Surgical Anatomy of the Lungs

Trachea bifurcation: 7th thoracic vertebra Right main bronchus: sharper angle, more direct line with trachea RMB: 1.2 cm Bronchus intermedius: cm

Left main bronchus: 4-6 cm 0.5 cm distal to the LUL orifice→superior segment of LUL Distal to superior segment of LUL: 1.5 cm as single trunk

The right main pulmonary artery is longer than the left, but its extrapericardial length up to its first branch is less than of the left Branches to LUL: 2-7, four is most common

Right SPV: drain the upper and middle lobe Anomalous Unilateral Single Pulmonary Vein (AUSPV): right lung(65%) left lung(35%) left lung(35%) more often as a single IPV more often as a single IPV

Intrapericardial anatomy

RPA: pass behind ascending aorta and SVC Right PV: enter into left atrium separately Left PV: the two vein form a common trunk in one of four persons

Bronchial arteries and veins Bronchial arterial system: systemic circulation, 1% of the cardiac output From aorta, intercostal arteries, subclavian or innominate arteries Main into the pulmonary veins,

Significance of the Lymphatic Drainage Patterns The drainage from the right lung is essentially unilateral and crossover to lymph nodes in the contralateral mediastinum is infrequent. Nohl-Oser(1972), Greschuchna and Maassen(1973): contralateral metastasis RUL: 5%, 7% RUL: 5%, 7% RLL : 7%, 5% RLL : 7%, 5%

Contralateral mediastinal drainage from the left lung is relative common, occurring most frequently through the subcarinal nodes. Nohl-Oser(1972), Greschuchna and Maassen(1973): contralateral metastasis LUL: 22%, 21% LUL: 22%, 21% LLL: 40%, 33% LLL: 40%, 33%

Skip metastases: direct lymphatic channels from either lung drain to the mediastinal lymph nodes, bypassing the bronchopulmonary nodes RUL to superior tracheobronchial nodes: most frequently Superior mediastinum continues to scalene lymph nodes: right >left