Human Anatomy

Lec. 11/ Dr. Mortadha Sami

The Pleura
The pleura refers to the serous membrane that lines the lungs and thoracic cavity. It
permit efficient and effortless respiration.

Structure of the Pleura

There are 2 pleurae in a human body that lie within the chest cavity. A pleura is a
serous membrane (a layer of simple squamous cells supported by connective tissue
also known as the mesothelium). Each pleura can be divided into two parts:
A. Visceral Pleura The visceral pleura covers the outer surface of the lungs, and
extends into the interlobar fissures. The visceral pleura is not sensitive to pain,
temperature or touch and it is continuous with the parietal pleura at the hilum of
each lung (this is where structures enter and leave the lung).
B. Parietal Pleura The parietal pleura covers the internal surface of the thoracic
cavity. It is thicker than the visceral pleura and it is sensitive to pressure, pain,
and temperature. The parietal pleura can be subdivided according to the part of
the body that it covers:
1. Mediastinal pleura: Covers the lateral aspect of the mediastinum.
2. Cervical pleura: Lines the extension of the pleural cavity into the neck.
3. Costal pleura: Covers the inner aspect of the ribs, costal cartilages, and
intercostal muscles.
4. Diaphragmatic pleura: Covers the thoracic surface of the diaphragm.
These two parts are continuous with each other at the hilum of each lung. There is a
potential space between the viscera and parietal pleura, known as the pleural cavity
contains a small volume of serous fluid to lubricate the surfaces of the pleurae,
allowing them to slide over each other. The serous fluid also produces a surface
tension, pulling the parietal and visceral pleura together. This ensures that when the
thorax expands, the lung also expands, filling with air.

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Mediastinum
 Mediastinum (from medieval Latin: mediastinus, which means 'midway') is a
division of the thoracic cavity, located between the lungs
 It contains all the principal tissues and organs of the chest except the lungs.
 It extends from the sternum, back to the vertebral column and is bounded laterally
by the pericardium (the membrane enclosing the heart) and the mediastinal
pleurae.
 The mediastinum contains the heart, thymus gland, portions of the esophagus,
trachea, thoracic duct, lymph nodes, large blood vessels, the vagus and phrenic
nerves.
 For clinical purposes it is divided into the anterior, middle, posterior, and
superior regions.

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Trachea
 The trachea is a mobile cartilaginous and membranous tube, descends in the
midline of the neck.
 It begins in the neck as a continuation of the larynx at the level of the 6th cervical
vertebra.
 In the thorax, the trachea ends below at the carina by dividing into right and left
bronchi at the level of the sternal angle (opposite the disc between the 4th and 5th
thoracic vertebrae).
 The fibroelastic tube is kept patent by the presence of U-shaped bars (rings) of
hyaline cartilage embedded in its wall.
 The posterior free ends of the cartilage are connected by smooth muscle, the
trachealis muscle.

The blood supply of the trachea

 Upper two thirds the inferior thyroid arteries.
 Lower third the bronchial arteries.
Nerve supply of the trachea
 Sensory nerve supply from the vagus and the recurrent laryngeal nerves.
 Sympathetic nerves supply the trachealis muscle.

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The Bronchi
 In the mediastinum, at the level of the fifth thoracic vertebra, the trachea divides
into the right primary bronchus and left primary bronchus (Pleural: Bronchi)
 The bronchi divides into smaller and smaller passageways, giving rise to several
million terminal bronchioles that terminate in tiny air sacs called alveoli.
 The right bronchus (the main) is wider, shorter than the left and is about 2.5
cm long. It divides into the superior, middle and inferior lobar bronchi. It has
a higher incidence of foreign body inhalation due to its wider shape and more
vertical course.
 The left bronchus is narrower, longer than the right and is about 5 cm long. The
left bronchus divides into superior and inferior lobar bronchi.

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The Lungs
The lungs are the organs of respiration. They are located in the thorax, on either side
of the mediastinum. The function of the lungs is to oxygenate the blood. They
achieve this by bringing inspired air into close contact with oxygen-poor blood in
the pulmonary capillaries.

Anatomical Position and Relations

 The lungs lie on either side of the mediastinum, within the thoracic cavity.
 Each lung is surrounded by a pleural cavity, which is formed by the visceral and
parietal pleura.
 They are separated from each other by the heart and great vessels and other
structures in the mediastinum .
 They are suspended from the mediastinum by the lung root which is a collection
of structures entering and leaving the lungs. Each root contains a bronchus, a
pulmonary artery, two pulmonary veins, bronchial vessels, pulmonary plexus of
nerves and lymphatic vessels. All these structures enter or leave the lung via the
hilum a wedge-shaped area on the mediastinal surface of the lung.
 The medial surfaces of both lungs lie in close proximity to several mediastinal
structures:
Left Lung Right Lung
 Heart  Heart
 Esophagus  Esophagus
 Arch of aorta  Inferior vena cava
 Thoracic aorta  Superior vena cava

Lung Structure
The lungs are roughly cone shaped, with an apex, base, three surfaces and three
borders. The left lung is slightly smaller than the right; this is due to the presence of
the heart.
Each lung consists of:
1. Apex: Each lung has a blunt apex, which projects upward, above the level of
the 1st rib and into the floor of the neck for about 2.5 cm above the clavicle.
2. Base: The inferior concave surface of the lung, which sits on the diaphragm.
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 3. Lobes (two or three): These are separated by fissures within the lung.
4. Surfaces (three): These correspond to the area of the thorax that they face.
They are named a convex costal surface (which corresponds to the concave
chest wall), a concave mediastinal surface (which is molded to the
pericardium and other mediastinal structures), and a concave diaphragmatic
surface.
5. Borders (three): the anterior, inferior and posterior borders.

Lobes
The right and left lungs do not have an identical lobular structure:
 The right lung has three lobes; superior, middle and inferior. These lobes are
separated from each other by two fissures:
a) Oblique fissure.
b) Horizontal fissure.
 The left lung has only two lobes, superior and inferior, which are separated by
an oblique fissure.

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Bronchial Tree
 The bronchial tree is a series of passages that supplies air to the alveoli of the
lungs. It begins with the trachea, which divides into a left bronchus and a right
bronchus.
 Each bronchus enters the root of the lung, passing through the hilum. Inside the
lung, they divide to form lobar bronchi supplying each lobe.
 Each lobar bronchus then further divides into several tertiary segmental bronchi.
 Each segmental bronchus provides air to a bronchopulmonary segment, these are
the functional units of the lungs.
 The segmental bronchi give rise to many conducting bronchioles, which
eventually lead into terminal bronchioles. Each terminal bronchiole gives off
respiratory bronchioles, which ends in a thin-walled pocket that extend from their
lumens. These are the alveoli, the site of gaseous exchange.

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Blood Supply of the lungs
 The lungs are supplied with deoxygenated blood by the paired pulmonary
arteries. Once the blood has received oxygenation, it leaves the lungs via
four pulmonary veins (two for each lung).
 The bronchi, lung roots, visceral pleura and supporting lung tissues require an
extra nutritive blood supply. This is delivered by the bronchial arteries, which
arise from the descending aorta.
 The bronchial veins provide venous drainage. The right bronchial vein drains
into the azygos vein, whilst the left drains into the accessory hemiazygos vein.

Nerve Supply
The nerves of the lungs are derived from the pulmonary plexuses. They feature
parasympathetic, sympathetic and visceral afferent fibers:
 Parasympathetic: derived from the vagus nerve. They stimulate secretion from
the bronchial glands, contraction of the bronchial smooth muscle, and
vasodilation of the pulmonary vessels.
 Sympathetic: derived from the sympathetic trunks. They stimulate relaxation of
the bronchial smooth muscle, and vasoconstriction of the pulmonary vessels.
 Visceral afferent: conduct pain impulses to the sensory ganglion of the vagus
nerve.