Post on 06-Mar-2020
INFERIOR MEDIASTINUM
(a) THYMUS
(b) HEART WITHIN THE
PERICARDIUM WITH THE
PHRENIC NERVES ON EACH
SIDE,
(c) ESOPHAGUS AND THORACIC
DUCT
(d) DESCENDING AORTA
(e) SYMPATHETIC TRUNKS
THE INFERIOR MEDIASTINUM
is bounded in front
by the body of the sternum
and
behind by the lower eight thoracic
vertebrae
Pleurae
The pleurae and lungs lie
on either side of the
mediastinum within the
chest cavity
the lung is covered with
visceral pleura and the thoracic
wall is lined with parietal
pleura
FORMATION OF THE LUNGS
Each lung bud invaginates
the wall of the coelomic
cavity and then grows to
fill a greater part of the
cavity
The original coelomic cavity is
reduced to a slitlike space called
the pleural cavity as a result of
the growth of the lung.
Each pleura has two parts:
2- Visceral layer: completely covers the outer surfaces of
A-The lungs
B- extends into the depths of THE
INTERLOBAR FISSURES
1- Parietal layer, which lines
A-The thoracic wall
B- Covers the thoracic surface of the
diaphragm
C- The lateral aspect of the
mediastinum
D-The root of the neck to line the
undersurface of the suprapleural
membrane at the thoracic outlet
The parietal and visceral layers of pleura
are separated from one another
by a slitlike space
the pleural cavity
The two layers become continuous with one
another by means of
a cuff of pleura that surrounds the structures entering and
leaving the lung at the hilum of each lung
To allow for movement of the pulmonary
vessels and large bronchi during respiration, the
pleural cuff hangs down as a loose fold
called
THE PULMONARY
LIGAMENT
The pleural cavity normally contains a small
amount of tissue fluid
the pleural fluid
which covers the surfaces of the pleura as a
thin film and permits the two layers to move
on each other with the minimum of friction.
The PARIETAL PLEURA can be divided
according to the region in which it lies or the
surface that it covers into:
2-The costal pleura lines the inner surfaces of
the ribs, the costal cartilages, the intercostal
spaces, the sides of the vertebral bodies, and
the back of the sternum
3-The diaphragmatic pleura covers the
thoracic surface of the diaphragm
1-The cervical pleura extends up into the
neck, lining the undersurface of the
suprapleural membrane
Note
The lower area of the pleural cavity into which the lung expands on inspiration is referred
to as the costodiaphragmatic recess
4-The mediastinal pleura
covers and forms the lateral boundary of the mediastinum
At the hilum of the lung, it is reflected as a cuff around the vessels and bronchi and here becomes
continuous with the visceral pleura
5-The costodiaphragmatic recesses are slitlike spaces between the costal and diaphragmatic
parietal pleurae that are separated only by a capillary layer of pleural fluid.
Nerve Supply of the Pleura
The parietal pleura
is sensitive to pain, temperature, touch, and
pressure and is supplied as follows:
The visceral pleura covering the lungs is
sensitive to stretch but is insensitive to
common sensations such as pain and touch. It
receives an autonomic nerve supply from
THE PULMONARY PLEXUS
A-The costal pleura is
segmentally supplied by the
intercostal nerves.
B-The mediastinal pleura is
supplied by the phrenic nerve.
C-The diaphragmatic pleura is
supplied over the domes by the
phrenic nerve and around the
periphery by the lower six
intercostal nerves
Trachea
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 at
the level of the sternal angle (opposite the disc between the
fourth and fifth thoracic vertebrae).
In adults the trachea is about (11.25 cm) long and
(2.5 cm) in diameter
The fibroelastic tube is kept patent by the presence of U-shaped bars (rings)
of hyaline cartilage embedded in its wall.
The posterior free ends of the cartilage are connected by smooth muscle,
THE TRACHEALIS MUSCLE.
Blood Supply of the Trachea
The sensory nerve supply is from the
vagi
and
the recurrent laryngeal nerves
Sympathetic nerves supply the
trachealis muscle
The upper two thirds are supplied by the inferior thyroid
arteries and the lower third is supplied by the bronchial
arteries
Nerve Supply of the Trachea
The Bronchi
The trachea bifurcates behind the arch of
the aorta into
the right and left principal
(primary, or main) bronchi
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
The bronchi divide giving rise to several
million terminal bronchioles that terminate
in one or more respiratory bronchioles.
Principal Bronchi
The right principal (main) bronchus
1-wider
2-shorter
3- more vertical than the left
4-is about 1 in. (2.5 cm) long
5-Before entering the hilum of the right lung,
the principal bronchus gives off the superior
lobar bronchus.
6- On entering the hilum, it divides into a
middle and an inferior lobar bronchus
The left principal (main) bronchus is
1-narrower
2-longer
3-more horizontal than the right
4- is about 2 in. (5 cm) long.
It passes to the left below the arch of the
aorta and in front of the esophagus.
5-divides into a superior and an inferior
lobar bronchus
Inhalation of foreign bodies into the lower
respiratory tract is common, especially in children
Because the right bronchus is the wider and more
direct continuation of the trachea foreign bodies
tend to enter
the right instead of the left bronchus
INHALED FOREIGN BODIES
Lungs
In the child, they are pink, but with age, they
become dark and mottled because of the
inhalation of dust particles that become trapped
in the phagocytes of the lung.
The lungs are situated so that one lies on each
side of the mediastinum.
They are therefore 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, being attached to the mediastinum only
by its root
Each lung has a blunt apex,
which 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
At about the middle of mediastinal
surface is the hilum 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
The posterior border is thick and lies beside the vertebral
column
Right Lung
The right lung is
slightly larger than the left
is divided by the oblique and horizontal
fissures into three lobes:
THE UPPER
MIDDLE
LOWER LOBES
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 horizontal fissure runs horizontally
across the costal surface at the level of
the fourth costal cartilage to meet
the oblique fissure in the midaxillary
line.
The middle lobe is thus a small triangular
lobe bounded by the horizontal and
oblique fissures
Left Lung The left lung is divided by a similar oblique
fissure into two lobes: the upper and lower
lobes There is no horizontal fissure in the left
lung
Bronchopulmonary Segments
The bronchopulmonary segments are the
anatomic, functional, and surgical units
of the lungs.
Each lobar (secondary) bronchus,
which passes to a lobe of the lung, gives
off branches called segmental (tertiary)
bronchi
Each segmental bronchus passes to
the segmental bronchus is accompanied by a branch of the
pulmonary artery, but the tributaries of the pulmonary veins run in
the connective tissue between adjacent bronchopulmonary segments.
Each segment has its own lymphatic vessels and autonomic nerve
supply
Each segmental bronchus divides into
smaller bronchi, the smallest bronchi divide
and give rise to bronchioles, which are less
than 1 mm in diameter
Bronchioles possess no cartilage in their
walls.The bronchioles then divide
and give rise to terminal bronchioles.
Gaseous exchange between blood and air takes place in the walls
of these outpouchings
The respiratory bronchioles end by branching into alveolar
ducts, which lead into tubular passages with numerous thin-
walled outpouchings called alveolar sacs
Blood Supply of the
Lungs
The bronchi, the
connective tissue of the
lung, and the visceral
pleura receive their blood
supply from the bronchial
arteries, which are
branches of the
descending aorta. The
bronchial veins (which
communicate with the
pulmonary veins) drain
into the azygos and
hemiazygos veins
Nerve Supply of the Lungs
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.