RESPIRATORY

SYSTEM
II

Rejtarová Olga

Department of Anatomy
PULMO - lungs
paired organ participating in respiratory process
respiratory cycle – 1. ventilation
2. diffusion of the air (gas)
3. transport to tissue via blood

half cone - shape

Lungs - basic parameters

weight: right lung - 3 lobes left lung - 2 lobes

600g / woman 500g / woman
650g / man 550g / man
size: (cm) 25

18 (depth)
12

volume: 4,5 – 6,5l

density: (0,35 – 0,75) it is <1….lighter than water

(forensic medicine – floating test)

colour: pale pink slate gray gray-black

pollutants accumulate in connective tissue……….. „marbling“

consistence: soft, spongy (fungous)

sensation of „crepitation“
 SURFACES – COSTAL, MEDIAL, DIAPHRAGMATIC
MARGINES – ANTERIOR, POSTERIOR, INFERIOR
FISSURES – HORIZONTAL, OBLIQUE

APEX PULMONIS (TOP)

superior lobe

superior lobe

INCISSURA CARDIACA
CARDIAC NOTCH

middle lobe inferior lobe

LINGULA PULMONIS

inferior lobe

BASIS PULMONIS
Fissures - horizontal
- oblique

*
* *
4 *
*
*
* *
6 *
* *
MEDIAL SURFACE (mediastinal) - lung hilum (6x3cm) + impressions of organs
common: impressio cardiaca (H), thymica (Thy), impressio costae primae (1.C), sulcus v.
brachiocephalicae (V.bc), impressio trachealis (Tr),sulcus a. subclaviae (A.scl),
impressio oesophagea (Oe)
pulmo dexter: pulmo sinister:
sulcus v. azygos (V.a) sulcus aorticus (Ao)
sulcus v. cavae superioris (VCS)

A.scl
Tr A.scl
V.bc
Tr 1.C
1.C V.bc
V.a
Thy

VCS
Thy

H
Ao Oe
H Oe
LUNG HILUM
Pulmonary gate with structures forming the root of the lung
radix pulmonis (bronchi, arteries, veins, nerves, lymphatic vessels and nodes)

ligamentum pulmonale

Right hilum – the shape of tennis racket Left hilum – the shape of hanging (pendent) drop

BAVV ABVV

BRONCHUS eparterial ARTERIA PULMONALIS sin.

ARTERIA PULMONALIS dx. BRONCHUS hyparterial

VENAE PULMONALES dx. VENAE PULMONALES sin.

LUNGS – bronchial tree
blood and lymphatic vessels
nerves
connective tissue
BRONCHIAL TREE TRACHEA

BRONCHUS PRINCIPALIS DEXTER (1) BRONCHUS PRINCIPALIS SINISTER (1)

primary

BRONCHUS LOBARIS SUP., MED., INF. (3) BRONCHUS LOBARIS SUP., INF. (2)
secundary

BRONCHUS SEGMENTALIS (10)

terciary

BRONCHUS SUBSEGMENTALIS
(intrasegmental)

BRONCHUS PRETERMINALIS (more than 1mm)

BRONCHIOLUS TERMINALIS (3-5)

BRONCHIOLUS RESPIRATORIUS (3)

ductus alveolaris
sacculus alveolaris
alveolus
 Bifurcation of trachea - Th 4-5 ( inspirium , expirium )
Angle of bifurcation: 70 - 80°
bronchus principalis dexter – shorter
wider
less tilted
75 % of aspiration of foreign bodies

LOBAR BRONCHUS - LOBE

branching of principal bronchus
! lobar borders are visible (pleura interlobularis)

SEGMENTAL BRONCHUS - SEGMENT

branching of lobar bronchus

! segmental borders are not visible
PULMONARY SEGMENT

Functional and morphological unit

of lungs

Functional unit:
Compartment of pulmonary tissue
ventilated by one segmental
bronchus which is accompanied
by one segmental artery

marbling Reason:

Morphological unit: Surgical

segmentectomy
Compartment of pulmonary tissue
in shape of pyramis Topical
with the top inversed to the hilum diagnosis
and the base inversed to the surface of the lung
This unit is separated by septal connective tissue More accurate
prognosis
Marbling – pigmental infiltration of lobular borders
PULMONARY SEGMENT - SCHEMA

In the middle
bronchus segmentalis
r. segmentalis a. pulmonalis

rr. bronchiales
vv. bronchiales
vasa lymfatica
nervi bronchiales

peripherally
venae pulmonales
 BRONCHIOLES

Originate by branching of small

bronchi (cross section – caliber of them
is smaller than 1 mm)

Changes in their structure:

Cartilage is absent
More smooth muscle
Columnar epithelium changes
into cubical epithelium
Cilia, goblet cells and glands
diminish
lobulus pulmonis secundarius – LOBULE
Ramification of terminal bronchiole
Pyramis deliminated by septal connective tissue (0,5 – 3cm) „marbling“

lobulus pulmonis primarius – ACINUS

Ramification of respiratory bronchiole
Smaller pyramis incompletely deliminated by septal connective tissue
Pulmonary acinus
terminal bronchiole Conductive part of bronchial tree
till TB

Respiratory part of bronchial tree

respiratory bronchiole from RB (occurrence of alveoli)

ductuli alveolares
sacculi alveolares
alveoli pulmonis

ALVEOLI PULMONIS
BLOOD – AIR BARRIER……gas exchange

area: 80m²
number : 300 milions
composition of wall : respiratory epithelium
comunication: Kohn´s pores, Lambert´s canals
Kohn´s pores (equalizing of pressure X inflammation spreading)
 PNEUMOCYTES – ALVEOLAR CELLS

Respiratory epithelium < BM

BM
20 nm

Vascular endotelium < ENDOTELIAL CELLS

small alveolar cell large alveolar cell
(membranous) (granulomatous)

surfactant
Two – layer substance (proteins, polysacharids, lipids)
Prenatal origin – 26. week
(prematurely born children – atelectatic lungs)

function: decrease surface tension

prevent of pulmonary atelectasis
(collaps) during inspiration
O2 CO2
 NUTRITIVE CIRCULATION - nutrition of bronchial tree, connective tissue, lymphatic nodes
respiratory br.
bronchial vv. bronchial rr.

V. AZYGOS, V HEMIAZYGOS AORTA (aortic arch, Th

aorta, intercostal post.aa.,
SVC, IVC thoracic int. a)
ATRIUM DX.
RV LV
------------------------------------- ATRIUM SINISTRUM -----------------------
PULMONARY TRUNC PULMONARY VV.
pulmonary aa. (dx., sin.)
principal br.

segmental aa.
segmental br. veins
arterioly
respiratory br.
precapillaries postcapillaries
alveolar ducts
capillaries alveoli
FUNCTIONAL CIRCULATION - oxygenation of blood
 AV

pulmonary a. pulmonary vv.

AV anastomosis
AA anastomosis
Lefort´s veins
(bronchopulmonary veins)
AA

rr. bronchiales
vv. bronchiales

RV RA AO LA
25% blood 75% blood
 INERVATION
sensory: n.phrenicus (parietal and hillar part of visceral pleura)
– lungs do not hurt

vegetative: n. vagus (n.X) rr. pulmonales (from ggl. cervicale med., inf)
PARASYMPATHETIC SYMPATHETIC
……………………………………………………………………………………………
bronchi contraction dilatation
vessels dilatation contraction

glands increased sectretion decreased secretion

……………………………………………………………………………………………
bronchial asthma – disturbance of vegetative system balance
LYMPHATIC DRAINAGE
lymphatic vessels - superficial
deep
Right lymph. trunk Thoracic duct
Bronchomediastinal tr. r. Bronchomediastinal tr. l.
lymphatic nodes

Tracheobronchial
- sup. (r.l.)

- inf.

Bronchopulmonal

Pulmonales

Connections !!!! parasternal n. ….. supraclavicular n.

mediastinal posterior n. ……... pancreaticolienal, coeliac n.
DEVELOPMENT OF EXTERNAL NOSE
4. week

Nasal fornix
Frontal fornix
-med.
-lat.

Fornix of the upper jaw

Fornix of the lower jaw stomodeum

DEVELOPMENT OF BRONCHIAL TREE

OBR. EMBRYOL.

FOREGUT (pharyngeal)

LARYNGOTRACHEAL BUD
- inception
- growth
- ramification
- luminization
TRACHEOEOSOPHAGEAL SEPTUM
VARIATIONS AND ANOMALIES

Deviations without clinical symptoms

with clinical symptoms

AGENESIS – undevelopment of organ (mistake in organ inception) X ACCESSORY ORGAN

HYPOGENESIS - imperfect development of organ

ATRESIS – organ without aperture (organ is not hollow, cavernous)

STENOSIS – tubular organ is narrowed X ECTASIS - dilatated organ

FISTULA – pathological communication

1. URT NOSE - deviation of nasal septum
cleft of the nose
choanal atresis
ductus nasolacrimal atresis

PNS - agenesis, size variation

2. LRT results of laryngotracheal bud damage

LARYNX – atresis
hypoplasis
inborn stridor - wheeze (vocal cords are in different hight)
saccus laryngis externus (rasping screams)

TRACHEA – agenesis
atresis
tracheooesophageal fistula

85%
BRONCHI, LUNGS
Mistake in inception and ramification
agenesis – unilateral accessory bronchi
bilateral (incompatible with life)
 lobar X lobus cardiacus dx.
 segmental lobus lingularis sin.
lobus v. azygoz (false)
hypoplasis
Mistake in lumuniation
atresis
stenosis x dilatation: bronchiectasis

situs inversus – opposite side localization

pulmonary sequestration (intralobar x extralobar)

result of persistent embryonal vessel from aorta to foregut,
this vessel separates part of lung – sequestr
(sequestr has anomalous blood circulation and
no connection with bronchial tree, but it is airy (Conś porus)
- the source of infection!)
Rokitanski´s lobe – atelectatic lobe (up from diaphragma, paravertebraly, on the left side)
PLEURAL CAVITY – development
coelom cavity - PERICARDIAL CAVITY
- PLEURAL CAVITY (paired canals)
transversal septum

- PERITONEAL CAVITY

MEDIASTINUM (middle compartment)

 PLEURA
Shiny serous membrane covered by mesotelium
 visceral
 parietal
PLEURAL CAVITY
capillary space
serouse fluid
pulmonary ligament

pleura costal
mediastinal
diaphragmatic
interlobar !
pleural cupola - dome
BORDERS OF THE LUNGS AND PLEURA ventral ± cranial ± dorsal
caudal borders are different

ventral borders: pleural cupola (apex pulmonis) to VI. SC joint (right side)
to VI costal cartilage (left side)

AREA INTERPLEURALIS
SUPERIOR (THYMICA)
II

IV IV

AREA INTERPLEURALIS
INFERIOR (CARDIACA)
VI
dorsal borders: 12. rib paravertebrally to pleural cupola

retrooesophageal recess

evagination of parietal pleura

behind the gullet: Th 12 – Th4

caudal border:
pleura extends 1 or 2 intercostal
spaces down (low)

Lung motion in recesses

Inspiration, expiration 12

+/- 1 IC space
1. LINEA MEDIOCLAVICULARIS 8. LINEA SCAPULARIS
2. LINEA PARASTERNALIS 9. LINEA PARAVERTEBRALIS
3. LINEA STERNALIS 10. LINEA MEDIANA POSTERIOR
4. LINEA MEDIANA ANTERIOR
5. LINEA AXILLARIS ANTERIOR
6. LINEA AXILLARIS MEDIA
7. LINEA AXILLARIS POSTERIOR
 LINEA MEDIOCLAVICULARIS
7th. rib

LINEA AXILLARIS ANTERIOR

8th. rib

LINEA AXILLARIS MEDIA

9th. rib

LINEA AXILLARIS POSTERIOR

10th. rib

LINEA SCAPULARIS
11th. rib

LINEA PARAVERTEBRALIS
12th. rib

7. 8. 9. 10. 11. 12.

PLEURAL RECESSES

 Evaginations - continuation
of individual sections of parietal
pleura
 Complementary spaces into
which the lungs put in during
deep inspiration but they never
did not fill up them entirely

*
RECESSUS
COSTODIAPHRAGMATICUS
(phrenicocostalis)
the most lowly located place *
accumulation of pathologic fluids

RECESSUS
PHRENICOMEDIASTINALIS *
RECESSUS
COSTOMEDIASTINALIS
 norm
Patological content in pleural cavity

FLUIDOTHORAX (fluid)
HEMOTHORAX (blood)

PNEUMOTHORAX (air) pneumothorax

 external
- communicating
- tension (the opening acts like a flap valve
retention of the air
displacement of mediastinum
to the healthy side
circulatory collaps)
 internal (disruption of the lung tissue
tension pneumothorax
and the visceral pleura)

Failure underpressure in pleural cavity

lung collaps
PUNCTION OF PLEURAL CAVITY

DORSAL ACCESS:

 VII. – VIII. IC space and higher (diaphragma)

 dorsally from dorsal axillary line (n. thoracicus longus)
 up from superior costal margin (V. A. N. intercostalis)

VENTRAL ACCESS:

 IV. IC space and higher (diaphragma)

 ventrally from anterior axillary line (n. thoracicus longus)
 in the half of IC space (rr. supracostales)
 2 cm laterally from sternum (a. thoracica interna)
APEX PULMONIS – 5 cm cranially upon of thoracic superior apperture
1 cm upon clavicule (fossa supraclavicularis minor)

PLEURAL CUPOLA – pleura covering apex pulmonis

SIBSON´S FASCIA – endothoracic fascia fixating pleura to thoracic superior
apperture
LIGAMENTS – costopleural, vertebropleural

*
INSPIRIUM
longitudinal, transversal and antero-
dorsal sizes increase
lungs put in to recesses
diaphragma descends

EXPIRIUM
reducing of sizes of thoracic cavity,
lung retraction
relaxation and ascending of diaphragma

1:3

the most mobile – lung bases

(2-4 cm ~1IC space)

the least mobile – pulmonary apex

( ventilation x TBC)
 MEDIASTINUM - THE MIDDLE COMPARTMENT IN THE THORACIC CAVITY
(between right and left pleural cavities)

division: ANATOMICAL CLINICAL

SUPERIOR

Th 4 - 5 POSTERIOR

membrana
INFERIOR bronchopericardiaca
- anterior
- middle
- posterior
ANTERIOR
- superior
- inferior
SUPERIOR ANTERIOR MEDIASTINUM
 thymus addipose tissue

 veins:
plexus thyroideus impar
brachiocephalic vv. (dx., sin.)
SVC

 arteries:
aortic arch + its branches

 trachea + bronchi

 phrenic n., laryngeal reccurent n.

 tracheal lymph. nodes,

tracheobronchial nodes, mediastinal
anterior nodes
ANTERIOR INFERIOR MEDIASTINUM

 heart + pericardium

 pericardiacophrenic a., v.
branches of thoracic interna a., v.

 phrenic n.,
pericardiac nervous plexus

 sternopericardiac ligaments
POSTERIOR MEDIASTINUM

 oesophagus

 vagus n. X (dx. + sin.) vagal ant. + post. trunk

oesophageal plexus

 aortic arch thoracic aorta + intercostal post. aa.

 thoracic duct

 azygos v., hemiazygos v., hemiazygos accesory v.

 sympathetic trunk ( dx., sin.) cardiac nn.

splanchnic nn.

 mediastinal posterior lymphatic nodes

Literature

Kahle W.; Leonhardt H.; Platzer W.: Internal organs, 1986

Čihák R.: Anatomie 1. díl, Grada, 2009

Kos J.: Přehled topografické anatomie, SPN, Praha, 1990

Agur, AMR.; Dalley, AF. Grantś anatomy, Williams and Wiklins, 12. vydání, 2009

Netter FH.: Anatomický atlas člověka, 1. vydání, Grada, 2003

Moore KL.: Clinical oriented anatomy, 3. edition, Williams and Wilkins, 1992

Gilroy A M.: Atlas of Anatomy, 2. edition, Thieme Medical Publishers, Inc. 2012

Heidegger´s W.: Atlas of Human anatomy, Berlín, 2000

Snell R., S: Clinical Anatomy By Regions, 9. edition, Williams and Wilkins, 2012

McKinley M.,: Human Anatomy, The McGraw-Hill Companies, 2012

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X-rays – UH-HK