MEDIASTINUM Superior mediastinum y Thymus y Large arteries and veins y Trachea and lymph nodes y Esophagus y Thoracic duct

y Sympathetic nerve trunk Anterior Mediastinum y Thymus y Lymph nodes y Sternopericardial ligaments Middle Mediastinum y Pericardium y Heart and roots of great blood vessels y Phrenic nerves y Bifurcation of trachea y Lymph nodes Posterior Mediastinum y Descending thoracic aorta y Esophagus y Thoracic duct y Azygos and hemiazygos veins y Lymph nodes y Vagus and splanchic nerves y Sympathetic trunks PLEURA is a thin layer of CT lines the thoracic cavity and the lung parenchyma Parietal Pleura: lines the thoracic wall, thoracic surface of the diaphragm, lateral surface of the mediastinum and extends to the neck. Visceral Pleura: covers and follows indentation of lung (Fissures) y two pleurae are separated by the slitlike space which is called the Pleural Space and become continuous with each other at the HILUM. Parietal Pleura Divisions y Cervical Pleura extends above the level of the first rib y Costal Pleura lines the ribs, VC and ICS -

y y

Diaphragmatic Pleura covers the diaphragm Mediastinal Pleura lies against the mediastinum

Pleural Reflection y Costaldiaphragmatic Recess (space) space where costal and diaphragmatic pleura meets. y Costalmediastinal Recess (space) space where mediastinal and costal pleura meets. y Pulmonary Ligament transition between visceral and parietal pleura at root of the lung. Nerve Supply of Pleura  Parietal pleura - is sensitive to pain, temperature, touch and pressure  Costal pleura intercostals nerves  Mediastinal pleura phrenic nerve  Diaphragmatic pleura  Dome phrenic nerve  Lateral intercostal nerve  Visceral Pleura - receives an autonomic nerve supply from pulmonary plexus; sensitive to stretching TRACHEA y Mobile cartilaginous and membranous tube y 5 inches long, 1 inch in diameter y Supported by C -shaped sacrtigae segments y Superior mediastinum y Starts from the cricoids cartilage (C6) y Bifurcates into primary bronchi at the sterna angle (disc between T4-5 vertebrae) Anterior y Sternum y Thymus y Left brachiocephalic veins y Left common carotid

y Arch of the aorta Porterior y Esophagus y Left recurrent laryngeal nerve Right Side y Azygous vein y Right vagus nerve and pleura y Right phrenic nerve Left Side y Arch of aorta y Left common carotid y Left subclavian y Left vagus nerve y Left phrenic nerve and pleura Innervations y Vagus via recurrent Laryngeal Nerve y Sympathetic trachealis muscle and tracheal mucosa BRONCHI Principal Bronchi y Right shorter, wider, and more vertical Prior to its entry in the lung hilum it trifurcates:  Superior Lobar Bronchus  Middle Lobar Bronchus  Inferior Lobar Bronchus y Left longer, narrower, and less vertical It enters the hilum inferior the Arch of the aorta and anterior the Esophagus  Superior Lobar Bronchus  Inferior Lobar Bronchus LUNGS y Conical in shape and covered with visceral pleura y Bilateral organs on each side of mediastinum y Spongy and elastic parenchyma y Pinkish reddish coloration y Separated by the heart and great vessels Right Lung Morphology y Slightly larger than the left

3 Lobes: Upper, Middle and Lower lobes Middle Lobes is a small, triangular lobe bound by both fissures Right Lung y Oblique Fissure runs from inferior border upward and backward across the medial and costal sufaces until it cuts the posterior border y Horizontal Fissure runs horizontally across the costal surface to meet the oblique fissure Lobes of the Right Lung y Superior Lobe: o Apical lobule o Posterior lobule o Anterior lobule y Middle Lobe: o Lateral lobule o Medial lobule y Inferior Lobe: o Apical/Superior lobule o Anterior basal lobule o Posterior basal lobule o Medial basal lobule o Lateral basal lobule Left lung Morphology y 2 Lobes: Upper and Lower Lobes y Oblique Fissure: same as for right Lung y No horizontal fissure Lobes of the Left Lung y Superior Lobe: o Apical lobule o Posterior lobule o Anterior lobule o Superior lingular lobule o Inferior lingular lobule y Inferior Lobe: o Apical/Superior lobule o Anterior basal lobule o Posterior basal lobule o Medial basal lobule o Lateral basal lobule y y BRONCHOPULMONARY SEGMENTS y Anatomic, functional, and surgical units of the lungs

y y y y y

y y

Each lobar (secondary) bronchus gives off branches called segmental (tertiary) bronchi Each segmental bronchus then enters a bronchopulmonary segment A subdivision of lung lobe Pyramidal in shape Surrounded by CT Has a segmental bronchus, a segmental artery, lymph vessels and autonomic nerves Segmental vein lies in the CT bet. adjacent BPS A diseased segment can be removed surgically

All the lymph from the lung leaves the hilum and drains into tracheobronchial nodes and into the bronchomediastinal lymph trunks

Nerve Supply of the Lungs Pulmonary Plexus  Anterior and Posterior Plexus: o Lie anterior and posterior to roots of lungs o Contain parasympathetic fibers: from vagus nerve (CN X) o Contain sympathetic fibers: from T1-4 Mechanics of Respiration y Quiet inspiration y Forced inspiration y Quiet expiration y Forced inspiration

Bronchopulmonary Tree y Trachea supported by cartilaginous rings y Primary Bronchi supported by cartilaginous rings y Secondary Bronchi supported by cartilaginous rings y Tertiary Bronchi/Bronchioles Bronchial Arteries y Supply bronchi, CT, and visceral pleura y Two left bronchial arteries from the descending thoracic aorta y Right bronchial artery origin is variable usually from first aortic intercostals artery. Bronchial Veins y Right lung azygos vein y Left lung accessory hemiazygos vein or left superior intercostals veins y Alveoli receive deoxygenated blood from the pulmonary arteries Lymph Darinage of the Lungs y Lymph vessels originate in the superficial and deep pleaxus y Superficial Plexus: drains over the surface of the lung toward the hilum y Deep Plexus: passes thru pulmonary nodes within the lungs