Dr.

Mujahid Khan
 The trachea is a mobile cartilaginous and
membranous tube

It begins in the neck as a continuation of

the larynx at the lower border of the
cricoid cartilage at the level of the sixth
cervical vertebra

It descends in the midline of the neck

 In the thorax the trachea ends below at
the carina by dividing into right and left
principal (main) bronchi

During expiration the bifurcation rises by

about one vertebral level

During deep inspiration may be lowered

as far as the sixth thoracic vertebra
 In adults the trachea is about 4 in. (11.25
cm) long and 1 in. (2.5 cm) in diameter

The fibroelastic tube is kept patent by the

presence of U-shaped rings of hyaline
cartilage embedded in its wall

The posterior free ends of the cartilage are

connected by smooth muscle, the
trachealis muscle
 Anteriorly: The sternum, the thymus,
the left brachiocephalic vein, the origins
of the brachiocephalic and left common
carotid arteries, and the arch of the aorta

Posteriorly: The esophagus and the left

recurrent laryngeal nerve
 Right side: The azygos vein, the right
vagus nerve, and the pleura

Left side: The arch of the aorta, the left

common carotid and left subclavian
arteries, the left vagus and left phrenic
nerves, and the pleura
 The upper two thirds are supplied by the
inferior thyroid arteries

The lower third is supplied by the

bronchial arteries
 The lymph drains into the pretracheal
and paratracheal lymph nodes and the
deep cervical nodes
 The sensory nerve supply is from the vagi
and the recurrent laryngeal nerves

Sympathetic nerves supply the trachealis

muscle
 The trachea bifurcates behind the arch of
the aorta into the right and left principal
(primary, or main) bronchi

The bronchi divide into several million

terminal bronchioles that terminate in
one or more respiratory bronchioles
 Each respiratory bronchiole divides into 2
to 11 alveolar ducts that enter the
alveolar sacs

The alveoli arise from the walls of the

sacs as diverticula
 Is wider, shorter, and more vertical than
the left

Is about 1 in. (2.5 cm) long

Before entering the hilum of the right lung,

it gives off the superior lobar bronchus

On entering the hilum, it divides into a

middle and an inferior lobar bronchus
 Is narrower, longer, and more horizontal
than the right and is about 2 in. (5 cm)
long

It passes to the left below the arch of the

aorta and in front of the esophagus

On entering the hilum of the left lung, the

principal bronchus divides into a superior
and an inferior lobar bronchus
 Two lungs are soft, spongy and elastic

In the child, they are pink, but with age,

they become dark and mottled because
of the inhalation of dust particles

These particles are trapped in the

phagocytes of the lung

The lungs are situated so that one lies on

each side of the mediastinum
 Two lungs are separated from each other
by the heart and great vessels and other
structures in the mediastinum

Each lung is conical, covered with visceral

pleura and suspended free in its own
pleural cavity

Attached to the mediastinum only by its

root
 A blunt apex projects upward into the neck for
about 1 in. (2.5 cm) above the clavicle

A concave base that sits on the diaphragm

A convex costal surface, which corresponds to

the concave chest wall

A concave mediastinal surface, which is

molded to the pericardium and other
mediastinal structures
 Hilum is a depression in which the bronchi,
vessels, and nerves that form the root enter and
leave the lung

The anterior border is thin and overlaps the heart

It is here on the left lung that the cardiac notch is

found

The posterior border is thick and lies beside the

vertebral column
 The right lung is slightly larger than the left

Divided by the oblique and horizontal

fissures into three lobes: upper, middle, and
lower

The oblique fissure runs from the inferior

border upward and backward across the
medial and costal surfaces until it cuts the
posterior border about 2.5 in. (6.25 cm)
below the apex
 The left lung is divided by a similar
oblique fissure into two lobes: upper and
lower

There is no horizontal fissure in the left

lung
 The bronchopulmonary segments are the
anatomic, functional, and surgical units of
the lungs

Each lobar (secondary) bronchus gives off

branches called segmental (tertiary) bronchi

Each segmental bronchus passes to a

structurally and functionally independent
unit of a lung lobe called a
bronchopulmonary segment, surrounded by
connective tissue
 The segmental bronchus is accompanied
by a branch of the pulmonary artery

Each segment has its own lymphatic

vessels and autonomic nerve supply

On entering a bronchopulmonary
segment, each segmental bronchus
divides repeatedly
 As the bronchi become smaller, the U-
shaped bars of cartilage found in the
trachea are gradually replaced by
irregular plates of cartilage

The smallest bronchi divide and give rise

to bronchioles, which are less than 1 mm
in diameter
 Bronchioles possess no cartilage in their
walls and are lined with columnar ciliated
epithelium

The submucosa possesses a complete

layer of circularly arranged smooth
muscle fibers
 The bronchioles then divide and give rise
to terminal bronchioles which show
delicate outpouchings from their walls

Gaseous exchange between blood and air

takes place in the walls of these
outpouchings, which explains the name
respiratory bronchiole
 The diameter of a respiratory bronchiole
is about 0.5 mm

The respiratory bronchioles end by

branching into alveolar ducts, which lead
into tubular passages with numerous
thin-walled outpouchings called alveolar
sacs
 The alveolar sacs consist of several
alveoli opening into a single chamber

Each alveolus is surrounded by a rich

network of blood capillaries

Gaseous exchange takes place between

the air in the alveolar lumen through the
alveolar wall into the blood within the
surrounding capillaries
 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
 Superior lobe: Apical, posterior, anterior

Middle lobe: Lateral, medial

Inferior lobe: Superior (apical), medial

basal, anterior basal, lateral basal,
posterior basal
 Superior lobe: Apical, posterior,
anterior, superior lingular, inferior
lingular

Inferior lobe: Superior (apical), medial

basal, anterior basal, lateral basal,
posterior basal
 The bronchi and the connective tissue of
the lung receive their blood supply from
the bronchial arteries, which are
branches of the descending aorta

The bronchial veins communicate with

the pulmonary veins and drain into the
azygos and hemiazygos veins
 The alveoli receive deoxygenated blood
from the terminal branches of the
pulmonary arteries

The oxygenated blood leaving the alveolar

capillaries drains into the tributaries of the
pulmonary veins

Two pulmonary veins leave each lung root

to empty into the left atrium of the heart
 The lymph vessels originate in superficial
and deep plexuses

They are not present in the alveolar walls

The superficial (subpleural) plexus lies

beneath the visceral pleura and drains
over the surface of the lung toward the
hilum, where the lymph vessels enter the
bronchopulmonary nodes
 The deep plexus travels to the hilum of
the lung and enters the
bronchopulmonary nodes

All the lymph from the lung leaves the

hilum and drains into the
tracheobronchial nodes and then into the
bronchomediastinal lymph trunks
 At the root of each lung is a pulmonary plexus composed
of efferent and afferent autonomic nerve fibers

The plexus is formed from branches of the sympathetic

trunk and receives parasympathetic fibers from the vagus
nerve

The sympathetic efferent fibers produce bronchodilatation

and vasoconstriction

The parasympathetic efferent fibers produce

bronchoconstriction, vasodilatation, and increased
glandular secretion