2 Pleura The pleura is divided into two major types, based on location: 1. Parietal pleura2. Visceral pleuraEach pleural cavity is the potential space enclosed between the visceral and parietal pleurae.
4 Parietal pleura 1. Costal part 2. Diaphragmatic part 3. Mediastinal part4. Cervical part
5 Parietal pleura has 4 parts Costal pleura- Lining internal surface of thoracic wallMediastinal pleura- Covering sides of mediastinumDiaphragmatic pleura- Covering superior surface of dome of each hemidiaphragmCervical pleura- A dome of pleura extending superiorly into superior thoracic aperture
7 Visceral pleura Covers the lungs Cannot be dissected from lung Insensitive to pain
8 Nerve Supply of the Pleura The parietal pleura is sensitive to pain, temperature, touch, and pressure and is supplied as follows:The costal pleura is segmentally supplied by the intercostal nerves.The mediastinal pleura is supplied by the phrenic nerve.The diaphragmatic pleura is supplied over the domes by the phrenic nerve and around the periphery intercostal nerves.
9 visceral pleuraThe visceral pleura covering the lungs is sensitive to stretch but is insensitive to common sensations such as pain and touch. It receives an autonomic nerve supply from the pulmonary plexus .
13 Pleural effusion Excess fluid that accumulates in pleural cavity Can impair breathing by limiting the expansion of lungs during inhalationTypesSerous fluid (hydrothorax)Blood (hemothorax)Chyle (chylothorax)Pus (pyothorax or empyema)
15 Pleural effusion Chest x ray(PA View) At least 300 ml of fluid must be present before upright chest films can pick up signs of pleural effusion
16 ThoracocentesisTo obtain a sample of pleural fluid or to remove blood or pus or airTo avoid damage to intercostal nerve and vessels, needle is inserted superior to rib, high enough to avoid collateral branchesIt is performed at Mid-Axillary Line, one or two intercostal spaces below the fluid level but not below the ninth intercostal space.The ideal site is eighth, or ninth intercostal space, and this site avoids possible accidental puncture of the lung, liver, spleen, and diaphragm.
20 LungsThe right lung is normally a little larger than the left lung because the middle mediastinum, containing the heart, bulges more to the left than to the right.Each lung has a half-cone shape, with a base, apex, two surfaces and three borders.1. Base2. Apex3. The two surfaces: Costal surface, mediastinal surface4. Three borders: Inferior border , Anterior and Posterior borders
22 Hilum of the lung 1.Pulmonary artery 2. Two pulmonary veins 3. Main bronchus4. Bronchial vessels5. Nerves and lymphatics.
23 Right lung The right lung has three lobes and two fissures. Fissures 1. Oblique fissure2. Horizontal fissure
24 Anatomy of the right lung displaying its two main fissures the horizontal and the oblique
25 Medial surface of the right lung 1. Heart2.Inferior vena cava3.Superior vena cava4.Azygos vein5.Esophagus
26 Left lungThe left lung is smaller than the right lung and has two lobes separated by an oblique fissure.On the anterior surface of the lower part of the superior lobe a tongue-like extension (the lingula of left lung) projects over the heart bulge.
27 Anatomy of the left lung displaying its fissure that separates it into two lobes upper and lower lobes
28 Medial surface of the left lung 1.Heart2.Aortic arch3.Thoracic aorta4. Esophagus
30 Trachiobronchial Tree TracheaBronchiRight and left [primary]Lobar [secondary] [3 or 2]Segmental [Tertiary] BronchioleTerminalRespiratoryAlveoliAlveolar ductAlveolar Sac
31 Bifurcation of the trachea Trachea bifurcates→ two main stem bronchi, right and leftCarina- keel-like ridge between two openings of main stem bronchiMain stem bronchus divides into lobar bronchi3 lobar bronchi on right: upper, middle, and lower2 lobar bronchi on left: upper and lowerEach lobar bronchus branches into segmental bronchi that supply a bronchopulmonary segment
32 The bifurcation of the trachea as seen through an operating bronchoscope
33 Aspiration of Foreign Bodies If food, liquids, or foreign bodies are aspirated, they often will lodge in the right mainstem bronchus.Because right bronchus is wider and shorter and runs more vertically than left bronchusEncountered by dentistsAspiration of piece of tooth, filling material, or a small instrument.If the endotracheal tube used for intubation is inserted too far, it usually lodges in the right mainstem bronchus. This allows ventilation of the right lung, but leaves the left lung useless.
34 Vasculature of lungs 2 sets of Blood Supply 1.Pulmonary Vessels: for Gas Exchange2. Bronchial Vessels: for blood supply to lung substance like any other organ
35 Pulmonary Vessels Pulmonary artery Pulmonary veins Carries unoxygenated blood from heart to lungsEach artery gives lobar and segmental arteriesPulmonary veinsIntrasegmental veins drain to intersegmental veins in pulmonary septa, which drain to two pulmonary veins for each lungCarry oxygenated blood from lungs to heart