204: Lungs and the Pleural Cavaity

Two pulmonary cavities - lung & pleurae

Mediastinum - Central compartment (heart, great vessels, trachea, esophagus)

What are the three compartments of the thoracic cavity and lungs?

Mediastinum

What structure is this axial cross-section of?

Trachea

What is shown at #1?

Hilum

What is shown at #2?

Right atrium

What is shown at #3?

Aortic arch "aortic knob"

What is shown at #4?

Left ventricle

What is shown at #5?

Right ventricle

What is shown at #6?`

right lung

which lung has a superior, middle and inferior lobe?

left lung

which lung has a cardiac notch?

left lung

which lung has a lungula?

right lung

which lung has a horizontal fissure?

Horizontal fissure

Identify the line

Oblique fissure

Identify the lines

Cardiac notch

Identify the part of the lung

left and right lung

which lung has an oblique fissue?

superior lobe of left lung

the lingula is located on which lobe?

superior lobe of left lung

the cardiac notch is located on which lobe?

Allows injection into heart without damaging lunch --> an opening directly to the heart

What is a clinical advantage about the cardiac notch?

hilum of lung

Identify this structure

Pulmonary veins

What passes through the inferior part of the hilum?

Pulmonary arteries

What passes through the superior part of the hilum?

Bronchi

What is the white thick wall in the hilum?

Azygous vein

Above the hilum, there is an impression for what vein?

the Pleurae

Lungs are surrounded by the serous membranes:

parietal pleura (includes costal, diaphragmatic, mediastinal, cervical)

lines the thoracic cavity and covers the diaphragm encasing the lungs:

visceral pleura

covers surface of lungs:

cervical pleura

which lung pleura extends above the 1st rib?

costal pleura

which part of the parietal pleura lines boarders the ribs?

mediastinal pleura

which part of the parietal pleura lines boarders the heart?

diaphragmatic pleura

which part of the parietal pleura lines boarders the diaphragm?

The patient's right lung is collapsed --> much smaller visceral pluera

What is the difference between the two lungs in this image?

intercostal nn.

cervical and costal pleura are innervated by:

phrenic n.

mediastinal and diaphragmatic pleura are innervated by:

shoulders (C3, C4 dermatomes) because of innervation by phrenic nerve (C3, C4)

pain in the mediastinal and diaphragmatic pleura will be referred to what dermatome?

autonomic nn.

the visceral pleura is innervated by:

Lubrication - allows lungs to move within the pleural cavity during respiration

Surface tension - keeps visceral and parietal pleurae (and lungs) in contact with the thoracic wall and diaphragm

What two functions does pleural fluid provide?

pleurisy

Inflamed visceral and parietal pleura rub against each other causing sharp pain during breathing, coughing and sneezing:

Pleurisy

What is inflammation of the pleura called?

Rough, scratchy sound

What sound does pleura rubbing against each other make?

Phrenic and intercostal nerves

Which nerves are responsible for the sensation of somatic pain in the parietal pleura?

somatic pain

the parietal pleura is sensitive to _____ pain

Sympathetic and parasympathetic

The visceral pleura is innervated by nerves that travel with which autonomic systems?

visceral pain

the visceral pleura is sensitive to _____ pain

bronchial aa.

blood supply for the visceral pleura comes from:

intercostal aa.

musculophrenic aa.

blood supply for the parietal pleura comes from:

Viral and bacterial infections (pneumonia, tuberculosis)

Pneumothorax

Pulmonary embolism

Lung cancer

What are some causes of pleurisy?

pleural effusion

build-up of fluid in pleural space and particularly in the costodiaphragmatic recess

Pleural effusion: blunting of costodiaphragmatic angle on affected side

What does the patient's left lung show?

costodiaphragmatic recess

space in the lowest part of the thoracic cavity where the costal and diaphragmatic pleurae join. It is a potential space into which the lung can expand during full inspiration and where excess fluids may accumulate when the person is standing upright.

Pleural effusion (hydrothorax)

What are these clinical signs and symptoms of?

- Shortness of breath

- Decreased breath sounds

- Change in character of sound on percussion

- Chest pain on deep inspiration

Vagus nerve

What nerve is shown at #1?

Phrenic nerve

What nerve is shown at #2?

pleural effusion

what is the diagnosis?

pneumothorax

what is the diagnosis?

hydrothorax, pleural effusion

when serous fluid accumulates in the pleural space:

hemothorax

when blood accumulates in the pleural space:

pyothorax, empyema

when pus accumulates in the pleural space:

pneumothorax

when air accumulates in the pleural space, lung collapses:

Pneumothorax

What is the following describing?

The pleural space is normally sealed from the outside environment. Injury to the parietal or visceral pleurae or lung allows air to enter the pleural cavity. The lung collapses due to its inherent elasticity and the patient's ability to breathe is compromised. It may occur spontaneously in people without chronic lung conditions as well as in those with lung disease or during trauma to the chest wall

Spontaneous pneumothorax

Pulmonary blebs are a common cause of _________ in young children and adults. Blebs are weakened out-pouchings in the lung, which can rupture, causing...

Other causes include chest injury, lung disease, e.g. pneumonia, COPD

Tension pneumothorax

What is the following describing:

Air enters the pleural cavity during

inspiration but is not expelled during exhalation, leading to progressive buildup of pressure in the pleural space.

Leads to significant impairment of respiration and blood circulation

Tension pneumothorax

What is the following describing:

Findings: chest pain and respiratory distress, often with an increased heart rate (tachycardia) and rapid breathing (tachyone) in the initial stages.

tension pneumothorax

patient presents with gun shot to the lungs. Patient has chest pain and respiratory distress, an increased heart rate and rapid breathing. What is the patient suffering from?

Decreased systemic venous return to the heart leading to decreased cardiac output - a medical emergency

Air enters the pleural cavity during inspiration but cannot be expelled during exhalation. An increasing volume of air accumulates within the pleural space, ultimately causing deviation of the lung and mediastinum to the opposite side of the chest (mediastinal shift). The increased pressure within the chest cavity causes...

tension pneumothorax on left-hand side, causing mediastinal shift to the right

identify the pathology:

pulmonary embolism

identify the pathology:

left

if a patient is shot and the bullet pierces the right lung, which direction will the heart be shifted?

right main bronchus

if a patient inhales a piece of amalgam, which main bronchi is it most likely to be stuck in?

trachialis m.

in the trachea, what muscle replaces the posterior portion of the cartilage?

T4/T5

at what level does the trachea divide (bifurcate) into left and right main bronchi?

The right side because it is larger

What side of the trachea does air primarily go into?

intermediate bronchi

moving distally, the main bronchi will transition into:

lobar bronchi

moving distally, the intermediate bronchi will transition into:

segmental bronchi

moving distally, the lobar bronchi will transition into:

carina

ridge-like structure that divides lower part of trachea into right and left main-stem bronchi

pulmonary a.

which lung vessels carry deoxygenated blood to the lungs?

pulmonary v.

which lung vessels carry oxygenated blood from the lungs?

pulmonary a.

which lung vessels run within (inside) the lung segments?

pulmonary v.

which lung vessels run in between (outside) the lung segments?

pulmonary embolism

Blockage of the pulmonary artery or one of its branches by a substance (e.g. blood clot) that has travelled from elsewhere in the body through the bloodstream

Pulmonary embolism

The following symptoms and clinical signs are of what?

Symptoms: difficulty breathing, chest pain upon inspiration

Clinical signs: low blood oxygen levels, cyanosis, rapid breathing, rapid heart rate

pulmonary a.

in a pulmonary embolism, what structure suffers the blockage?

autonomic nervous system

Smooth muscle, glands and blood vessels in the bronchi are innervated by the:

pulmonary

The nerve fibers that innervate the smooth muscle, glands and blood vessels in the bronchi make up the _________ plexus

Parasympathetic

Does the vagus nerve supply sympathetic or parasympathetic innervation to the pulmonary plexus?

Vagus n. (CN X)

What in the pulmonary plexus does the following:

Constricts smooth muscle in bronchi (bronchoconstrictor)

Vagus n. (CN X)

What in the pulmonary plexus does the following:

Promotes secretion of mucous glands

Vagus n. (CN X)

What in the pulmonary plexus does the following:

Relaxes blood vessels

Sympathetic fibers

What in the pulmonary plexus does the following:

Relax smooth muscle in bronchi (broncho-dilator)

Sympathetic fibers

What in the pulmonary plexus does the following:

Inhibit secretion of mucous

vagus n.

what nerve supplies parasympathetic innervation to the pulmonary plexus?

sympathetic trunk

what nerve supplies sympathetic innervation to the pulmonary plexus?

parasympathetic division

Constricts smooth muscle in bronchi:

parasympathetic division

Promotes secretion of mucous glands:

parasympathetic division

Relaxes blood vessels:

sympathetic division

Relax smooth muscle in bronchi:

sympathetic division

Inhibit secretion of mucous:

sympathetic division

Constrict blood vessels:

sympathomimetic

patients with asthma will use albuterol for ______ stimulation over the bronchi