1. Iman Galal, MD Pulmonary Medicine Department Ain Shams University CLINICAL ANATOMY OF LUNG & PLEURA

2. Page  2 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 6 th costochondral junction.  The anterior border of left lung continues running downwards till the 4 th costal cartilage then curves laterally ½ inch forming the cardiac notch then descends downwards till the 6 th costochondral junction.

3. Page  3 Borders of the lung:  The lower border of the lungs represented by a line starting from 6 th rib in the MCL, 8 th rib in the MAL & 10 th rib in the scapular line.

4. Page  4 Right Lung

5. Page  5 Lung Fissures: Oblique fissure (Right & Left): It starts at the 3 rd 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 5 th rib & ending at the 6 th costal cartilage 3 inches from the midline. It starts at the 3 rd 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 5 th rib & ending at the 6 th costal cartilage 3 inches from the midline. In cadaver it arise at the 2 nd thoracic spine. In cadaver it arise at the 2 nd thoracic spine. The transverse fissure (Right): It arises at the 4 th costal cartilage, runs horizontally to meet the oblique fissure in the midaxillary line in the 5 th rib. It arises at the 4 th costal cartilage, runs horizontally to meet the oblique fissure in the midaxillary line in the 5 th rib.

6. Page  6 Fissures & Lobes of the Lungs

7. Page  7 Fissures & Lobes of the Right Lung

8. Page  8 Right Upper Lobe

9. Page  9 Right Middle Lobe

10. Page  10 Right Lower lobe

11. Page  11 Left Lung

12. Page  12 Fissures of the Left Lung

13. Page  13 Left Upper Lobe

14. Page  14 Left Lower Lobe

15. Page  15 Segmental Bronchi

16. Page  16 Segmental Bronchi

17. Page  17 Segmental Bronchi (Anterior) 1 23 4 5 8 1-2 3 4 5 8

18. Page  18 Segmental Bronchi (Posterior) 11-2 2 3 4 6 10 9 3 6 109 4

19. Page  19 Pleura

20. Page  20 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 8 th rib in MCL, 10 th rib in MAL and 12 th rib in Scapular line.

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22. Page  22 Pleura

23. Page  23 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 1 st costal cartilage & one inch above medial 1/3 clavicle; covers apex of lung Diaphragmatic pleura: Lines superior surface of diaphragm

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26. Page  26 Traube’s area: 4 points: Left 6 th rib in the MCL to 8 th costal cartilage in the parasternal line,then along the left costal margin to the 11 th rib in the MAL, then the 9 th rib in the MAL. Left 6 th rib in the MCL to 8 th costal cartilage in the parasternal line,then along the left costal margin to the 11 th rib in the MAL, then the 9 th rib in the MAL.

27. Page  27 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 7 th cervical spine.

28. Page  28 Bare area of the heart :  Medial border: left lateral border of the sternum  Lateral border: left parasternal line  Superior border: lower border of Lt 4 th rib.  Inferior border: upper border of Lt 6 th rib

29. Page  29 Surface anatomy of liver: Upper border: It starts from the left 6 th rib just inside the MCL, passing to the Rt and slightly upwards to the 5 th rib in the MCL, then the 7 th rib in anterior axillary line, to the 9 th rib in mid- axillary line. It starts from the left 6 th rib just inside the MCL, passing to the Rt and slightly upwards to the 5 th rib in the MCL, then the 7 th rib in anterior axillary line, to the 9 th rib in mid- axillary line.

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31. Thank You