Embryology, Gross

Anatomy and Histology

of Lungs and Pleura

For PC-II medicine Students

By: Zelalem A.

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 Embryology

splanchnic mesenchyme
 The thoracic cavity
The thoracic cavity is divided into three
compartments:

Right and left pulmonary cavities which

contain the lungs.

A central mediastinum, a compartment

intervening between and completely separating the
two pulmonary cavities, which contains essentially
all other thoracic structures - the heart, thoracic
parts of the great vessels, thoracic part of the
trachea, esophagus, thymus, and etc.
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 PLEURAL CAVITIES
Two pleural cavities, one on either side of
the mediastinum, surround the lungs

The pulmonary cavities are lined by pleural

membranes (pleurae) that also reflect onto
and cover the external surface of the lungs
contained within the cavities

The medial wall of each pleural cavity is the

mediastinum.
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 Pleurae
The pleurae consists of two continuous
membranes:
The visceral pleura, which invests all surfaces of
the lungs
The parietal pleura, which lines the pulmonary
cavities.
The pleural cavity: is the potential space
enclosed between the visceral and parietal
pleurae. Contains only a very thin layer of
serous fluid
The fluid: lubricates the pleural surfaces,
allows the layers of pleura to slide smoothly
over each other during respiration.

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 The parietal pleura consists of four parts:
The costal part (costovertebral or costal pleura)
The mediastinal part (mediastinal pleura)
The diaphragmatic part (diaphragmatic pleura)
The cervical pleura (pleural cupula, dome of
pleura)

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 The costal part of the parietal pleura
covers the internal surfaces of the
thoracic wall.

It is separated from the internal surface of

the thoracic wall by endothoracic fascia.

Forms a natural cleavage plane for the

surgical separation of the costal pleura
from the thoracic wall.
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 The mediastinal part of the parietal pleura
covers the lateral aspects of the
mediastinum

It continues superiorly into the root of the

neck as cervical pleura.

At the hilum of the lung, it reflects laterally

onto the structures making up the root of
the lung and becomes continuous with the
visceral pleura.
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 The diaphragmatic part of the parietal pleura
covers the superior surface of the
diaphragm except ; along its costal
attachments , where the diaphragm is fused
to the pericardium.

The cervical pleura is the dome-shaped cap

of the pleural sac and is the superior
continuation of the costal and mediastinal
parts of the parietal pleura.
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 Pleural reflections
The relatively abrupt lines along which the
parietal pleura changes direction as it passes
(reflects) from one wall of the pleural cavity
to another are the lines of pleural reflection.
The sternal line of pleural reflection occurs
where the costal pleura becomes continuous
with the mediastinal pleura anteriorly.
The costal line of pleural reflection occurs
where the costal pleura becomes continuous
with diaphragmatic pleura inferiorly above the
costal margin .
The vertebral line of pleural reflection occurs
where the costal pleura becomes continuous
with the mediastinal pleura posteriorly.
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 The sternal line of reflection on the left side
passes inferiorly in the median plane only to
the level of the 4th costal cartilage.

Here it passes to the left margin of the

sternum and then continues inferiorly to the
6th costal cartilage, creating a notch, and
allows a part of the pericardium (heart sac)
to be in direct contact with the anterior
thoracic wall.

This is important for pericardiocentesis

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 In the midclavicular line, the pleural cavity
extends inferiorly to the 8th rib.

In the midaxillary line, it extends to 10th rib.

From this point, the inferior margin courses

somewhat horizontally, crossing the 11th and 12th
ribs to reach T12 vertebra.

From the midclavicular line to the vertebral

column, the inferior boundary of the pleura can
be approximated by a line that runs between the
8th rib, 10th rib, and T12 vertebra
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 Pleural recesses
The lungs do not occupy the pulmonary cavities
completely during expiration - thus the peripheral
diaphragmatic pleura is in contact with the lowermost
parts of the costal pleura.

This results in potential pleural spaces (recesses) in

which two layers of parietal pleura become opposed.

Expansion of the lungs into these spaces usually occurs

only during forced inspiration

The recesses provide potential spaces in which fluids

can collect and from which fluids can be aspirated.
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Costomediastinal recesses
Located posterior to the sternum where the
costal pleura is in contact with the mediastinal
pleura.
The left recess is potentially larger in the region
overlying the heart.

Costodiaphragmatic recesses
The largest and clinically most important recesses,
which occur in each pleural cavity between the
costal pleura and diaphragmatic pleura
These are regions between the inferior margin of
the lungs and inferior margin of the pleural cavities.
They are the deepest, after forced expiration and
the shallowest after forced inspiration.

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The Lungs

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 Lungs
The lungs are the vital organs of respiration.

Their main function is to oxygenate blood by bringing

inspired air into close relation with the venous blood
in the pulmonary capillaries.

Healthy lungs in living people are normally light, soft,

and spongy, and fully occupy the pulmonary cavities.

They are also elastic and recoil to approximately one

third of their size when the thoracic cavity is opened.

The lungs are separated from each other by the

mediastinum, to which they are attached by the roots
of the lungs

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 Root and hilum
The root of each lung attaches the lung to
structures in the mediastinum
It is covered by a sleeve of mediastinal pleura
that reflects onto the surface of the lung as
visceral pleura (pleural sleeve).
Within each root located in the hilum are:
a pulmonary artery;
two pulmonary veins (superior and inferior);
a main bronchus;
bronchial vessels;
the pulmonary plexuses of nerves (sympathetic,
parasympathetic, and visceral afferent fibers);
lymphatics.
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 In the mediastinum, the vagus nerves pass
immediately posterior to the roots of the lungs,
while the phrenic nerves pass immediately
anterior to them.

The hilum of the lung is a wedge-shaped area of

the medial surface of each lung, the point at
which the structures forming the root enter and
leave the lung

The pulmonary ligament stabilizes the position of

the inferior lobe and may also accommodate the
down-and-up translocation of structures in the
root during breathing.
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 Generally at the hilum,
the pulmonary artery is superior,
the pulmonary veins are inferior,
the bronchi are somewhat posterior in
position.

Each lung has a base, apex, three surfaces

and three borders.

The apex projects above rib I and into the

root of the neck.
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 The three surfaces
The costal surface lies immediately adjacent to
the ribs and intercostal spaces of the thoracic
wall.

The mediastinal surface is concave, includes the

hilum and is related to the middle mediastinum,
which contains the pericardium and heart.

The diaphragmatic surface is concave, forms the

base of the lung, which rests on the dome of the
diaphragm.

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 The three borders
The anterior border is where the costal and
mediastinal surfaces meet anteriorly and overlap the
heart
The cardiac notch indents this border of the left lung.

The inferior border of the lung circumscribes the

diaphragmatic surface of the lung and separates this
surface from the costal and mediastinal surfaces.

The posterior border of the lung is where the costal

and mediastinal surfaces meet posteriorly.

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 The horizontal and oblique fissures divide the
lungs into lobes.

The right lung

has three lobes and two fissures
the oblique fissure separates the inferior lobe
from the superior lobe and the middle lobe;
the horizontal fissure separates the superior
lobe from the middle lobe.
it is larger, heavier than the left, but shorter and
wider

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 There is a groove for the esophagus and a
cardiac impression for the heart on the
mediastinal surface of the right lung.

The cardiac impression on the mediastinal

surface of the left lung is much larger.

The anterior border is relatively straight

The concavity of the base/ inferior border is

deeper in the right lung.

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 The medial surface of the right lung lies
adjacent to a number of important
structures in the mediastinum and the
root of the neck .
These include:
the heart,
inferior vena cava,
superior vena cava,
azygos vein,
esophagus,
right subclavian artery and vein

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The left lung
Is smaller than the right lung and has two lobes
separated by an oblique fissure.

The inferior portion of the medial surface is

notched (cardiac notch) because of the
deviation of the apex of the heart to the left
side.

On the anterior surface of the lower part of

the superior lobe a tongue-like extension, the
lingula (L. tongue), projects over the heart
bulge.
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 The medial surface of the left lung lies
adjacent to a number of important
structures in the mediastinum and root of
the neck.
These include:
the heart,
aortic arch,
thoracic aorta,
Esophagus,
left subclavian artery and vein.

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 Bronchopulmonary segment

Is the largest subdivisions of a lobe of lung

supplied by a segmental bronchus and its
accompanying pulmonary artery branch.

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The bronchopulmonary segments are:
Pyramidal-shaped segments of the lung, with their
apices facing the lung root and their bases at the
pleural surface.

Separated from adjacent segments by connective

tissue septa, hence surgically resectable.

Supplied independently by a segmental bronchus

and a tertiary branch of the pulmonary artery.

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 Named according to the segmental bronchi
supplying them.

Drained by intersegmental parts of the

pulmonary veins that lie in between the
connective tissue and drain adjacent
segments.

Usually 18-20 in number (10 in the right

lung; 8-10 in the left lung,) depending on the
combining of segments.
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 Vasculature of the Lungs and Pleurae
Each lung has a large pulmonary artery supplying blood
to it and two pulmonary veins draining blood from it.

The right and left pulmonary arteries arise from the

pulmonary trunk and carry poorly oxygenated
(venous) blood to the lungs for oxygenation.

Each pulmonary artery gives off its first branch to the

superior lobe before entering the hilum.

Within the lung, each artery divides into lobar and

segmental arteries.
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 The bronchial arteries supply blood for
nutrition of the structures making up the root of
the lungs, the supportive connective tissues of
the lungs, and the visceral pleura.
The two left bronchial arteries usually arise directly
from the thoracic aorta.
The single right bronchial artery most commonly
arises from the right 3rd posterior intercostal artery.
The distal-most branches of the bronchial
arteries anastomose with branches of the
pulmonary arteries in the walls of the
bronchioles and in the visceral pleura.
The parietal pleura is supplied by the arteries
that supply the thoracic wall.
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 The pulmonary veins, two on each side, carry
well-oxygenated blood from the lungs to the
left atrium of the heart.

Begin in the pulmonary capillaries and unite

into larger and larger vessels.

The pulmonary veins run independently of the

arteries and bronchi, coursing between and
receiving blood from adjacent segments as
they run toward the hilum intersegmental.

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 The bronchial veins drain only part of the blood
supplied to the lungs by the bronchial arteries,
primarily that distributed to or near the more
proximal part of the roots of the lungs.

The remainder of the blood is drained by the

pulmonary veins.

The right bronchial vein drains into the azygos

vein and the left bronchial vein drains into the
accessory hemiazygos vein or the left superior
intercostal vein.
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Lymphatic drainage
The superficial (subpleural) lymphatic plexus lies deep
to the visceral pleura and drains the lung parenchyma
(tissue) and visceral pleura.

These drain into the bronchopulmonary lymph nodes

(hilar lymph nodes) in the hilum of the lung.

The deep lymphatic plexus is located in the submucosa

of the bronchi and in the peribronchial connective
tissue.

It drains the structures that form the root of the lung

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 Nerves of the Lungs and Pleurae
Are derived from the pulmonary plexuses anterior and
(mainly) posterior to the roots of the lungs.
Contain:
parasympathetic fibers from the vagus nerves (CN X)
sympathetic fibers from the sympathetic trunks.

The sympathetic ganglion cells are in the paravertebral

sympathetic ganglia of the sympathetic trunks.

The parasympathetic ganglion cells are in the

pulmonary plexuses and along the branches of the
bronchial tree.
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 The parasympathetic fibers from the vagus
nerves are:
- motor to the smooth muscle of the bronchial tree
(bronchoconstrictors),
- inhibitory to the pulmonary vessels (vasodilator),
- secretory to the glands of the bronchial tree
(secretomotor).
The sympathetic fibers are:
- inhibitory to the bronchial muscle (bronchodilator),
- motor to the pulmonary vessels (vasoconstrictor),
- inhibitory to the alveolar glands of the bronchial tree,
i.e., type II secretory epithelial cells of the alveoli.

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