The Lungs

Dr. J. Shaik

Main function is oxygenation of venous blood Healthy lungs are light, soft and spongy Very elastic organs Each lung has its own pleural sac

Lungs are attached to the heart and trachea by pulmonary arteries, pulmonary veins and bronchi (these are found at the root of the lungs) and to the pericardium by the pulmonary ligaments Each lung has an apex, base, root and hilum (hilus)

Apex of the lungs:

- Rounded, tapered

superior end - Extends 3 cm above the first rib and medial clavicle - Most superior part is protected only soft tissue - Apex of the lung is crossed by the subclavian artery

Base of the lungs:

- Concave surface

which is related to the dome of the diaphragm - Base of right lung is deeper than left - Inferior border enters costodiaphragmatic recess

Root and hilum of the lungs:

- Root serves as attachment

of the lung - Connects medial surface of the lungs to the heart and trachea - Hilum is where the root is attached to the lung - Contains the main bronchus, pulmonary vessels, bronchial vessels, lymph vessels and nerves

Lobes and Fissures of the lungs: Left lung: - Divided into upper (superior) and lower (inferior) lobes by oblique fissure - Superior lobe has cardiac notch on anterior surface to allow for the bulge of the heart - Inferior lobe is larger than the superior lobe

Right lung:

- This is divided into

upper (superior), middle and lower (inferior) lobes by horizontal and oblique fissures - Superior lobe is smaller than in the left lung - Middle lobe is wedgeshaped

Bronchi:

- One main
bronchi to each lung - Bifurcate from trachea at level of sternal angle and enter lungs at the roots

Bronchial wall are supported by C-shaped rings of cartilage The bronchus accompanies the pulmonary artery to the hilum of the lungs where it subdivides into a characteristic pattern, the bronchial tree Right main bronchus is wider, shorter and more vertical then the left; it is about 2.5 cm long and passes directly to the root of the lungs Left main bronchus is 5 cm long and passes inferolaterally

Each main bronchus divides into secondary or lobar bronchi (2 on left and 3 on right) each supplies a lobe of the lung Each lobar bronchi divides into tertiary bronchi or segmental bronchi which supply specific segments of the lungs called bronchopulmonary segments

Arterial Supply to the Lungs

Pulmonary arteries arise from the pulmonary trunk Distribute deoxygenated blood to the lungs for aeration Give a branch to the superior lobe before entering the hilum Each pulmonary artery sends a branch to the lobar and segmental bronchi Terminal branches of the pulmonary artery divide into capillaries in the walls of the alveoli where gas exchange takes place

Bronchial arteries: - Supply blood to connective tissue of the bronchial tree - The 2 left bronchial arteries arise from the superior part of the thoracic aorta - The single right bronchial artery arises as a common trunk with the 3rd (or 5th ) posterior intercostal artery or from the superior left bronchial artery

Venous drainage of the Lungs

Pulmonary veins carry oxygenated blood from the lungs to the heart (left atrium) Begins in the pulmonary capillaries, the veins unite into larger vessels A main vein drains each bronchopulmonary segment The bronchial veins drain large subdivisions of the bronchi; right bronchial vein drains into the azygous vein and the left bronchial vein drains into the accessory hemiazygous vein or into the left superior intercostal vein

Lungs and visceral pleura are innervated by the anterior and posterior pulmonary plexus which are located anterior and posterior to the roots of the lungs The contain vagal (parasympathetic) and sympathetic fibers

Efferent fibers of the vagus nerve:

- smooth muscle of
the bronchial tree bronchoconstrictor - Inhibitor to pulmonary vessels vasodilator - Secretor to glands of the bronchial tree secretomotor

Right vagus nerve Afferent fibers of the vagus nerve: - Sensory to respiratory epithelium (touch and pain) and to branches of the bronchial tree (stretch)

Thoracic sympathetic trunk Efferent fibers of the sympathetic trunk: - Inhibitor to bronchial muscle (bronchial dilator) - Motor to pulmonary vessels (vasoconstrictor) - Inhibitor to glands of bronchial tree Function of afferent sympathetic fibers is unknown

Lymph drainage of the lungs: Superficial lymphatic plexus: - Lies deep to visceral pleura - Lymph vessels drain into bronchopulmonary lymph nodes (hilum) which drain into the tracheobronchial lymph nodes (bifurcation of the trachea) these drain the lungs and visceral pleura

Deep lymphatic plexus: - Located in submuscosa of the bronchi - Drain into pulmonary lymph nodes (along large branches of main bronchi) bronchopulmonary lymph nodes tracheobronchial lymph nodes (trachea and main bronchi) broncheomediastinal lymph trunks (right and left) which terminate at the junction of the subclavian and internal jugular veins