BRONCHO PULMONARY SEGMENTS of lung .pptx

Bronchopulmonary segments

1. BRONCHOPULMONARY SEGMENTS Presenter: Dr. A. Meghana 1 ST Year Postgraduate , NRIIMS. Moderator: Dr. Girish Assistant Professor , NRIIMS.

2. DEFINITION : The bronchopulmonary segments are the well defined anatomic, structural and functional unit of lung parenchyma, each ventilated by a tertiary or segmental bronchus. There are ten segments on the right lung and ten on left lung.

3. CHARECTERISTICS: Subdivision of a lung lobe. Each segment is pyramidal in shape with its apex directed towards the root of the lung. Each segment has a segmental bronchus,segmental artery autonomic nerves and lymph vessels

4. The segmental venules lies in the connective tissue between adjacent pulmonary units of bronchopulmonary segments. Surrounded by connective tissue that is continuous with visceral pleura. Each segment can be delineated radiologically.

5. The segmental venules lies in the connective tissue between adjacent pulmonary units of bronchopulmonary segments.

6. NOMENCLATURE OF BRONCHOPULMONARY SEGMENTS

7. RELATION TO PULMONARY ARTERY: The branches of the pulmonary artery accompany the bronchi. The artery lies dorsolateral to the bronchi. Thus, each segment has its own separate artery

8. INTRA PULMONARY BLOOD CIRCULATION

9. RELATION TO PULMONARY VEIN:- The pulmonary veins do not accompany the bronchi or pulmonary arteries , they run in the intersegmental plains. Each segment has more than one vein and each vein drains more than one bronchopulmonary segment. Near the hilum , the veins are ventromedial to the bronchus. It should be noted that the bronchopulmonary segment is not a broncho vascular segment because it does not have its own vein.

10. LOCATION OF SEGMENTS ON CHEST XRAY

11. RIGHT UPPER LOBE APICAL SEGMENT:

12. POSTERIOR SEGMENT

13. ANTERIOR SEGMENT:

14. MIDDLE LOBE – LATERAL AND MEDIAL SEGMENTS

15. LOWER LOBE

16. MEDIAL BASAL

17. ANTERIOR BASAL

18. LATERAL BASAL

19. POSTERIOR BASAL

20. CLINICAL IMPORTANCE : The infection of the bronchopulmonary segments remains restricted to it , although tuberculosis and bronchogenic carcinoma may spread from one segment to another segment. TUBERCULOSIS : apical and posterior segments of upper lobes are involved because of high ventilation perfusion ratios with elevated alveolar PO2 relative to other zones. SEQUESTRATION OF LUNG : seen in posterior basal segment of lower lobe (left>right ) .

21. CANCEROUS LESSIONS : anterior segments of right upper lobe. LUNG ABCESS : posterior segment of the upper lobe or the superior or posterior basal segment of the lower lobe, especially on the right lung because of more vertical bronchus and also that aspirated secretions tend to gravitate in these segments in supine position.

22. ASPIRATION PNEUMONIA : posterior segments of upper lobes and superior segments of lower lobes in supine position . Posterior basal segment of the right lower lobe in standing position.

23. BRONCHIECTASIS : more common in left lower lobe because of longer and narrower bronchus leading to retained secretions. SURGICAL IMPORTANCE : during segmental resection the surgeon works along the segmental veins to isolate the particular segment.

24. INDICATIONS FOR SEGMENTECTOMY: Aspergilloma Tuberculosis Bronchiectasis Metastatic lung disease Primary lung cancer

25. PREREQUIITES : complete bronchoscopy ADVANTAGES : 1)thorough resection 2)better staging 3)decreasing local recurrence

26. REFERRENCES : MILLERS (9 th EDITION) BD CHAURASIA (9 TH EDITION) GRAY’S ANATOMY VISHRAM SINGH-HEAD&NECK (3 rd EDITION) ATLAS OF NETTERS ANATOMY

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