Lungs

Lungs

1. Apex

   • It is the rounded upper end.
   • Projects upwards through the thoracic inlet into the root of the neck.
   • Related to suprapleural membrane

2. Base

   • Is the concave lower surface that rests on upper surface of the diaphragm.
   • The diaphragm separates the base of the lung from :
     • Right lung : Right lobe of the liver
     • Left Lung :
       • Liver
       • Fundus of the stomach
       • Spleen
   • The concavity of the base is deep on right lung because of the presence of liver.

3. Surfaces

   • Costal Surface
     • related to :
       • Sternum
       • Costal Cartilages
       • Ribs
       • Intercostal muscles
       • Sternocostalis muscle
   • Medial Surface
     • Vertebral part
       • lies behind hilum
       • related to :
         • sides of vertebral bodies
         • Intervertebral disc
         • Posterior intercostal vessels
         • Sympathetic Trunk
         • Splanchnic nerves
     • Mediastinal part
       • is anterior part
       • differs between right & left lungs

4. Mediastinal surface of right lung

   • Hilum
     • Shows cut section of:
       • 2 Bronchi
       • 1 Pulmonary artery
       • 2 pulmonary veins
       • 1 bronchial artery
       • Bronchopulmonary LN
       • Anterior & Posterior pulmonary plexuses
   • Pericardial impression infront of Hilum and pulmonary ligament
   • Impression for upper part of IVC
   • Impression for SVC infront of upper part of hilum
     • continuous upwards with the groove for the right brachiocephalic vein.
   • Groove for the ARCH OF VENA AZYGOS vein: above the hilum reaching groove for SVC
   • Impression for the TRACHEA and the RIGHT VAGUS NERVE: Above the hilum, Lies behind the SVC groove and above arch of the azygos vein.
   • Esophagus Impression
   • Azygos vein Groove
   • The esophagus is related to the right lung in the following sites:
     • Behind the Hilum
     • Behind Pulmonary Ligament
     • Behind the groove of the trachea above the arch of the azygos vein.

5. Mediastinal surface of Left lung

   • Hilum
     • 1 principle Bronchus
     • 1 Pulmonary artery
     • 2 Pulmonary veins
     • 2 Bronchial arteries
     • Bronchopulmonary L.N
     • Anterior & Posterior pulmonary plexuses
   • Pericardial impression; related to:
     • Pericardium
     • Left Ventricle
     • Left auricle
   • Impression for the pulmonary trunk and remains of the thymus gland
     • Lies just above the pericardial impression & in front of upper part of the hilum
   • Groove for AORTIC ARCH:
     • Well-defined groove above the hilum
     • related to:
       • Left vagus nerve
       • Left phrenic nerve
       • Left superior Intercostal vein
   • Descending aorta Groove:
     • broad longitudinal groove behind the hilum and the pulmonary ligament.
   • Groove for left subclavian & left common carotid arteries
     • lies in front of and parallel to the groove for the left subclavian.
   • The left phrenic nerve
     • Passes between the grooves for the left common carotid and left subclavian
   • Area related to esophagus, thoracic duct & left recurrent laryngeal nerve
     • Narrow vertical area behind the groove for the left subclavian artery.
   • The Esophagus
     • forms a groove in front of the descending aorta.

6. Lingula

   • Tongue-like projection of the upper lobe at the cardiac notch
   • Corresponds to the right middle lobe
   • The cardiac notch is produced on the upper lobe of the left lung owing to the bulging of the heart.

7. Fissures of the lungs

   • The left lung: Has only 1 fissure (oblique) dividing it into upper & lower lobes.
   • The right lung: Has 2 fissures (oblique and horizontal) into 3 lobes (upper, middle & lower).
   • Oblique fissure
     • Begins at the posterior border:
       • opposite the 3rd thoracic spine
     • Extends downwards and forwards
     • Cuts the inferior border of the lung opposite the 6th costo-chondral junction
     • Follows the medial border of the scapula when the arm is abducted
   • Horizontal fissure
     • Extends from the anterior border of the right lung at the level of the 4th costal cartilage
     • Ends at the oblique fissure in the midaxillary line
     • On the surface of the body, it passes forwards from the oblique fissure following the line of the 4th rib.

8. Hilum and root of the lung

   • Hilum: Is the part of medial surface of the lung, which gives passage to structures
   • Root: Structures passing through the hilum connecting mediastinum to the lung
   • Structure Arrangment in the lung root
     • The most superior structure is the PULMONARY ARTERY.
     • The more posterior structure is MAIN BRONCHUS.
     • The most anterior and inferior are the PULMONARY VEINS

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