respiratory system anatomy Pleura & Lungs dr khalid.pptx

anatomy of the pleura & lung

1. Dr. Khalid Mohamed Abd Elhafiz MBBS, MS.c Human Clinical Anatomy, MHPE TRACHEA, PLEURA & LUNGS

2. Learning Objectives Describe the anatomy of the trachea and bronchial tree. Describe the anatomy of the pleura. List the parts of parietal pleura and its recesses . Describe the anatomy of lungs : (shape, surfaces, relations, nerve supply, blood supply and lymphatic drainage . Describe the difference between right & left lungs.

3. Lungs Filters, warms & humidifies air Organization of Respiratory System Upper respiratory system Nose Nasal cavity Paranasal sinuses Pharynx Lower respiratory system Larynx Trachea Lungs

4. Cavity of thorax contains right & left pleural cavities completely invaginated & occupied by lungs Right & left pleural cavities separated by thick median partition called mediastinum Heart lies in mediastinum Thoracic Cavity

5. Thoracic Cavity

6. Its an elastic tube that convey air into and out the lungs Course : the trachea begins at the level of the cricoid cartilage in the neck (C6 ). It terminates at the level of the angle of Louis ( T4/5) where it bifurcates into right and left main bronchi . The trachea

7. • Structure : the trachea is a rigid fibroelastic structure . it consist of 16-20 ring Incomplete rings of hyaline cartilage continuously maintain the patency of the lumen. The trachea is lined internally with ciliated columnar epithelium .

8. Relations : Anteriorly: - Isthmus of thyroid gland (2 nd ,3 rd & 4 th rings) - Arch of aorta - Remnant of thymus gland Posteriorly: - esophagus Left side: - left recurrent laryngeal nerve - left CCA - left BCA Right side: Rt vagus nerve Arch of azygos Brachiocephalic artery

9. At the thorax it divides into two principle bronchi (right and left main/principle bronchus). Carina is the site of branching to left and right primary bronchi ( tracheal bifurcation ) Each principle bronchus enters its corresponding lung. Then each bronchus continue to divide inside the lung.

10. Nerve supply: - Autonomic fibers from the 2 vagi & 2 sympathetic chains

11. Tracheostomy is a medical procedure — either temporary or permanent — that involves creating an opening in the neck in order to place a tube into a person's windpipe. The tube is inserted through a cut in the neck below the vocal cords. This allows air to enter the lungs.

12. Pleura Each lung is invested by and enclosed in a serous pleural sac that consists of two continuous membranes: 1- Visceral pleura , which is the inner membrane (covers the outer surface of the lungs); gives the lungs their shiny appearance) . 2- Parietal pleura , which is the outer membrane. 15 Visceral pleura & lung Parietal pleura

13. Pleural Cavity The pleural cavity—the potential space between the layers of pleura—contains a serous fluid, which lubricates the pleural surfaces and allows the layers of pleura to slide smoothly over each other during respiration. Parietal pleura Visceral pleura Pleural cavity 17

14. Parts of Parietal Pleura 1- Cervical. 2- Costal. 3- Diaphragmatic. 4- Mediastinal . 18

15. Cont… 19

16. Cervical pleura: It is part of parietal pleura which protrudes up into the root of the neck. Costal pleura: It lines inner surface of ribs, costal cartilages, intercostal muscles and back of the sternum. Diaphragmatic pleura: It covers upper surface of the diaphragm. Mediastinal pleura: It covers mediastinal surface of the lung. Subdivision of parietal pleura

17. Costodiaphragmatic Recesses Are slit-like spaces between the costal and diaphragmatic parietal pleurae During deep inspiration, the lower margins of the lungs descend into the recesses. During expiration, the lower margins of the lungs ascend so that the costal and diaphragmatic pleurae come together again. 21

18. Costodiaphragmatic Recess Between costal pleura and diaphragmatic pleura 22

19. Causes : Stab wound or broken rib damaging the parietal pleura. More commonly in a spontaneous pneumo -thorax due to a little bulla of the lung bursting and tearing the visceral pleura. The presence of air in the pleural cavity . Pneumothorax 23

20. Pleural Effusion Accumulation of fluids within the pleural cavity. Cause: Commonly caused by diseases that affecting the lungs (e.g. TB). 24

21. The lungs The lungs are the vital organs of respiration. Their main function is to oxygenate the blood by bringing inspired air into close relation with the venous blood in the pulmonary capillaries.

22. Lungs main features Lungs are Pyramidal in shape Apex & Base Three surfaces Costal, Medial & inferior Three borders Anterior, Posterior & inferior Lung root (Hilum ) - On medial surface

23. Left lung: Smaller (2 lobes ) Superior lobe Inferior lobe Right lung: Larger (3 lobes) Superior lobe Middle lobe Inferior lobe

24. Lung Roots

25.  Root and hilum The root of each lung is collection of structures that together attach the lung to structures in the mediastinum.  the hilum , is the region in the lung where structures enter and leave.

26. Within each root are: • Pulmonary artery • Two pulmonary veins • Main bronchus • Bronchial vessels • Nerves • Lymphatics

27. Pul vein Pul vein Bro Bro Pul artery Pul vein Bro Pul artery Pul vein Hilum of left lung Hilum of right lung

28.  The pulmonary ligament It is a thin fold of pleura projects inferiorly from the root of the lung.

29. What is the benefit of the pulmonary ligament? Image from: Richard L.Drake, Wayne Vogl,Adam W.M.Mitchell, GRAYS anatomy for students, Elsevier Inc. 2007

30. Differentiating Right from Left Lungs Identification of parts of the lung is the first step.  Apex.  Base: deep concavity.  Borders :  Anterior : sharp.  Posterior : rounded .  Surfaces  Lateral : (Costal)  Medial (Mediastinal)  Inferior (Diaphragmatic) c. 

31. Borders and surfaces

32. Lobes and fissures of The Right Lung  Lobes:  Superior lobe .   Inferior lobe.  Middle lobe. Fissures:  Horizontal .  Oblique.

33. Impressions Of The Right Lung  Impressions are for:  Superior vena cava.  Subclavian artery & vein Arch of azygos.  Esophagus.  First rib.  The heart. 

34. Impressions Of The Right Lung

35. Lobes Of The Left Lung  Lobes:  Superior lobe .   Inferior lobe. Fissures:  Oblique.

36. Impressions Of The Left Lung  Impressions are for:  Arch of the aorta .  Esophagus.  First rib.  The heart.

37. Impressions Of The Left Lung

38.  Clinical note : Aspiration of Foreign Bodies The right bronchus is wider and shorter and runs more vertically than the left bronchus.  Foreign material is more likely to enter and lodge in right bronchus or one of its branches.

39.  For the bronchial tree.  Pulmonary arteries :  Gas exchange. Blood Supply of The Lungs  Bronchial arteries :

40. Innervation (Autonomic) Sympathetic - From sympathetic chain  Parasympathetic: - From vagus nerve.

41. Clinical note: Auscultation of the Lungs  It is listening to lung sounds with a stethoscope.  It assesses airflow through the tracheobronchial tree into the lobes of the lung. Auscultation should always include the root of the neck where the apices of the lungs are located

42. Anatomical relation: apex of the lung and root of the neck

43. Surface anatomy: areas for auscultation (anterior)

44. Surface anatomy: areas for auscultation (anterior)

45.  Clinical note: Percussion of the Thorax It is tapping the thorax over the lungs with the fingers to detect sounds in the lungs.  Percussion helps establish whether the underlying tissues are:  Air filled (resonant sound).  Fluid filled (dull sound).  Or solid (flat sound). Percussion should always include the root of the neck where the apices of the lungs are located

46. Thanks