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Pleura & Lungs Dr. Sarwar Hossain Khan Dr. Sarwar Hossain Khan Slide 2 The Pleura Is a sac on either sides of the mediastinum. Are occupied by the lungs by invagination. Is a serous membrane, lined by the mesothelium. Has 2 layersparietal & visceral layers. Is continuous with each other at the hilum of the lung. The 2 layers enclose between them the pleural cavity. This cavity is a site forpneumothorax, pleural effusion,empyema & haemothorax. Slide 3 Slide 4 Slide 5 Slide 6 Cont. Pulmonary pleuracovers the surface of lung,is free at the hilum & along the pulmonary ligament. Pulmonary pleuracovers the surface of lung,is free at the hilum & along the pulmonary ligament. Cont. with the parietal pleura. Cont. with the parietal pleura. Parietal pleuradivided into costal,diaphragmatic,mediastinal & cervical. Parietal pleuradivided into costal,diaphragmatic,mediastinal & cervical. Cervicalcovers the apex of the lung & lies about 1 inch above the medial 1/3 rd of the clavical. Cervicalcovers the apex of the lung & lies about 1 inch above the medial 1/3 rd of the clavical. Is covered by the sibsons fascia. Is covered by the sibsons fascia. Slide 7 Slide 8 PULMONARY LIGAMENT Is a fold of the parietal pleura. Is a fold of the parietal pleura. Around the hilum. Around the hilum. Acts as a dead space for the expansion of the veins. Acts as a dead space for the expansion of the veins. Contains lymphatics & areolar tissues. Contains lymphatics & areolar tissues. RECESSES: are folds of the parietal pleura making room for expansion of the lungs during breathing. RECESSES: are folds of the parietal pleura making room for expansion of the lungs during breathing. Costomediastinal & costodiaphragmatic. Costomediastinal & costodiaphragmatic. Slide 9 Slide 10 Slide 11 Slide 12 CLINICAL IMPORTANCE These get filled by pleural effusion when diseased. These get filled by pleural effusion when diseased. SURFACE MARKING: SURFACE MARKING: Cervical pleura Cervical pleura Anterior margin Anterior margin Inferior margin Inferior margin Posterior margin Posterior margin Slide 13 Slide 14 Nerve supply Parietal intercostal & phrenic nerves Is pain sensitive. Pulmonary pleura autonomic nerves sympathetic nerves. Not pain sensitive. Slide 15 BLOD & LYMPHATIC SUPPLY Parietalintercostal,internal thoracic and musculophrenic arteries. Parietalintercostal,internal thoracic and musculophrenic arteries. Veins drain into azygos and internal thoracic veins. Veins drain into azygos and internal thoracic veins. Lymphaticsintercostal, internal mammary & diaphragmatic nodes. Lymphaticsintercostal, internal mammary & diaphragmatic nodes. Pulmonary pleurabronchial arteries & bronchopulmonary nodes. Pulmonary pleurabronchial arteries & bronchopulmonary nodes. Slide 16 APPLIED Thoracocentesis Pleurisy Effusion Pneumothorax Haemothorax Hydropneumothorax empyema Slide 17 THE LUNGS Slide 18 LUNGS Organs of respiration Organs of respiration Mediastinum separates the 2 lungs Mediastinum separates the 2 lungs Spongy, grey, dark later on. Spongy, grey, dark later on. 600-700gm. R>L 600-700gm. R>L Has apex, base, 3 borders, 2 surfaces. Has apex, base, 3 borders, 2 surfaces. Apexabove the level of the anterior end of the 1 st rib1 inch above the medial 1/3 rd end of the clavicle. Apexabove the level of the anterior end of the 1 st rib1 inch above the medial 1/3 rd end of the clavicle. Covered by sibson,s fascia. Covered by sibson,s fascia. Slide 19 Base lies on the diaphragm. Anterior border is thin vertical on the R. Ant. Border of L lung is notched cardiac notch. Here the heart is not covered by the lung & the pericardium. Post.border is thick & corresponds to the heads of the ribs. Extend from 7 th C vert. to the 10 th T vert. Slide 20 Inferior borderseparates the base from the costal & medial surfaces. Inferior borderseparates the base from the costal & medial surfaces. Costal surface. Costal surface. Medial surfacepost. & anterior parts. Medial surfacepost. & anterior parts. Has numerous impressions. Has numerous impressions. Slide 21 Fissures & lobes. R Lung3 lobes2 fissures; oblique & horizontal. L Lung2 lobes; 1 fissure. Oblique fissurecuts the whole thickness of the lung, except at the hilum. Crosses post. Border, 2-3 inches below the apex. Crosses inf. Border 2 in. from the medial plane. Slide 22 Cont. Horizontal fissure of R lobe divides the middle lobe from the upper lobe. L lobe has a lingula below the cardiac notch. No. of lobes may vary. Slide 23 Slide 24 Structures related to the medial surfaces of the 2 lungs. Slide 25 Slide 26 Slide 27 ROOTS OF THE LUNG A pedicle connecting the medial surface of the lung with the mediastinum. Short & broad. Various structures exit & enter here from & to the lungs. Lies opposite 5 th -7 th T vertebra. Slide 28 CONTENTS Slide 29 contents L1-brochus, R-2-bronchi 1 PA each. 2 PV each. Bronchial art.2 on L, 1 on R BV Pulmonary plexusesant,post. Lymphatics, LN, etc. Slide 30 relations Slide 31 Brochial tree Slide 32 2 bronchi branch out from the trachea. At the lower end of the 4 th T vertebra. R bronbus is short, wide,straight. Infections are common. Slide 33 Enters lungs through the hilum. Divides into lobar bronchi3 on R, 2 on L. Slide 34 These further divide intotertiary or segmental bronchi 10 on the R, 8 on the L(10) These further divide into terminal bronchioles & these into respiratory bronchioles which aerates the pulmonary unit formed by alveolar ducts,atria, air saccules, & pulmonary alveoli. Slide 35 Slide 36 Slide 37 Slide 38 Slide 39 Slide 40 Arteries,veins, lymphatics & nerve supply. Arterybronchial art.R side, one art.- either from 3 rd post. Intercostal or upper L bronchial art. L side-2 in no. from desc. Aorta. Pulmonary art. deoxygenated blood. PV carry oxygenated blood to the heart. Slide 41 Slide 42 veins 2 bronchial veins on each side R bronchial veins drain to azygos vein, L veins-- into hemiazygos or the superior intercostal veins. Drain blood from the 1 st 1-2 divisions of the bronchi. Rest of the blood is drained by the pulmonary veins. Slide 43 Slide 44 Slide 45 Slide 46 lymphatics Bronchopulmonary nodes.from superficial & deep vessels Some connection bet. the 2 groups exists. NERVES Parasympatheticvagusmotor,sensory & secretomotor. SympatheticsT2-T5bronchodilation. Form plexuses around the hilum. Slide 47 Slide 48 Slide 49 Bronchopulmonary segments Sector of a lung that is aerated by a tertiary bronchus. Pyramidal in shape with apex towards root. There are 10 on the R, & 8 on the L. Intersegmental planesbet. The segments. Slide 50 Slide 51 Bronchopulmonary segments Crossed by the PV. Segments have pulm. Art. With the bronchus together with the bronchial art. So the segment cannot be called a bronchovascular segment. it has no vein. Slide 52 Slide 53 Slide 54 Slide 55 Slide 56 Slide 57 Slide 58 Slide 59 Clinical Infections No barrier Surgery Postural drainage Bronchoscopy Slide 60 Slide 61 Slide 62 Slide 63 MEDIASTINUM Medium septum of the thorax bet. The 2 lungs. Medium septum of the thorax bet. The 2 lungs. Ant.sternum Ant.sternum Post.vert column Post.vert column Sides --mediastinal pleura Sides --mediastinal pleura Sup.thoracic inlet Sup.thoracic inlet Inf.diaphragm. Inf.diaphragm. Slide 64 Slide 65 Divided intosuperior & inferior. Divided intosuperior & inferior. Inf.---ant., middle & post. Inf.---ant., middle & post. Middlecontains the pericardium. Middlecontains the pericardium. SUPERIOR SUPERIOR Contents: tra, oeso, muscles, arteries, veins, nerves,thymus, thoracic duct, lymph nodes. Contents: tra, oeso, muscles, arteries, veins, nerves,thymus, thoracic duct, lymph nodes. Clinical: mediastinitis,site of neoplasms,dead space. Clinical: mediastinitis,site of neoplasms,dead space. Slide 66 Slide 67 ANTERIOR MEDIASTINUM In front of pericardium. In front of pericardium. Is cont. with the pretracheal space of the neck. Is cont. with the pretracheal space of the neck. Contents: ligaments, LN, internal thoracic art. Branches,thymus & areolar tissue. Contents: ligaments, LN, internal thoracic art. Branches,thymus & areolar tissue. Slide 68 Slide 69 MIDDLE mediastinum Contains heart,great arteries & veins, nerves, LN & bronchi. POSTERIOR MEDIASTINUM CONTENTS: oeso, DTA, veins, nerves, LN & lymphatics. Slide 70 Slide 71 CLINICAL Sup. & post. mediastinal infections can spread along each other,s territory. Mediastinal syndrome.SVC, TRACHEA, OESOPHAGUS, LRLN, PHRENIC NERVE,INTERCOSTAL NEURALGIA. Cause: carcinoma, aneurysm, hodgkins. Slide 72 TRACHEA Windpipeorgan of respiration Lower part neck, in the superior mediastinum Divides into R & L bronchi Is 4-6 inches long. Dia.2 & 1.5 in M & F. Lumen is 12mm. Starts from the lower border of cricoid cartilage. Slide 73 Structure:--fibroelastic, C-shaped rings 16 20 in no. Structure:--fibroelastic, C-shaped rings 16 20 in no. Post. It is closed by fibroelastic membrane & contains the trachealis muscle. Post. It is closed by fibroelastic membrane & contains the trachealis muscle. Blood supplyinf. Thyroid art. Blood supplyinf. Thyroid art. Vein: L brachiocephalic vein Vein: L brachiocephalic vein Lymph: pre & paratracheal LN. Lymph: pre & paratracheal LN. Slide 74 Slide 75 Slide 76 Nerve suply---parasympathetic & sympathetic Nerve suply---parasympathetic & sympathetic APPLIED APPLIED Tranlucency Tranlucency Palpation Palpation Tracheal tug Tracheal tug Tracheostomy Tracheostomy Swallowing Swallowing Mucus barrier Mucus barrier Husky voice Husky voice Slide 77 Thoracic duct Largest lymphatic vessel Largest lymphatic vessel Starts from the upper part of the abdomen to the lower part of neck. Starts from the upper part of the abdomen to the lower part of neck. Crosses from the R to the L. Crosses from the R to the L. Goes through the post. & sup. Mediastinum. Goes through the post. & sup. Mediastinum. 18 inch. Long. 18 inch. Long. Has valves so looks beaded. Has valves so looks beaded. Slide 78 Cysterna chyli cont. up as the TD. Cysterna chyli cont. up as the TD. Enters though the aortic opening. Enters though the aortic opening. At level of 7 th C Vert., it arches laterally. At level of 7 th C Vert., it arches laterally. Ends by opening into the bifurcation of the L brachiocephalic vein into L subclavion vein & the L IJV. Ends by opening into the bifurcation of the L brachiocephalic vein into L subclavion vein & the L IJV. RELATION: in theaortic opening, post., sup. Mediastinum & in the neck. RELATION: in theaortic opening, post., sup. Mediastinum & in the neck. Slide 79 Slide 80 Slide 81 TRIBUTARIES Receives lymph from below the diaphragm Receives lymph from below the diaphragm & also from the L upper half of the body. & also from the L upper half of the body. Collects lymph from the L jugular trunk, L subclavion trunk, L Mediastinal trunk. Collects lymph from the L jugular trunk, L subclavion trunk, L Mediastinal trunk. Slide 82 Slide 83 Thank you