14 Lungs

Learning Objectives: At the end of this topic you should be able to: Identify the anatomical features of the lungs, trachea and bronchial tree. Explain the concept of a bronchopulmonary segment. Air enters and leaves the lungs via the nasal cavity, pharynx, larynx, trachea and bronchi.

Lungs Gross Anatomy

Pleura The lungs and surface of the pleural cavities are covered by a thin skin called the pleural membrane. The lungs are covered by visceral pleura. The cavity is lined by parietal pleura. The visceral and parietal pleura are continuous at the root of the lung. The parietal pleura is described as costal pleura, diaphragmatic pleura or mediastinal pleura, depending on its location

Figure 14-01 Visceral and Parietal pleura in transverse section.

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Figure 14-02 Visceral and Parietal Pleura in coronal section. The lungs are composed of the bronchial tree, the alveoli and the dense vascular network that invests the alveoli. The left lung is divided into two lobes by the oblique fissure. The right lung is divided into three lobes by the oblique and horizontal fissures. Lungs are innervated by sensory nerves and both sympathetic (pleural plexus) and parasympathetic (Vagus) nerves.

Figure 09-03 Lungs, frontal view. 178

Trachea
The trachea is about 11 cm long and is continuous with the larynx. It sits in the superior mediastinum, posterior to the sternum and anterior to the esophagus. It is composed of 16-20 cartilaginous rings, which are incomplete posteriorly. Between each ring, and along its posterior aspect the tracheal wall is composed of a fibro-muscular membrane. A smooth muscle the trachealis muscle, is embedded in the membrane between the ends of the cartilages posteriorly. The trachea is 20 -25 mm in diameter in the adult. It is 3 mm in diameter in the infant. In children, the diameter of the trachea in mm is approximately equal to the childs age.

Figure 14-04 Larynx, trachea and primary bronchi.

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The trachea is lined by a ciliated epithelium. Sero-mucous glands provide a sticky secretion which traps inhaled debris. The cilia beat towards the upper end of the trachea, moving the secretions and trapped debris out of the respiratory system. At its inferior end, posterior to the sternal angle, the trachea divides into two major (primary) bronchi.

Figure 14-05 Trachea, Cross section.

Bronchial Tree
The structure of the main bronchi is similar to that of the trachea, except that, beginning with the secondary bronchi, the cartilaginous rings are complete. The main bronchi divide into the lobar bronchi three on the right and 2 on the left, The lobar bronchi divide into segmental bronchi 10 on the right and 8-9 on the left. Each segmental bronchus supplies a bronchopulmonary segment a discrete unit of the lung separated from other segments by a fibrous septum (wall).

Figure 14-06. Bronchopulmonary segments. Images from Grants Atlas of Anatomy

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BRONCHOPULMONARY SEGMENT: The bronchopulmonary segment is the anatomical, functional, and surgical unit/subdivision of the lung and refers to the portion of the lung supplied by each segmental/tertiary bronchus and segmental/tertiary artery. It consists of the segmental/tertiary bronchus, a segmental branch of the tertiary artery, a segment of the lung tissue, and the surrounding connective-tissue septum. The bronchopulmonary segment is important because a surgeon can remove one segment without seriously disrupting surrounding segments.
http://www.healthsystem.virginia.edu/Internet/Anesthesiology-Elective/airway/glossary.cfm

The right main bronchus is slightly larger than, and angled more vertically than the left main bronchus. Because of this, foreign objects that enter the trachea are more likely to be lodged in the right bronchus than in the left. In the adult there are about 24 generations of divisions from the main bronchi to the respiratory bronchioles. As the bronchi continue to divide, their structure changes. The cartilaginous rings become plates, and then disappear altogether when they are about 1 mm in diameter. At this stage they consist of muscular tubes called bronchioles. The bronchioles end in respiratory bronchioles, which lead to alveolar ducts and the alveoli, where exchange of respiratory gasses (oxygen and carbon dioxide) takes place.

Figure 14-07. Divisions of the bronchial tree.

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Figure 14-08 Schematic diagram of bronchiolar tree leading to alveoli. Image Courtesy of Dr. A. Narvane. from: http://it.spcollege.edu:8500/edtech/instructorResources/RLO/RLO_Objects/staticRLO/na ravane/RESPIRATORYHISTOLOGY/

Alveoli
There are approximately 7 million alveoli whose total surface area is 70-90 square meters. Alveolar walls are composed of a single layer of epithelial cells resting on a thin basement membrane. The walls are invested by an elaborate network of thin-walled capillaries approximate total length of 1000 miles. Two major types of cells compose the epithelium, thin epithelial cells: Type I pulmonary cells, (or Type I pneumocytes), across whose walls gas exchange takes place, and surfactant-producing cells (Type II pneumocytes). The pulmonary surfactant decreases the surface tension of the fluid on the alveolar surfaces by 5-10 fold. Without surfactant, the surface tension would require exhaustive muscular effort to overcome during inspiration. When infants are born prematurely, before surfactant is produced, they have great difficulty breathing. They become exhausted and suffer fetal respiratory distress syndrome. 182

A Image courtesy of Dr. A. Narvane. from: http://it.spcollege.edu:8500/edtech/instructorResources/RLO/RLO_Objects/staticRLO/na ravane/RESPIRATORYHISTOLOGY/

B Figure 14-09 A Histological section of several alveoli showing type I pneumocytes (blue arrows) and type II pneumocytes (green arrows). B Illustration of alveolar sac.

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NOTES

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