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SURFACE ANATOMY OF THE LUNGS Katerina Kyprianou Surface anatomy of the anterior thoracic wall Clavicle Jugular notch Sternal angle Xiphoid process Ribs Anterior lung surface markings REMEMBER: 2,4,6,8,10 Lungs Each lung extends 3cm above the clavicle (apex) Anterior borders of lungs are closest at the sternal angle – 2nd costal cartilage (cc) Both reach to 4thcc Left: Right: Moves away from the midline at the 4th cc Moves away from the midline at the 6th cc Both cross the midclavicular line at the 8th cc Both cross the midaxillary line at the 10th cc Note about pleura: They have the same surface markings as the lungs but reach further down to the 12th cc REMEMBER: 2,4,6,8,10,12 Pleura Lungs & pleura Each lung is enclosed in a pleural sac consisting of 2 continuous membranes: Visceral pleura: covers the lungs & is adherent to all of its surfaces, including the surfaces of horizontal and oblique fissures Can NOT be dissected from the lungs Parietal pleura: Lines the pulmonary cavities Adheres to the thoracic wall, mediastinum & diaphragm CAN be dissected from the lungs Parietal pleura The parietal pleura consists of 4 parts: Costal part: Mediastinal part: Covers the central compartment of the thoracic cavity (lateral aspects of mediastinum) Diaphragmatic part: Covers the internal surfaces of the thoracic wall Covers the superior/thoracic surface of the diaphragm Cervical pleura: Extends into the root of the neck Lines of pleural reflections Pleural reflections: sharp lines where pleura changes direction from one wall of the pleural cavity to the other Lines of pleural reflections Sternal line Costal line Occurs where costal pleura becomes continuous with mediastinal pleura ANTERIORLY Occurs where the costal pleura becomes continuous with the diaphragmatic pleura INFERIORLY Vertebral line Occurs where the costal pleura becomes continuous with the mediastinal pleura POSTERIORLY Clinical relevance – Normal chest X-ray Clinical relevance – Tension Pneumothorax Pneumothorax: entry of air into the pleural cavity Tension pneumothorax: life threatening condition resulting from worsening of simple pneumothorax Air becomes trapped between the pleural cavity and lung & keeps it from fully inflating Treatment: insertion of needle/cannula to release pressure from the lung In this Xray: Mediastinal shift to the Right