Transcript Anatomy Of Tracheo

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Anatomy Of Tracheo-Bronchial Tree
Dr. Supreet Singh Nayyar, AFMC
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17-07-2012
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Layout
• Embryology
• Respiratory Tree
▫ Trachea and main bronchi
▫ Segmental Bronchi
▫ Bronchopulmonary Segments
• Structure
• Vasculature , Lymphatic and Nerve Supply
• Applied Anatomy
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EMBRYOLOGY
• Tracheobronchial Diverticulum below
Hypobranchial Eminence – 4th wk IUL
• edges – oesophagotracheal septum
• fuses caudally
• endoderm lining
• cranial – Trachea / Larynx
• caudal – Bronchi / Lungs
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EMBRYOLOGY
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EMBRYOLOGY
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The Trachea
• Cartilaginous and Membranous tube
• Dimensions
▫ Length -10- 12 cm
▫ Ext Dia – 2.0 cm ( 1.5 cm)
• Extent – C6 – T4
• Incomplete rings
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Relations
• Cervical
▫ Anteriorly
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Isthmus of thyroid with inf thyroid vessels
Pretracheal fascia
Sternothyroid & Sternohyoid
Investing layer of Deep Cervical Fascia
Skin & superficial fascia
▫ Posteriorly
 Oesophagus; longus colli; RLN
▫ On each side
 Thyroid
 Common Carotid Artery
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Relation o cervical trachea at C 7
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Relations
• Thoracic
▫ Anterior
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Manubrium Sterni
Sternothyroid
Thymus
Lt Brachiocephalic V
Aorta & Lt CCA
Deep Cardiac Plexus
▫ Posterior
 Oesophagus
 Vertebral Column
▫ Rt Side
 Right Lung & Pleura
 Rt Vagus
 Azygous V
▫ Lt Side
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

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Arch of Aorta
Lt Common Carotid
Lt Subclavian A
Lt RLN
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The main Bronchi and Branches
• Rt and Lt Main Bronchi – T4 level
• Carina
• The Right Bronchus (bronchus dexter),
wider, shorter, and more vertical
▫
▫
▫
▫
5 cm. long
Enters right lung opposite fifth thoracic vertebra
Azygos vein arches over it from behind
Right pulmonary artery lies at first below and then
in front
▫ 2.5 cm along course- Rt Upper Lobe Bronchus
▫ At Hilum of Lung – Middle & Lower Lobe Bronchi
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Bronchi, Bronchioles, & Alveoli
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• Trachea divides into
• Primary bronchii
divide into
• Secondary bronchi
divide into
• Tertiary bronchi divide
into
• Bronchioles divide into
• Terminal bronchioles
divide into
• Respiratory
bronchioles divide into
• Alveolar ducts end in
• Alveoli
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The Respiratory Tree
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The Respiratory Tree
Structure through the airways
1.Trachea
2.
Bronchus (Right- or Left- Primary
Bronchus)
3.
Lobar Bronchus
4.
Segmental Bronchus
5.
Bronchus
6.
Bronchiole
7.
Terminal Bronchiole
8.
Respiratory Bronchiole
9.
Alveolar Duct
10.
Alveolar Sac / Alveolus
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The Respiratory Tree
• Rt Upper Lobe Bronchus
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▫
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Rt lat aspect of bronchus
Superolaterally
3 segmental Bronchi ( Apical; Post; Ant )
Apical Segmental – Apical & Ant. Subsegmental Br
Post Segmental – Lateral & Ant. Subsegmental Br
Ant. Segmental – Lateral & Ant. Subsegmental Br
• Rt Middle Lobe Bronchus
▫
▫
▫
▫
2.5 cm beyond Rt Upper Lobe Bronchus
Ant aspect
Forwards Downwards and Laterally
Lateral and Medial Subsegments
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The Respiratory Tree
• Rt lower lobe bronchus
▫ Apical Segmental – post aspect
Medial ; Sup ; Lat subsegmental
br
▫ Medial Basal ( Cardiac ) – Rt Border of heart
▫ Ant Basal
▫ Lateral Basal
▫ Post Basal
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The Respiratory Tree
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The Respiratory Tree
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The Respiratory Tree
• Left Bronchus (bronchus sinister)
smaller in calibre but longer than the
right
▫ 5.5 cm long
▫ Enters root of the left lung opposite sixth thoracic
vertebra
▫ Passes beneath Aortic arch,
▫ crosses in front of oesophagus, thoracic duct,
descending aorta
▫ Left pulmonary artery lies at first above then in
front
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The Respiratory Tree
• Lt upper Lobe Bronchus
▫ Anterolateral aspect 5.5cm from carina
▫ Curves laterally then divides
 Cranial divisions: Apico posterior and Anterior
 Caudal divisions : anterolaterally
Lingular area of lung
Sup and Inf segmental
• Lt Lower Lobe Bronchus
▫ Apical segmental
 Originates posteriorly 1cm below upper lobe orifice
▫ Anteromedial (Anterior Basal and Medial Basal )
▫ PosterolateralLateral Basal and Post Basal)
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The Lungs
• Soft, spongy, coneshaped
• Right lung
▫ 3 lobes
• Left lung
▫ 2 lobes
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Bronchopulmonary segments
• Independent respiratory units
• Sectors of lung with tertiary/ segmental
bronchus ;separate Br of Pulmonary A
• Pyramidal with apex to root of lung
• Clinical Significance
▫ Restriction of infections
▫ Segmental resection
▫ Bronchoscopy
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Structure of Trachea and
Major Bronchi
• Cartilages
▫ 16-20
▫ Incomplete Rings (4 mm vertically and 1 mm
thick)
▫ Union of 2 or more rings partially or completely
▫ Highly elastic
▫ 1st Tracheal Cartilage
• Fibrous Membrane
▫ Perichondrium of cartilages
▫ Collgen with elastic fibres
▫ Non striated mus fibres
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Changes as the Respiratory Tree Branches
• As branching of
bronchi becomes
more extensive
▫ Rings of cartilage
become plates
▫ Smooth muscle
increases
▫ Columnar
epithelium becomes
cuboidal, then
squamous (in
alveoli
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• Mucous Membrane
▫ Epith lining – thins and single layered
▫ Tubulo-racemose glands
▫ Not present in bronchioles
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Vasculature and lymphatics
• Blood Supply
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Inf Thyroid A
Bronchial A – 1 for Rt lung ;2 for Lt
Lie against post wall of Bronchi
2 Bronchial Veins
 Rt – Azygous V
 Lt – Lt Sup Intercostal V or HemiazygousV
▫ Pulmonary V
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Vasculature and lymphatics
• Lymphatic Drainage
▫ Pretracheal and Paratracheal groups
▫ Superficial System- Tissue beneath pleura
vessels round lung borders and fissures to reach
hilum
numerous Valves
▫ Deep System- Bronchial Tree; Pulm Vessels
hilum- drain into Bronchopulmonary Nodes
less no. of Valves
▫ Rt and Lt Paratracheal LN unite with Internal
Thoracic and Brachiocephalic LN
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Nerve Supply
▫ Parasympathetic ( Vagus)
 Motor to bronchial muscle – bronchospasm
 Secretomotor to mucous gland
 Sensory- stretch and Cough Reflex
▫ Sympathetic
 Cervical Ganglion and Spinal N. T2 – T5
 Inhibitory to smooth muscle and glands
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Applied Anatomy
• Tracheostomy
• Bronchoscopy
• Foreign Body In Respi Tract
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