Practical lesson

Heart, mediastinum, respiratory system

HEART
The heart has four chambers: two upper chambers (the right atrium, the left atrium) and two lower ones (the right
ventricle, the left ventricle). The right atrium and right ventricle together make up the right half of the heart, and the
left atrium and the left ventricle make up left half of the heart. A wall of muscle called the septum separates the two
sides of the heart.
The heart circulates blood through two pathways: the pulmonary circuit and the systemic circuit.
In the pulmonary ciruit, deoxygenatd blood leaves the right ventricle of the heart via the pulmonary trunk and travels
to the lungs, then returns as oxygenated blood to the left atrium of the heart via the pulmonary veins.
In the systemic circuit, oxygenated blood leaves the body via the left ventricle to the aorta, and from there enters the
arteries and capillaries where it supplies the body´s tissues with oxygen. Deoxygenated blood returns via veins to the
venae cavae (superior vena cava, inferior vena cava) and enters the heart´s right atrium.

EXTERNAL FEATURES OF HEART (general shape and orientation of the heart)

 base of the heart – contains entering and emerging vessels, is directed posteriorly, superiorly and to
the right
 apex is directed inferiorly, anteriorly and to the left
 surfaces of the heart: anterior (sternocostal), posterior, and inferior (diaphragmatic) surface
Surfaces of the heart

Surface Orientation Cardiac chambers that form the surface

Anterior (sternocostal) Directed anteriorly toward the  Right auricle

surface posterior surface of the sternum
and the ribs
Posterior (vertebral) Directed posteriorly toward the
surface posterior mediastinum
 Right ventricle
 Small part of left ventricle
 Left auricle
 Left atrium with termination of four
pulmonary veins
 Part of right atrium with termination of
superior and inferior venae cavae

Inferior Directed inferiorly toward the  Left ventricle

(diaphragmatic) surface diaphragm  Right ventricle
(clinically: the posterior
wall)

Borders of the heart

The right margin of the heart (right border of heart) is long, and is formed by the right atrium above and
the right ventricle below. The atrial portion is almost vertical. The ventricular portion, thin and sharp, is named
the acute margin; it is nearly horizontal, and extends to the apex of the heart.
The left margin of heart (or obtuse margin) is shorter than the right border of heart, full, and rounded: it is
formed mainly by the left ventricle, but to a slight extent, above, by the left atrium.

External sulci of the heart

 coronary sulcus – separates atria of the heart from the ventricles
 anterior interventricular sulcus – separates the right ventricle from the left ventricle on the sternocostal
surface
  posterior interventricular sulcus - separates the right ventricle from the left ventricle on the diaphragmatic
surface

Layers of heart wall

The wall of each chamber of the heart consists of threee layes from superficial to deep:
 Epicardium, a thin external layer (mesothelium) formed by the visceral layer of serous pericardium.
 Myocardium, a thick middle layer composed of cardiac muscle.
 Endocardium, a thin internal layer (endothelium and subendothelial connective tissue) or linning membrane
of the heart that also covers its valves.

Pericardium - lies within the middle mediastinum

- is double-walled fibroserous sac that encloses heart ad the roots of its great vessels
 fibrous pericardium – outer strong fibrous layer of pericardial sac
 serous pericardium – lines the internal surface of the fibrous pericardium and external surface of
heart
o parietal layer of serous pericardium – lines inner surface of fibrous pericardium
o visceral layer of serous pericardium - lines external surface of heart
-is called epicardium

 pericardial cavity – slitlike space between parietal and visceral layer of the serous pericardium

 pericardial fluid – film of fluid in pericardial cavity between visceral and parietal layers of serous
pericardium allows heart to mooove freely within paricardial sac

 pericardial sinuses
On the posterior surface of the heart, the reflection of the serous pericardium around the large veins
forms a recess called the oblique sinus.

Also on the posterior surface of the heart is the transverse sinus, which is a short passage that lies
between the reflexion of serous pericardium around the aorta and pulmonary trunk and the reflexion
around large veins. The pericardial sinuses form as a consequence of the way the heart bends during
development.

Chambers of heart

The atria are thin walled inflow chambers of the heart.

 The right atrium receives the superior and inferior venae cavae from the systemic circulation and the
coronary sinus (cardiac veins) from the heart.
 The left atrium receives the pulmonary veins from the lungs.
 Each atrium is associated with an auricle, a small pouch that expands the capacity of the atrium and
whose roughened walls contain pectinnate muscles.
 A depression on the right side of the interatrial septum, the oval fossa, is a remnant of the oval
foramen, an opening through which blood was shunted from the right to left atria in the prenatal
circulation

 The right atrium is divided into two parts by a muscular ridge, the terminal crest. The ridge is
evident on the outside of the heart as the terminal sulcus. The two parts of the right atrium are:
1. the venous sinus, a smooth walled region on the posterior wall that contains the openings of the
superior vena cava, inferior vena cava and coronary sinus; and
 2. the atrium proper, the anterior muscular portion that, like the right auricle, contains pectinate
muscles.
 The left atrium is smaller but thicker walled than the right atrium and receives four pulmonary veins
from the lungs. The atrial walls are smooth posteriorly, and with the pectinate muscles in the left
auricle.

The ventricles are thick-walled chambers that connect to the outflow channels of the heart: the right ventricle
to the pulmonary artery and the left ventricle to the aorta.

 The walls of the ventricles are marked with a meshwork of thick musccular ridges known as
trabeculae carneae.
 Most of the interventricular septum is muscular, but there is a small membranous part at the
superior end that is common site of septal defects.

 The right ventricle is the smaller and thinner walled of the two ventricles. A muscular ridge, the
supraventricular crest, separates it into two parts:

1. The inflow portion of the ventricle that receives blood from the right atrium
o An anterior and posterior papillary muscle arise from its floor, and a septal papillary
muscle arises from the interventricular septum.
o A muscular septomarginal trabecula (moderator band) extends from the septum to the
base of the anterior papillary muscle and carries a part of the electrical conduction system
(the right branch of the atrioventricular bundle) that facilitates the coordinated contraction
of the papillary muscle.

2. The conus arteriosus (infundibulum), the smooth walled outflow channel through which blood
flows into the pulmonary trunk.

 The left ventricle which includes the apex of the heart, is the thickest walled chamber of the heart.
Similar to the right ventricle, the left is divided into inflow and outflow portions:

1. The left ventricle proper, which receives blood from the left atrium. A large anterior and
posterior papillary muscle arise from its floor.
2. The aortic vestibule, the smooth walled outflow channel through which blood flows into the
aorta.

Heart valves

There are two types of cardiac valves: atrioventricular and semilunar.

1. Atrioventricular valves separate the atria from the ventricles and prevent regurgitation of blood into the
atria during contraction of ventricles.
 The atrioventricular valves are made up of cusps, thin leaflets with free inner margins and outer
margins that are attached to the fibrous rings of the cardiac skeleton

 Slender threads called tendinous cords (chordae tendineae) attach the free edges of the valve
leaflets to the papillary muscles in the ventricles. These cords maintain closure of the valves and
prevent regurgitation of blood during ventricular contraction. Each cusp attaches to tendinous
cords from more one than papillary muscle.

 The atrioventricular valve include

o the tricuspid valve, which separates the right atrium from the right ventricle and is
composed of anterior, posterior, and septal cusps; and
o the bicuspid (or mitral) valve, which separates the left atrium from the left ventricle and
is composed of anterior and posterior cusps.
 2. Semilunar valves prevent outflow from the ventricles as the chambers fill and backflow of blood into the
ventricles after it has been expelled.
 Each valve is composed of three semilunar cusps with free inner margins and attached outer
margins. A sinus, or pocket, is created between each cusp and the vessel wall. The thickened free
margin of the cusp, the lunule, is the point of contact of the cusps. A nodule marks the center of
the lunule.
 The semilunar valve include the following:

o The pulmonary semilunar valve (pulmonary valve) is located in the pulmonary trunk
at the top of the conus arteriosus, where it moderates blood flow through the right
ventricular outflow channel. Its cusps are in the anterior, right, and left positions.

o The aortic semilunar valve (aortic valve) is located within the aortaimmediately
adjacent to the mitral valve, where it moderates blood flow through the left ventricular
outflow channel. Its cusps are in the posterior, right, and left positions. The coronary
arteries arise from the sinuses above the right and left cusps.

Cardiac skeleton (fibrous skeleton of the heart)

Muscle fibres of the heart are anchored to the fibrous skeleton of the heart (fibrous framework of dense collagen).
The cardiac skeleton forms four fibrous rings, which surround the orifices of the valves, right and left fibrous
trigones, formed by connecting the rings, and the membranous parts of the interatrial and interventricular septa.
Four fibrous rings:
 Aortic ring (surrounds aortic valve)
 Pulmonary ring (surrounds pulmonary valve)
 Right fibrous ring (surrounds tricuspid valve)
 Left fibrous ring (surrounds mitral valve)
Cardiac skeleton - function:
 Keeps the orifices of the atrioventricular (AV) and semilunar valves open and from being overly
disteended by the volume of blood pumping through them.
 Provides attachments (origin and insertion) for the leaflets and cusps of the valves.
 Provides attachment (origin and insertion) for the myocardium.
 Forms an electrical „insulator“ by separating the myenterically conducted impulses of atria and ventricles
so that they contract independently, and by surrounding and providing passage for initial part of the AV
bundle.

Conducting system of heart (sinoatrial node, atrioventricular node, atrioventricular bundle of His, right and left
bundle branches, Purkinje fibres) – learn it according to lecture

Arterial supply of heart

The right and left coronary arteries arise from the acscending aorta just superior to the right and left cusps of the aortic
valve. They supply the myocardium.

 The right coronary artery descends within the coronary sulcus around the right side of the heart. Its major
branches are
o the SA nodal artery, which supplies the right atrium and the SA node
o the right marginal branch, which supplies the right margin of the right ventricle
o the posterior interventricular branch, which supplies the right and left ventriclesand posterior third
of the interventricular septum and anastomoses with the interventricular branch of the left coronary
artery near the apex on the diaphragmatic surface; and
o the AV nodal artery, which supplies the AV node
  The left coronary artery is typically thicker than the right coronary artery. After a short course, it divides
into two large branches, the anterior interventricular artery, which descends in the anterior interventricular
sulcus, and the circumflex artery, which runs around the left side of the heart in the coronary sulcus.
o The anterior interventricular artery supplies the anterior aspects of the right and left ventricles and the
anterior two thirds of the interventricular septum, including th AV bundle of the conducting system.
o The circumflex artery supplies the left atrium and,via its left marginal branch, the left ventricle. In
40% of the population, an SA nodal branch arises from the left coronary artery to supply the SA node.

Venous drainage of heart

The coronary sinus, which receives most of the venous return from the heart, runs in the posterior coronary sulcus
between the left atrium and ventricle. The large veins of the heart are tributaries of coronary sinus:

 The great cardiac (anterior interventricular) vein travels with the anterior interventricular artery and
drains the left atrium and both ventricles.
 The middle cardiac (posterior interventricular) vein runs in the posterior interventricular groove with the
posterior interventricular artery and drains the posterior part of the interventricular septum.
 The small cardiac vein which drains the posterior surface of the right atrium and the right ventricle,
accompanies the right coronary artery in the atrioventricular groove (coronary sulcus).
 The posterior left ventricular vein drains the diaphragmatic surface of the left ventricle.
Anterior cardiac veins drains the anterior surface of the right ventricle and open directly into the right atrium. (They
are not tributaries of coronary sinus)

NERVE SUPPLY OF HEART

The autonomic nerves of the cardiac plexus innervate the conduction system of the heart; they therefore regulate the
heart rate but do not initiate the heartbeat.
 Sympathetic innervation increases rate and force of contractions by increasing the response of the SA and
AV nodes . It also allows dilation of the coronary arteris.
 Parasympathetic innervation decreases the rate of contractions and causes vasoconstriction of the coronary
arteries.
 Visceral sensory fibres innervating the barroreceptors (receptors that measure blood pressure) and
chemoreceptors (receptors that measure blood CO 2 ) in the heart and aortic arch travel with the
parasympathetic fibres of the vagus nerve.
 Visceral sensory fibres carrying pain sensation travel with sympathetic fibres to the T1-T5 segments of spinal
cord.
PERICARDIUM

 transverse pericardial sinus – is located between the arteries and the veins
 oblique pericardial sinus – is located between the left and right pulmonary veins

Auscultation sites for the cardiac valves (where to listen for heart sounds)
Valve Auscultation site (position of stethoscope)

Mitral (left atrioventricular) valve Left fifth intercostal space on the midclavicular line

Tricuspid (right atrioventricular) valve Right fifth intercostal space close to the sternum

Aortic valve Right second intercostal space close to the sternum

Pulmonary valve Left second intercostal space close to the sternum

MEDIASTINUM
Please, learn teoretically these topics:
- ascending aorta, aortic arch and its three big branches (brachiocephalic trunk, left common carotid artery,
left subclavian artery)
- thoracic aorta (course and all branches)
- superior vena cava, left brachiocephalic vein, right brachiocephalic vein and their tributaries
- phrenic nerve (course in thorax, branches)
- vagus nerve (course in thorax, branches in thorax: cardiac, bronchial, oesophageal), left reccurent
laryngeal nerve
- thymus

(trachea will be taught later, together with the respiratory system)

- thoracic duct (main lymphatic duct of the human body)

- esophagus – parts, course in thorax, blood supply of the thoracic part of esophagus
- azygos venous system (repetition)
- sympathetic trunk – thoracic part
- greater splanchnic nerve, lesser splanchnic nerve, the least splanchnic nerve

- lymph nodes around the oesophagus and descending aorta – posterior mediastinal lymph nodes
- regional lymph nodes around the tracheal bifurcation – tracheobronchial lymph nodes
- regional lymph nodes in the pulmonary hilum – bronchopulmonary lymph nodes

Good Videos for studying: M ediastinum superius https://www.youtube.com/watch?v=KoSIzyL7610

Diaphragm - movements https://www.youtube.com/watch?v=qiP28StzWDA
Medi astinum (anatomy) – by Sa m Webster https://www.youtube.com/watch?v=C-oZLY7a5EM
Medi astinum – dra wing – easy a natomy https://www.youtube.com/watch?v=lNy3MJuCcPs

RESPIRATORY SYSTEM
Nasal cavity
- external nose – basic anatomy:
 nostrils are anterior nasal openings
 dorsum of the nose extends from its superior angle-the root - to the apex
 alae of the nose are nasal wings
 nasal septum
 choanae are posterior nasal openings
- learn cartilages which form the external nose :
 one septal cartilage
 two lateral nasal cartilages
 two major alar cartilages, minor alar cartilages)

- please, do not learn bones which form framework of the nasal cavity (bones will be learned later, together with the skull - in
Anatomy 3)
- do not learn blood supply, nerve supply and lymphatic drainage of the nasal cavity (you will learn it later, together with the head and
neck - in Anatomy 3)

- there are two anatomical parts of nasal cavity: nasal vestibule + nasal cavity proper

- nasal vestibule is lined with skin, contains tiny hairs

- nasal cavity proper is lined with mucosa
The limen nasi is a mucose ridge between the nasal cavity proper and the nasal vestibule.
 inferior two thirds of nasal mucosa is the respiratory area (is lined with ciliated pseudostratified
columnar epithelium – respiratory epithelium), and the superior one third is the olfactory area (is
lined with olfactory epithelium which contains receptors for the sense of smell)
  The choanae are the posterior openings by which the nasal cavity communicates with the
nasopharynx.

- please, learn mucosal landmarks of the nasal cavity (interior of the nasal cavity):

 The lateral wall of the nasal cavity has three folds called the superior, middle, and inferior nasal
conchae. They increase the surface area of the nasal cavity, enabling it to warm and humidify the
inspired air more efficiently.
 The space below each concha is called a meatus (superior, middle, inferior nasal meatus).
The inferior nasal meatus is a passage lying inferior to the inferior nasal concha. The nasolacrimal
duct opens into the anterior part of this meatus.
The middle nasal meatus communicates with the frontal sinus, maxillary sinus and anterior and
middle ethmoidal sinuses.
The superior meatus communicates with the posterior ethmoidal sinuses.
The sphenoethmoidal recess, lying superoposterior to the superior concha, receives the opening of
the sphenoidal sinus.

 The semilunar hiatus is a crescent-shaped groove in the middle nasal meatus.

o is the location of openings for the frontal sinus, maxillary sinus, and anterior ethmoidal sinuses
o is bounded inferiorly by the sharp margin called uncinate process of the ethmoid bone
o the ethmoid bulla –
is elevation above the semilunar hiatus
is caused by bulging of middle ethmoid air cells which open on it

The paranasal sinuses (maxillary, frontal, ethmoid, sphenoidal) – they communicate with the nasal cavity through
relatively small apertures. The interior of each sinus is lined with respiratory epithelium. Normal drainage of
secretions from the paranasal sinuses:
The maxillary sinus is the largest of the paranasal sinuses and occpies entire maxilla. The sinus drains by an opening
into the middle meatus of the nose.
The frontal sinuses are between the outer and inner tables of the frontal bone. Frontal sinus drains into the semilunar
hiatus of the middle nasal meatus.
Ethmoid sinuses are anterior, middle and posterior.
The anterior and middle ethmoid sinuses open into the middle meatus,
the posterior ethmoid sinuses open directly into the superior meatus.
Sphenoidal sinus opens into the sphenoethmoidal recess of superior meatus.

Nasal cavity – anatomy – video https://www.youtube.com/watch?v=wJEenATGwg8

Nasopharynx
- learn only mucosal structures of the nasopharynx:
 pharyngeal fornix (fornix pharyngis), vault of the pharynx - roof of the pharynx which is fixed to the
skull base
 pharyngeal tonsil – is located on the roof of pharynx (Enlarged pharyngeal tonsil blocks the choanae,
obstructing the nasal airway and forcing the child to breathe through the mouth. Enlarged pharyngeal
tonsil is common in pre-school age children. The pharyngeal tonsil begins to regress at 6 or 7 years of
age)
 pharyngeal opening of the auditory (pharyngotympanic, Eustachian) tube – connects the pharynx
with the tympanic cavity, serves to equalize the air pressure in the middle ear
 torus tubarius – elevation (cushion, fold) of mucous membrane lying superiorly and posteriorly to
pharyngeal orifice of the tube, torus tubarius is formed by the underlying cartilagineous portion of the
 Eustachian tube, contains masses of lymphatic tissue (tubal tosil), swelling around the
pharyngotympanic tube orifice may occlude the orifice
From the inferior aspect of the torus tubarius, two mucosal folds extend inferiorly:
o salpingopalatine fold (anterior fold) – overlies salpingopalatine muscle fibres
o salpingopharyngeal fold (posterior fold) – overlies salpingopharyngeus muscle

 torus levatorius – elevation located below the opening of the auditory tube (produced by levator veli
palatini muscle)
 pharyngeal recess – is deep recess which lies behind the orifice of the Eustachian tube (posterolateral
pharyngeal recess, is the most common site of origin for nasopharyngeal carcinoma)

LARYNX
Please, learn the laryngeal skeleton which consists of cartilages that are joined by ligaments and membranes and
moved by muscle

Laryngeal cartilages
 thyroid (right and left laminae, laryngeal prominence, superior hons, inferior horns, superior thyroid notch)
 cricoid (lamina, arch,thyroid articular facet, arytenoid articular facet)
 two arytenoid (apex, base, muscular process, vocal process, three surfaces )
 epiglottic (stalk of epiglottis, lamina)
 small additional cartilages:
o two corniculate (lie on the apex of arytenoid cartilages, produces corniculate tubercle of laryngeal
inlet)
o two cuneiform (produces cuneiform tubercle of laryngeal inlet)

Laryngeal joints
 crico-thyroid
 crico-arytenoid

Laryngeal membranes and ligaments

 thyrohyoid membrane (contains thickened portions – median and lateral thyrohyoid ligaments)
 median cricothyroid ligament,
 cricotracheal ligament
 quadrangular membrane extends superiorly to aryepiglottic fold
 quadrangular membrane has free inferior margin- vestibular ligament
 conus elasticus
 vocal ligaments
 thyroepiglottic ligament

Laryngeal muscles

 They move various parts of the larynx against each other.

According to position and origin they are divided into external laryngeal muscles and internal laryngeal
muscles inside the thyroid cartilage.
Extrinsic muscles act to move the larynx superiorly and inferiorly.They include suprahyoid and infrahyoid
group of muscles. We will learn them later, together with the neck, in the third semester.
 Intrinsic laryngeal muscles (true laryngeal muscles) act on the individual components of the larynx. They
control the shape of the rima glottidis (opening between the vocal folds and the arytenoid cartilages), and the
length and tension of the vocal folds. They include muscles:

 The cricothyroid arises on each side anteriorly from the cricoid cartilage and extends in two parts
(anteromedially lies the straight part, and laterally the oblique part) toward the thyroid cartilage. It stretches
the vocal cord.
 The posterior cricoarytenoid (called “posticus” clinically) arises on both sides from the dorsal surface of the
cricoid plate and runs laterally upwards to the muscular process of the arytenoid cartilage. It pulls the
muscular process backward and thus displaces the vocal cords sideways. It widens the rima glottidis and is in
fact the only dilator for the whole rima glottidis.
 The lateral cricoarytenoid (called “lateralis” clinically) arises from the outer surface of the cricoid cartilage
and runs upward and backward to the muscular process of the arytenoid cartilage. It narrows the rima
glottidis.
 The vocalis runs within the vocal fold (the true vocal cord). It arises from the posterior surface of the thyroid
cartilage and goes to the vocal process of the arytenoid cartilage. It controls the tension of the true vocal cord,
thereby affecting the pitch at which vibrates.
 The thyroarytenoid is paired. It arises together with vocalis muscle. It acts as constrictor of rima glottidis.
 The thyroepiglottic extends toward the epiglottis, it assists in opening the entrance into the larynx.
 The oblique and transverse arytenoideus. They approximate arytenoid cartilages toward each other. They
aid closure of the rima glottidis.
 The aryepiglottic. It runs in a fold of the mucosa, the aryepiglottic fold. It assists in narrowing the entrance
into the larynx.

The cricothyroid is innervated by the superior laryngeal nerve – derived from the vagus nerve.

All the intrinsic muscles of the larynx (except the cricothyroid) are innervated by the reccurent laryngeal nerve –
again derived from the vagus nerve.

- Laryngeal cavity - mucosal surface anatomy

- laryngeal inlet
- laryngeal vestibule
- vestibular folds
- middle region of laryngeal cavity – laryngeal ventricle
- vocal folds
- rima vestibuli
- rima glottidis
- infraglottic cavity
- median and lateral glossoepiglottic folds, epiglottic vallecula

Good videos:
How Vocal Cords Work https://www.youtube.com/watch?v=P2pLJfWUjc8&t=11s
Larynx – cartilages https://www.youtube.com/watch?v=Z3S2dD9BrSY
Larynx Membranes, ligaments, vocal cords https://www.youtube.com/watch?v=jqTKSorDRJo
Muscles of the larynx
Part 1 https://www.youtube.com/watch?v=lqeDLsP1ISE
Part 2 https://www.youtube.com/watch?v=GEM quo7qxpg
TRACHEA AND EXTRAPULMONARY MAIN BRONCHI

- tracheal cartilages are C-shaped (horseshoe-shaped) rings

- anular ligaments – connective tissue that connects tracheal cartilages
- membranous wall of the trachea – is posterior wall composed of connective tissue and trachealis muscle
- tracheal bifurcation (division of the trachea into the right and left main bronchi)
Note: The right main bronchus is more vertical and wider than the left main bronchus, and therefore it is
more common for aspirated foreign bodies to enter the right main bronchus than the left.
- carina of trachea – cartilagineous ridge which can be seen in tracheal bifurcation, projects upward into the
tracheal lumen
- the left and right main bronchi divide into two or three lobar bronchi, respectively, which subsequently
branch into segmental bronchi

LUNGS

- The left lung is divided into two lobes (superior and inferior) by one oblique fissure.
- The right lung consists of three lobes (superior, middle, and inferior) separated by one oblique fissure and
one horizontal fissure.
- Apex – lies above 2cm above the clavicle
Note: Penetrating wound above the medial third of the clavicle may therefore involve the apex of the lung,
resulting in a pneumothorax or a collapsed lung. This is most commonly seen as an iatrogenic complication
during the insertion of a subclavian (central) venous catheter.

- Base – broad, concave surface which rests upon the diaphragm

The right diaphragmatic dome separates the right lung from the liver.
The left diaphragmatic dome separates the left lung from the stomach and the spleen.
The base of the lung descends during inspiration and ascends during expiration.

- Surfaces of the lung:

o Costal surface faces the ribs.
o Mediastinal surface relates medially to the mediastinum.
o Diaphragmatic surface relates inferiorly to the diaphragm.
- Borders of the lung:
o Anterior border: sharp, thin border located at the junction of the costal and mediastinal surfaces
o Inferior border: surrounds the base of the lung

- Impressions (cardiac imression, impressions produced by subclavian artery, azygos vein, esophagus, aortic
arch, thoracic aorta)
- Hilum of the lung (the arrangement of bronchi and pulmonary arteries and veins on the right and left sides are
not symmetrical)

 Right side (from superior to inferior): Eparterial bronchus, Pulmonary artery, and inferiorly and
ventraly are pulmonary veins
 Left side: Pulmonary artery, hyparterial bronchus and inferior are pulmonary veins

- Pulmonary ligament – is fold of pleura which extends from the hilum downward to the diaphragm, it is
duplicature of pleura (contains two pleural layers)

Videos : The pulmonary ligament https://www.youtube.com/watch?v=zp7zZVo7JvA

Lungs anatomy – models ( Sam Webster) https://www.youtube.com/watch?v=_RhUBoM85vo

Lungs shapes (anatomy) – Sam Webster https://www.youtube.com/watch?v=jA2lPVAsTtk

Divisions of the bronchi and bronchopulmonary segments
- lobar bronchi
- segmental bronchi
- bronchopulmonary segments

PLEURA

- pulmonary pleura (visceral pleura) and parietal pleura (parts: diaphragmatic, mediastinal, costal part)
- pleural cavity, pulmonary ligament
- pleural cupula
- pleural recesses (costodiaphragmatic, costomediastinal)
- lung and pleural borders