Thoracic Cavity, Lungs, and Pleura | Gross HSB A
1st Year – 1st Semester – Midterms – 4th Week (Capulong, M.D.)
Important muscles & structures (a checklist)
✓ Thoracic inlet
✓ Anterolateral wall
✓ Posterior wall
✓ Inferior wall
✓ Pleural cavity
✓ Mediastinum
✓ Pleura
✓ Lungs
Thorax
▪ Location – superior part of the trunk between the neck & the abdomen
o Note: Located below the anterior thoracic wall
▪ Organs – lungs & heart
▪ Three main compartments:
o 2 pleural compartments (lateral) – contains the lungs
o 1 mediastinum compartment (central) – contains the heart
o Note: Allows for independence of the organs within enabling them to
function on their own amidst a disease entity in other components
▪ Thoracic cage (anterior thoracic wall)
o Direction – anteroposterior
o Components – 12 pairs of ribs & thoracic vertebra, sternum, and costal
cartilages (together with skin, fascia, and muscles)
▪ Imaginary lines of orientation
o Midsternal line – divides the thorax vertically into two equal halves
o Midclavicular line – divides right & left thorax into medial & lateral halves
o Axillary lines
▪ Anterior axillary line
▪ Midaxillary line
▪ Posterior axillary line
▪ Note: Important since it is where the nerves run through hence, it
must be used as a guide in placing a pleural tube
Pleura
▪ Importance – specific fascia which supports & protects the lungs
▪ Description – bileaf (two folds) in structure
o Parietal pleura (outer fold)
▪ Innervation – sensitive to pain, touch, temperature, and pressure
• Note: Responsible for the pain felt upon repeated coughing &
more commonly responsible for the pain sensation
▪ Nerve supply – intercostal & phrenic nerves
▪ Note: When the chest wall is removed, the parietal pleura often
comes with its removal
o Visceral pleura (inner fold)
▪ Innervation – sensitive to stretching reflex only felt upon inspiration
▪ Note: Very adherent to the lungs, it will not be removed upon chest
wall removal which often gives the lungs a glistening appearance
▪ Four pleural subdivisions (according to adjacent structures):
o Costal pleura – in contact with the ribs
o Mediastinal pleura – in contact with the mediastinum
o Diaphragmatic pleura – in contact with the diaphragm
o Cervical pleura/cupula – in the level of the clavicle
o Note: Only the apex of the lung is not protected by the ribcage since it
protrudes over the first rib & the clavicle (root of the neck) meaning that
it is prone to injuries
▪ Pleural cavity
o Description – small space in between the two pleural leaves
o Importance – contains the pleural fluid (10-20 mL) which prevents or
minimizes friction between the two pleural leaves
▪ Note: Reduced pleural fluid volume may cause pain sensation due
to increased friction
o Diseases affecting the pleural cavity:
▪ Pneumothorax – air into the pleural cavity
▪ Hydrothorax – fluid into the pleural cavity (may be pleural effusion)
▪ Hemothorax – blood into the pleural cavity
▪ Pleuritis/pleurisy – inflammation of the pleura making the lung
surface very rough generating a pleural rub sound
o Common sites of fluid accumulation per lung:
▪ Left lung – costomediastinal recess
▪ Right lung – costodiaphragmatic recess
• Note: Most common site of fluid accumulation hence it is the
site for thoracentesis or pleural fluid drainage
▪ Imaginary lines of importance
o Lower border of the pleural reflection (oblique orientation):
▪ 8th rib – on the midclavicular line
▪ 10th rib – on the midaxillary line
▪ 12th rib – on the sides of the vertebral column
o Lower margin of the lungs (oblique orientation):
▪ 6th rib – on the midclavicular line
▪ 8th rib – on the midaxillary line
▪ 10th rib – on the sides of the vertebral column
o Note: Serves as a guide in determination of the extent of lung
parenchyma which is important in pleural fluid drainage
▪ Anatomical landmarks of importance
o Anterior landmarks:
▪ Supraclavicular area – apical portion of the lung
▪ 2nd intercostal space – superior lobe of the lung
▪ 4th intercostal space – middle lobe of the right lung
▪ 6th intercostal space – inferior lobe of the lung
o Posterior landmarks:
▪ T4 – point of tracheal bifurcation or branching
▪ T10 – lower border of the lung
▪ T12 – level of the separation between the thoracic & abdominal
cavity
o Note: Important landmarks for auscultation of the lungs
Trachea
▪ Importance – conduit wherein air is passed to the lungs & can be a control
point for entry of air (as in upper airway obstruction)
o Two methods in order to relieve upper airway obstruction:
▪ Cricothyroidotomy – provides access to the lungs at the interspace
between the cricoid & thyroid cartilages
▪ Tracheotomy – provides pathway for air by incision in the trachea
between the 1st & 2nd or 2nd to 4th tracheal rings
▪ Location – extends from the lower border of cricoid cartilage (C6) to the level
of the sternal angle (T4) where it bifurcates
o Hence, tracheal bifurcation occurs at the level of T4
▪ Right bifurcation – wider, shorter, & more vertical approach
• Significance – usually the right lung is the common site for
lower airway obstruction & aspiration pneumonia
o Note: Not located inside the thoracic cavity
▪ Relations of the trachea:
o Anterior relation – isthmus of the thyroid gland, inferior thyroid veins,
jugular arch, thyroid artery, sternothyroid, and sternohyoid muscles
o Posterior relation – right & left recurrent laryngeal nerves, esophagus, &
vertebral column
o Lateral relation – lobes of the thyroid gland
Bronchi
▪ Types of bronchi:
o Primary (main) bronchi
▪ Right – wider, shorter, and more vertical
• Importance – foreign body aspiration is more likely to enter &
lodge in the right bronchus
▪ Left – narrower, shorter, and less vertical
o Secondary (lobar) bronchi
▪ Right – 3 lobar bronchi (one per lobe) ▪ Differentiation of the lungs as to laterality:
▪ Left – 2 lobar bronchi (one per lobe) o Fissures & lobes
o Tertiary (segmental) bronchi ▪ Right lung – 3 lobes with 2 fissures
▪ Bronchoscopy ▪ Left lung – 2 lobes with one fissure
o Description – examination of the bronchi using a bronchoscope o Location of the secondary bronchus
o Carina – keel-shaped ridge located at the site of tracheal bifurcation ▪ Eparterial – bronchus is located above the pulmonary artery
• Right lung – superior secondary bronchus
▪ Hyparterial – bronchus is located below the pulmonary artery
• Right lung – middle & inferior secondary bronchi
• Left lung – both secondary bronchi
o Presence of cardiac notch & lingula
▪ Right lung – no cardiac notch or lingula
▪ Left lung – with cardiac notch & lingula
o Grooves of the lungs
▪ Right lung – superior & inferior vena cava, esophagus, azygos vein,
right subclavian vein & right subclavian artery
• Heart indentation – shallow depression
▪ Left lung – thoracic aorta, esophagus, arch of aorta & its branches,
left subclavian artery & left brachiocephalic vein

Lungs
▪ Function – vital organs of respiration which oxygenate the blood
▪ Description – healthy lungs are light, soft, and spongy
▪ Apex of the lung – located at each lung 2.5 cm above the clavicle
▪ Right lung – 3 lobes
o Fissures – oblique & horizontal fissure
o Note: Larger, heavier, shorter, & wider than the left fissures
▪ Left lung – 2 lobes
o Fissure – oblique fissure
▪ Three surfaces: (according to adjacent structures)
o Costal
o Mediastinal
o Diaphragmatic
▪ Three borders: (according to anatomical position)
o Anterior
o Posterior
o Inferior (in contact with the diaphragm)
▪ Hilum
o Description – segment of the structures which enter the lung
parenchyma
▪ Also, the only part where the lung is fixed, elsewhere it is free
o Importance – point of entrance & exit of the major structures such as
nerves, bronchi, arteries, and veins
o Protection – via the covering of the two leaves of the pleura
o Inferior part of the hilum
▪ Importance – fusion point of the two pleura → pulmonary ligament
▪ Root
o Description – short segment before entering the lung parenchyma which
also contains the exact structures at the hilum
▪ Bronchopulmonary segments If you aren’t willing to keep looking for light in the darkest of places without stopping even when it seems impossible, you will never succeed.
Grey’s Anatomy
o Characteristic – the anatomical & surgical unit of the lung AngeloBautista

o Importance – allows for complete removal of a certain segment without

affecting even the adjacent bronchopulmonary segment
o Description – smallest portion of the lung which is structurally-complete
and is considered as the largest subdivision of a lobe
o Shape – pyramidal-shaped with the apex directed to the lung root
o Components of each bronchopulmonary segment:
▪ Bronchus
▪ Blood supply & drainage (venous & arterial)
▪ Lymphatic drainage
▪ Nerve supply
o Connective tissue – allows for separation from adjacent segments
o Note: When there is a lung problem necessitating for a portion to be
surgically-removed, the specific bronchopulmonary segment may be
removed without damaging the entire lung’s function
o Right lung (10 segments)
▪ Segments of the superior lobe
• Apical (S1)
• Posterior (S2)
• Anterior (S3)
▪ Segments of the middle lobe
• Lateral (S4)
• Medial (S5)
▪ Segments of the inferior lobe
• Superior (S6)
• Medial basal (S7)
• Anterior basal (S8)
• Lateral basal (S9)
• Posterior basal (S10)
o Left lung (10 segments)
▪ Segments of the superior lobe
• Apico-posterior (S1+2)
• Anterior (S3)
• Superior lingular (S4)
• Inferior lingular (S5)
▪ Segments of the inferior lobe
• Superior (S6)
• Anteromedial basal (S7+8)
• Lateral basal (S9)
• Posterior basal (S10)
▪ Lung resections
o Segmentectomy – surgical resection of one or more bronchopulmonary
segments
o Lobectomy – surgical resection of one or more lobes of the lungs
o Pneumonectomy – removal of one side of the lung
▪ Blood supply
o Bronchial arteries – direct branches of the descending thoracic aorta
▪ Structures supplied – specific segments of the lung & thoracic wall
o Pulmonary arteries – carries unoxygenated blood from the pulmonary
trunk (from the right ventricle)
▪ Venous drainage
o Bronchial veins – drains into the azygous & hemiazygous veins
o Pulmonary veins – carries oxygenated blood into the circulation (into the
left atrium)
▪ Pulmonary thromboembolism
o Etiology – obstruction of a pulmonary artery by a thrombus
o Predisposition – often occurs in uncontrolled hypertensive individuals &
can occur after venous stasis (deep vein thrombosis)
o Result – large embolus may cause acute respiratory distress & may
cause death within a few minutes
▪ Lymphatic drainage
o Location – occurs at the hilar/hilum area of the lung
o Drainage – further drains into the bronchopulmonary & tracheobronchial
lymph nodes
o Two divisions of the lymphatic drainage:
▪ Superficial/subpleural plexus
• Location – deep in the visceral pleura
• Note: Allows for drainage of lymph from the surface to the
hilum of the lung
▪ Deep plexus
• Location – lies inside the lung
▪ Pulmonary plexus (nerve supply)
o Sympathetic efferent → bronchodilation & vasoconstriction
o Parasympathetic efferent → bronchoconstriction & vasodilation with
increased glandular secretion