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CLINICAL ANATOMY OF LUNG & PLEURA Iman Galal, MD Pulmonary Medicine Department Ain Shams University Borders of the lung: The apex is about 2-3 cms (1 inch) above the medial 1/3 of the clavicle, then the anterior border of both lungs run downwards & medially meeting each other in the middle line behind the angle of Louis. The anterior border of right lung continues running downwards till the 6th costochondral junction. The anterior border of left lung continues running downwards till the 4th costal cartilage then curves laterally ½ inch forming the cardiac notch then descends downwards till the 6th costochondral junction. Page 2 Borders of the lung: The lower border of the lungs represented by a line starting from 6th rib in the MCL, 8th rib in the MAL & 10th rib in the scapular line. Page 3 Right Lung Page 4 Lung Fissures: Oblique fissure (Right & Left): It starts at the 3rd thoracic spine while the arms are elevated, descends downwards, laterally & anteriorly along the medial border of the scapula touching the inferior angle of the scapula) cutting the midaxillary line in the 5th rib & ending at the 6th costal cartilage 3 inches from the midline. In cadaver it arise at the 2nd thoracic spine. The transverse fissure (Right): It arises at the 4th costal cartilage, runs horizontally to meet the th rib. oblique fissure in the midaxillary line in the 5 Page 5 Fissures & Lobes of the Lungs Page 6 Fissures & Lobes of the Right Lung Page 7 Right Upper Lobe Page 8 Right Middle Lobe Page 9 Right Lower lobe Page 10 Left Lung Page 11 Fissures of the Left Lung Page 12 Left Upper Lobe Page 13 Left Lower Lobe Page 14 Segmental Bronchi Page 15 Segmental Bronchi Page 16 Segmental Bronchi (Anterior) 1 2 3 1-2 3 4 4 5 5 8 8 Page 17 Segmental Bronchi (Posterior) 1-2 1 2 3 6 6 3 4 4 9 Page 18 10 10 9 Pleura Page 19 The borders of the Pleura: The pleura runs close to the lung except at the lower border which extends for 3-5 cm below it both anteriorly & posteriorly & 9-10 cm below in the axilla. The lower border cuts the 8th rib in MCL, 10th rib in MAL and 12th rib in Scapular line. Page 20 Page 21 Pleura Page 22 Parietal Pleura Costal pleura: Lines thoracic wall (ribs, intercostal spaces) Mediastinal pleura: Lines corresponding surface of mediastinum; reflected over root of lung & becomes continuous with visceral pleura around hilum Cervical pleura: Extends into neck about 2 inches above 1st costal cartilage & one inch above medial 1/3 clavicle; covers apex of lung Diaphragmatic pleura: Lines superior surface of diaphragm Page 23 Page 24 Page 25 Traube’s area: 4 points: Left 6th rib in the MCL to 8th costal cartilage in the parasternal line ,then along the left costal margin to the 11th rib in the MAL, then the 9th rib in the MAL. Page 26 Kronig’s Isthmus : It is a band of resonance representing lung apex. Laterally it is marked by a line joining 2 points: 1. The junction of the medial 2/3 of the clavicle with the lateral 1/3. 2. The junction of the medial 1/3 of the scapular spine with the lateral 2/3. Medially marked by a line between the sternal end of clavicle and the 7th cervical spine. Page 27 Bare area of the heart : Medial border: left lateral border of the sternum Lateral border: left parasternal line Superior border: lower border of Lt 4th rib. Inferior border: upper border of Lt 6th rib Page 28 Surface anatomy of liver: Upper border: It starts from the left 6th rib just inside the MCL, passing to the Rt and slightly upwards to the 5th rib in the MCL, then the 7th rib in anterior axillary line, to the 9th rib in midaxillary line. Page 29 Page 30 Thank You