Anatomy of lung & pleura

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Anatomy of lung & pleura

  1. 1. Iman Galal, MDIman Galal, MD Pulmonary Medicine DepartmentPulmonary Medicine Department Ain Shams UniversityAin Shams University CLINICALCLINICAL ANATOMY OFANATOMY OF LUNG & PLEURALUNG & PLEURA
  2. 2. Page  2 Borders of the lung:Borders of the lung:  The apexThe apex is about 2-3 cms (1 inch) above the medial 1/3 of theis about 2-3 cms (1 inch) above the medial 1/3 of the clavicle, thenclavicle, then the anterior border of both lungsthe anterior border of both lungs run downwards &run downwards & medially meeting each other in the middle line behind the angle ofmedially meeting each other in the middle line behind the angle of Louis.Louis.  The anterior border of right lung continues running downwards till theThe anterior border of right lung continues running downwards till the 66thth costochondral junction.costochondral junction.  The anterior border of left lung continues running downwards till theThe anterior border of left lung continues running downwards till the 44thth costal cartilage then curves laterally ½ inch forming the cardiaccostal cartilage then curves laterally ½ inch forming the cardiac notch then descends downwards till the 6notch then descends downwards till the 6thth costochondral junction.costochondral junction.
  3. 3. Page  3 Borders of the lung:Borders of the lung:  The lower border of the lungsThe lower border of the lungs represented by a linerepresented by a line starting from 6starting from 6thth rib in the MCL, 8rib in the MCL, 8thth rib in the MAL & 10rib in the MAL & 10thth ribrib in the scapular line.in the scapular line.
  4. 4. Page  4 Right LungRight Lung
  5. 5. Page  5 Lung Fissures:Lung Fissures: Oblique fissureOblique fissure (Right & Left):(Right & Left): It starts at theIt starts at the 33rdrd thoracic spinethoracic spine while the arms are elevated, descendswhile the arms are elevated, descends downwards, laterally & anteriorly along the medial border of the scapuladownwards, laterally & anteriorly along the medial border of the scapula touching the inferior angle of the scapula) cutting the midaxillary line intouching the inferior angle of the scapula) cutting the midaxillary line in the 5the 5thth rib & ending at the 6rib & ending at the 6thth costal cartilage 3 inches from the midline.costal cartilage 3 inches from the midline. In cadaver it arise at the 2In cadaver it arise at the 2ndnd thoracic spine.thoracic spine. The transverse fissureThe transverse fissure (Right):(Right): It arises at theIt arises at the 44thth costal cartilagecostal cartilage, runs horizontally to meet the, runs horizontally to meet the oblique fissure in the midaxillary line in the 5oblique fissure in the midaxillary line in the 5thth rib.rib.
  6. 6. Page  6 Fissures & Lobes of the LungsFissures & Lobes of the Lungs
  7. 7. Page  7 Fissures & Lobes of the Right LungFissures & Lobes of the Right Lung
  8. 8. Page  8 Right Upper LobeRight Upper Lobe
  9. 9. Page  9 Right Middle LobeRight Middle Lobe
  10. 10. Page  10 Right Lower lobeRight Lower lobe
  11. 11. Page  11 Left LungLeft Lung
  12. 12. Page  12 Fissures of the Left LungFissures of the Left Lung
  13. 13. Page  13 Left Upper LobeLeft Upper Lobe
  14. 14. Page  14 Left Lower LobeLeft Lower Lobe
  15. 15. Page  15 Segmental BronchiSegmental Bronchi
  16. 16. Page  16 Segmental BronchiSegmental Bronchi
  17. 17. Page  17 Segmental BronchiSegmental Bronchi (Anterior)(Anterior) 11 22 33 44 55 88 1-21-2 33 44 55 88
  18. 18. Page  18 Segmental BronchiSegmental Bronchi (Posterior)(Posterior) 111-21-2 22 33 44 66 1010 99 33 66 101099 44
  19. 19. Page  19 PleuraPleura
  20. 20. Page  20 The borders of the Pleura:The borders of the Pleura:  The pleura runs close to the lung except at the lowerThe pleura runs close to the lung except at the lower border which extends for 3-5 cm below it both anteriorlyborder which extends for 3-5 cm below it both anteriorly & posteriorly & 9-10 cm below in the axilla.& posteriorly & 9-10 cm below in the axilla.  The lower border cuts the 8The lower border cuts the 8thth rib in MCL, 10rib in MCL, 10thth rib in MALrib in MAL and 12and 12thth rib in Scapular line.rib in Scapular line.
  21. 21. Page  21
  22. 22. Page  22 PleuraPleura
  23. 23. Page  23 Parietal PleuraParietal Pleura Costal pleura:Costal pleura: Lines thoracic wall (ribs, intercostalLines thoracic wall (ribs, intercostal spaces)spaces) Mediastinal pleura:Mediastinal pleura: Lines corresponding surface ofLines corresponding surface of mediastinum; reflected over root of lungmediastinum; reflected over root of lung & becomes continuous with visceral& becomes continuous with visceral pleura around hilumpleura around hilum Cervical pleura:Cervical pleura: Extends into neck about 2 inches aboveExtends into neck about 2 inches above 11stst costal cartilage & one inch abovecostal cartilage & one inch above medial 1/3 clavicle; covers apex of lungmedial 1/3 clavicle; covers apex of lung Diaphragmatic pleura:Diaphragmatic pleura: Lines superior surface of diaphragmLines superior surface of diaphragm
  24. 24. Page  24
  25. 25. Page  25
  26. 26. Page  26 Traube’s area:Traube’s area: 4 points:4 points: Left 6Left 6thth rib in the MCL to 8rib in the MCL to 8thth costal cartilage in thecostal cartilage in the parasternal line ,then along the left costal margin to the 11parasternal line ,then along the left costal margin to the 11thth rib in the MAL, then the 9rib in the MAL, then the 9thth rib in the MAL.rib in the MAL.
  27. 27. Page  27 Kronig’s Isthmus :Kronig’s Isthmus :  It is a band of resonance representing lung apex.It is a band of resonance representing lung apex.  LaterallyLaterally it is marked by a line joining 2 points:it is marked by a line joining 2 points: 1.1. The junction of the medial 2/3 of the clavicle with theThe junction of the medial 2/3 of the clavicle with the lateral 1/3.lateral 1/3. 2.2. The junction of the medial 1/3 of the scapular spine withThe junction of the medial 1/3 of the scapular spine with the lateral 2/3.the lateral 2/3.  MediallyMedially marked by a line between the sternal end ofmarked by a line between the sternal end of clavicle and the 7clavicle and the 7thth cervical spine.cervical spine.
  28. 28. Page  28 Bare area of the heart :Bare area of the heart :  Medial border: left lateral border of the sternumMedial border: left lateral border of the sternum  Lateral border: left parasternal lineLateral border: left parasternal line  Superior border: lower border of Lt 4Superior border: lower border of Lt 4thth rib.rib.  Inferior border: upper border of Lt 6Inferior border: upper border of Lt 6thth ribrib
  29. 29. Page  29 Surface anatomy of liver:Surface anatomy of liver: Upper border:Upper border: It starts from the left 6It starts from the left 6thth ribrib just inside the MCL, passing tojust inside the MCL, passing to the Rt and slightly upwards to the 5the Rt and slightly upwards to the 5thth rib in the MCL, thenrib in the MCL, then the 7the 7thth rib in anterior axillary line, to the 9rib in anterior axillary line, to the 9thth rib in mid-axillaryrib in mid-axillary line.line.
  30. 30. Page  30
  31. 31. Thank YouThank You

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