LOWER AIRWAY TRACT

ANATOMY
YOKANAN
PPDS Pulmonologi Juli 2020 FKUB - RSSA
Pembimbing :
Dr. dr. Susanthy Djajalaksana, Sp.P(K)
dr. Aditya Sri Listyoko, Sp.P
LOWER AIRWAY

• Lower respiratory tract is elongated from distal laring unto the distal part of lung
parenchym. It divided into two groups. First is the conduction respiratory system (thick
walled and no diffusion process), starts from trachea, bronchus, and ended in terminal
bronchiole. The conduction respiratory system followed with blood vessels, lymphatic
system, and nerves. Diffusion respiratory system roles the air changes, starts from
respiratory bronchioles, alveolar sacs, alveolar ducts, and alveoles.
• The lungs are well covered with pleural lining, which consists of visceral pleura (cover the
lungs surface) and parietal pleura (which cover the chest wall, mediastinum, and
diapraghma).
TRACHEA

• The tracehobroncial tree and the lung parenchyma comprise the lower respiratory tract.
• Trachea is a midline structure that extends from lower end of cricoid cartilage at level of
C6 vertebrae to its termination at bronchial bifurcation.
• Living subject in erect position : Extends to level of upper border of 5 th thoracic vertebrae
or in full inspiration up to 6th thoracic vertebrae.
• Comprises 16 – 20 C shaped cartiladge rings, cartilages are joined vertically by
fibroelastic tissue and closed posteriorly by non striated trachealis muscle.
TRACHEA (2)

• In adult
• Length 10 – 12 cm
• Diameter 15 – 20 mm
TRACHEA (3)

• Trachea divides into right and left primary main bronchi. Each further divides into lobar bronchi which
in turn give rise to segmental bronchi-supply air to bronchopulmonary segments.
• Segmental bronchi divides dichotomously, eventually giving rise to terminal bronchioles which further
terminates into respiratory bronchioles.
• Originating from each respiratory bronchioles are 2 – 11 alveolar ducts leading to the alveolar sacs
which are extended as a group of alveoli.
• Airway becomes progressively narrower, shorter and more numerous, and cross sectional area, enlarges.
• Areas of tracheobronchial tree furthest from the trachea are collectively called the distal respiratory tree.
BRONCHIAL TREE
RIGHT MAIN BRONCHUS

• The right main bronchus is 2 cm long on average and has an internal diameter of 10 – 16
mm. This is slightly larger than the diameter of the left main bronchus.
• The bronchus intermedius of the right bronchial tree is actually quite short, extending for
1 – 2.5 cm until its anterior wall extends into and becomes the middle lobe bronchus. Its
posterior wall extends into and becomes the right lower lobe bronchus.
• The Right Upper Lobe Bronchus divides into (3)
• Apical bronchus
• Anterior bronchus
• Posterior bronchus

• Distally just beyond the bronchus intermedius, another

division occurs into : The Middle Lobe Bronchus with
its anterior direction, dividing into (2)
• Medial
• Lateral segmental bronchus

• The Right Lower Lobe Bronchus divides immediately

into
• Superior segmental bronchus (just across from the right
middle lobe bronchus).
• Medial basal segmental bronchus (a bit more distally and
along its medial bronchus).

• Finally dividing into three lower lobe bronchus :

• Antero basal
• Latero basal
• Postero basal
LEFT MAIN BRONCHUS

• The left main bronchus is usually 4 – 5 cm long. Its lumen is narrower and relative
horizontal. The usual length of the left lower lobe bronchus beyond the origin of the
superior segmental bronchus is 1 cm.
• Divides into (2) :
• Upper lobe bronchus
• Lower lobe bronchus
• The Upper Lobe Bronchus divides into
(2) :
• Upper division (3)
• Apical
• Posterior
• Anterior
• Lingular bronchus (2)
• Superior division
• Inferior division

• The Lower Lobe Bronchus divides into

(4) :
• Apical
• Antero basal
• Postero basal
• Latero basal
 TRACHEA

Right Main Left Main

Bronchus Bronchus

Superior Lobar Middle Lobar Inferior Lobar Superior Lobar Inferior Lobar
Bronchus Bronchus Bronchus Bronchus Bronchus

Apical Lateral Superior Apical Apical

Posterior Medial Medial basal Posterior Antero basal

Anterior Antero basal Anterior Latero basal

Superior
Postero basal Postero basal
lingular

Latero basal Inferior lingular

SEGMENTAL VIEWS
ALVEOLES
EPITHELIUM

• Trachea to Terminal bronchioles

• Ciliated pseudo stratified columnar epithelium

• Respiratory bronchioles to Alveolar ducts to Alveoli

• Non ciliated cuboidal epithelium
PLEURA

• A pleura is a serous membrane that folds back on itself to form a two-layered

membranous pleural sac. The outer layer is called the parietal pleura and attaches to the
chest wall. The inner layer is called the visceral pleura and covers the lungs, blood
vessels, nerves, and bronchi. There is no anatomical connection between the right and left
pleural cavities. [1] With the addition of pleural fluid, the lung pleura allows for easy
movement of the lungs and inflation during breathing.
• The pleural cavity is a space between the
visceral and parietal pleura. The space contains
a tiny amount of serous fluid which has two key
functions.
• The serous fluid continuously lubricates the
pleural surface and makes it easy for them to
slide over each other during lung inflation and
deflation. The serous fluid also generates
surface tension, which pulls the visceral and
parietal pleura adjacent to each other. This
function will allow the thoracic cavity to
expand during inspiration. 
MEDIASTINUM

• The mediastinum is a central compartment in the thoracic cavity between the pleural sacs
of the lungs. It is divided into two major parts, the superior and inferior portions. The
inferior portion is then further divided into the anterior, middle, and posterior portion.
Each region of the mediastinum contains specific groups of structures.
MEDIASTINUM
COMPARTMENT
• Superior mediastinum: Organs: thymus, trachea, esophagus;
Arteries: aortic arch, brachiocephalic trunk, left common
carotid artery, left subclavian artery; Veins and lymphatics:
superior vena cava, brachiocephalic vein, thoracic duct;
Nerves: vagus nerve, left recurrent laryngeal nerve, cardiac
nerve, phrenic nerve
• Anterior mediastinum: Organs: thymus; Arteries: small arterial
branches; Veins and lymphatics: small branches; Nerves: none
• Middle mediastinum: Organs: heart, pericardium; Arteries:
ascending aorta, pulmonary trunk, pericardiacophrenic arteries;
Veins and lymphatics: superior vena cava, azygos vein,
pulmonary vein, pericardiacophrenic vein; Nerve: phrenic
• Posterior mediastinum: Organs: esophagus; Arteries: thoracic
aorta; Veins and lymphatics: Azygos vein, hemiazygos vein,
thoracic duct; Nerve: vagus nerve
 Mediastinum Anterior

Mediastinum Medial

Mediastinum Posterior

www.themegallery
MEDIASTINUM
RANGKA DADA
OTOT DADA (1)
OTOT DADA (2)
M. LEVATOR COSTARUM
M. INTERCOSTALIS INTIMUS &
M. SUBCOSTALIS
DIAPHRAGMA PERMUKAAN THORACAL
DIAPHRAGMA PERMUKAAN ABDOMINAL
DIAPHRAGMA (1)

1. Centrum tendineum
2. serabut-serabut otot
diaphragma
4. Crus dextra diaphragma
7. M. psoas major
DIAPHRAGMA (2)

1. Centrum tendineum
2. Serabut otot diaphragma
3. Crus sinistra
4. Crus dextra
5. Hiatus aorticus
6. Hiatus oesophagei
7. M. psoas major
8. M. quadratus lumborum
RONGGA DADA TERBAGI MENJADI 2
RONGGA PLEURA DAN MEDIASTINUM
FUNGSI OTOT DADA
PENDARAHAN & PERSARAFAN DINDING DADA
SELA IGA
ISI RONGGA DADA
PLEURA (3)
RECESSUS PLEURA
PUNKSI PLEURA
TRACHEA DAN PERCABANGAN BRONCHUS
TRACHEA
V: a. anonyma, a. carotis communis kiri, v. ano-
nyma ki, thymus
Ki: a. carotis comm. Ki
a. subclav ki, cbng-
cbng cardiac N. X &
symphaticus
TRACHEA
Ka: a. anonyma, N. X, arcus V. azygos,
cbng-cbng cardiacus N. X & symphaticus.

D: oesophagus,
N. recurrent kiri
TRACHEA DAN ALAT SEKITARNYA
STRUKTUR SEKITAR TRACHEA (1)
STRUKTUR SEKITAR TRACHEA (2)
PENDARAHAN TRACHEA & BRONCHUS
BRONCHUS EXTRAPULMONAL
BRONCHUS
EXTRAPULMONAL
Br. Primer ka.: di caudal arcus v.
azygos
Br. Sec. Lobus sup. kanan: br.
Eparterialis.
Br. Primer ki: di caudal arcus aortae
Br. Sec. Kiri : hyparterialis
ARTERIA DAN VENA PULMONALIS
PENDARAHAN BRONCHUS
PERSARAFAN BRONCHUS
PARU
IN
SITU
PERMUKAAN MEDIASTINALIS PARU
PROYEKSI PARU DAN LIPATAN PLEURA (1)
PROYEKSI PARU DAN LIPATAN PLEURA (2)
PROYEKSI PARU DAN LIPATAN PLEURA (3)
OTOT PUNGGUNG DAN TRIGONUM
AUSKULTASI
GETAH BENING PARU
SEKITAR BRONCHUS EXTRAPULMONAL
OTOT INSPIRASI TAMBAHAN

1. M. sternocleido-
mastoideus
2. M. scalenus anterior
3. M. scalenus medius
4. M. scalenus posterior
OTOT INSPIRASI DAN EKSPIRASI TAMBAHAN (1)

9. M. obliquus abdominis
internus (E)
10. M. latissimus dorsi (I)
11. M. serratus posterior superior (I)
12. M. iliocostalis bagian atas (I)
13. M. iliocostalis bagian bawah (E)
14. M. longissimus (E)
15. M. serratus posterior inferior (E)
OTOT INSPIRASI DAN EKSPIRASI TAMBAHAN (2)

1. M. sternocleidomastoid (I)
2. M. scalenus anterior (I)
3. M. scalenus medius (I)
4. M. pectoralis major (I)
5. M. pectoralis minor (I)
6. M. serratus anterior (I)
7. M. rectus abdominis (E)
8. M. obliquus abdominis ext (E)
9. M. obiquus abdominis int (E)
SEWAKTU KONTRAKSI DIAPHRAGMA

Centrum tendineum turun

Diameter vertikal rongga dada
meningkat
Resistensi alat dalaman perut
meningkat melalui otot-otot
dinding depan perut
BEDA GERAK DIAPHRAGMA YANG NORMAL
DAN YANG LUMPUH PADA INSPIRASI

Inspirasi normal Diaphragma kanan lumpuh

REFERENCES

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tomography scans and lung anatomy during guided bronchoscopy. Journal of Thoracic Disease. 2020
Apr;12(4):1595.
• Edwards, Z. and Annamaraju, P., 2020. Physiology, Lung Compliance.
• Aung HH, Sivakumar A, Gholami SK, Venkateswaran SP, Gorain B. An Overview of the Anatomy and
Physiology of the Lung. InNanotechnology-Based Targeted Drug Delivery Systems for Lung Cancer 2019 Jan
1 (pp. 1-20). Academic Press.
• McKleroy W, Lyn-Kew K. 500 Million Alveoli from 30,000 Feet: A Brief Primer on Lung Anatomy. InLung Innate
Immunity and Inflammation 2018 (pp. 3-15). Humana Press, New York, NY.
• Bernhard W. Lung surfactant: Function and composition in the context of development and respiratory
physiology. Annals of Anatomy-Anatomischer Anzeiger. 2016 Nov 1;208:146-50.
SURFACTANTS

• Lung surfactant is a complex with a unique phospholipid and protein composition. Its specific function is to reduce surface tension at
the pulmonary air–liquid interface. The underlying Young–Laplace equation, applying to the surface of any geometrical structure, is
the more important the smaller its radii are. It therefore applies to the alveoli and bronchioli of mature lungs, as well as to the tubules
and saccules of immature lungs. Surfactant comprises 80% phosphatidylcholine (PC), of which dipalmitoyl-PC, palmitoyl-myristoyl-
PC and palmitoyl-palmitoleoyl-PC together are 75%. Anionic phosphatidylglycerol and cholesterol are about 10% each, whereas 
surfactant proteins SP-A to -D comprise 2–5%. Maturation of the surfactant system is not essentially due to increased synthesis but to
decreased turnover of specific components. Molecular differences correlate with resting respiratory rate (RR), where PC16:0/16:0 is
the lower the higher RR is. PC16:0/14:0 is increased during alveolar formation, and decreases immune reactions that might impair
alveolar development. In rigid bird lungs, with air-capillaries rather than alveoli, and no surface area changes during the respiratory
cycle, PC16:0/16:0 is highest and PC16:0/14:0 absent. As there is no need for a surface-associated surfactant reservoir, SP-C is absent
in birds as well. Airflow is lowest and particle sedimentation highest in the extrapulmonary air-sacs, rather than in the gas-exchange
area. Consequently, SP-A and -D for particle opsonization are absent in bird surfactant. In essence, comparative analysis is consistent
with the concept that surfactant is adapted to the physiologic needs of a given vertebrate species at a given developmental stage.