Iman Galal, MDIman Galal, MD

Pulmonary Medicine DepartmentPulmonary Medicine Department

Ain Shams UniversityAin Shams University

CLINICAL CLINICAL ANATOMY OF ANATOMY OF

LUNG & PLEURALUNG & PLEURA

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Borders of the lung:Borders of the lung:

The apexThe apex is about 2-3 cms (1 inch) above the medial 1/3 of the is about 2-3 cms (1 inch) above the medial 1/3 of the

clavicle, then clavicle, then the anterior border of both lungsthe anterior border of both lungs run downwards & run downwards &

medially meeting each other in the middle line behind the angle of medially meeting each other in the middle line behind the angle of

Louis. Louis.

The anterior border of right lung continues running downwards till The anterior border of right lung continues running downwards till

the 6the 6thth costochondral junction. costochondral junction.

The anterior border of left lung continues running downwards till the The anterior border of left lung continues running downwards till the

44thth costal cartilage then curves laterally ½ inch forming the cardiac costal cartilage then curves laterally ½ inch forming the cardiac

notch then descends downwards till the 6notch then descends downwards till the 6thth costochondral junction. costochondral junction.

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Borders of the lung:Borders of the lung:

The lower border of the lungsThe lower border of the lungs represented by a represented by a

line starting from 6line starting from 6thth rib in the MCL, 8 rib in the MCL, 8thth rib in the rib in the

MAL & 10MAL & 10thth rib in the scapular line. rib in the scapular line.

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Right LungRight Lung

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Lung Fissures:Lung Fissures:

Oblique fissureOblique fissure (Right & Left):(Right & Left):

It starts at theIt starts at the 33rdrd thoracic spine thoracic spine while the arms are elevated, while the arms are elevated,

descends downwards, laterally & anteriorly along the medial border of descends downwards, laterally & anteriorly along the medial border of

the scapula touching the inferior angle of the scapula) cutting the the scapula touching the inferior angle of the scapula) cutting the

midaxillary line in the 5midaxillary line in the 5thth rib & ending at the 6 rib & ending at the 6thth costal cartilage 3 inches costal cartilage 3 inches

from the midline.from the midline.

In cadaver it arise at the 2In cadaver it arise at the 2ndnd thoracic spine. thoracic spine.

The transverse fissureThe transverse fissure (Right):(Right):

It arises at theIt arises at the 44thth costal cartilage costal cartilage, runs horizontally to meet the , runs horizontally to meet the

oblique fissure in the midaxillary line in the 5oblique fissure in the midaxillary line in the 5thth rib. rib.

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Fissures & Lobes of the LungsFissures & Lobes of the Lungs

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Fissures & Lobes of the Right Fissures & Lobes of the Right LungLung

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Right Upper LobeRight Upper Lobe

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Right Middle LobeRight Middle Lobe

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Right Lower lobeRight Lower lobe

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Left LungLeft Lung

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Fissures of the Left LungFissures of the Left Lung

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Left Upper LobeLeft Upper Lobe

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Left Lower LobeLeft Lower Lobe

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Segmental BronchiSegmental Bronchi

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Segmental BronchiSegmental Bronchi

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Segmental Bronchi Segmental Bronchi (Anterior)(Anterior)

11

22 33

44 55

88

1-21-2

33

44

55

88

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Segmental Bronchi Segmental Bronchi (Posterior)(Posterior)

111-21-2

22

3344

66

1010 99

3366

101099

44

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PleuraPleura

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The borders of the Pleura:The borders of the Pleura:

The pleura runs close to the lung except at the The pleura runs close to the lung except at the

lower border which extends for 3-5 cm below it lower border which extends for 3-5 cm below it

both anteriorly & posteriorly & 9-10 cm below in both anteriorly & posteriorly & 9-10 cm below in

the axilla.the axilla.

The lower border cuts the 8The lower border cuts the 8th th rib in MCL, 10 rib in MCL, 10thth rib rib

in MAL and 12in MAL and 12th th rib in Scapular line. rib in Scapular line.

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PleuraPleura

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Parietal PleuraParietal Pleura

Costal pleura:Costal pleura:

Lines thoracic wall (ribs, Lines thoracic wall (ribs,

intercostal spaces)intercostal spaces)

Mediastinal pleura:Mediastinal pleura:

Lines corresponding surface of Lines corresponding surface of

mediastinum; reflected over root of mediastinum; reflected over root of

lung & becomes continuous with lung & becomes continuous with

visceral pleura around hilumvisceral pleura around hilum

Cervical pleura:Cervical pleura:

Extends into neck about 2 inches Extends into neck about 2 inches

above 1above 1stst costal cartilage & one costal cartilage & one

inch above medial 1/3 clavicle; inch above medial 1/3 clavicle;

covers apex of lungcovers apex of lung

Diaphragmatic pleura:Diaphragmatic pleura:

Lines superior surface of Lines superior surface of

diaphragmdiaphragm

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Traube’s area:Traube’s area:

4 points:4 points:

Left 6Left 6thth rib in the MCL to 8 rib in the MCL to 8thth costal cartilage in the costal cartilage in the

parasternal line ,then along the left costal margin parasternal line ,then along the left costal margin

to the 11to the 11thth rib in the MAL, then the 9 rib in the MAL, then the 9thth rib in the rib in the

MAL.MAL.

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Kronig’s Isthmus :Kronig’s Isthmus :

It is a band of resonance representing lung apex.It is a band of resonance representing lung apex.

LaterallyLaterally it is marked by a line joining 2 points:it is marked by a line joining 2 points:

1.1. The junction of the medial 2/3 of the clavicle with The junction of the medial 2/3 of the clavicle with

the lateral 1/3.the lateral 1/3.

2.2. The junction of the medial 1/3 of the scapular The junction of the medial 1/3 of the scapular

spine with the lateral 2/3.spine with the lateral 2/3.

MediallyMedially marked by a line between the sternal marked by a line between the sternal

end of clavicle and the 7end of clavicle and the 7thth cervical spine. cervical spine.

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Bare area of the heart :Bare area of the heart :

Medial border: left lateral border of the sternumMedial border: left lateral border of the sternum

Lateral border: left parasternal lineLateral border: left parasternal line

Superior border: lower border of Lt 4Superior border: lower border of Lt 4thth rib. rib.

Inferior border: upper border of Lt 6Inferior border: upper border of Lt 6thth rib rib

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Surface anatomy of liver:Surface anatomy of liver:

Upper border:Upper border:

It starts from the left 6It starts from the left 6thth rib rib just inside the MCL, just inside the MCL,

passing to the Rt and slightly upwards to the 5passing to the Rt and slightly upwards to the 5thth rib rib

in the MCL, then the 7in the MCL, then the 7thth rib in anterior axillary line, rib in anterior axillary line,

to the 9to the 9thth rib in mid-axillary line. rib in mid-axillary line.

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Thank YouThank You