antomy

1. Anatomy of pleura and the lung
Prepared by Amanuel
Ibrahim
Submitted to Diliab.D( Msc
in C .Anatomy)
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2. Outlines
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 Introduction to pleural cavity
 Pleural layers
 Parts of parietal pleural
 Neuro-vasculature of pleura
 Anatomical features of the lung
 Lobes of the lung
 Neurovasculatures of the lung
 Clinical correlations

3. Introduction to pleural cavity
3
 The pleura is a serous membrane
lined by flattened epithelium
(mesothelium) which invests each
lung.
• The parietal and visceral layers are separated from each
other by a slit-like potential space called pleural cavity
• It has two layers
 Visceral pleura
 Parietal pleura

4. Layers of the pleura
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1. Visceral pleura
 Covers the surface the lung completely except:-
 at hilum and
 Along the attachment site of pulmonary ligament.
 It also extends into the depths of the fissures and firmly
adherent to the lung surface and cannot be separated from it.

5. 5
2. Parietal pleura
 is thicker than the visceral pleura and lines the walls of the
pulmonary cavity.
 Subdivisions
 Costal pleura.
 Diaphragmatic pleura.
 Mediastinal pleura.
 Cervical pleura.
Left lung

6. 6
Costal pleura: is loosely attached by a thin
layer of loose areolar tissue called endothoracic

7. Cervical pleura:
7
 is the dome of parietal
pleura.
 Extends into the root of
neck 1 inch above clavicle
and 2 inches above the first
costal cartilage.
 It is covered by
suprapleural membrane.

8. Relations of the cervical pleura
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 Anteriorly :
 Subclavian artery and scalenus
anterior muscle.
 Posteriorly :
 neck of the first rib structures
around it
 Medially:
 great vessels of the neck.
 Laterally:
 scalenus medius muscle

9. Pulmonary ligament
9
 Is a double fold of the mediastinal
parietal pleura.
 It extends from root of the lung as far
as the diaphragm between lung and
mediastinum.
 Functions:
 provide dead space to pulmonary
veins and
 Allow the descent of the root the
lung.

10. 10
Surface markings of the pleura

11. Recesses of the pleura
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 are the expanded regions of the pleural
cavity.
 Are essential for lung expansion
and serve as the reserve space
during deep inspiration.
 are:
 Costodiaphragmatic recesses(R n
L)
 Costomediastinal recesses (R n L

12. Differences between two layers of pleura
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13. Neurovasculature of the pleura
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 Arterial supply:
 Visceral pleura: Bronchial arteries
 Parietal pleura: intercostal, internal thoracic and
musculophrenic arteries.
 Venous drainage
 Visceral pleura: bronchial veins
 Parietal pleura: azygous and internal thoracic vein.

14. Lymphatic drainage
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 Parietal pleura:
 Intercostal lymph nodes
 Internal thoracic lymph nodes
 Posterior mediastinal lymph nodes
 Diaphragmatic lymph nodes
 Visceral pleura:
 Bronchomediastinal lymph nodes

15. Nerve supply
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 Visceral pleura
 is supplied by autonomic (sympathetic) nerves (T2-T5)
 Parietal pleura :
 Costal and peripheral part of the diaphragmatic pleura
is supplied by the intercostal nerves.
 Mediastinal and central part of the diaphragmatic pleura
is supplied by the phrenic nerve.

16. Clinical conditions
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 Pleurisy or pleuritis:
 Is an inflammation of the parietal pleura.
 Acute pleuritis is marked by sharp, stabbing pain,
especially on exertion,
 Referred pain of the pleura:
 Irritation of costal and peripheral part of
diaphragmatic pleura referred to thoracic and
abdominal wall.
 Irritation from the mediastinal and the central part of
the diaphragmatic pleura referred to root of the neck

17. Pleural effusion
17
 Is accumulation of
excess amount of
fluid in the pleural
cavity.
 Can be
 hydrothorax
 Hemothorax
 Chylothorax

18. Pleural effusion
18

19. Pneumothorax
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 Accumulation of air in the pleural cavity is called pneumothorax.
 Spontaneous pneumothorax: As the name indicates, air enters
pleural cavity suddenly due the rupture of emphysematous bullae of the
lung
 Open pneumothorax: This occurs due to stab wounds on the thoracic
wall piercing the pleurae, leading to the communication of air in the
pleural cavity with the outside (atmospheric) air.
 Consequently, each time when patient inspires, the air is sucked into the
pleural cavity

20. Insertion of the chest tube
20
 Used to drain air, fluid,
blood, pus etc.
 Inserted in the 5th or
6th intercostal space in
the midaxillary line.

21. Lungs
21
 Are vital organs of respiration.
 Their main function is to
oxygenate the blood.
 are situated in the thoracic cavity,
one on either side of the
mediastinum enclosed in the
pleural sac.
 The right lung is heavier than left
lung
• Are large conical or pyramidal shaped

22. External features of the lungs
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 Each lung presents:
 Apex
 Base
 Three borders
anterior, posterior, and inferior
 Two surfaces
 costal and mediastinal
 Two or three lobes

23. Anatomical position and side determination
23
 Apex is directed upwards and base is directed downwards,
 its convex surface (costal surface) is directed outwards and
its flat medial surface presenting hilum is directed inwards,
 its thin margin (anterior margin) should face forwards and
its rounded border (posterior border) should face backward

24. Apex of the lung
24
 Is rounded/blunt superior end of
the lung.
 Relations :
 Anteriorly:
 Subclavian artery,
 internal thoracic artery,
 scalenus anterior
 Posteriorly:
 Neck of 1st rib and structures
in front of it

25. Base of the lung
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 is lower concave
surface, which rests
on the dome of the
diaphragm.
 It is also
diaphragmatic surface

26. Borders of the lung
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 Anterior border: thin and
shorter than the posterior.
 In the right lung:-Is vertical.
 In the left lung:-
 It presents wide cardiac
notch and lingula–tongue
shaped projection.
 Posterior border:
 Thick and rounded.
 Extends from C7 to T10.
 Inferior border:
 Semilunar and separates
costal
and medial surfaces

27. Surfaces of the lungs
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A. Costal Surface
 It is large, smooth, and convex.
 It is covered by the costal pleura
and endothoracic fascia
 Relations :
 Related to lateral thoracic wall.
 Upper 6 ribs in midclavicular
line.
 Upper 8 ribs in midaxillary
line.
 Upper 10 ribs in scapular line.

28. B. Mediastinal surface
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 It presents a hilum.
 it is related to mediastinal
structures such as
 heart,
 great blood vessels, and
 Nerves
 The relations of the
mediastinal surface of the two
lungs differ.

29. Relation of Mediastinal surface of the right
lung
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 Right atrium
 Superior and inferior venacava
 Azygos vein
 Right brachiocephalic vein
 Esophagus and trachea
 Three neural structures:
 Right phrenic nerve
 Right vagus nerve
 Sympathetic trunk
Mediastinal surface of the right lung

30. Relation of Mediastinal surface of the left lung
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 Left ventricle
 Ascending aorta
 Aortic arch and descending
thoracic aorta
 Left subclavian and left
common carotid arteries
 Esophagus and thoracic duct
 Four neural structures
 Left phrenic nerve
 Left vagus nerve
 Left recurrent laryngeal
nerve
 Left sympathetic chain

31. Root of the lung
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 Is a short broad pedicle
connecting the medial
surface of the lung with the
mediastinum.
 it consists of structures
entering
and leaving the lung at hilum
 The hilum is the area on the
mediastinal surface of the
lung through which structures
enter or leave the lung.

32. Components of the root of the lung
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 Root of the lung consists ;
 Principal bronchus in the left lung and in the right lung.
 Pulmonary artery.
 Pulmonary veins (two in number).
 Bronchial arteries (one on the right side and two on the left side).
 Bronchial veins.
 Lymphatics of the lung.
 Anterior and posterior pulmonary plexuses of the nerves.

33. Right lung
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34. 34

35. Left lung
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36. 36

37. Lobes and fissures of the lungs
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 There are two fissures forming two or three
lobes.
1. Oblique fissure
 runs obliquely downwards and forwards
 Separates superior lobe or superior and
middle from inferior lobe.
2. Transverse fissure
 It starts from oblique fissure at the
midaxillary line and runs horizontally
forward to the anterior border of the lung

38. Lobes of the right lung
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 Right lung is divided into
three lobes:
 Superior lobe
 Middle lobe, and
 Inferior lobe .
 by oblique and horizontal
fissures

39. Lobes of the left lung
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 The left lung has two
lobes.
 Superior lobe
 Inferior lobe
 Lobes are formed by
one oblique fissure.

40. Differences between the right and left lungs
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features Right lung Left lung
Size and shape Larger, shorter, and
broader
Smaller, longer, and
narrower
Weight 700g 650g
Lobe 3 lobes 2 lobes
Fissures Two fissures one
Anterior border vertical Has cardiac notch
Hilum Two bronchial One principal
bronchi

41. Tracheobronchial tree
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 Trachea bifurcates at sternal angle
into left and right main bronchi.
 Right bronchus
 wider, shorter, and runs more
vertical.
 Left bronchus
narrower, longer, and more
horizontal than the right
 passes inferolaterally, inferior to
the arch of the aorta and anterior
to the esophagus and thoracic
aorta.

42. 42
 Within the lung the bronchi
branch in the constant
fashion to form branches of
tracheobroncheal tree.
 Each main bronchus
divides into secondary lobar
bronchi, two in the left and
three in the right .
 Each lobar bronchus
divides into several tertiary
segmental bronchi that
supply bronchopulmonary
Tracheobronchial tree…..

43. Bronchopulmonary segments
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 Are largest subdivisions of a
lobe.
 Pyramidal-shaped segments of the
lung
 Supplied independently by a
segmental bronchus and a tertiary
branch of the pulmonary artery.
 Drained by intersegmental parts of
the pulmonary veins.
 Separated from adjacent segments
by connective tissue septa
Right
lung
Left
lung
are demonstrated after injection of a
different color latex into each tertiary

44. Neurovasculatures of the lung
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 Blood supply to lung.
 The lung has dual blood
supply
 Through pulmonary
arteries and bronchial
arteries.
 Pulmonary arteries arise
from pulmonary trunk as
left and right braches
which supply each lung.

45. Blood supply of the lung
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 Pulmonary arteries carry low
oxygen blood to the lung for
oxygenation.
 Each pulmonary artery
becomes part of the root of the
corresponding lung and
divides to give secondary
lobar artery.
 Then to tertiary segmental
arteries paired with branching
bronchus to supply
bronchopulmonary
Pulmona
venule
Pulmonary
artery
Ts
bronchus

46. Bronchial artery
46
 Supply nutrition to the bronchial
tree and pulmonary tissue.
 The right lung :
 one bronchial artery branch
of right 3rd posterior
intercostal or from upper left
bronchial artery.
 The left lung
 by two bronchial arteries,
which arise from descending
thoracic aorta.

47. Venous drainage of the lung
47
 Venous blood of the lungs are
drained by two veins:
 Pulmonary veins
 Bronchial veins
 Pulmonary veins:
 Drain oxygenated blood to heart.
 There are two pulmonary veins in
each side and don’t accompany
arteries.
 Their tributaries are
intersegmental veins
 Bronchial veins
 Drain deoxygenated blood from
tissue.
 Right bronchial vein to azygos
vein.
 Left bronchial vein drain to
hemiazygos vein or left
superior intercostal vein.

48. 48
Lymphatic drainage of the lung
 Drained by superficial and deep lymph vessels.
 Superficial lymph vessels
 Drain peripheral lung tissue and form superficial lymph plexus which
drains into bronchopulmonary (hilar) lymph nodes.
 Deep lymph vessels
 Form deep plexus and drain bronchial tree, pulmonary vessels, and
connective tissue septa.
 Pass into pulmonary lymph nodes and then into bronchopulmonary
lymph nodes.

49. 49
 Thus both superficial and deep
lymphatic plexuses drain into
bronchopulmonary (hilar) lymph
nodes.
 The hilar lymph nodes drains into
tracheobronchial lymph nodes into
pre- and paratracheal lymph nodes into
bronchomediastinal lymph trunk into
right lymphatic duct and thoracic duct
Lymphatic drainage of the lung

50. Nerve supply to lung
50
 Lung is supplied by both
sympathetic and
parasympathetic nerve
fibers.
 Sympathetic nerve fibers
 are derived from T2 to T5
spinal segments
 Parasympathetic nerve
fibers
 Are derived from vagus
nerve

51. Clinical condition related to lung
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 Variations in Lobes of Lung
 Aspiration of Foreign Bodies
 Lung Resections
 Pulmonary Embolism
 Bronchogenic Carcinoma

52. References
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 Moore clinically oriented human anatomy 8th edition
 Vishram Singh text book of human anatomy 2nd edition
 Gray’s atlas of human anatomy 3rd edition
 Principles of human Anatomy G.Tortora 12th edition

53. Thank you
53