Lecture about lung and pleura

1. By Prof.
Saeed Abuel Makarem

2. Pleura
‫الرئوي‬ ‫الغشاء‬
• Double-layered serous
membrane enclosing the
lung.
• Has two layers:
– Parietal layer, which
lines the thoracic walls.
– Visceral layer, which
covers the surfaces of
the lung.
• The two layers continue with
each other around the root
of the lung ‫الصوره‬ ‫انظر‬,
where it forms a loose cuff
hanging down called the
pulmonary ligament.
• The space between the two
layers, the pleural cavity,
contains a thin film ‫جدا‬ ‫دقيق‬
of pleural fluid ( 5-10 ml.).
Root of the lung:
‫واالوعيه‬ ‫الشرايين‬ ‫دخول‬ ‫منطقه‬
‫المنطقه‬ ‫هذه‬ ‫وفي‬ ‫للرئه‬ ‫والقصبات‬
‫الرئوي‬ ‫الغشاء‬ ‫طبقتي‬ ‫التحم‬ ‫يتم‬
‫واحده‬ ‫بطبقه‬
Pulmonary
ligament

3. Parietal Pleura
• Divided according to the region in which it lies
and the surfaces it covers, into:
1- Cervical ‫عنقي‬
2- Costal
3- Mediastinal
4- Diaphragmatic
‫القادمه‬ ‫بالشرائح‬ ‫مفصال‬ ‫تشرح‬

4. Parietal Pleura
• Cervical Pleura:
• Projects up ‫تبرز‬ into the neck
about 1-1.5 inches above the
medial1/3rd of clavicle.
• It lines the under surface of
the suprapleural membrane
‫الرئوي‬ ‫الغشاء‬ ‫فوق‬ ‫غشاء‬.
• Costal pleura:
• lines, the back of the:
• 1- sternum,
• 2- Ribs & costal cartilages,
• 3- Intercostal spaces &
• 4- Sides of vertebral bodies

5. Parietal Pleura
• Mediastinal pleura:
covers the mediastinum
‫الصوره‬ ‫انظر‬.
• At the hilum ‫دخول‬ ‫منطقه‬
‫االوعيه‬
(
‫شرحها‬ ‫سبق‬
) , it is
reflected on to the
vessels and bronchi, to
become continuous
with the visceral pleura
• Diaphragmatic pleura:
covers the thoracic
(upper) surface of the
diaphragm

6. Pleural Recesses
:
‫تجويفات‬
• 1- Costodiaphragmatic:
• Slit ‫عميق‬ ‫دقيق‬ ‫تجويف‬ like
space between costal
and diaphragmatic
pleurae. The inferior
border ‫الحقا‬ ‫ياتي‬ of the
lung descends ‫ينزل‬ into it
during deep inspiration
• 2- Costomediastinal:
• Slit like space between
costal and mediastinal
pleurae, is filled by the
anterior border of the
lung during deep
inspiration

7. Costophrenic
‫حاله‬ ‫الصوره‬
‫الزايه‬ ‫الن‬ ‫مرضيه‬
‫هواء‬ ‫يصلها‬ ‫ال‬

8. Pleura: Nerve Supply
• Parietal pleura:
• is sensitive to pain, temperature,
touch & pressure and is supplied
as follows:
 Costal pleura segmentally
supplied by the intercostal
nerves.
 Mediastinal pleura supplied by
phrenic nerves.
 Diaphragmatic pleura supplied
over the domes by phrenic
nerves, around the periphery by
lower six intercostal nerves.
• Visceral pleura sensitive to
stretch only and is supplied by the
autonomic fibers from the
pulmonary plexus

9. Lungs

10. Lungs
• Located in the thoracic
cavity, one on each
side of the
mediastinum
• Each lung is:
Conical in shape.
Covered by the
visceral pleura.
Suspended ‫معلقه‬
free in its own
pleural cavity.
Attached to the
mediastinum only
by its root.

11. Borders
‫حدود‬ ‫معناها‬
‫يعني‬ ‫الرئه‬
‫اطرافها‬
• Each lung has:
1- A thin anterior
‫امامي‬ border that
overlaps the heart.
 The left lung shows
cardiac notch along
this border.
2- A thick posterior
‫خلفي‬ border that lies
beside the vertebral
column.
3- A thin inferior ‫سفلي‬
border, that is
related to diaphragm
cardiac notch

12. Surfaces ‫يعني‬ ‫الرئه‬ ‫سطوح‬
‫الحدود‬ ‫غير‬ ‫الباقيه‬ ‫االجزاء‬
Each lung has:
• An apex ‫قمه‬, which
projects upward into
the neck for about 1
inch ‫يتمد‬ ‫الغالف‬ ‫تذكر‬
‫ونصف‬ ‫النش‬ above the
clavicle.
• A concave base,
which rests on the
diaphragm.
• A convex costal
surface, which
corresponds to the
concave chest wall.

13. • A mediastinal surface,
which is molded ‫تطبع‬
‫عليها‬
(
‫واللي‬ ‫الصوره‬ ‫مثل‬
‫بالعملي‬ ‫ورونا‬
) to the
mediastinal structures.
• At bout ‫مرض‬
-
‫نوبه‬ the
middle of this surface is
a depression ‫تنضغط‬, the
hilum, where the
structures enter the
lung:
• (bronchi, bronchial &
pulmonary arteries) or
leave (bronchial &
pulmonary veins,
nerves & lymphatics)

14. Mediastinal
surface
‫االجزاء‬
‫للرئه‬ ‫المجاوره‬
‫والتي‬ ‫اليمنى‬
‫كم‬ ‫عليها‬ ‫تطبع‬
‫ا‬
‫المربعات‬ ‫في‬
‫المرقمه‬ of
the right
lung
1
2
3
Right
atrum
4
‫تحفظ‬ ‫مهمه‬
‫فصوص‬ ‫ثالث‬ ‫بها‬ ‫اليمنى‬ ‫الرئه‬
‫المرقمه‬ ‫الدوائر‬ ‫في‬ ‫كما‬
1
2
3

15. Mediastinal
surface of
the left lung
1
2
Left
ventricle
‫اللسان‬
:
‫يوجد‬
‫فقط‬ ‫اليسرى‬ ‫بالرئه‬
‫القلب‬ ‫وجود‬ ‫بسبب‬
‫نوتش‬ ‫كارديك‬
:
‫يوجد‬
‫فقط‬ ‫اليسرى‬ ‫بالرئه‬
‫القلب‬ ‫وجود‬ ‫بسبب‬
3
‫لها‬ ‫اليسرى‬ ‫الرئه‬
‫فقط‬ ‫فصين‬
2
1

16. Fissures ‫الفاصل‬ ‫الخط‬ &
Lobes ‫الفصوص‬
• Right Lung:
• Divided by two
fissures, the oblique &
horizontal, into:
• 1- Superior,
• 2-Middle and
• 3- Inferior
• Left lung:
• Divided by only one
oblique fissure into:
• 1- Superior and
• 2- Inferior

17. Fissures
• Oblique fissure:
• Runs from the
inferior border
upward and
backward across the
medial and costal
surfaces until cuts
the posterior border
about 2½ inches
below the apex
• Horizontal fissure:
runs horizontally
across the costal
surface at the level of
right 4th costal
cartilage to meet the
oblique fissure in the
midaxillary ‫الخط‬
‫االبطي‬ ‫الفاصل‬ line

18. Blood Supply ‫للرئه‬
• Arterial supply:
• By bronchial arteries,
branches of the
descending thoracic
aorta.
• Venous Drainage
‫االورده‬:
• By bronchial veins,
which drain into
azygos & hemiazygos
veins.

19. Nerve Supply
• Through pulmonary
plexuses located at
the root of each lung,
and composed of:
– Sympathetic
fibers from the
sympathetic trunk
– Parasympathetic
fibers from the
vagus nerve

20. Root of the Lung
• Formed by the structures
entering or leaving the lung:
bronchi, pulmonary vessels,
lymphatics, bronchial vessels
and nerves.
• Surrounded by a tubular sheath
of pleura which hangs down to
form pulmonary ligament.
• The pulmonary ligament
provides a potential space for
the movement of pulmonary
vessels and large bronchi

21. Surface Anatomy of Pleurae
& Lungs
‫للرئه‬ ‫الكتاب‬ ‫اقرا‬
‫صفحه‬
68
‫اقرا‬ ‫الرئوي‬ ‫وللغشاء‬
‫صفحه‬
72

24. ‫توضح‬ ‫صوره‬
‫النفس‬ ‫سماع‬ ‫اماكن‬
‫والصورة‬ ‫للرئه‬
‫نفسها‬ ‫تشرح‬
‫مهمه‬

25. ‫تابع‬

26. Bronchopulmonary segments: ‫للرئه‬ ‫الشعب‬ ‫تدخل‬ ‫عندما‬
‫ش‬ ‫سيقمنت‬ ‫لكل‬ ‫ان‬ ‫فائدتها‬ ‫السيقمينت‬ ‫هذه‬ ‫تكون‬ ‫بالرئه‬ ‫ترتبط‬ ‫عندما‬ ‫بالرئه‬ ‫ترتبط‬ ‫حتى‬ ‫تتفرع‬
‫ريان‬
‫الرئه‬ ‫عمل‬ ‫على‬ ‫تؤثر‬ ‫وال‬ ‫ازالتها‬ ‫يمكن‬ ‫به‬ ‫مشكله‬ ‫حدوث‬ ‫فعند‬ ‫به‬ ‫خاص‬ ‫وعصب‬
• Definition: Are the smallest
anatomic, surgical, and
functional units of the
lung.
Each segment is pyramidal in shape
with its apex directed medially
toward the lung root, and its base
toward the lung surface.
Each segment receives segmental
bronchus, branch of pulmonary
artery, its own lymphatic vessels,
and autonomic nerve.
The branch of pulmonary vein lie in
the connective tissue between the
segment.

29. Clinical Notes
• Pleural effusion
• Pleuritis, pleural rub,
pleural adhesions
• Pneumothorax
• Empyema
• ‫الدرس‬ ‫باشرحها‬ ‫الدكتور‬ ‫قال‬
‫الجاي‬