1. Anatomy Of Tracheo-Bronchial Tree
Dr. Supreet Singh Nayyar, AFMC
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2. Layout Embryology Respiratory Tree Structure
Layout
Embryology
Respiratory Tree
Trachea and main bronchi
Segmental Bronchi
Bronchopulmonary Segments
Structure
Vasculature , Lymphatic and Nerve Supply
Applied Anatomy

3.
EMBRYOLOGY
Tracheobronchial Diverticulum below Hypobranchial Eminence – 4th wk IUL
edges – oesophagotracheal septum
fuses caudally
endoderm lining
cranial – Trachea / Larynx
caudal – Bronchi / Lungs

4.
EMBRYOLOGY

5.
EMBRYOLOGY

6.
The Respiratory Tree

7. The Trachea Cartilaginous and Membranous tube Dimensions
The Trachea
Cartilaginous and Membranous tube
Dimensions
Length cm
Ext Dia – 2.0 cm ( 1.5 cm)
Extent – C6 – T4
Incomplete rings

9. Relations Cervical Anteriorly Posteriorly On each side
Relations
Cervical
Anteriorly
Isthmus of thyroid with inf thyroid vessels
Pretracheal fascia
Sternothyroid & Sternohyoid
Investing layer of Deep Cervical Fascia
Skin & superficial fascia
Posteriorly
Oesophagus; longus colli; RLN
On each side
Thyroid
Common Carotid Artery

11. Relation o cervical trachea at C 7

12. Relations Thoracic Rt Side Anterior Lt Side Posterior
Relations
Thoracic
Anterior
Manubrium Sterni
Sternothyroid
Thymus
Lt Brachiocephalic V
Aorta & Lt CCA
Deep Cardiac Plexus
Posterior
Oesophagus
Vertebral Column
Rt Side
Right Lung & Pleura
Rt Vagus
Azygous V
Lt Side
Arch of Aorta
Lt Common Carotid
Lt Subclavian A
Lt RLN

15. The main Bronchi and Branches
The main Bronchi and Branches
Rt and Lt Main Bronchi – T4 level
Carina
The Right Bronchus (bronchus dexter), wider, shorter, and more vertical
5 cm. long
Enters right lung opposite fifth thoracic vertebra
Azygos vein arches over it from behind
Right pulmonary artery lies at first below and then in front
2.5 cm along course- Rt Upper Lobe Bronchus
At Hilum of Lung – Middle & Lower Lobe Bronchi

16. Bronchi, Bronchioles, & Alveoli
Bronchi, Bronchioles, & Alveoli
Trachea divides into
Primary bronchii divide into
Secondary bronchi divide into
Tertiary bronchi divide into
Bronchioles divide into
Terminal bronchioles divide into
Respiratory bronchioles divide into
Alveolar ducts end in
Alveoli

17. The Respiratory Tree FG24_10D.JPG
FG24_10D.JPG
Title: The Bronchial Tree and Divisions of the Lungs, Anterior View
Notes: (a)Gross anatomy of the lungs; bronchial tree and divisions. (b)Distribution of bronchopulmonary segments. (c)Bronchogram, slightly oblique, posteroanterior view. (d)Plastic cast of adult bronchial tree.
Keywords: bronchopulmonary segments, distribution, bronchial tree, bronchus, apex of lung, diaphragm

18.
The Respiratory Tree
Structure through the airways 1.Trachea 2. Bronchus (Right- or Left- Primary Bronchus) 3. Lobar Bronchus 4. Segmental Bronchus 5. Bronchus 6. Bronchiole 7. Terminal Bronchiole 8. Respiratory Bronchiole 9. Alveolar Duct 10. Alveolar Sac / Alveolus

20. The Respiratory Tree Rt Upper Lobe Bronchus Rt Middle Lobe Bronchus
Rt Upper Lobe Bronchus
Rt lat aspect of bronchus
Superolaterally
3 segmental Bronchi ( Apical; Post; Ant )
Apical Segmental – Apical & Ant. Subsegmental Br
Post Segmental – Lateral & Ant. Subsegmental Br
Ant. Segmental – Lateral & Ant. Subsegmental Br
Rt Middle Lobe Bronchus
2.5 cm beyond Rt Upper Lobe Bronchus
Ant aspect
Forwards Downwards and Laterally
Lateral and Medial Subsegments

21. The Respiratory Tree Rt lower lobe bronchus
Rt lower lobe bronchus
Apical Segmental – post aspect Medial ; Sup ; Lat subsegmental br
Medial Basal ( Cardiac ) – Rt Border of heart
Ant Basal
Lateral Basal
Post Basal

23. The Respiratory Tree FG24_10D.JPG
The Respiratory Tree
FG24_10D.JPG
Title: The Bronchial Tree and Divisions of the Lungs, Anterior View
Notes: (a)Gross anatomy of the lungs; bronchial tree and divisions. (b)Distribution of bronchopulmonary segments. (c)Bronchogram, slightly oblique, posteroanterior view. (d)Plastic cast of adult bronchial tree.
Keywords: bronchopulmonary segments, distribution, bronchial tree, bronchus, apex of lung, diaphragm

24.
The Respiratory Tree

25.
The Respiratory Tree
Left Bronchus (bronchus sinister) smaller in calibre but longer than the right
5.5 cm long
Enters root of the left lung opposite sixth thoracic vertebra
Passes beneath Aortic arch,
crosses in front of oesophagus, thoracic duct, descending aorta
Left pulmonary artery lies at first above then in front

26. The Respiratory Tree Lt upper Lobe Bronchus Lt Lower Lobe Bronchus
Lt upper Lobe Bronchus
Anterolateral aspect 5.5cm from carina
Curves laterally then divides
Cranial divisions: Apico posterior and Anterior
Caudal divisions : anterolaterally Lingular area of lung Sup and Inf segmental
Lt Lower Lobe Bronchus
Apical segmental
Originates posteriorly 1cm below upper lobe orifice
Anteromedial (Anterior Basal and Medial Basal )
PosterolateralLateral Basal and Post Basal)

28. The Lungs Soft, spongy, cone- shaped Right lung Left lung 3 lobes
The Lungs
Soft, spongy, cone- shaped
Right lung
3 lobes
Left lung
2 lobes

29. Bronchopulmonary segments
Independent respiratory units
Sectors of lung with tertiary/ segmental bronchus ;separate Br of Pulmonary A
Pyramidal with apex to root of lung
Clinical Significance
Restriction of infections
Segmental resection
Bronchoscopy

31. Structure of Trachea and Major Bronchi
Structure of Trachea and Major Bronchi
Cartilages
16-20
Incomplete Rings (4 mm vertically and 1 mm thick)
Union of 2 or more rings partially or completely
Highly elastic
1st Tracheal Cartilage
Fibrous Membrane
Perichondrium of cartilages
Collgen with elastic fibres
Non striated mus fibres

33. Changes as the Respiratory Tree Branches
Changes as the Respiratory Tree Branches
As branching of bronchi becomes more extensive
Rings of cartilage become plates
Smooth muscle increases
Columnar epithelium becomes cuboidal, then squamous (in alveoli

35. Mucous Membrane Epith lining – thins and single layered
Mucous Membrane
Epith lining – thins and single layered
Tubulo-racemose glands
Not present in bronchioles

36. Vasculature and lymphatics
Blood Supply
Inf Thyroid A
Bronchial A – 1 for Rt lung ;2 for Lt
Lie against post wall of Bronchi
2 Bronchial Veins
Rt – Azygous V
Lt – Lt Sup Intercostal V or HemiazygousV
Pulmonary V

37. Vasculature and lymphatics
Vasculature and lymphatics
Lymphatic Drainage
Pretracheal and Paratracheal groups
Superficial System- Tissue beneath pleura vessels round lung borders and fissures to reach hilum numerous Valves
Deep System- Bronchial Tree; Pulm Vessels hilum- drain into Bronchopulmonary Nodes less no. of Valves
Rt and Lt Paratracheal LN unite with Internal Thoracic and Brachiocephalic LN

39. Nerve Supply Parasympathetic ( Vagus) Sympathetic
Nerve Supply
Parasympathetic ( Vagus)
Motor to bronchial muscle – bronchospasm
Secretomotor to mucous gland
Sensory- stretch and Cough Reflex
Sympathetic
Cervical Ganglion and Spinal N. T2 – T5
Inhibitory to smooth muscle and glands

40. Applied Anatomy Tracheostomy Bronchoscopy Foreign Body In Respi Tract
Applied Anatomy
Tracheostomy
Bronchoscopy
Foreign Body In Respi Tract

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