Respiratory System

Objectives
By the end of the lecture, the student should be able to :
• Describe the anatomy of the pleura: (subdivisions
into parietal & visceral pleurae, nerve supply).
• List the parts of parietal pleura and its recesses.
• Describe the surface anatomy of both pleurae and
lungs.
• Describe the anatomy of lungs : (shape, surfaces,
relations, nerve supply, blood supply and lymphatic
drainage.
• Describe the difference between right & left lungs.
• Describe the formation of bronchopulmonary
segments and its main characteristics.
Functions of the Respiratory
System
 Air Distributor
 Gas exchanger
 Filters, warms, and humidifies
air
 Influences speech
 Allows for sense of smell
 Divisions of the
Respiratory System
 Upper respiratory
tract (outside
thorax)
 Nose
 Nasal Cavity
 Sinuses
 Pharynx
Larynx
 Divisions of the
Respiratory System
 Lower respiratory
tract (within
thorax)

 Trachea
 Bronchial Tree
 Lungs
 Structures of the Lower
Respiratory Tract
• Larynx - voice box
– Root of tongue to
upper end of trachea.
– Made of cartilage
– 2 pairs of folds
• Vestibular - false
vocal cords
• True vocal cords
 Structures of the Lower
Respiratory Tract
• Trachea (windpipe)
– Larynx to bronchi
– Consists of smooth
cartilage and C
shaped rings of
cartilage.
– Tracheostomy -
cutting of an opening
in trachea to allow
breathing.
 Trachea
• 10-12 cm long
• 1.5-2.5 cm wide
• Extends to second rib anteriorly and T4-T5
posteriorly
• 15-20 C shaped rings
 Structures of the Lower
Respiratory Tract
• Bronchi
– Tubes that branch off
trachea and enter into
lungs
– Ciliated
– Branches: Primary
bronchi—secondary
bronchi—tertiary
bronchi—bronchioles
– Bronchioles branch into
microscopic alveolar ducts.
Terminate into alveolar
sacs
– Gas exchange with blood
occurs in sacs.
 Structures of the Lower
Respiratory Tract
• Lungs
– Extend from
diaphragm to
clavicles
– Divided into lobes
by fissures.
– Visceral pleura
adheres to the
lungs.
• Pleurisy =
inflammation of the
pleural lining
(Plural – bronchi) Bronchioles
SURFACE ANATOMY OF LUNG
• Apex, anterior border
and posterior border
correspond nearly to the lines
of pleura but are slightly away
from the median plane.
• Inferior margin:
• as the pleura but more
horizontal and finally reaching
to the 10th thoracic spine.
• Oblique fissure:
• represented by a line
extending from 3rd thoracic
spine, obliquely ending at 6th
costal cartilage.
• Transverse fissure only in
right lung: represented by a
line extending from 4th right
costal cartilage to meet the
oblique fissure.
SUFACE ANATOMY OF PLEURA
• Apex:
• lies one inch above the medial 1/3 of
the clavicle.
• Left pleura:
• The anterior margin extends from
sternoclavicular joint to the level of 4th
costal cartilage, then deviates for
about 1 inch to left at 6th costal
cartilage to form cardiac notch.
• Right pleura:
• The anterior margin extends vertically
from sternoclavicular joint to 6th costal
cartilage.
• Inferior margin : passes round chest
wall, on the 8th rib in midclavicular line,
10th rib in mid-axillary line and finally
reaching to the last thoracic spine.
• Posterior margin : along the vertebral
column from the apex to the inferior
margin.
 PLEURA
• It is a closed serous
sac which surrounds
the lung and
invaginated from its
medial side by the root
of lung.
• It has 2 – layers:
parietal pleura which
lines the thoracic
cavity. & visceral pleura
which surrounds the
lung, separated by a
pleural cavity.
• Pleural cavity:
• Contains 5-10 ml. of
serous fluid which
lubricates both sufaces
and allows the lungs to
move free during
respiration.
Divisions of parietal pleura
• 1- Cervical pleura:
It is part of parietal
pleura which protrudes
up into the root of the
neck.
• 2-Costal pleura:
It lines inner surface of
ribs, costal cartilages,
intercostal muscles
and back of the
sternum.
• 3-Diaphragmatic
pleura:
It covers upper surface
of the diaphragm.
• 4-Mediastinal pleura:
It covers mediastinal
surface of the lung.
Visceral Pleura
 firmly covers outer
surfaces of the lung and
extends into its fissures.
 The 2- layers (mediastinal
parietal pleura & visceral
pleura) are continuous
with each other to form a
tubular sheath (pleural
cuff) that surrounding root
of lung (vessels, nerves &
bronchi) in the hilum of
the lung.
 On the lower surface of
root of the lung, pleural
cuff hangs down as a fold
called pulmonary
ligament.
 Pleural
Recesses
 Costodiaphragmatic
recess :
lies between costal
& diaphragmatic
parietal pleura along
the inferior border.
 Costomediastinal
recess :
lies between costal
& mediastinal
parietal pleura along
the anterior border.
 The lung reaches these
recesses only in deep
inspiration.
Nerve Supply of Pleura
• Parietal pleura….
• Costal P.P….by
intercostal nerves.
• Mediastinal P.P….by
phrenic nerve.
• Diaphragmatic P.P.:
1-Medially by phrenic
nerve.
2-Peripheral part.. by
lower 6 intercostal
nerves.
• Visceral pleura…
sympathetic N.S.
from pulmonary
plexus.
Pleural Effusion • It is an abnormal
accumulation of pleural fluid
about 300 ml, in the
Costodiaphragmatic recess
, (normally 5-10 ml of clear
fluid)
• Causes:
• Inflammation, TB,
malignancy, congestive
heart disease.
• The lung is compressed &
the bronchi are narrowed.
• Auscultation would reveal
only faint & decreased
breath sounds over the
compressed or collapsed
lung.
• Dullness on percussion
over the effusion.
Blood supply of Pleura
• Parietal pleura… by
intercostal, internal
thoracic &
musculophrenic
vessels.
• Visceral pleura ….by
bronchial vessles.
Lymphatic Drainage:
• Parietal pleura : into
intercostal,,
mediastinal &
diaphragmatic
Lymph Nodes.
• Visceral pleura : into
broncho-pulmonary
Lymph Nodes in the
hilum of the lung.
 The Mediastinum
Concept all of organs
between the left and
right mediastinal
pleurae is called
mediastinum. It extends
from the sternum in
front to the vertebral
column behind, and
from the thoracic inlet
above to the diaphragm
below.
Mediastinum
• Behind Sternum
• Mediastinum
borders are:
– Lateral
– Posterior
– Anterior
– Inferior
 Structures

• Heart
• Trachea
• Great Vessels
• Thymus Gland
• Nerves
• Lymph Nodes &
Vessels
• 3 parts: Manubrium, Body * Sternum
Xiphoid process.
• Manubrium: Lies opposite
T3,4. Body: T5 toT8
• Xiphoid T9
 Subdivisions of
mediastinum
• Superior mediastinum
• Inferior mediastinum
– Anterior mediastinum
– Middle mediastinum
– Posterior mediastinum
 Superior mediastinum
Locating - from inlet of
thorax to plane extending
from level of sternal angle
anteriorly to lower border of
T4 vertebra posterioly
Contents
• Superficial layer
– Thymus
– Three veins
• Left brachiocephelic v.
• Right brachiocephelic v.
• Superior vena cava
 Inferior mediastinum

Anterior mediastinum
• Location - posterior to body of
sternum and attached costal
cartilages, anterior to heart and
pericardium
• Contents - fat, remnants of
thymus gland, anterior
mediastinal lymph nodes
Middle mediastinum
• Location - between
anterior mediastinum and
posterior mediastinum
• Contents: hart and
pericardium, beginning or
termination of great
vessels, phrenic nerves,
pericardiacophrenic
vessels , lymph nodes,
Posterior mediastinum
• Location - posterior to heart
and pericardium, anterior to
vertebrae T5 - T12
• Contents: esophagus, vagus
n., thoracic aorta, azygos
system of veins, thoracic duct,
thoracic sympathetic trunk,
posterior mediastinal lymph
nodes
 Mediastinal spaces
• Retrosternal space - lies
beween sternum and
endothoracic fascia
• Pretracheal space - lies within
superior mediastinum, between
trachea, bifurcation of trachea
and aortic arch
• Retroesophagus space - lies
within superior mediastinum,
beween esophagus and
endothoracic fascia
 • Intercostal Spaces
• There are 9 anterior and
11 posterior
• Each space contains:
• 1- Intercostal muscles:
(External, Internal and
transversus thoracicus)
• 2- An Intercostal nerve.
• 3- Intercostal vessels:
• a. Intercostal arteries
(Anterior & Posterior)
• b. Intercostal veins
(Anterior & Posterior).
 Azygos Vein
• Connects IVC with SVC S
V
• Begins in abdomen from C
back of IVC at level of L2
• Enters thorax through Aortic
opening of diaphragm on Rt.
side of thoracic duct & aorta.
• In post. Mediastinum it
passes behind Rt. Border of
esophagus & root of rt. Lung I
V
• In sup. Mediastinum (L4) it
C
crosses above the root of rt.
lung
Enters the middle of the back
of the SVC.
 Posterior Intercostal veins
• One in each of the 11 spaces.
• On the right:
• 1st drains into Rt. Innominate v.
• 2nd,3rd & sometimes the 4th unite to
form Rt. Superior Intercostal vein (B)
which drains into azygos vein.
• From 5th to 11th & subcostal veins
drain into azygos vein ©.
• On the Left:
• 1st drains into Lt. innominate V.
• 2nd,3rd& sometimes the 4th join to form
Lt. Superior Intercostal vein which
drains into Lt innominate vein.
• 5th,6th,7th, & 8th form superior
hemiazygos vein to azygos vein
• 9th,10th.11th &Subcostal form inferior
hemiazygos vein to azygos vein.
 Lung Borders
• Anterior Chest –
– Apex 3 -4 cm. ↑ inner 1/3 of the clavicles
– Base – rests on the diaphragm, 6th rib, MCL
• Lateral Chest
– Extends from Axilla apex to 7th –8th rib
• Posteriorly
– Apex of lung is at C7 – Base T10 (on deep inspiration
to T12)
 Reference Lines
• Anterior Chest
– Midsternal line
– Midclavicular line

• Posterior Chest
– Vertebral line – midspinal
– Scapular line
• Lateral Chest
– Anterior Axillary line
– Posterior Axillary line
– Mid–axillary line
 Right
lung
• Larger &
shorter than
left lung.
• Divided by
2 fissures
(oblique &
horizontal)
into 3 lobes
(upper,
middle and
lower lobes).
 Left
Lung
• Divided by
one oblique
fissure into -2
lobes, Upper
and lower.
• There is No
horizontal
fissure.
• It has a
cardiac notch
at lower part
of its anterior
border.
 Surfaces: Costal & Mediastinal
• Costal surface:
• Convex.
• Covered by costal pleura
which separates lung from:
ribs, costal cartilages &
intercostal muscles.
• Medial surface:
• It is divided into 2 parts:
• Anterior (mediastinal) part:
• Contains a hilum in the
middle (it is a depression
in which bronchi, vessels,
& nerves forming the root
of lung).
• Posterior (vertebral) part:
• It is related to: bodies of
thoracic vertebrae,
intervertebral discs,
Lateral & medial surfaces of right lung posterior intercostal
vessels & sympathetic
trunk.
Characteristics of Bronchopulmonary segments
• It is a subdivision of a
lung lobe.
• It is pyramidal in
shaped, its apex lies
toward the root, while its
base lies on the lung
surface.
• It is surrounded by
connective tissue septa.
• It has a segmental
bronchus, a segmental
artery, lymph vessels,
and autonomic nerves.
• The segmental vein lies
in the inter- segmental
C.T. septa between the
segments.
• A diseased segment
can be removed
surgically, because it is
a structural unit.
Structures of the Lower
Respiratory Tract
 Bronchi
• The trachea divides
into 2 main bronchi:
• Right main
bronchus:
It divides before
entering the hilum,
it gives off superior
lobar (secondary)
bronchus.
On entering hilum, it
divides into middle
& inferior lobar
bronchi.
• Left main bronchus:
On entering hilum, it
divides into superior
& inferior lobar
bronchi.
 Tracheobronchial Tree
• Dichotomous branching (daughter
branches)
• Airways become progressively narrower,
shorter, and more numerous
• Cross-sectional area enlarges
• Common histology (at the nose) and
throughout until the bronchiole generation
 Tracheobronchial Tree

• Series of branching
airways commonly
referred to a
“generations” or
“orders”
• The first generation
or order is zero (0),
the trachea itself.
• Bifucrates at the
carina
 Bronchial Divisions

• Within the lung each

bronchus divides into
number of branches
that can be divided
into two groups:

I- Conduction zone
branches
Primary (main) bronchi
Secondary (lobar) bronchi
Tertiary (segmental)
II- Respiratory zone
bronchi (supply the branches
bronchopulmonary • Respiratory
segment) bronchioles
Smaller bronchi • Alveolar ducts
Bronchioles
• Alveolar sacs
Terminal bronchioles
• Alveoli
Weibel model of airways
Bronchopulmonary segments
• They are the
anatomic, functional,
and surgical units of
the lungs.
• Each lobar
(secondary) bronchus
gives off segmental
(tertiary) bronchi.
• Each segmental
bronchus divides
repeatedly into
bronchioles.
• Bronchioles divide into
terminal bronchioles,
which show delicate
outpouchings ‘the
respiratory
bronchioles’.
Bronchopulmonary segments

• The respiratory
bronchioles end
by branching into
alveolar ducts,
which lead into
alveolar sacs.
• The alveolar sacs
consist of several
alveoli, each
alveolus is
surrounded by a
network of blood
capillaries for gas
exchange.
http://people.eku.edu/ritchisong/301notes6.htm
 Inspiration
-contraction of diaphragm and
intercostal muscles
 Expiration
• relaxation of diaphragm and
intercostal muscles
 Upper Airways
• Nose
• Paranasal sinuses
• Pharynx
 Main Stem Bronchi
• Right bronchus • Left bronchus
– Wider – Narrower
– More vertical – More angular
– 5 cm shorter – Longer
– Supported by C – Supported by C
shaped cartilages shaped cartilages
– 20-30 degree angle – 40-60 degree angle
– First generation – First generation
 Lobar Bronchi
• R main stem divides • L main stem divides
into: into:
– Upper lobar bronchus – Upper lobar bronchus
– Middle lobar bronchus
– Lower lobar bronchus – Lower lobar bronchus
 Segmental Bronchi
3rd generation
• R lobar divides into • L lobar divides into
– Segmental bronchi – Segmental bronchi
– 10 segments on right – 8 segments on left
 Subsegmental Bronchi
• 4th to 9th generations
• Progressively smaller airways
• 1-4 mm diameter
• At 1 mm diameter connective tissue
sheath disappears
 Terminal Bronchioles
• 16th to 19th generation
• Average diameter is 0.5 mm
• Cilia and mucous glands begin to
disappear totally
• End of the conducting airway
• Canals of Lambert-interconnect this
generation,provide collateral ventilation
 Gas exchange terminology
• All of the structures arising from a single
terminal bronchiole are called
– Primary lobule
– Acinus
– Terminal respiratory unit
– Lung parenchyma
– Functional units
 Acinus/Primary lobule
• Respiratory bronchioles with some alveoli
arising from their walls

• Alveolar ducts arise from respiratory

bronchioles--alveoli whose septal wall
contain smooth muscle
 Alveoli
• Ca. 300 million alveoli
• Between 75 µ to 300 µ in diameter

• Most gas exchange takes place at

alveolar-capillary membrane
 Anatomic Arrangement of
Alveoli
• 85-95% of alveoli covered by small
pulmonary capillaires

• The cross-sectional area or surface area is

approximately 70m2
 Acinus or Lobule
• Each acinus (unit) is approximately 3.5
mm in diameter
• Each contains about 2000 aveloli

• Approximately 130,000 primary lobules in

the lung
 Alveoli
• Ca. 300 million alveoli
• Between 75 µ to 300 µ in diameter

• Most gas exchange takes place at

alveolar-capillary membrane
 Anatomic Arrangement of
Alveoli
• 85-95% of alveoli covered by small
pulmonary capillaires

• The cross-sectional area or surface area is

approximately 70m2
 LUNGS
• Each lung has
the following
features:
• It is conical in
shape.
• It has an apex, a
base and 2
surfaces.
• The costal
surface of each
lung borders the
ribs (front and
back).
• On the medial
(mediastinal)
surface, the
bronchi, blood
vessels, and
lymphatic
vessels enter
the lung at the
hilum.
 LUNGS
• Apex: projects into
root of the neck (one
inch above the
medial 1/3 of the
clavicle).
It is covered by
cervical pleura.
It is grooved
anteriorly by
subclavian artery.
• Base: (inferior=
diaphragmatic
surface) is concave
and sits on the
diaphragm.
Borders: Anterior & Posterior
• Anterior border :
is sharp, thin and
overlaps the
heart.
• Anterior border of
left lung presents
a cardiac notch
at its lower end +
thin projection
called the lingula
below the cardiac
notch.
• Posterior border :
is rounded, thick
and lies beside
the vertebral
column.
 RIGHT
LUNG
ROOT
• 2 bronchi lie
posterior.
• Pulmonary
artery is
superior
• 2 Pulmonary
veins are
inferior and
anterior.
 LEFT
LUNG
ROOT

• One
bronchus
lies posterior
• Pulmonary
artery is
superior
• 2 Pulmonary
veins are
inferior and
anterior.
 Mediastinal surface of right lung
• On the mediastinal
surface of the right
lung, you find these
structures:
• Azygos vein and its
arch (posterior and
over the root of the
lung).
• Vagus nerve posterior
to the root.
• Esophagus above and
posterior to the root.
• Phrenic nerve anterior
Cardiac to the root.
impression • Cardiac impression:
related to right atrium.
• Below hilum and in
front of pulmonary
ligament:
• Groove for I.V.C.
Mediastinal surface of left lung
• On the mediastinal
surface of the left
lung, you will find
these structures:
• Descending aorta
posterior to the root.
• Vagus nerve posterior
to the root.
• Arch of the aorta over
the root.
• Groove for left
common carotid
Cardiac artery.
impression • Groove for left
subclavian artery.
• Phrenic nerve anterior
to the root.
• Cardiac impression :
related to left
ventricle.
 Blood supply of lung

• Bronchial arteries (branches of descending

thoracic aorta)….. supply oxygenated blood
to bronchi , lung tissue & visceral pleura.
• Bronchial veins : drain into azygos &
hemiazygos veins.
• Pulmonary artery which carries
non-oxygenated blood from right ventricle to
the lung alveoli.
• 2 pulmonary veins : carry oxygenated blood
from lung alveoli to the left atrium.
 Nerve Supply of the lung

• Pulmonary plexus :
• at the root of lung….is formed of autonomic
N.S. from sympathetic & parasympathetic
fibres.
1- Sympathetic F. from ..sympathetic trunk
broncho-dilatation /and vasoconstriction.
2- Parasympathetic F. from….Vagus nerve
…. Broncho-constriction and secretomotor to
bronchial glands /and vasodilatation.
Lymph drainage of the lungs
• There are 2 lymphatic
plexuses…. superficial & deep
plexuses.
• Superficial plexus (subpleural):
lies under the visceral pleura
and drain to bronchopulmonary
nodes in the hilum of lung.
• Deep plexus:
• Lies along the bronchial tree &
pulmonary blood vessels and
drain into the pulmonary nodes
within the lung substance.
• Then into bronchopulmonary
nodes in the hilum of lung.
• Then into the tracheo-bronchial
nodes at the bifurcation of
trachea , and finally into
broncho-mediastinal lymph
trunks to end in thoracic duct
(left) or in right lymphatic duct
(right).
Blood Supply to the
Pulmonary System
Two Systems
 Bronchial Blood Supply
• Bronchial arteries
– From aorta to temrinal bronchioles

– Merge with pulmonary arteries and capillaries

– 1% of total cardiac output (left ventricle)

 Bronchial Blood Supply
• Bronchial arteries
– From aorta to temrinal bronchioles

– Merge with pulmonary arteries and capillaries

– 1% of total cardiac output (left ventricle)

 Bronchial arteries
• Also nourish
– Mediastinal lymph nodes
– Pulmonary nerves
– Some muscular pulmonary arteries and veins
– Portions of the esophagus
– Visceral pleura
 Bronchial venous system
• 1/3 blood returns to right heart
– Azygous
– Hemiazygous
– Intercostal veins

– This blood comes form the first two or three

generations of bronchi
 Bronchial venous return
• 2/3 of blood flowing to terminal bronchioles
drains into pulmonary circulation via
“bronchopulmonary anastomoses”
• Then flows to left atrium via pulmonary
veins
• Contributes to “venous admixture” or
“anatomic shunt” (ca. 5% of C.O.)
 Pulmonary Vascular System
• The second source of blood to the lungs
• Primary purpose is to deliver blood to
lungs for gas exchange
• Also delivers nutrients to cells distal to
terminal bronchioles
• Composed of arteries, arterioles,
capllaries, venules, and veins
 Pulmonary Capillaries
• Walls are les than 0.1µ thick
• Total external thickness is about 10µ
• Selective permeability to water,
electrolytes, sugars
• Produce and destroy biologically active
substances