Notes on the Lungs

The Lungs
The lungs are elastic and recoil to approx. 1/3 of their size

when the thoracic cavity is opened. Sectioning of root of lung before branching of the main bronchus: o Superior-most on left: Pulmonary Artery o Superior-most on right: May be the superior lobar bronchus o Anterior-most: Superior Pulmonary vein o Inferior-most: Inferior Pulmonary Vein o Posterior wall & approx. at middle: Primary bronchus Medial to hilum, root enclosed within area of continuity between visceral and parietal layers: Pleural sleeve/Mesopneumonium Right lung: 3 lobes, larger & heavier that left but shorter & wider because dome of diaphragm is higher (liver) Left Lung: 2 lobes, greatly infringed upon by heart 2/3 of heart is to the left of the mid-line Percussion of lungs helps to establish whether underlying tissues are air filled [resonant sound], fluid filled [dull sound] or solid [flat sound] Trachea & Bronchi Walls of airways are supported by C-shaped rings of hyaline cartilage.

 Sublaryngeal airway constitutes: Tracheobronchial tree Bifurcation of trachea occurs @ Transverse thoracic plane (SAT4) into main (primary) bronchus (Note: Carina) Right main bronchus: wider, shorter & runs more vertically than left Left main bronchus: passes inferolaterally , inferior to arch of aorta & anterior to esophagus & thoracic aorta Each main bronchus divides into lobar bronchi: (1 per lobe) o 3 on right o 2 on left (Note: Lingular Bronchus) Lobar bronchi divide into segmental bronchi: o Right Upper Lobe: Usually 3 segments o Middle Lobe: Usually 2 segments o Right Lower Lobe: Usually 5 segments o Left Upper Lobe: Usually 5 segments o Left Lower Lobe: Usually 4 segments Bronchopulmonary segments: o Pyrimidal segments of the lung, with apices facing lung root & bases @ pleural surface o Largest subdivision of lobe separated from adjacent segments by connective tissue septa o Named according to segmental bronchi supplying them Beyond segmental bronchi are 20-25 generations, ending in terminal bronchioles

 Sequence of Tracheo-broncho-alveolar tree: o Trachea o Main (Primary) Bronchus o Lobar Bronchi o Segmental Bronchi o Large Intrasegmental Bronchi o Small Intrasegmental Bronchi o Bronchiole, consisting of: Lobule, consisting of: Terminal bronchiole Acinus*, consisting of: o Respiratory bronchiole o Alveolar Sacs & Alveoli *Acinus: part of lung supplied by terminal bronchiole Vasculature of the Lungs & Pleurae Each lung: Large pulmonary artery & 2 pulmonary veins Right & Left pulmonary arteries arise from pulmonary trunk at level of sternal angle Arterial branch goes to each lobe and bronchopulmonary segment of the lung, usually on anterior aspect of corresponding bronchus. Pulmonary veins run independantly of arteries and bronchi course between different segments Veins from visceral pleurae drain into pulmonary veins

 Bronchial arteries supply blood for nutrition of structures making up root of lungs, supporting tissues of lungs, and visceral pleurae: o 2 left bronchial arteries: usually arise directly from aorta o 1 right bronchial artery: may arise directly/indirectly from aorta either via Intercostal arteries or common trunk with left bronchial arteries Pleurae are supplied by anterior & posterior intercostal arteries Majority of blood drained by pulmonary veins, except most proximal part which is drained by bronchial veins (specifically that part returning from the visceral pleura) o Right bronchial vein drains into azygos vein o Left bronchial vein drains into accessory hemiazygos or superior intercostal vein Nerves of the Lungs & Pleurae Parasympathetic fibres from the Vagus Nerve (CNX): Are motor to the smooth muscle of the bronchial tree Inhibitory to the pulmonary vessels Secretory to the glands of the bronchial tree

Parasympathetic ganglion cells are in the pulmonary plexi and along the branches of the bronchial trees Pulmonary plexi also contain sympathetic fibres from the sympathetic trunks; sympathetic ganglion cells are in the paravertebral sympathetic ganglia of the sympathetic trunks

 The sympathetic fibres are: o Inhibitory to the bronchial muscle o Motor to the pulmonary vessels o Inhibitory to the alveolar glands of the bronchial tree T2 secretory epithelial cells of the alveoli Nerves of the parietal pleurae derive from the intercostal and phrenic nerves costal pleura and peripheral part of the diaphragmatic pleura are supplied by the intercostal nerves, mediating touch/pain central part of diaphragmatic pleura and the mediastinal pleura supplied by phrenic nerves