Anatomy of lung & pleura

1. Iman Galal, MDIman Galal, MD
Pulmonary Medicine DepartmentPulmonary Medicine Department
Ain Shams UniversityAin Shams University
CLINICAL CLINICAL
ANATOMY OF ANATOMY OF
LUNG & PLEURALUNG & PLEURA

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Borders of the lung:Borders of the lung:
The apexThe apex is about 2-3 cms (1 inch) above the medial 1/3 of the is about 2-3 cms (1 inch) above the medial 1/3 of the
clavicle, then clavicle, then the anterior border of both lungsthe anterior border of both lungs run downwards & run downwards &
medially meeting each other in the middle line behind the angle of medially meeting each other in the middle line behind the angle of
Louis. Louis.
The anterior border of right lung continues running downwards till the The anterior border of right lung continues running downwards till the
66
thth
costochondral junction. costochondral junction.
The anterior border of left lung continues running downwards till the The anterior border of left lung continues running downwards till the
44
thth
costal cartilage then curves laterally ½ inch forming the cardiac costal cartilage then curves laterally ½ inch forming the cardiac
notch then descends downwards till the 6notch then descends downwards till the 6
thth
costochondral junction. costochondral junction.

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Borders of the lung:Borders of the lung:
The lower border of the lungsThe lower border of the lungs represented by a line represented by a line
starting from 6starting from 6
thth
rib in the MCL, 8 rib in the MCL, 8
thth
rib in the MAL & 10 rib in the MAL & 10
thth
rib rib
in the scapular line.in the scapular line.

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Right LungRight Lung

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Lung Fissures:Lung Fissures:
Oblique fissureOblique fissure (Right & Left):(Right & Left):
It starts at theIt starts at the 33
rdrd
thoracic spine thoracic spine while the arms are elevated, descends while the arms are elevated, descends
downwards, laterally & anteriorly along the medial border of the scapula downwards, laterally & anteriorly along the medial border of the scapula
touching the inferior angle of the scapula) cutting the midaxillary line in touching the inferior angle of the scapula) cutting the midaxillary line in
the 5the 5
thth
rib & ending at the 6 rib & ending at the 6
thth
costal cartilage 3 inches from the midline. costal cartilage 3 inches from the midline.
In cadaver it arise at the 2In cadaver it arise at the 2
ndnd
thoracic spine. thoracic spine.
The transverse fissureThe transverse fissure (Right):(Right):
It arises at theIt arises at the 44
thth
costal cartilage costal cartilage, runs horizontally to meet the , runs horizontally to meet the
oblique fissure in the midaxillary line in the 5oblique fissure in the midaxillary line in the 5
thth
rib. rib.

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Fissures & Lobes of the LungsFissures & Lobes of the Lungs

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Fissures & Lobes of the Right LungFissures & Lobes of the Right Lung

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Right Upper LobeRight Upper Lobe

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Right Middle LobeRight Middle Lobe

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Right Lower lobeRight Lower lobe

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Left LungLeft Lung

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Fissures of the Left LungFissures of the Left Lung

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Left Upper LobeLeft Upper Lobe

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Left Lower LobeLeft Lower Lobe

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Segmental BronchiSegmental Bronchi

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Segmental BronchiSegmental Bronchi

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Segmental Bronchi Segmental Bronchi (Anterior)(Anterior)
11
22 33
44
55
88
1-21-2
33
44
55
88

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Segmental Bronchi Segmental Bronchi (Posterior)(Posterior)
111-21-2
22
33
44
66
1010 99
33
66
101099
44

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PleuraPleura

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The borders of the Pleura:The borders of the Pleura:
The pleura runs close to the lung except at the lower The pleura runs close to the lung except at the lower
border which extends for 3-5 cm below it both anteriorly border which extends for 3-5 cm below it both anteriorly
& posteriorly & 9-10 cm below in the axilla.& posteriorly & 9-10 cm below in the axilla.
The lower border cuts the 8The lower border cuts the 8
th th
rib in MCL, 10 rib in MCL, 10
thth
rib in MAL rib in MAL
and 12and 12
th th
rib in Scapular line. rib in Scapular line.

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PleuraPleura

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Parietal PleuraParietal Pleura
Costal pleura:Costal pleura:
Lines thoracic wall (ribs, intercostal Lines thoracic wall (ribs, intercostal
spaces)spaces)
Mediastinal pleura:Mediastinal pleura:
Lines corresponding surface of Lines corresponding surface of
mediastinum; reflected over root of lung mediastinum; reflected over root of lung
& becomes continuous with visceral & becomes continuous with visceral
pleura around hilumpleura around hilum
Cervical pleura:Cervical pleura:
Extends into neck about 2 inches above Extends into neck about 2 inches above
11
stst
costal cartilage & one inch above costal cartilage & one inch above
medial 1/3 clavicle; covers apex of lungmedial 1/3 clavicle; covers apex of lung
Diaphragmatic pleura:Diaphragmatic pleura:
Lines superior surface of diaphragmLines superior surface of diaphragm

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Traube’s area:Traube’s area:
4 points:4 points:
Left 6Left 6
thth
rib in the MCL to 8 rib in the MCL to 8
thth
costal cartilage in the costal cartilage in the
parasternal line ,then along the left costal margin to the 11parasternal line ,then along the left costal margin to the 11
thth

rib in the MAL, then the 9rib in the MAL, then the 9
thth
rib in the MAL. rib in the MAL.

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Kronig’s Isthmus :Kronig’s Isthmus :
It is a band of resonance representing lung apex.It is a band of resonance representing lung apex.
LaterallyLaterally it is marked by a line joining 2 points:it is marked by a line joining 2 points:
1.1.The junction of the medial 2/3 of the clavicle with the The junction of the medial 2/3 of the clavicle with the
lateral 1/3.lateral 1/3.
2.2.The junction of the medial 1/3 of the scapular spine with The junction of the medial 1/3 of the scapular spine with
the lateral 2/3.the lateral 2/3.
MediallyMedially marked by a line between the sternal end of marked by a line between the sternal end of
clavicle and the 7clavicle and the 7
thth
cervical spine. cervical spine.

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Bare area of the heart :Bare area of the heart :
Medial border: left lateral border of the sternumMedial border: left lateral border of the sternum
Lateral border: left parasternal lineLateral border: left parasternal line
Superior border: lower border of Lt 4Superior border: lower border of Lt 4
thth
rib. rib.
Inferior border: upper border of Lt 6Inferior border: upper border of Lt 6
thth
rib rib

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Surface anatomy of liver:Surface anatomy of liver:
Upper border:Upper border:
It starts from the left 6It starts from the left 6
thth
rib rib just inside the MCL, passing to just inside the MCL, passing to
the Rt and slightly upwards to the 5the Rt and slightly upwards to the 5
thth
rib in the MCL, then rib in the MCL, then
the 7the 7
thth
rib in anterior axillary line, to the 9 rib in anterior axillary line, to the 9
thth
rib in mid-axillary rib in mid-axillary
line. line.

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31. Thank YouThank You