What vertebral level does the trachea start and end at?
C6 to T4/T5
What is the name of the hooked cartilage at the bottom of the trachea?
Carina
What are the three divisions of the bronchi?
Primary - Lobar - Segmental
What are the cartilaginous structures found at the top of the airway?
Thyroid Cartilage Cricoid Cartilage (from resp 1/2)
What is the clinical significance of the gap between these two structures?
In an emergency situation, a cricothyroidotomy can be performed by piercing a hole in the median cricothyroid ligament.
How are the two primary bronchi different?
The right bronchus has a larger diameter and is more vertical
How many bronchopulmonary segments are there per lung?
10
What do the vessels, nerves and bronchi from the mediastinum have to pass through to get to the lungs?
Root/Hilum of the lung.
Where is the apex of the lung?
3-4 cm above the level of the first costal cartilage
What are the three edges of the lung?
Anterior, Posterior, Inferior
What are the three surfaces of the lung?
Costal, Mediastinal, Diaphragmatic
What does the diaphragm separate?
Right lung from the right lobe of the liver
Left lung from the left lobe of the liver, the stomach and the spleen
What is found above and behind the cardiac impression on the mediastinal surface of the lung?
The hilum of the lung where the vessels, bronchi and nerves enter the lung from the mediastinum
Describe the arrangement of the vessels and bronchi in the hilum of the lung.
The pulmonary artery is superior to the pulmonary veins. Bronchus is generally superior. The left bronchus divides into lobar bronchi within the lung. The right bronchus may divide into lobar bronchi in the hilum (before entering the lung).
Name the lobes in the right and left lung.
Right = superior, middle and inferior
Left = superior, inferior
Name the fissures separating the lobes.
Right:
Superior from Middle = horizontal
Middle from Inferior = oblique
Left:
Superior from Inferior = oblique
What structures enter of leave the hilum of the lung?
Pulmonary artery, pulmonary veins, bronchus, pulmonary nerve plexus, lymph vessels and nodes
What is the pulmonary ligament?
Inferior fold of pleura (below the hilum)
Where do the visceral and parietal pleura become continuous?
At the hilum of the lungs
What is the gap between the inferior surface of the lung and the inferior surface of the pleura called?
Costo-diaphragmatic recess
What are the attachments of the diaphragm?
Costal margin
Xiphoid process
Ends of ribs 11 and 12
Lumbar vertebrae
How do the dimensions of the thoracic cavity change when inspiring?
Anteroposterior diameter increases
Transverse diameter increases
What causes expiration?
Expiration is PASSIVE - it is caused by the natural recoil of the lungs
What happens in forced expiration?
The abdominal muscle contracts pushing the abdominal viscera against the diaphragm and pulling the costal margin down
What are the structures associated with the sternal angle?
RATPLANT
Rib 2
Aortic Arch
Tracheal Bifurcation/Carina
Pulmonary Trunk
Ligamentum arteriosum/Left recurrent
laryngeal loops under aortic arch
Azygos vein drains into SVC
Nerves (cardiac plexus)
Thoracic duct empties into Left
Subclavian Vein
What is the pleura?
A thin layer of flattened cells supported by connective tissue that lines each pleural cavity and covers the exterior of the
lungs
What is the pleural cavity?
Potential space between the visceral and parietal pleura. Allows lungs to glide and contains serous fluid.
Describe innervation and vasculature of the pleura?
Visceral Pleura
Not sensitive to pain, temperature, touch
Sensory fibres detect stretch
Bronchial arteries
Parietal pleura
Well localised pain, sensitive to temperature and touch
Phrenic and intercostal nerves
Intercostal arteries
Surface landmarks of the right pleura?
Down to xiphoid process (6th CC)
MCL 8th rib
MAL 10th rib (lowest point of costal margin)
Scapular line (line at the border of erector spinae muscles) at 12th rib
6-8-10-12
Surface landmarks of the lung?
After xiphoid process (6th CC),
lung is 2 ribs above pleura
MCL 6th rib
MAL 8th rib
Scapular line 10th
6-6-8-10
Surface landmarks of the fissures/lobes?
Oblique: from T3 posteriorly to 6th CC at MCL
Horizontal: from 4th CC on the right to meet oblique fissure at MAL