"  It is drawn with the medial border of scapula when arm is da raised above the head o Horizontal fissure:  Found in right lung only  Extend from “anterior border at 4th costal cartilage” en till it cuts oblique fissure in mid-axillary line H Pleural recess Definition: Extension of pleural cavity allowing lung expansion Types: R. o Costo-mediastinal: found between costal & mediastinal surfaces along anterior border of pleura o Costo-diaphragmatic: found between costal & diaphragmatic surfaces along inferior border of pleura D Thoracentesis (pleural tap): o Site: in 8th & 9th space at mid-axillary line “to avoid injury of liver, spleen” o A needle is inserted on the upper border of the rib to avoid injury to the intercostal nerve. Anatomist “lung” 7  Broncho-pulmonary segmentation  Definition: wy Functional independent unit of lung  Clinical importance: Can be isolated & removed without da affecting nearby segments  Structures: Each segment contains: en  segmental bronchus, bronchioles & alveoli H  segmental branch of pulmonary artery R.  segmental radical of pulmonary vein “run between the segments” D Anatomist “lung” 8   Distribution::  Right lung: formed of 10 segments o Superior lobe: is formed of 3 segments ”apical ,anterior &posterior” wy o Inferior lobe is formed of 5 segments “Apical, medial basal, anterior basal, lateral basal & posterior basal” o Middle lobe: is formed of 2segments da “Medial & lateral”  Left lung: formed of 8-10 segments  Superior lobe: is formed of 3 segments en ”apical ,anterior &posterior”  Inferior lobe is formed of 5 segments “Apical, medial basal, anterior basal, H lateral basal & posterior basal  Lingual: is formed of 2segments “superior & inferior” R. N.B: Apical & posterior segments of superior lobe of left lung may fuse “apico-posterior segment” N.B: Medial basal segment in the inferior lobe of the left lung may be absent D Anatomist “lung” 9  Right lung Left lung Size Larger Smaller Cardiac notch Absent Present “opposite left 4th & 5th space” wy Lingula Absent Present Length Shorter Longer Base concavity More concave by right lobe of liver Less concave da Bronchi Divide before entering hilum Divide after entering hilum Bronchial artery 1 from right 3rd posterior ICA 2 from descending thoracic aorta en Fissures Oblique & horizontal Oblique Lobes 3 2 Bronchopulmonary segment 10 segments 8-10 segments H R. D Anatomist “lung” 10