what is significant about the right main bronchus compared to the left
the RMB is shorter, wider and more vertical than the left
order of bronchial divisions
Main bronchus - lobar bronchi - segmental bronchi - bronchioles - terminal bronchioles - respiratory bronchiols - alveolar ducts - alveoli
lobe delineations in the left lung
1 fissure oblique fissure - separates upper lobe from lower lobe
what are the imprints on the left lung?
imprints of arterial structures - Aorta and LV
where do the lymphatics of the lungs all end up? and where does it then go?
at the hilar lymph nodes --> then series of lymph nodes at the bifurcation of the trachea --> ascending lymphatic channels along the trachea and up into the thoracic lymphatics
where are pulmonary veins always situated in the hilum
they are always the most anterior and inferior structures in the hilum
What are the two branches of the right main bronchus called before going into the hilum of the lung and where are they situated relative to each other?
Right upper lobe bronchus - sits superior to... Bronchus intermedius
where does the trachea begin
in the neck, at the level of C6
lobe delineations in the right lung
2 fissures horizontal fissure - separates upper lobe from middle lobe oblique fissure - separates lower lobe behind, from upper and middle lobe infront
where is the pulmonary artery in the hilum in the left and right lungs
left - superior to the bronchus right - anterior to the bronchus
what are the imprints on the right lung?
imprints of venous structures - RA, SVC, arch of azygous vein
where are the pulmonary veins situated in the hilum?
one anterior, one inferior
where does the visceral pleura become the parietal pleura?
when it reflects over the hilar structures
how does the trachea descend
inferiorly, through the thoracic inlet, into the superior mediastinum At T4-5 - divides into R and L main bronchus
what is each bronchopulmonary segment supplied by?
segmental bronchus, segmental artery, segmental vein
4 sections of the parietal pleura?
cervical pleura mediastinal pleura costal plerua diaphragmatic pleura
what is the clinical significance of the apical segment of the lower lobe?
this is where any fluid would first develop (as the pathway is the easiest) - this is where we auscultate for fluid
where is the lingular
on the left lung starts at the cardiac notch tongue like projection that hangs down inferiorly from the upper lobe
what is the difference between RMB and LMB in the hilums of the R and L lung
The RMB gives off the right upper lobe bronchus before entering the lung (this means that the pulmonary artery also splits) The LMB does not do this - only 1 bronchial, and 1 arterial structure in the hilum
what surfaces do the visceral and parietal pleura cover?
visceral - thin, serous membrane covering both lungs parietal - thin, serous membrane lines the walls of the inside of the thoracic cavity
what is the shape of a bronchopulmonary segment?
pyramid shape - apex directed to hilum and base on the surface
where are pulmonary arteries placed in the hilum
always anterior or superior to the bronchial tree
what is the purpose of the pulmonary ligament
it is a potential space for the pulmonary veins to expand into if needed
where is the trachealis muscle
on the posterior of the trachea - closes off the cartilage rings
where is the pulmonary plexus?
associated with the bifurcation of the trachea
tell me about the surfaces of the lungs?
- concave inferior surface (sits over the convexity of the domes of the diaphragm) - has a pointed apex - has a rounded costal/lateral surface that sits against the ribs - inner surface bears the hilar structures and bears the imprint of the structures
what is in the hilum?
1) branches of the tracheobronchial tree 2) vascular supply (pulmonary artery, bronchial arteries, pulmonary veins, bronchial veins) 3) neural 4) lymphatics
nerve supply to the lungs
autonomic supply (both SNS and PNS) - regulates both mucus production and the diameters of the bronchioles