Basic Pulmonary Anatomy

dr. Redha Cipta Utama

Respiratory System

Upper Airways

Nose
Paranasal sinuses
Pharynx

Lower Airway

Begins with true

vocal cords and
extends to alveoli
Larynx
Trachea
Main stem bronchi
Segmental bronchi
Subsegmental
bronchi

Bronchioles
Terminal
bronchioles
Respiratory
bronchioles
Alveolar ducts
Alveolar sacs
alveoli

The Functions of the Nose

Filter the air

Humidify the air
Warm the air
Site for sense of
small
To generate
resonance in
speech

The Nose

Rigid structure composed of

cartilage and bone
Septal cartilage divides nasal
cavity into two nasal fossae
Palate divides nasal cavity and oral
cavity
Nose divided into 3 regions

Nasal structure

Nares and Nasal Cavity

Regions of the nose

Nares or nostrils serve as opening

for the nasal fossaetwo cavities in
middle of the face
Vestibule/vestibular region

Lined with stratified squamous

epithelium
Contain vibrissae-nasal hair, first
line of defense, function to filter
inspired air

Sagital section of the head

Nasal regions

Vestibular area contains sebaceous

glands; secrete sebum
Keeps vibrissae soft and filter gases
Olfactory region:
region pseudostratified
columnar epithelium and olfactory
cells

Regions of the nose

Respiratoryhighly vascular;
ciliated, pseudostratified
columnar epithelium

Contains turbinates or conchae;

increase surface area (166 cm2) for
humidification, heating/cooling and
filtering of air
Mucous membranes provide up to 6501000 ml of water/day to humidify air

Respiratory region of nose

Goblet cells in mucus membrane

secrete 100 ml/day of mucous; aids
in trapping inspired particles and
prevents them from entering lower
respiratory trace
Each columnar cell contains 200250 cilia; beat in waves toward
oropharynx (mouth), 2cm/min

Sinuses

Air-filled cavities within the skull

(cranium)
Aka paranasal sinuses (four pairs)
Function not clear, lighten head and
provide voice resonance
Lied with pseudostratified cliated
columnar epithelium and goblet cells

Paranasal Sinuses

Oral Cavity

Alternate respiratory passage

Anterior 2/3 of tongue located in
oral cavity
Another respiratory muscle
Lined with stratified squamous
epithelium

+Pharaynx

(Throat), hollow, upper portion of

the airway and the digestive tract
Subdivided into: nasopharynx,
oropharynx, laryngopharynx

Nasopharynx

Pseudostratified ciliated columnar

epithelium

Pharynx

Nasopharynx

Filters bacteria and foreign

particles from inspired air
Carries this to the stomach
Eustachian tube and auditory tube
open into lateral surfaces, connect
nasopharynx to middle each,
equalizes pressure of middle ear

Nasopharynx

Oropharynx

Between soft palate above and

base of tongue below
From tip of uvula to epiglottis
Stratified squamous epithelium
Gas conduction, filtering of air
Defense mechanism: gag reflex

Oropharynx

Laryngopharynx

Stratified squamous epithelium

Gas conduction
Connecting zone between upper
and lower airway (vocal cords and
below)

Lower Airway

Begins with true

vocal cords and
extends to alveoli
Larynx
Trachea
Main stem bronchi
Segmental bronchi
Subsegmental
bronchi

Bronchioles
Terminal
bronchioles
Respiratory
bronchioles
Alveolar ducts
Alveolar sacs
alveoli

Larynx

Lies between base of tongue and

trachea
Protrusion is the thyroid cartilage,
aka Adams apple.
Houses the vocal cords, primary
use is vocalization
Connection point-upper and lower
airways

Larynx

Larynx

Extends from C3
to C6
Pseudostratified
ciliated columnar
epithelium
Functions:

Free flow of air to

the lungs

During inspiration,
vocal folds abduct,
move apart, and
widen glottis
Valsalva
maneuver and
Muller maneuver

Larynx

Composed of 3 single
cartilaginous structures:

Epiglottis-flap, swings
down to meet larynx
during swallowing

Thyroid-bulk of this forms

larynx

Cricoid-circular, keeps
head of trachea open

Larynx Posterior view

Epiglottis

Covers the rima glottidis during

swallowing (glottis=cords & space)
Larynx has poor lymphatic drainge,
prone to edema
Epiglottitis is a life-threatening
condition (supraglottic croup),
bacterial origin
Narrowest part of lower airway in adult

Glottis

Thyroid

Largest of the laryngeal cartilages

Primary housing the vocal cords
Inflammation below the vocal cords
known as laryngotracheobronchitis

Croup
Subglottic croup
Viral orgins

Cricoid

A complete cartilaginous ring

Narrowest portion of the lower
airway in a neonate and infant
Actual start of the lower airway

Larynx superior view

Tracheobronchial Tree

Series of branching
airways commonly
referred to a
generations or
orders
The first generation
or order is zero (0),
the trachea itself.
Bifucrates at the
carina

Two Types of Airways

Cartilaginous
-serve only to
conduct air
between external
environment and
the sites of gas
exchange

Non-cartilaginous

-serve both as
conductors of
inspired air and as
sites of gas
exchange

Tracheobronchial Tree

Dichotomous branching (daughter

branches)
Airways become progressively
narrower, shorter, and more
numerous
Cross-sectional area enlarges
Common histology (at the nose) and
throughout until the bronchiole
generation

Histology

Three major layers

Epithelial lining

Lamina propria

Cartilaginous layer

Histology

Tracheal lining

Pseudostratified columnar
epithelium with cilia; goblet cells,
serous cells, and specialized
submucosal bronchial glands
200+ cilia per cell, 5-7 microns long
Beat cephalid (head) toward
oropharynx

Tracheal Lining

Epithelial lining

Pseudostratified ciliated columnar

epithelium is homogenous until the
level of the bronchioles
Cilia disappear in terminal
bronchioles
Cilia absent in respiratory
bronchioles

Histology

Mucous blanket

Covers the epithelial lining

Composed of

-95% water
-glycoproteins
Carbohydrate lipids
DNA
Cellular debris

Mucous

Mucus produced by

Goblet cells
Found through terminal bronchioles
Submucosal (bronchial) glands
extend into laminar propria
Innervated by vagus nerve
(parasympathetic)
Produce 100 ml of secretions/day
Disappear at end of terminal bronchioles

Mucous Blanket

Two distinct layers

Sol layer
Gel layer

Cilia move through

sol layer and strike
gel layer propelling
it toward mouth
At a rate of 2
cm/minute

Mucocilliary Escalator

Defense mechanism of lower

airways
Mucus propelled up airway to
larynx
Cough mechanism moves
secretions into oropharynx via
sheering forces

Mucociliary transport &

cough

Factors Which Slow

Mucocilliary Transport

Cigarette smoke
Dehydration
Positive pressure
ventilation
Endotracheal
suctioning
High inspired
oxygen
concentrations

Hypoxia
Atmospheric
pollutants
General
anesthesia
Parasympatholyti
c drugs

Lamina Propria

Submucosal layer
Contains loose fibrous tissue with

Tiny blood vessels

Lymphatic vessels
Branches of the vagus nerve
Two sets of smooth muscle fibers
which continue/extend down to
alveolar ducts

Lamina propria

Mast cells

Found in lamina propria near

Branches of vagus nerve and blood

vessels
Scattered throughout smooth muscle
Loose connective tissue of skin and
intestinal mucosa
Cell constituents of submucosal glands

Important part of humoral immune response

(circulating antibodies) which defend
against antigens

Mast Cells

Release histamine

Cartilaginous Layer

Outermost layer of
tracheobronchial tree
Consist of

Trachea
Mainstem bronchi
Lobar bronchi
Segmental bronchi
Subsegmental bronchi

Trachea

10-12 cm long
1.5-2.5 cm wide
Extends to second rib anteriorly
and T4-T5 posteriorly
15-20 C shaped rings

Main Stem Bronchi

Right bronchus

Wider
More vertical
5 cm shorter
Supported by C
shaped cartilages
20-30 degree
angle
First generation

Left bronchus

Narrower
More angular
Longer
Supported by C
shaped cartilages
40-60 degree
angle
First generation

Lobar Bronchi

R main stem
divides into:

Upper lobar
bronchus
Middle lobar
bronchus
Lower lobar
bronchus

L main stem
divides into:

Upper lobar
bronchus

Lower lobar
bronchus

Segmental Bronchi
3rd generation

R lobar divides
into

Segmental bronchi
10 segments on
right

L lobar divides
into

Segmental bronchi
8 segments on left

Subsegmental Bronchi

4th to 9th generations

Progressively smaller airways
1-4 mm diameter
At 1 mm diameter connective
tissue sheath disappears

Noncartilagenous Airways

Bronchioles

10-th to 15th
generation
Cartilage is absent
Lamina propria is
directly connected
with lung
parenchyma

Surrounded by
spiral muscle fibers
Epithelial cells are
cuboidal
Less goblet cells
and cilia
With no cartilage,
airway remains
open due to
pressure gradients

Terminal Bronchioles

16th to 19th generation

Average diameter is 0.5 mm
Cilia and mucous glands begin to
disappear totally
End of the conducting airway
Canals of Lambert-interconnect this
generation,provide collateral
ventilation

Gas exchange zone

Respiratory bronchioles
Acinus (aka primary acinus; aka
primary lobule)respiratory
bronchioles to the alveoli
Ducts, sacs, alveolar

Squamous epithelium

The Functional Units of

Gas Exchange

Functional Units of Gas

Exchange

Three generations of respiratory

bronchioles

Three generations of alveolar ducts

15-20 clusters--sacs

Gas exchange terminology

All of the structures arising from a

single terminal bronchiole are
called

Primary lobule
Acinus
Terminal respiratory unit
Lung parenchyma
Functional units

Acinus/Primary lobule

Respiratory bronchioles with some

alveoli arising from their walls

Alveolar ducts arise from

respiratory bronchioles--alveoli
whose septal wall contain smooth
muscle

Alveoli

Ca. 300 million alveoli

Between 75 to 300 in
diameter
Most gas exchange takes place at
alveolar-capillary membrane

Anatomic Arrangement of
Alveoli

85-95% of alveoli covered by small

pulmonary capillaires

The cross-sectional area or surface

area is approximately 70m2

Acinus or Lobule

Each acinus (unit) is approximately

3.5 mm in diameter
Each contains about 2000 aveloli
Approximately 130,000 primary
lobules in the lung

Acinus

Alveolar epithelium

Two principle cell types:

Type I cell, squamous pneumocyte

Type II cell, granular pneumocyte

Type I Cell

95% of the alveolar surface is

made up of squamous pneumocyte
cells

Between 0.1 and 0.5 thick

Major site of gas exchange

Type II Cell

5% of the surface of alveoli

composed of granular pneumocyte
cells
Cuboidal in shape with microvilli
Primary source of pulmonary
surfactant
Involved with reabsorption of fluids
in the dry, alveolar spaces

Type II Pneumocyte

Pore of Khon

Small holes in the walls of adjoining

alveoli (alveaolar septa)
Between 3 to 13 in diameter
Formation of pores may be due to:

Desquamation due to disease

Normal degeneration due to aging
Movement of macrophages leaving
holes

Canals of Lambert/Pores of
Kohn

Provide for collateral ventilation of

difference acinii or primary lobules
Additional ventilation of blocked
units
May explain why diseases spread
so quickly at the lung tissue
(paremchymal) level

Pores of Kohn

Alveolar macrophages

So-called Type III cell

Remove bacteria and foreign
particles
May originate as

Stem cells precursors in bone marro

Migrate as monocytes through the
blood and into the lungs

Intersitium/interstial space

Surround, supports, and shapes

the alveoli and capillaries
Composed of a gel like substance
and collagen fibers
Contains tight space and loose
space areas

Alveolar-Capillary Site-Interstitial Space

Interstitium

Water content in loose space can

increase by 30% before there is a
significant change in pulmonary
capillary pressure
Lymphatic drainage easily exceeded
Collagen limits alveolar distensibility
Area of scarring, making for stiffer or
non-compliant lungs

Blood Supply to the

Pulmonary System
Two Systems

Bronchial Blood Supply

Bronchial arteries

From aorta to temrinal bronchioles

Merge with pulmonary arteries and

capillaries

1% of total cardiac output (left

ventricle)

Bronchial arteries

Also nourish

Mediastinal lymph nodes

Pulmonary nerves
Some muscular pulmonary arteries
and veins
Portions of the esophagus
Visceral pleura

Bronchial venous system

1/3 blood returns to right heart

Azygous
Hemiazygous
Intercostal veins
This blood comes form the first two or
three generations of bronchi

Bronchial venous return

2/3 of blood flowing to terminal

bronchioles drains into pulmonary
circulation via bronchopulmonary
anastomoses
Then flows to left atrium via
pulmonary veins
Contributes to venous admixture
or anatomic shunt (ca. 5% of C.O.)

Pulmonary Vascular
System

The second source of blood to the

lungs
Primary purpose is to deliver blood
to lungs for gas exchange
Also delivers nutrients to cells distal
to terminal bronchioles
Composed of arteries, arterioles,
capllaries, venules, and veins

Pulmonary Capillaries

Walls are les than 0.1 thick

Total external thickness is about
10
Selective permeability to water,
electrolytes, sugars
Produce and destroy biologically
active substances

Lymphatic System

Lymphatic vessels
remove fluids and
protein molecules
that leak out of the
pulmonary
capillaries

Transfer fluids back

into the circulatory
system

Lymphatics

Lymphatic vessels arise within

loose spaces of connective tissue

Vessels then follow bronchial

airways, pulmonary airways,
pulmonary arteries and veins to
the hilum

Lymphatics

Vessels end in pulmonary and

bronchopulmonary lymph nodes
within and outside of lung
parenchyma
Nodes acts as filters to keep
particles and bacteria from
entering the blood

Lymphatics

Lymphatic vessels are not

in the walls of the alveoli.

Within the interstial spaces

to help drain fluids and
foreign materials.

More lymphatic vessels on

surface of lower lobes than
on upper and middle lobes
(dependent portions)

Lymphatic vessels

Thoracic duct
carries lymph fluid
coming from tissues
inferior to
diaphragm and from
left side of upper
body

Eventually empties
into left subclavian
vein

Lymphatic vessels

Right lymphatic duct drains the

right half of the body superior to
the diaphragm

Empties into the right subclavian

vein

THANKYOU
dr. REDHA CIPTA UTAMA