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com
TABLE OF CONTENTS

1.1.
Lungs
1. Pleura, Lobes, and Bronchi
2.
2. Blood Vessels,
Blood Vessels, Blood
Blood Supply
Supply and
and Hilum
Hilum
3.
3. Nerves and Innervations
Lymphatics
4.
4. Practice
Nerves Questions
and Innervations
5.
5. Clinical -Questions
Practice Aspiration of Foreign Bodies,
6. Bronchopulmonary
Clinical Segments
- Aspiration of Foreign Bodies,
6. Clinical - Lung Diseases
Bronchopulmonary Segments
7.
7. Clinical -- Lung
Clinical Pneumothorax
Diseases
8. Clinical - Pneumothorax
REVIEW OUTLINE

1. Pleura 4. Nerves

Lungs ●
●
Visceral
Parietal
●
●
Phrenic
Vagus
○ Cervical
○ Costal 5. Lung
○ Diaphragmatic ● Oblique (major) fissure
○ Mediastinal ● Horizontal (minor) fissure
● Costodiaphragmatic recess ● Superior lobe (right lung)
● Costomediastinal recess ● Middle lobe (right lung)
● Inferior lobe (right lung)
2. Arteries ● Superior lobe (left lung)
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● Pericardiacophrenic ● Inferior lobe (left lung)
● Pulmonary ● Lingula
● Bronchial ● Primary (main) bronchi
● Secondary (lobar) bronchi
3. Veins ● Tertiary (segmental) bronchi
● Pulmonary
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PLEURA OF THE LUNGS

VISCERAL PLEURA
PARIETAL PLEURA

DIAPHRAGM
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PARIETAL PLEURA
CERVICAL
COSTAL
DIAPHRAGMATIC
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MEDIASTINAL

DIAPHRAGM
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COSTODIAPHRAGMATIC RECESS

DIAPHRAGM
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COSTOMEDIASTINAL RECESS

RIGHTLUNG LEFTLUNG

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MEDIASTINUM
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LOBES FISSURES
RIGHT LUNG LEFT LUNG
SUPERIOR LOBE SUPERIOR LOBE
MIDDLELOBE INFERIORLOBE
INFERIORLOBE OBLIQUEFISSURE
OBLIQUEFISSURE
HORIZONTAL FISSURE

DIAPHRAGM
Lungs Bootcamp.com

PRIMARY MAIN BRONCHI

TRACHEA E
SECONDARY LOBAR BRONCHI
BRONCHIAL TREE
TERTIARY SEGMENTAL BRONCHI

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BRONCHIAL ARTERY TRACHEA

USUALLYTWOARTERIES ONLEFT
USUALLY ONEARTERY ON RIGHT
AORTICARC

ORIGIN
BRONCHIAL
THORACICDESCENDING AORTA

SUPPLIES BRONCHI

VISCERALPLEURAOFLUNG

E
e
o
E posterior
IntercostalAA

a
 Lungs Bootcamp.com

SUBCLAVIANA

it
r1
t Internal
THORACICA
I
ri
rI PERICARDIACOPHRENICA
1I ORIGIN
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1 INTERNALTHORACIC A
I
T SUPPLIES
rI PERICARDIUM
r1 THORACICDIAPHRAGM
1
i
ri

n
v

https://upload.wikimedia.org/wikipedia/commons/7/75/Gray530.png
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PULMONARY ARTERIES

ORIGIN
PULMONARY TRUNK

TERMINALBRANCHES
PULMONARY ARTERIOLES

SUPPLIES
DEOXYGENATED BLOODTO LUNGS

1 PULMONARY
ARTERY

PULMONARY
ARTERIOLES

https://upload.wikimedia.org/wikipedia/commons/5/5f/Gray491.png
 Lungs Bootcamp.com

PULMONARY VEINS
COLLECTS OXYGENATEDBLOODFROM
THE ALVEOLI OFTHE LUNGS
COMES FROM
PULMONARY VENULES OFLUNG

DRAINSINTO
LEFT ATRIUM
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PULMONARY
VEINS
PULMONARY
VENULES

https://upload.wikimedia.org/wikipedia/commons/5/5f/Gray491.png
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HILUM OF LUNG
BRONCHI
we a
PULMONARY A

PULMONARY VV
REVIEW OUTLINE

1. Lymph Flow from the Lungs

Lymphatics of ● Superficial subpleural lymphatic plexus
● Deep bronchopulmonary lymphatic plexus
the Lungs ● Pulmonary nodes
● Bronchopulmonary nodes
● Inferior tracheopulmonary nodes
● Superior tracheopulmonary nodes
● Paratracheal nodes
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● Right and left bronchomediastinal trunks

2. Case Study
● Identifying nodes on X-ray
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Thoracic Duct
Internal Jugular Vein

Subclavian Vein
Right Lymphatic Duct
Lymphatic Drainage from the Lungs
1. Pulmonary (Intrapulmonary)
2. Bronchopulmonary (Hilar)
Right Left
3. Inferior Tracheobronchial Bronchomediastinal
Bronchomediastinal
Trunk Trunk
4. Superior Tracheobronchial
5. Paratracheal
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Clinical Application
● A patient presents to your clinic with the following
symptoms:
○ Fever & Fatigue
○ Dyspnea
○ Hemoptysis
○ Unintentional weight loss
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● A CXR is ordered
○ What is abnormal about this image?
○ What nodes could be involved?
○ What is on your differential diagnosis?
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Clinical Application
● A patient presents to your clinic with the following
symptoms:
○ Fever & Fatigue
○ Dyspnea
○ Hemoptysis
○ Unintentional weight loss
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● A CXR is ordered
○ What is abnormal about this image?
○ What nodes could be involved?
○ What is on your differential diagnosis?
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References
1. Slide 2: Created with BioRender.com
2. Slide 5 & 6: Basem Abbas Al Ubaidi, CC BY 4.0
<https://creativecommons.org/licenses/by/4.0>, via Wikimedia Commons
3. Slide 6: Stillwaterising, CC0, via Wikimedia Commons
 Lungs Bootcamp.com

PHRENIC NERVE
CI ROOTS
CZ E3 CS
3 PATHWAY
4
1 ANTERIORTO ANTERIORSCALENE MUSCLE
CS
2 POSTERIORTO SUPERIOR VENACAVA
6
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3 ANTERIORTO ROOT OFTHELUNG
C7
cg TRAVELS WITH THE

T1 PERICARDIACOPHRENIC A

https://en..wikipedia.org/wiki/Phrenic_nerve#/media/File:Gray806.png
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PERICARDIACOPHRENIC ARTERY
AND
PHRENIC NERVE

https://upload.wikimedia.org/wikipedia/commons/7/75/Gray530.png
 Lungs Bootcamp.com

PHRENIC NERVE
l
SENSORY FUNCTION
cz
FIBROUSPERICARDIUM
3
MEDIASTINALPLEURA
4
DIAPHRAGMATIC PERITONEUM
MOTOR FUNCTION
CG
AfraTafreeh.com DIAPHRAGM
7
c8 WHAT WOULD HAPPEN IF THE
T1 PHRENICNERVEWASLESIONED

https://en..wikipedia.org/wiki/Phrenic_nerve#/media/File:Gray806.png
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VAGUS NERVE
ORIGIN
BRAINSTEM MEDULLA
DIVISIONS BRANCHES
RIGHTELEFT RECURRENTLARYNGEALNN
ANTERIOR 4POSTERIOR VAGALTRUNKS
PATHWAY
TRAVELSPOSTERIORTOROOT OF LUNG
LEFT RECURRENTWRAPS AROUND LIGAMENTUM ARTERIOSUM
LEFTSIDE FORMS ANTERIORVAGALTRUNK
RIGHTSIDE FORMS POSTERIOR VAGALTRUNK
RIGHT
recurrent
Larynaennerve

LARP

https://upload.wikimedia.org/wikipedia/commons/thumb/6/64/Recurrent_laryngeal_nerve.svg/926px-Recurrent_laryngeal_nerve.svg.png
 Lungs Bootcamp.com

VAGUS NERVE
SENSORY FUNCTION
VISCERAL SENSORY INFORMATION FOR MOST
OFTHEDIGESTIVE TRACT UPTOSPLENICFLEXURE
MOTOR FUNCTION
INTRINSIC LARYNGEAL MUSCLES
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THYROARYTENOID
POSTERIOR CRICOARYTENOID
LATERALCRICOARYTENOID
TRANSVERSE OBLIQUE ARYTENOIDS
WHATWOULD HAPPEN IF THIS NERVE WAS LESIONED

https://en..wikipedia.org/wiki/Phrenic_nerve#/media/File:Gray806.png
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VAGUS NERVE
PARASYMPATHETIC FUNCTION
DECREASESHEARTRATE
INCREASES VASODILATION
INCREASES CONSTRICTION OF BRONCHI0L
SMOOTH MUSCLE
INCREASES GI MOTILITY PERISTALSIS
INCREASES GLYCOGEN SYNTHESIS IN LIVER
INCREASES URINARYOUTPUT
RELAXES SPHINCTER OF BLADDER
WHATWOULD HAPPEN IF THIS NERVE WAS LESIONED

https://en..wikipedia.org/wiki/Phrenic_nerve#/media/File:Gray806.png
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WHERE DOES THE BRONCHIAL A ORIGINATE

WHAT AREA DOES IT SUPPLY
AORTICARC

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WHAT IS THE MOTOR FUNCTION

OF THE VAGUS NERVE

https://en..wikipedia.org/wiki/Phrenic_nerve#/media/File:Gray806.png
REVIEW OUTLINE

1. Pleura 4. Nerves

Lungs ●
●
Visceral
Parietal
●
●
Phrenic
Vagus
○ Cervical
○ Costal 5. Lung
○ Diaphragmatic ● Oblique (major) fissure

Review Questions ●
○ Mediastinal
Costodiaphragmatic recess
●
●
Horizontal (minor) fissure
Superior lobe (right lung)
● Costomediastinal recess ● Middle lobe (right lung)
• Can you draw the pattern of ● Inferior lobe (right lung)
the hilus for the right and left 2. Arteries ● Superior lobe (left lung)
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lungs? ● Pericardiacophrenic
● Pulmonary
●
●
Inferior lobe (left lung)
Lingula
● Bronchial ● Primary (main) bronchi
● Secondary (lobar) bronchi
3. Veins ● Tertiary (segmental) bronchi
● Pulmonary
 AfraTafreeh.com
REVIEW OUTLINE

1. Foreign Bodies
• Right vs left primary bronchi

2. Right Lung

Aspiration of • Superior lobe (apical, anterior, posterior)

• Middle lobe (lateral, medial)
Foreign Bodies & • Inferior lobe (superior, anterior basal, posterior
basal, lateral basal, medial basal)
Bronchopulmonary
3. Left Lung
Segments • Superior lobe (apicoposterior, anterior, superior
lingular, inferior lingular)
• Inferior lobe (superior, posterior basal, medial
basal, lateral basal, anterior basal)

4. Clinical Significance
• Pulmonary resection
• Lobectomy
Aspiration of Foreign Bodies Bootcamp.com

Inhalation of a foreign object causing an obstruction in the lower respiratory tract

Right Primary Bronchus Left Primary Bronchus

• Wider & shorter • Narrower, longer
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Secondary (Lobar) Bronchi

Left superior
lobar bronchus
Right superior
lobar bronchus

Left inferior
Right middle lobar bronchus
lobar bronchus

Right inferior
lobar bronchus
 Bronchopulmonary Segments Bootcamp.com

Anatomical & functional unit with its own pulmonary artery & tertiary bronchus

Right Lung Left Lung

Superior Lobe Superior Lobe

1. Apical 1. Apicoposterior
2. Anterior 2. Anterior
3. Posterior* 3. Superior lingular
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4. Inferior lingular
Middle Lobe
1. Lateral Inferior Lobe
2. Medial 1. Superior
2. Posterior basal
Inferior Lobe 3. Medial basal
1. Superior* 4. Lateral basal
2. Anterior basal 5. Anterior basal
3. Posterior basal
4. Lateral basal
5. Medial basal
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Anatomical & functional unit with its own pulmonary artery & tertiary bronchus

Tumor

Surgical Treatment
• Pulmonary resection
(lung segmentectomy)
 Bronchopulmonary Segments Bootcamp.com

Anatomical & functional unit with its own pulmonary artery & tertiary bronchus

Tumor

Surgical Treatment
• Lobectomy
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Knowledge Check Bootcamp.com

A 4-year-old girl is brought in with coughing, and you are told by her mother that she had been
playing with some beads and had apparently aspirated one (gotten it into her airway). Where
would you expect it to most likely be?

a. Apicoposterior segmental bronchus of left lung

b. Left main bronchus
c. Lingular segment of left lung
d. Right main bronchus
e. Terminal bronchiole of right lung

Because of its angle with the trachea and size of the main bronchus, a bronchoscope would
pass more readily into which lung?

a. Left
b. Right
Knowledge Check Bootcamp.com

A 4-year-old girl is brought in with coughing, and you are told by her mother that she had been
playing with some beads and had apparently aspirated one (gotten it into her airway). Where
would you expect it to most likely be?

a. Apicoposterior segmental bronchus of left lung

b. Left main bronchus
c. Lingular segment of left lung
d. Right main bronchus
e. Terminal bronchiole of right lung AfraTafreeh.com

Because of its angle with the trachea and size of the main bronchus, a bronchoscope would
pass more readily into which lung?

a. Left
b. Right
 AfraTafreeh.com
References Bootcamp.com

Slide 2
• <a href="https://commons.wikimedia.org/wiki/File:LarynxTracheaandbronchi.svg">Madhero88</a>, <a
href="https://creativecommons.org/licenses/by-sa/3.0">CC BY-SA 3.0</a>, via Wikimedia Commons

Slide 3, 4
• <a href="https://commons.wikimedia.org/wiki/File:Lungs_diagram_simple.svg">Patrick J. Lynch, medical illustrator</a>, <a
href="https://creativecommons.org/licenses/by/2.5">CC BY 2.5</a>, via Wikimedia Commons
REVIEW OUTLINE

1. Foreign Bodies
• Right vs left primary bronchi

2. Right Lung

Aspiration of • Superior lobe (apical, anterior, posterior)

• Middle lobe (lateral, medial)
Foreign Bodies & • Inferior lobe (superior, anterior basal, posterior
basal, lateral basal, medial basal)
Bronchopulmonary AfraTafreeh.com
3. Left Lung
Segments • Superior lobe (apicoposterior, anterior, superior
lingular, inferior lingular)
• Inferior lobe (superior, posterior basal, medial
basal, lateral basal, anterior basal)

4. Clinical Significance
• Pulmonary resection
• Lobectomy
 AfraTafreeh.com
REVIEW OUTLINE

1. Pneumonia
• Causes
• Symptoms
• X-Ray
Lung • Histology

Diseases 2. Bronchogenic Carcinoma

• Causes
• Symptoms
• Metastases
 Pneumonia Bootcamp.com

Inflammation of the alveoli due to infection (bacteria, virus or fungi) or chemical injury

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Symptoms
• Cough
• Chest pain
• Fever
• Difficulty breathing
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Normal Pneumonia
 Bronchogenic Carcinoma Bootcamp.com

Refers to any type of lung cancer that mostly arises in the mucosa of the large bronchi

Bronchial lymph nodes

Other thoracic lymph nodes &

supraclavicular lymph nodes
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Symptoms
• Persistent cough
• Hemoptysis
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Hematogenous metastases is common to the brain, bones, lungs & suprarenal glands
Knowledge Check Bootcamp.com

What is pneumonia?

Inflammation of the alveoli

Pneumonia can be caused by:

a. Bacteria
b. Virus
c. Fungi AfraTafreeh.com
d. All the above

Explain where and how a bronchogenic carcinoma may metastasize to other areas of the body.
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What is pneumonia?

Inflammation of the alveoli

Pneumonia can be caused by:

a. Bacteria
b. Virus
c. Fungi
d. All the above

Explain where and how a bronchogenic carcinoma may metastasize to other areas of the body.

1. It may metastasize to the bronchial lymph nodes then to other thoracic and
supraclavicular lymph nodes
2. Tumor cells may invade the pulmonary veins to enter the left side of the heart
to the aorta to other areas such as the brain, bones, lungs, and suprarenal
glands
References Bootcamp.com

Slide 2
• Alveoli: <a href="https://commons.wikimedia.org/wiki/File:Blausen_0994_Pneumonia.png">BruceBlaus</a>, <a
href="https://creativecommons.org/licenses/by-sa/4.0">CC BY-SA 4.0</a>, via Wikimedia Commons
• Chest X-Ray: <a href="https://commons.wikimedia.org/wiki/File:Aspiration_pneumonia201711-3264.jpg">melvil</a>, <a
href="https://creativecommons.org/licenses/by-sa/4.0">CC BY-SA 4.0</a>, via Wikimedia Commons

Slide 3
• Normal: <a href="https://commons.wikimedia.org/wiki/File:Normal_lung_Alveoli_(3678762542).jpg">Yale Rosen from USA</a>, <a
href="https://creativecommons.org/licenses/by-sa/2.0">CC BY-SA 2.0</a>, via Wikimedia Commons
• Pneumonia: <a href="https://commons.wikimedia.org/wiki/File:Lobar_pneumonia,_acute_(3785988179).jpg">Yale Rosen from USA</a>, <a
href="https://creativecommons.org/licenses/by-sa/2.0">CC BY-SA 2.0</a>, via Wikimedia Commons

Slide 4
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• Radiograph of small cell carcinoma in lungs by Yale Rosen, https://www.flickr.com/photos/pulmonary_pathology/6327961394, CC by 2.0
https://creativecommons.org/licenses/by-sa/2.0/

Slide 5
• Alveoli with blood supply: <a
href="https://commons.wikimedia.org/wiki/File:An_alveolus,_is_an_anatomical_structure_that_has_the_form_of_a_hollow_cavity._Mainly_found_in_the_l
ung,_the_pulmonary_alveoli_are_spherical_outcroppings_of_the_respiratory_bronchioles_and_are_the.png">LadyOfHats</a>, CC0, via Wikimedia
Commons
• Heart: <a href="https://commons.wikimedia.org/wiki/File:Diagram_of_the_human_heart.svg">Wapcaplet, Yaddah</a>, <a
href="http://creativecommons.org/licenses/by-sa/3.0/">CC BY-SA 3.0</a>, via Wikimedia Commons
 AfraTafreeh.com
REVIEW OUTLINE

1. Pneumonia
• Causes
• Symptoms
• X-Ray
Lung • Histology

Diseases 2. Bronchogenic Carcinoma

• Causes
• Symptoms
• Metastases
REVIEW OUTLINE

1. Causes

2. Pressure Within Pleural Cavity

Pneumothorax 3. CT - Normal vs Pneumothorax

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4. Hemothorax vs Hydrothorax

5. Treatment options
• Thoracentesis
• Chest tube
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Entry of air into the pleural cavity causing the lung to collapse

Causes
• Penetrating stab wound or bullet
• Fractured rib
• Rupture of a pulmonary lesion
• Lung disease

Types
• Primary spontaneous
• Secondary spontaneous
• Traumatic

Pleural cavity

Parietal pleura
Visceral pleura
 Pneumothorax Bootcamp.com

Entry of air into the pleural cavity causing the lung to collapse

Normal: atmospheric pressure > pressure

within pleural cavity
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Puncture: ↑ pressure within pleural cavity

Pleural cavity

Parietal pleura
Visceral pleura
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Normal Pneumothorax
Hemothorax vs Hydrothorax Bootcamp.com

Hemothorax (hemo = blood) Hydrothorax (hydro = fluid)

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Pleural effusion
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Treatment Options Bootcamp.com

Thoracentesis

• Needle inserted in the 9th

intercostal space at midaxillary line

• Upright position allows fluid to

accumulate in costodiaphragmatic
recess

Chest Tube

• Incision in the 5th or 6th intercostal

space at midaxillary line

• Tube directed superiorly (air

removal) or inferiorly (fluid/blood
removal)
Knowledge Check Bootcamp.com

Explain how a pneumothorax occurs and the pressure changes that occur within the
pleural cavity.

When air enters the pleural cavity causing the lung to collapse

Normal: atmospheric pressure is greater than the pressure in the pleural cavity
Pneumothorax: air enters the pleural cavity increasing the pressure in the pleural cavity
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You are called to perform a thoracentesis (remove fluid from the pleural cavity). If you
are to avoid injuring lung or neurovascular elements, where would you insert the
aspiration needle?

a. The top of the 8th intercostal space at midclavicular line

b. The bottom of the 8th intercostal space at the midclavicular line
c. The top of the 9th intercostal space at the midaxillary line
d. The bottom of the 9th intercostal space at the midaxillary line
 AfraTafreeh.com
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Explain how a pneumothorax occurs and the pressure changes that occur within the
pleural cavity.

When air enters the pleural cavity causing the lung to collapse

Normal: atmospheric pressure is greater than the pressure in the pleural cavity
Pneumothorax: air enters the pleural cavity increasing the pressure in the pleural cavity

You are called to perform a thoracentesis (remove fluid from the pleural cavity). If you
are to avoid injuring lung or neurovascular elements, where would you insert the
aspiration needle?

a. The top of the 8th intercostal space at midclavicular line

b. The bottom of the 8th intercostal space at the midclavicular line
c. The top of the 9th intercostal space at the midaxillary line
d. The bottom of the 9th intercostal space at the midaxillary line
References Bootcamp.com

Slide 2, 3
• <a href="https://commons.wikimedia.org/wiki/File:Tension-pneumothorax.png">Baedr-9439</a>, CC0, via Wikimedia
Commons

Slide 4
• Normal: <a
href="https://commons.wikimedia.org/wiki/File:High-resolution_computed_tomograph_of_a_normal_thorax,_axial_plane_(6
3).jpg">Mikael Häggström</a>, CC0, via Wikimedia Commons
• Pneumothorax: <a href="https://commons.wikimedia.org/wiki/File:Pneumothorax.jpg">Clinical Cases</a>, <a
href="https://creativecommons.org/licenses/by-sa/4.0">CC BY-SA 4.0</a>, via Wikimedia Commons
AfraTafreeh.com
Slide 5
• Hemothorax: <a
href="https://commons.wikimedia.org/wiki/File:CT_scan_showing_hemothorax_caused_by_warfarin_use.png">Cevik
Y</a>, <a href="https://creativecommons.org/licenses/by/3.0">CC BY 3.0</a>, via Wikimedia Commons
• Hydrothorax: <a href="https://commons.wikimedia.org/wiki/File:Effusionhalf.PNG">James Heilman, MD</a>, <a
href="https://creativecommons.org/licenses/by-sa/3.0">CC BY-SA 3.0</a>, via Wikimedia Commons

Slide 6
• Thoracentesis: <a href="https://commons.wikimedia.org/wiki/File:Thoracentesis.jpg">National Heart,
Lung and Blood Institute</a>, Public domain, via Wikimedia Commons
 AfraTafreeh.com
REVIEW OUTLINE

1. Causes

2. Pressure Within Pleural Cavity

Pneumothorax 3. CT - Normal vs Pneumothorax

4. Hemothorax vs Hydrothorax

5. Treatment options
• Thoracentesis
• Chest tube