A broad overview of Anatomy of Human Lungs for Medical Students

1. ANATOMY OF LUNGS
Dr Surajit Kundu
Associate Professor
DEPARTMENT OF ANATOMY
GOVT. MEDICAL COLLEGE
RAIGARH (CG)
4/15/2021 1
GMC RAIGARH

2. A surgeon decides to undergo
segmental resection of right Lungs
for a patient suffering with
Bronchogenic Carcinoma.
Use your Anatomical Knowledge to
Answer the following:
1. What is Segmental Resection?
2. Cite the Clinical Correlation of knowledge of
Broncho pulmonary Segment.
3. Discuss the Anatomy of Broncho pulmonary
Segment. 4/15/2021 2
GMC RAIGARH

3. 1. Gross Anatomy of Lungs
2. Surfaces and Borders of
Lungs
3. Hilum and Root of Lungs
4. Fissures and Lobes of
Lungs
5. Bronchopulmonary
segments
6. Blood supply of lungs
7. Lymphatics of Lungs
8. Nerve supply of Lungs
OBJECTIVES
4/15/2021 3
GMC RAIGARH

4. GROSS ANATOMY OF LUNGS
CAN BE DISCUSSED AS:
1. INTRODUCTION
2. PRESENTING PARTS (SURFACES &
BORDERS)
3. MEDIASTINAL SURFACE OF LUNGS AND
ITS IMPRESSIONS
4. FISSURES AND LOBES
5. HILUM AND ROOT OF LUNGS
6. PULMONARY LIGAMENT & ITS CLINICAL
SIGNIFICANCE
7. BRONCHIAL TREE
8. BRONCHOPULMONARY SEGMENTS AND
4/15/2021
GMC RAIGARH 4

5. GROSS ANATOMY OF LUNGS -
INTRODUCTION
Lungs are a pair of respiratory organs situated in a thoracic cavity.
Right and left lung are separated by the mediastinum.
Texture -- Spongy
Color – Young – brown
Adults -- mottled black due to
deposition of carbon particles
Weight-
Right lung - 600 gms
Left lung - 550 gms
4/15/2021 5
GMC RAIGARH

6. THORACIC CAVITY
4/15/2021 6
GMC RAIGARH

7. - Conical
Apex
Base
3 Borders
2 Surfaces
- anterior
- posterior
- Inferior
- costal
- medial
- anterior (mediastinal)
- posterior (vertebral)
4/15/2021 7
GMC RAIGARH
PRESENTING
PARTS

8. APEX
Blunt
Lies above the level of
anterior end of 1st Rib.
Reaches 1-2 cm above
medial 1/3rd of clavicle.
Coverings –
cervical pleura.
suprapleural membane
Grooved by-
Subclavian artery
Subclavian vein
4/15/2021 8
GMC RAIGARH
What is Supra pleural
membrane ??????

9. 4/15/2021 9
GMC RAIGARH

10. BASE
Semilunar and concave.
Rests on dome of Diaphragm.
Right sided dome is higher than left.
4/15/2021 10
GMC RAIGARH

11. APEX & BASE OF LUNGS
- RELATIONS
4/15/2021
GMC RAIGARH 11

12. BORDERS
ANTERIOR BORDER –
1. Corresponds to the anterior
(Costomediastinal) line of pleural reflection.
2. It is deeply notched in the left lung posterior
to 5th costal cartilage by the pericardium
and extends vertically downwards to form
Lingula. This is called cardiac
notch(percussion in this area gives a dull
note as compared to dull note obtained over
lung). 4/15/2021 12
GMC RAIGARH

13. INFERIOR BORDER
Thin and sharp
It seperates the base of lung from the
costal surface and extends into
phrenicocostal sinus.
4/15/2021 13
GMC RAIGARH

14. POSTERIOR BORDER
Thick and ill defined
Fits into deep paravertebral gutter.
Extends from C7 to T10.
4/15/2021 14
GMC RAIGARH

15. SURFACES OF THE LUNG
1. CostalSurface
2. MedialSurface
-It is in contact with costal
pleura and overlying
thoracic wall.
- Posterior / Vertebral Part
- Anterior / Mediastinal Part
4/15/2021 15
GMC RAIGARH

16. Relations of Posterior Part
1. Vertebral Part
2. Intervertebral Discs
3. Posterior Intercostal Vessels
4. Splanchic Nerves
4/15/2021 16
GMC RAIGARH

17. 4/15/2021
GMC RAIGARH 17
MEDIASTINAL SURFACE OF
LUNGS AND IMPRESSIONS

18. RELATIONS OF ANTERIOR PART
1. Right atrium
2. Small part of RV
3. SVC
4. Right brachiocephalic
vein(lower part)
5. Azygos vein
6. Esophagus
7. IVC
8. Trachea
9. Right vagus nerve
10. Right phrenic nerve
RIGHT SIDE LEFT SIDE
1. Left ventricle
2. Pulmonary trunk
3. Arch of Aorta
4. Descending thoracic
aorta
5. Left Subclavian Artery
6. Thoracic duct
7. Left Brachiocephalic
Vein
8. Left vagus nerve
9. Left phrenic nerve
10. Left recurrent
laryngeal nerve
4/15/2021 18
GMC RAIGARH

19. 4/15/2021 19
GMC RAIGARH

20. 4/15/2021 20
GMC RAIGARH

21. 4/15/2021 21
GMC RAIGARH

22. PULMONARY LIGAMENT AND ITS
ANATOMIC SIGNIFICANCE
HILUM OF LUNGSVs ROOT OF LUNGS

23. HILUM
It is a large depressed area that lies
near the centre of the medial surface.
Various structures enter and leave the
lung via its root.
4/15/2021 23
GMC RAIGARH

24. ROOT OF THE LUNG
The root is enclosed in
a short tubular sheet of
pleura that joins the
pulmonary and
mediastinal parts of
pleura . It extends
inferiorly as a narrow
fold - The pulmonary
ligament.
It lies opposite of the
bodies of 5th, 6th and
7th thoracic vertebra 4/15/2021 24
GMC RAIGARH

25. 4/15/2021 25
GMC RAIGARH

26. STRUCTURES OF THE ROOT
Principal Bronchus on the
left side.
Eparterial and Hyparterial
on the right side.
One pulmonary artery .
Two pulmonary veins -
Superior
Inferior
Bronchial arteries
One on right side
Two on left side
4/15/2021 26
GMC RAIGARH

27. Bronchial veins
Anterior and
posterior pulmonary
plexus of nerves.
Lymphatics
Bronchopulmonary
Lymphnodes
Areolar tissue.
4/15/2021 27
GMC RAIGARH

28. ARRANGEMENT OF STRUCTURES IN
THE ROOT
BEFORE BACKWARDS
1. Superior pulmonary vein.
2. Pulmonary artery.
3. Bronchus.
4/15/2021 28
GMC RAIGARH

29. ARRANGEMENT OF STRUCTURES IN
 ABOVE DOWNWARDS
A. Right Side
1. Eparterial Bronchus.
2. Pulmonary Artery.
3. Hyparterial Bronchus.
4.Inferior Pulmonary
Vein.
 .
THE ROOT
4/15/2021 29
GMC RAIGARH

30. ARRANGEMENT OF STRUCTURES IN
THE ROOT
ABOVE DOWNWARDS
B. Left Side
1. Pulmonary artery.
2. Bronchus.
3. Inferior pulmonary vein
4/15/2021 30
GMC RAIGARH

31. PULMONARY LIGAMENT
4/15/2021
GMC RAIGARH 31

32. FISSURES AND LOBES OF LUNGS
4/15/2021 32
GMC RAIGARH

33. OBLIQUE FISSURE
It begins posteriorly at the level of 5th
thoracic vertebra.
Passes antero-inferiorly in a spiral
course to meet the inferior margin close
to 6th costochondral junction.
4/15/2021 33
GMC RAIGARH

34. HORIZONTAL FISSURE
It extends from anterior margin at the level of
4th costal cartilage.
Runs horizontally backwards to meet the
oblique fissure in the mid-axillary line.
Pulmonary pleura extends into the fissures of
the lungs so that the lobes can move on each
other during respiration.
4/15/2021 34
GMC RAIGARH

35. 4/15/2021 35
GMC RAIGARH

36. LETS REVISE
4/15/2021
GMC RAIGARH 36

37. BRONCHOPULMONARY SEGMENTS
 ANATOMIC SIGNIFICANCE
 AETIOLOGIC SIGNIFICANCE
(CLASSIFICATION / NOMENCLATURE)
 RADIOLOGIC SIGNIFICANCE
 CLINICO-SURGICL SIGNIFICANCE
4/15/2021
GMC RAIGARH 37

38. BRONCHO PULMONARY SEGMENTS
DEFINITION
These are well defined structural,
functional, Anatomic and surgical areas of
the lung tissue each of which is aerated
by a segmental / tertiary bronchus.

39. 4/15/2021 39
GMC RAIGARH

40. 4/15/2021
GMC RAIGARH 40

41. RESPIRATORY PASSAGE
(UPPER & LOWER RESPIRATORY
TRACT Vs CONDUCTING PART &
RESPIRTORY PART OF
RESPIRATORY TRACT)
4/15/2021
GMC RAIGARH 41

42. Trachea
Right and Left Principal Bronchus
Lobar Bronchi(Secondary)[2L,3R]
Segmental Bronchi(Tertiary)[8L,10R]
Terminal Bronchioles(25000 in no.)
Respiratory Bronchioles
Alveolar ducts
ACINUS
Alveolar sacs
Alveoli
4/15/2021 42
GMC RAIGARH

43. 4/15/2021 43
GMC RAIGARH

44. 4/15/2021
GMC RAIGARH 44

45. The ultimate pulmonary unit from respiratory
brochiole to alveoli is called Acinus.
There are about 28 orders of division of
tracheo-bronchial tree.
Total no. of alveoli has been estimated to be
between 200 - 600 million, with a total surface
area of 40 - 80 meter square.
4/15/2021 45
GMC RAIGARH

46. 4/15/2021 46
GMC RAIGARH

47. BRONCHIAL TREE
4/15/2021
GMC RAIGARH 47

48. BRONCHOPULMONARY SEGMENTS
3. More in line with
trachea at an
angle of 15
degrees
Right main bronchus Left main bronchus
1. Shorter 1. Longer
2. Wider. 2. Narrower.
3. More oblique than
the right at an
angle of 45
degrees with the
trachea
4/15/2021 48
GMC RAIGARH

49. WHAT IS CARINA?
4/15/2021
GMC RAIGARH 49

50. 4/15/2021
GMC RAIGARH 50

51. 4/15/2021
GMC RAIGARH 51

52. 4/15/2021
GMC RAIGARH 52

53. 4/15/2021
GMC RAIGARH 53

54. BRONCHOPULMONARY SEGMENTS
CLASSIFICATION
Right Main Bronchus
Right upper lobe Bronchus Right Middle lobe Bronchus Right Lower Lobe Bronchus
Segmental Bronchi
Apical
Anterior
Posterior
Segmental Bronchi
Medial
Lateral
Segmental Bronchi
Apical
Anterior
Posterior
Medial and Lateral
4/15/2021 54
GMC RAIGARH

55. BRONCHOPULMONARY SEGMENTS
CLASSIFICATION
Left Main Bronchus
Left upper lobe Bronchus
Upper Branch Lower Branch
Anterior
Apico-posterior
Superior Lingular
Inferior Lingular
Left lower lobe bronchus
Segmental Bronchi
Apical
Anterior
Posterior
Lateral
4/15/2021 55
GMC RAIGARH

56. 4/15/2021
GMC RAIGARH 56

57. 4/15/2021 57
GMC RAIGARH

58. These segments are pyramidal in shape with
apex towards the root of lung.
Each segment is an independent respiratory unit.
Each segment has its own separate
artery(branches of pulmonary artery).
Pulmonary Veins run in inter-segmental planes
between adjoining segments.
Thus a bronchopulmonary segment is not a
bronchovascular segment as it does not have
its own vein. 4/15/2021 58
GMC RAIGARH

59. 4/15/2021 59
GMC RAIGARH

60. CLINICAL SIGNIFICANCE
Segmental resection with minimal
destruction to the surrounding lung
tissue.
To visualize the interior of a bronchi
through a bronchoscope when diseases
process is limited in a segment.
4/15/2021 60
GMC RAIGARH

61. 4/15/2021
GMC RAIGARH 61

62. 4/15/2021
GMC RAIGARH 62

63. 4/15/2021
GMC RAIGARH 63

64. 4/15/2021
GMC RAIGARH 64

65. SEGMENTS AND DISEASE
DISEASE /
FOREIGN
BODY
BRONCHO PULMONARY
SEGMENT
1. FOREIGN
BODY
ASPIRATION
APICAL SEGMENTS OF BOTH
LOWER LOBES OR POSTERIOR
SEGMENTS OF RIGHT UPPER LOBE
2.
TUBERCULOSIS
APICAL & POSTERIOR SEGMENTS
OF UPPER LOBES
3. LUNG
ABSCESS
POSTERIOR SEGMENT OF UPPER
LOBES OR SUPERIOR / POSTERIOR
BASAL SEGMENTS OF LOWER
LOBES
4. LEFT LOWER LOBE
4/15/2021
GMC RAIGARH 65

66. NEUROVASULAR SUPPLY
4/15/2021
GMC RAIGARH 66

67. A surgeon decides to undergo
segmental resection of right Lungs
for a patient suffering with
Bronchogenic Carcinoma.
Use your Anatomical Knowledge to
Answer the following:
1. What is Segmental Resection?
2. Cite the Clinical Correlation of knowledge of
Broncho pulmonary Segment.
3. Discuss the Anatomy of Broncho pulmonary
Segment. 4/15/2021 67
GMC RAIGARH

68. UNIVERSITY QUESTIONS
1. DISCUSS THE LUNGS AS UNDER: (a)
PRESENTING PARTS (b) MEDIASTINAL
SURFACE. ADD A NOTE ON
BRONCHOPULMONARY SEGMENTS
2. SHORT NOTES:
(a) ROOT & HILUM OF LUNG
(b)MEDIASTINAL SURFACE OF LUNGS &
ITS IMPRESSIONS
(c) PULMONARY LIGAMENT
(d)BRONCHOPULMONARY SEGMENTS &
THEIR CLINICAL RELEVENCE
4/15/2021
GMC RAIGARH 68

69. THANK YOU
4/15/2021 69
GMC RAIGARH