- The chest wall is composed of the sternum anteriorly and the rib
cage and vertebrae posteriorly
- It is made up of
12 ribs, intercostal spaces and
the thoracic vertebra from T1-T12.
- The first seven ribs articulate at
- Ribs 8,9,10 articulate with manubriosternal cartilage.
- Ribs 11 and 12 are free floating and do not articulate
- Inferiorly lies the dome shaped diaphragm which is supplied by
- The trachea extends from cricoid cartilage to the bifurcation
the level of manubriosternal joint
- Trachea in cross section is composed of
cartilage rings deficient posteriorly closely related to oesophagus.
carina at the level of the sternal angle (T4/5) it bifurcates into
bronchus and then left main bronchus.
- The right main bronchus is
and more vertical than the left and so is the destination of aspirated
- There is repeated branching until terminal bronchioles and
- Right lung
of 3 lobes
- Upper, Middle, Lower
- Transverse and oblique fissures.
- Left lung
- Composed of 2 lobes
- Upper (+
lingula) and lower
- Separated by the oblique fissure.
- Medial surface of the lungs where the vessels, nerves and
lymphatics all enter the lung
- Bronchopulmonary segments
- Lung can be divided into surgical define units each with their
own segmental bronchus and artery and vein.
- Airway branches below the terminal bronchioles receive their
arterial supply from the bronchial arteries which originate as an
- The Lungs are enveloped by visceral pleural and then a pleural
space and then parietal pleura.
- The pleurae are continuous. The pleural space contains only a
small amount of fluid and a virtual space.
- Surface tension keeps the layers together and normal
intrapleural pressure is between - 2 and - 5 cm H2O.
- Parietal pleura is innervated by the intercostal and phrenic
nerves so pleuritic pain can go to the shoulder and to the chest wall.
Airway levels - multiple levels
- (Ventilator circuit and tubing and
mask or ET tube at raised FiO2 or pressures) or Normal Atmosphere
- Nasal →
- Nasopharynx →
- Larynx →
- Trachea →
- R/L Main Bronchi →
- Lobar bronchi →
- Segmental Bronchi →
- Successive Small bronchi→
- Bronchioles →
- Terminal bronchioles →
- Respiratory bronchioles→
- Alveolar ducts and sacs →