LOWER RESPIRATORY TRACT

(trachea, bronchi, pleura, lungs)

 Trachea and Bronchi
The trachea, located in the superior mediastinum, is the
proximal part of the tracheobronchial tree, a passageway
for air between the lungs and the external environment.
◦ As the trachea descends through the superior mediastinum,
slightly to the right of the midline, it lies anterior to the
esophagus and posterior to the great vessels.
◦ C-shaped cartilaginous rings form the skeleton of the trachea
and prevent collapse of the lumen. Cartilaginous rings are
connected by anular ligaments. A muscular membrane
connects the ends of the rings posteriorly.
◦ The carina, a wedge-shaped cartilage, marks the bifurcation of
the trachea into a right and left bronchus at the T4–T5
vertebral level.
◦ Of the two main bronchi, the right is shorter, wider, and more
vertical than the left, and therefore is more prone to obstruction
by foreign objects.
 The Lungs
 Each lung has costal, mediastinal, and diaphragmatic surfaces.
 The apex of each lung projects into the neck above the first costal
cartilage; the base of each lung rests on the diaphragm.
 The root of the lung, which connects the lung to the mediastinum,
contains the pulmonary vessels, nerves, and bronchi. The root enters
the lung at the hilum, an indentation on the mediastinal surface.
 Fissures, lined by visceral pleura, divide each lung into lobes: three
lobes on the right and two lobes on the left.
 Thin connective tissue septa (intersegmental septa) that are
continuous with the visceral pleura subdivide lobes of the lungs into
discrete pyramidal-shaped units called broncho-pulmonary
segments.
◦ Each bronchopulmonary segment is an anatomically and functionally
independent respiratory unit.
◦ This independence allows the surgical resection of individual segments.
◦ There are 10 bronchopulmonary segments in the right lung and 8 to 10
segments in the left lung.
 Right Lung
 Because the dome of the diaphragm is higher on the right
side, the right lung is shorter and wider than the left lung.
 Horizontal and oblique fissures divide the right lung into
superior, middle, and inferior lobe.
 The root of the lung passes under the arch of the aorta,
posterior to the right atrium, and under the arch of the
azygos vein.
 The right bronchus and its branches are the most
posterior structures within the root of the lung. The
pulmonary artery passes anterior to the bronchus, and the
pulmonary veins lie anterior and inferior to the artery.
 Left Lung
 An oblique fissure divides the left lung into superior and
inferior lobes.
 A deep indentation along the anterior border of the superior
lobe called the cardiac notch accommodates the leftward
projection of the apex of the heart.
 The lingula, a thin tongue of lung tissue from the superior
lobe, forms the inferior border of the cardiac notch and
moves into and out of the costomediastinal recess during
respiration.
 The aortic arch crosses over the left bronchus, and the
descending aorta passes behind the root of the lung.
 The left pulmonary artery arches over the left bronchus to
become the most superior structure in the root of the lung.
Pulmonary veins pass anterior and inferior to the bronchus.
 The Tracheobronchial Tree
 The tracheobronchial tree consists of the trachea and the bronchi in the
mediastinum, and the bronchial tree (generations of branches formed by
successive bifurcations) within the lungs.
 The tracheobronchial tree has conducting and respiratory components.
◦ The trachea and its larger proximal branches form the conducting component, a
passageway for air exchange between the lung and the external environment. All
except the most distal of these branches have cartilaginous rings or plates in their
walls. The branches include
 the right and left main (primary) bronchi, formed by the bifurcation of the trachea in the
superior mediastinum. One main bronchus enters the root of each lung.
 the lobar (secondary) bronchi, which branch from the main bronchi. One lobar bronchus
enters each lobe of the respective lung (three on the right and two on the left).
 the segmental (tertiary) bronchi, which branch from the lobar bronchi. One segmental
bronchus enters each bronchopulmonary segment.
 the conducting bronchioles, a network of airways without cartilage that are formed as the
segmental bronchi subdivide and decrease in size.
 the terminal bronchioles, the last branches of the conducting bronchioles and the final part of
the conducting airway.
◦ The respiratory component (seen only histologically), made up of passages distal to
the terminal bronchioles, is involved in air conduction as well as in gas exchange.
 The structures in this part of the bronchial tree include the respiratory bronchioles, alveolar
sacs, and alveoli.
 The single-celled walls of the alveoli are designed for efficient gas exchange.
Respiratory portion of the bronchial tree
The Pleura and Pleural Cavity

 The pleura is a fibroserous

membrane that surrounds each
lung and lines the pulmonary
cavities
 The pleura is composed of two
layers:
◦ The parietal pleura, which is a
continuous layer that lines the
inner wall of the thoracic cavity,
the superior surface of the
diaphragm, and the
mediastinum. Its parts are
named according to location:
cervical, costal, diaphragmatic,
and mediastinal.
◦ The visceral pleura, which
covers the surface of the lung
and extends into its fissures.
◦ The visceral and
parietal layers are
continuous with one
another at the hilum
of the lung. Together
they form the inner
and outer walls of a
closed pleural sac that
contains a pleural
cavity.
◦ The pulmonary
ligament is a double-
layered fold of
visceral and parietal
pleura that extends
vertically from the
hilum to the
diaphragm along the
mediastinal border of
 Pleura and pleural cavity
 The pleural cavity, the cavity within the pleural sac, is the potential
space between the visceral and parietal layers of pleura
 The pleural cavity contains a thin layer of serous fluid, which
lubricates the adjacent pleural surfaces, facilitates the movement of
the lung, and maintains surface tension that is crucial to respiration.
 On most surfaces, the two pleural layers approximate
one another, but the lung and its visceral pleura are
somewhat smaller than the outer wall of the pleural
cavity and its lining of parietal pleura. Two recesses
that form as a result of this discrepancy accommodate
the expansion of the lungs during inspiration:
◦ The costodiaphragmatic recess forms where the
diaphragmatic pleura reflects from the perimeter of the
diaphragm to meet the costal pleura on the thoracic wall.
◦ The costomediastinal recess forms between the
pericardial sac and the sternum, where the mediastinal
pleura reflects to meet the costal pleura.
 Costomediastinal and costodiaphragmatic recesses
 On the left side of the thorax, an examiner’s fingertips are placed
in the costomediastinal and costodiaphragmatic recesses. These
recesses are formed by the acute reflection of the costal part of the
parietal pleura onto the fibrous pericardium (costomediastinal) or
diaphragm (costodiaphragmatic).
 Pneumothorax
 Pneumothorax is a condition in which air enters the pleural
space. It may result from a tear in the chest wall and parietal
pleura (such as from a stab wound) or a tear of the visceral
pleura (such as from a rupture of a pulmonary lesion). Air in the
pleural space decreases the negative pressure that normally
keeps the lungs inflated and leads to a partial or complete lung
collapse.
 Tension pneumothorax is a life-threatening condition in which
air accumulates in the pleural space and becomes trapped
because the injured tissue acts as a one-way valve. This causes
complete collapse of the lung on the affected side and a shifting
of the heart to the opposite side, thus compromising venous
return and cardiac output. This mediastinal shift also compresses
the opposite lung and impairs its ventilatory capacity.