Tracheo Bronchial Tree Dr Supreet Singh N ayyar AFMC f or more presentations visit wwwnayyarENTcom 17072012 wwwnayyarENTcom 1 Layout Embryology Respiratory Tree Trachea and main bronchi ID: 230188
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Anatomy Of Tracheo-Bronchial Tree
Dr. Supreet Singh Nayyar, AFMCfor more presentations, visit www.nayyarENT.com
17-07-2012
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LayoutEmbryology
Respiratory TreeTrachea and main bronchiSegmental BronchiBronchopulmonary SegmentsStructureVasculature , Lymphatic and Nerve SupplyApplied Anatomy
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EMBRYOLOGYTracheobronchial Diverticulum below Hypobranchial Eminence – 4
th wk IULedges – 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 Respiratory Tree
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The TracheaCartilaginous and Membranous tube
DimensionsLength -10- 12 cmExt Dia – 2.0 cm ( 1.5 cm)Extent – C6 – T4Incomplete rings17-07-2012
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Relations
Cervical AnteriorlyIsthmus of thyroid with inf thyroid vesselsPretracheal fasciaSternothyroid & Sternohyoid Investing layer of Deep Cervical Fascia
Skin & superficial fasciaPosteriorlyOesophagus; longus
colli; RLNOn each sideThyroid
Common Carotid Artery
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Relation o cervical trachea at C 7
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Relations
Thoracic AnteriorManubrium SterniSternothyroidThymusLt Brachiocephalic V
Aorta & Lt CCADeep Cardiac PlexusPosterior
OesophagusVertebral Column
Rt
Side
Right Lung & Pleura
Rt
Vagus
Azygous
V
Lt Side
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 levelCarinaThe Right Bronchus (bronchus dexter), wider, shorter, and more vertical5 cm. long
Enters right lung opposite fifth thoracic vertebraAzygos 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
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 airways1.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 BronchusRt lat aspect of bronchusSuperolaterally3 segmental Bronchi ( Apical; Post; Ant )Apical Segmental – Apical & Ant.
Subsegmental BrPost Segmental – Lateral & Ant.
Subsegmental BrAnt. 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 bronchusApical Segmental – post aspect Medial ; Sup ; Lat subsegmental brMedial Basal ( Cardiac ) – Rt
Border of heartAnt 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 right5.5 cm longEnters 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 BronchusAnterolateral aspect 5.5cm from carinaCurves laterally then divides Cranial divisions: Apico posterior and Anterior
Caudal divisions : anterolaterally Lingular
area of lung Sup and Inf segmentalLt 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, cone-shapedRight lung3 lobesLeft lung2 lobes
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Bronchopulmonary segments
Independent respiratory unitsSectors of lung with tertiary/ segmental bronchus ;separate Br of Pulmonary APyramidal with apex to root of lungClinical SignificanceRestriction of infectionsSegmental resectionBronchoscopy
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Structure of Trachea andMajor Bronchi
Cartilages16-20Incomplete Rings (4 mm vertically and 1 mm thick)Union of 2 or more rings partially or completelyHighly elastic1
st Tracheal CartilageFibrous MembranePerichondrium
of cartilagesCollgen with elastic
fibres
Non striated
mus
fibres
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Changes as the Respiratory Tree Branches
As branching of bronchi becomes more extensiveRings of cartilage become platesSmooth muscle increasesColumnar epithelium becomes cuboidal
, then squamous (in alveoli
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Mucous MembraneEpith lining – thins and single layered
Tubulo-racemose glandsNot present in bronchioles17-07-2012www.nayyarENT.com
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Vasculature and lymphatics
Blood SupplyInf Thyroid A Bronchial A – 1 for Rt lung ;2 for LtLie against post wall of Bronchi2 Bronchial VeinsRt –
Azygous VLt – Lt Sup
Intercostal V or HemiazygousVPulmonary V
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Vasculature and lymphatics
Lymphatic DrainagePretracheal and Paratracheal groupsSuperficial System- Tissue beneath pleura vessels round lung borders and fissures to reach hilum numerous ValvesDeep 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 – bronchospasmSecretomotor to mucous glandSensory- stretch and Cough ReflexSympathetic
Cervical Ganglion and Spinal N. T2 – T5Inhibitory to smooth muscle and glands
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Applied Anatomy
TracheostomyBronchoscopyForeign Body In Respi Tract17-07-2012
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Thank
you
for more presentations, visit www.nayyarENT.com
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