Pulmonary agenesis is a rare malformation that can be isolated or associated with other anomalies. There is an association with ipsilateral radial defects and/or hemifacial microsomia. A review of cases of pulmonary agenesis and associated anomalies in children confirmed the association of pulmonary agenesis with ipsilateral involvement of the face and radius.

Tracheal bronchus, cardiac bronchus

Tracheal is called bronchus (upper lobe, apical segment, middle lobe), extending from the trachea in an atypical place, or supernumerary bronchus, arising directly from the trachea. In most cases, it extends along the right side wall of the lower third of the trachea. Cardiac bronchus is a supernumerary bronchus, usually rudimentary, which most often arises from the medial wall of the intermediate bronchus and passes down and medially towards the heart.

Clinical significance These anomalies are that they predispose to repeated infectious inflammation and the development of bronchiectasis, which is often limited to the territory of only these bronchi. After endotracheal intubation, it is possible to accidentally close such a bronchus with a balloon, which leads to atelectasis of the right upper lobe.

Bronchial atresia

The apical-posterior segment of the left upper lobe is most often affected. This developmental anomaly can be combined with a bronchogenic cyst.

Morphology

Atresia of the lobar or segmental bronchi occurs, while the distal segments are well preserved. Mucus that is secreted in the airways distal to the obliterated lumen cannot pass through this area of ​​stenosis, resulting in the formation of mucus plugs and retention cysts (mucoceles). The affected segment remains airy due to collateral ventilation, and due to the valve mechanism, swelling of this segment occurs. On CT, mucoceles appear as hilar branching structures, accompanied by swelling of the affected segment.

Tracheobronchomegaly

Tracheobronchomegaly can have various causes. The most common of them is destruction of the cricoid cartilage.

Morphology

Tracheobronchomegaly is present if the diameter of the trachea exceeds 2.5 cm, and the diameter of the left and right main bronchi is 2 and 2.3 cm, respectively. The absence or hypotrophy of elastic fibers and hypotrophy of muscle fibers lead to pathological dynamics of air outflow with expansion of the airways during inhalation and collapse during exhalation. A common accompanying finding is bronchiectasis.

Bronchogenic cysts

Bronchogenic cysts are the most common bronchial anomaly and

is a consequence of a violation of the branching of the bronchial tubes in the embryonic period. They are divided into intrapulmonary (70%) and mediastinal (30%).

Morphology

Intrapulmonary cysts are most often found in the lower lobes. Cysts can reach a diameter of several centimeters (central type) or can be multilocular, consisting of many small cysts (peripheral type).

Cysts with very high content proteins can have a density of up to 50 units. X. Uninfected cysts do not enhance after intravenous contrast. Characteristically, there is no communication with the tracheobronchial tree until the cysts are infected, which occurs in 75% of cases. If this message is present, the cysts contain air or fluid levels are detected in them. Infected cysts lose their sharp contours due to compaction of the underlying parenchyma, their walls become thickened and are enhanced by contrast, which simulates a lung abscess. Differential diagnosis between bronchogenic and acquired cysts, for example after adult respiratory distress syndrome or a healed abscess, can be difficult. Mediastinal cysts are most often found in the area of ​​the tracheal bifurcation on the right, but can also be located paratracheal or paraesophageal. Only in very rare cases do they communicate with the tracheobronchial system. Their infection is extremely rare. Mediastinal bronchogenic cysts are usually larger than pulmonary ones (more than 20 cm).

Pulmonary sequestration

This term denotes a non-functioning mass of aberrant lung tissue with no normal connection with the tracheobronchial system, having an arterial blood supply from great circle blood circulation Sequestration is found in 65% of cases in the posterior segments of the left lower lobe, in the rest - in the posterior segments of the right lower lobe.

There are two forms depending on the relationship to the pleura:

• intralobar sequestration (75-85%): the sequestered segment of the lung is covered by a common pleura with the rest of the lung and drains into the pulmonary veins: usually detected in adults;
• extralobar (15-25%) sequestration: the sequestered segment has its own pleural covering, drains into the vena cava or azygos and is diagnosed in newborns or early infancy.

Sequestration must be kept in mind in all cases of prolonged or recurrent lower lobe pneumonia.

Morphology

With intralobar sequestration, the sequestered segment may be airy due to collateral ventilation through the pores of Cohn and areas of expiratory swelling are often found in it. In this case, sequestration can only be recognized by the atypical blood supply from the descending aorta. A typical finding is retention cysts (mucoceles) in the rudimentary bronchi. If a sequestered segment of the lung becomes infected or perforates bronchial tree, CT can reveal single- or multi-chamber cysts containing different quantity air and liquid.

With extralobar sequestration, the corresponding segment does not communicate with the tracheobronchial tree at all and has a completely soft tissue density. A correct diagnosis can be made by intravenous contrast, which reveals homogeneous contrast enhancement of the sequestered lung segment, simultaneous with enhancement of the aorta. Some patients have emphysematous changes in the adjacent lung parenchyma and cystic areas within the sequestered segment.

This anomaly is often combined with other congenital changes. Occasionally, a fistula occurs between the sequestered segment and the esophagus or stomach.

Venolobar syndrome, scimitar syndrome, congenital pulmonary hypogenesis syndrome

Venolobar syndrome is a collective term for various developmental anomalies chest cavity, which often coexist in the same patient.

Morphology

CT scan reveals a small hypoplastic lung with abnormalities in the course and branching of various bronchi. Frequent accompanying findings are bronchial diverticula and bronchiectasis. The examining physician should look for abnormal pulmonary veins that drain into the vena cava right atrium or atrial appendage. Most often, the right lung is drained by a single vein, which may run inferiorly parallel to the right edge of the heart and enter the inferior vena cava below the diaphragm.

On direct radiographs it looks like a Turkish saber (scimitar). Atypical pulmonary veins may be detected even in the absence of detectable pulmonary parenchymal abnormalities. The lung is usually supplied by the systemic circulation - the descending or abdominal aorta - and sequestration may occur.

Abnormal pulmonary venous drainage

Abnormal pulmonary venous drainage is characterized by venous drainage directly into the right heart or into the veins of the systemic vein. May be partial or complete, affect some or all veins, and in either case creates an extracardiac shunt from left to right. The anatomical relationships vary greatly, with approximately 30 different types existing. Often combined with other cardiovascular anomalies (eg, atrial septal defect). One of the keys to diagnosis is equal oxygen saturation of all four chambers of the heart as blood from the pulmonary veins mixes with venous blood from a large circle. A long-term effect of increased blood flow to the affected lung is pulmonary hypertension.

Morphology

KTA makes it possible full characteristics such anomalies, including hypoplasia of the pulmonary veins themselves. If this abnormality is not clinically suspected, it is easily missed on axial CT slices. Typical features include pulmonary veins that drain directly into the right atrium or superior vena cava, an aberrant left pulmonary vein that occupies the position of an accessory left superior vena cava lateral to the aortic arch, and no veins draining into the left atrium.

However, the abnormality is best visualized in volumetric view (VR) of pulmonary vascularity, as it gives best review often complex anatomy. In the presence of an atrial septal defect, a stream of highly concentrated (undiluted) contrast agent may be observed from the right to the left atrium, which can also be seen in VR images.

13. Knee joint, ligaments.

14. Bones of the foot. Ankle joint.

15. Arches of the feet. Chopart and Lisfranc joints.

16. Air-bearing bones of the skull. The structure of the sphenoid bone.

17. Structure of the roof of the skull. Seams.

18. Internal base of the skull, cranial fossae, boundaries.

19. Nasal cavity, nasal passages, communication with the sinuses.

20. Temporal bone, parts, structure of the tympanic cavity.

21. Upper and lower jaws. Temporomandibular joint.

22. Pterygopalatine fossa, walls and openings, their contents.

23. Skull of a newborn, fontanelles.

24. Classification of bone joints. Types of continuous connections.

3. Discontinuous (synovial) joints or joints.

25. Intermittent connections. Mandatory and auxiliary elements of the joint. Classification of joints by structure.

26. Types of movements in joints. Classification of joints according to axes of rotation and shape.

27. Back muscles (superficial), functions, innervation.

28. Chest muscles. Chest triangles.

29. Diaphragm, structure, function, innervation.

30. Abdominal muscles, innervation.

31. Sheath of the rectus abdominis muscle.

33. Inguinal canal, walls, contents.

33. Vascular and muscular lacunae.

34. Muscles of the shoulder girdle, innervation.

35. Three-sided and four-sided holes and their contents.

36. Shoulder muscles, innervation, grooves.

37. Brachial canal, its contents.

38. Forearm muscles, innervation.

39. Muscles of the hand (thenar and hypothenar), innervation.

40. Thigh muscles, functions, innervation.

41. Scarpa's triangle, femoral canal.

42. Gunterov channel, walls, holes, contents.

43. Muscles of the lower leg, functions, innervation.

44. Popliteal fossa, walls, contents. Gruber Canal.

45. Neck muscles, classification.

47. Neck triangles, borders.

49. Chewing muscles, functions, innervation.

50. Facial muscles, functions, innervation.

1. Oral cavity, walls:

2.Muscles of the soft palate and tongue, their blood supply.

3. Pharynx, parts, muscles of the pharynx.

13. Pancreas, parts, topography, blood supply, functions.

15. Larynx, structure. Laryngeal cartilages.

16. Muscles of the larynx.

17.Trachea and bronchi, structure, definition of the bronchopulmonary segment.

23.Structure of nephrons, their functions. A wonderful arterial network.

25. Bladder, parts, wall structure, relationship to the peritoneum, blood supply.

27.Structure of the testicle, membrane.

28.Uterus, fallopian tubes, parts, wall structure, blood supply.

29. Ovary, surfaces, edges, ligaments, parenchyma structure, functions.

30. Perineum, areas, muscles and fascia.

31. Thyroid gland structure, topography, hormones, blood supply.

32.Endocrine glands of ectodermal origin, hormones.

34.Structure of the lymph node. Red and white pulp of the spleen

35. Heart, wall structure.

36. Boundaries of the heart. Heart valves. Pericardium, its sinuses.

37. Conducting system of the heart, blood supply.

38. Aorta, parts, branches of the aortic arch.

39. Brachiocephalic trunk, common and external carotid arteries and their branches.

41. Thoracic and abdominal parts of the aorta, topography, branches.

42. Subclavian a. Axillary a. Topography, branches.

43. Brachial, radial and ulnar arteries. Palmar arches.

44. Common iliac artery, branches of the external and internal iliac arteries.

45. Femoral artery, its branches.

46. ​​Anterior and posterior tibial arteries, branches.

47. Formation of the superior vena cava. Azygos vein.

48. Internal jugular vein, formation, intra- and extracranial tributaries.

49. Formation of the inferior vena cava, tributaries.

50. Portal vein system, formation, tributaries.

18. Long branches of the brachial plexus. Areas of innervation of the ulnar nerve.

19. Median nerve, its branches, areas of innervation.

20. Radial nerve, its branches, areas of innervation.

22.Lumbar plexus, topography, branches.

23. Femoral nerve, areas of innervation.

24. Sciatic nerve, its branches. Common peroneal nerve, areas of innervation.

25. Tibial nerve, its branches, areas of innervation.

26. Cranial nerves, nuclei, topography at the base of the brain.

27. 3rd, 4th, 6th pairs of cranial nerves: nuclei, exit from the brain and skull, innervation zones.

28. 5th pair of cranial nerves, exit from the brain and skull, zones of innervation.

29. 7th pair: nuclei, exit from the brain and skull, branches.

30. 9th pair: nuclei, exit from the brain and skull, branches.

32. 11th and 12th pairs. Nuclei, exit from the brain and skull, areas of innervation.

33. Autonomic nervous system. Central and peripheral sections.

34. Sympathetic trunk, formation, sections, types of fibers.

35. Cervical sympathetic trunk, nodes, nerves.

36. Thoracic sympathetic trunk, nodes, nerves.

37. Parasympathetic division of the autonomic nervous system, peripheral and central divisions.

38. Autonomic ganglia of the head and their connections with cranial nerves.

39. The organ of vision and its auxiliary apparatus.

40. Organ of vision, structure of the eyeball.

41. The structure of the fibrous and choroidal membranes. The structure of the retina.

42. Light-refracting media of the eye, chambers of the eye. Aqueous humor: products and outflow pathways.

43. Accessory apparatus of the eye: muscles of the eyeball, their innervation. Conducting path of the visual analyzer.

44. Organ of hearing. The structure of the outer ear and tympanic cavity.

45. Inner ear, parts. Bone and membranous labyrinths, organ of Corti.

46. ​​Conducting path of the auditory analyzer.

47. Organ of taste and smell, gustatory and olfactory analyzers.

48. Conducting tracts of the skin analyzer: anterior and lateral spinothalamic tracts.

49. Proprioceptive pathways of the cortical and cerebellar direction.

17.Trachea and bronchi, structure, definition of the bronchopulmonary segment.

The trachea tube, 10-11 cm long, consists of 16-20 cartilaginous half-rings connected by annular ligaments, forming a membranous wall at the back, to which the esophagus is adjacent. It begins at the level of the upper edge of the VII cervical vertebra, ends at the level of the upper edge of the V thoracic vertebra, has parts - the cervical to the 2nd thoracic vertebra and the thoracic. In front of the cervical part of the trachea is the thyroid gland, the pretracheal plate of the cervical fascia, the sternohyoid and sternothyroid muscles, behind is the esophagus, and on the sides are the neurovascular bundles of the neck. Adjacent to the thoracic part in front is the aortic arch, the brachiocephalic trunk, the left brachiocephalic vein, the thymus, and the mediastinal pleura on the sides. The place where the trachea divides into two main bronchi is the tracheal bifurcation (5th thoracic vertebra). The tracheal wall consists of the mucous membrane, submucosa, fibrocartilaginous and adventitial membranes.

Main bronchi(bronchi of the 1st order) from the bifurcation of the trachea go to the gates of the lungs as part of the roots of the lungs, where they are divided on the right into three, and on the left into two lobar bronchi (bronchi of the 2nd order). Right bronchus(bronchus principalis dexter) is wider and shorter, consists of 6-8 cartilaginous half-rings, the azygos vein spreads over it, and the right pulmonary artery is located below it. Left main bronchus(bronchus principalis sinister) is narrower and longer, consists of 9-12 cartilaginous half-rings, the left pulmonary artery and aortic arch are located above, the esophagus and the descending aorta are located behind. The main bronchi at the gates of the lungs are divided into lobar, segmental, lobular, terminal - they form bronchial tree - its function is to conduct air.

?? The alveolar tree performs the respiratory function (gas exchange function) it consists of respiratory bronchioles, alveolar ducts, alveolar sacs and alveoli.

The bronchopulmonary segment is a section of the lung parenchyma, cone-shaped, with its apex facing the hilum of the lungs, ventilated by a segmental bronchus (third order). The right lung has 3 lobes, 10 segments; in the upper lobe: apical, anterior and posterior segments; in the middle: medial and lateral; in the lower: apical basal, medial basal, lateral basal, anterior basal, posterior basal. The left lung has 2 lobes, 10 segments: in the upper lobe there are apical, anterior, posterior, superior and inferior lingular segments; in the lower lobe are the same as in the lower lobe of the right lung

Lungs,surfaces, gates. Root of the lung.

Lungs ( pulmo ) right and left, consists of air parenchyma, it contains air and hascone-shaped, top and base, three surfaces - costal, diaphragmatic, mediastinal, and 3 edges - anterior, inferior and posterior. Located in the right and left half of the chest cavity. Right lung shorter and wider, the left one is narrower and longer, and also on the anterior edge the left lung has a cardiac notch, due to the position of the heart. This notch is limited below by a tongue. On the mediastinal surface there is the gate of the lungs - chyle pulmonis. All anatomical formations going to the gates of the lungs form the roots of the lungs (bronchi, arteries, veins, nerves, lymphatic vessels and nodes); in the root of the right lung, the bronchus occupies a superior position in relation to the pulmonary artery and pulmonary veins - BAV. In the left - the bronchus lies between the pulmonary artery above and pulmonary veins below - ABC.

The lungs are divided into lobes by deep fissures. In the right lung there are oblique and horizontal fissures, which divide the right lung into three lobes (upper, middle, lower), in the left lung - oblique fissure divides left lung on two lobes (upper and lower). As the bronchi and blood vessels divide in the lungs, the following structural and morphological units are distinguished - segments. Each lung has 10 segments. The segments are formed by lobules that are separated septa, the lobular bronchiole approaches the lobule.

Main bronchi at the gates of the lungs they are divided into lobar, segmental, lobular, terminal they form a “bronchial tree”, which performs the function of conducting air. The terminal bronchioles continue to divide (dichotomous division) and form respiratory bronchioles (1st, 2nd, and 3rd order), from which the alveolar ducts arise, they are covered with alveolar vesicles and end in alveolar sacs and constitute the “alveolar tree.” All structures of the alveolar tree, intertwined with a dense network of blood capillaries, form the structural and functional unit of the lung - the acinus (bunch). The acini performs the respiratory function (gas exchange function). The apex of the lung protrudes above the collarbone by 2 cm, above the first rib by 3-4 cm.

??? The anterior border of the right lung runs behind the body of the sternum to the cartilage of the 6th rib to the 11th rib along the paravertebral line. The anterior border of the left lung at the level of the 4th rib turns to the left, then down to the 6th rib and goes slightly lower, to the intercostal space, of the right border.

Pleura, parts, sinuses.

Pleura, a thin serous membrane which has two layers - visceral and parietal.

Visceral pleura covers the lung and grows tightly with its surface, enters deep into the cracks and lines the interlobar surfaces. It forms the inner wall of the pleural cavity and along the root of the lung passes into the parietal pleura, which forms the outer wall of the pleural cavity. Parietal pleura lines the walls of the chest cavity: it is distinguished as mediastinal on the side of the mediastinum, diaphragmatic on the diaphragm and costal on the inner surface of the chest wall; above the apex the pleura forms dome of pleura . !! When one part of the parietal pleura passes into another,pleural sinuses. At the transition of the diaphragmatic pleura to the costal costophrenic sinuses, place of transition of the mediastinal pleura into the costal pleura (in front) costomediastinal sinus; and mediastinal to diaphragmatic (inferior) phrenic-mediastinal sinus. Fluid can accumulate in the sinuses during inflammatory processes. ! Dome of pleura is projected from the neck of the first rib in front to the spinous process of the 7th cervical vertebra in the back. The dome of the pleura rises 3-4 cm above the first rib and 2-3 cm above the collarbone. The upper and anterior boundaries of the pleura coincide with the boundaries of the lungs, the lower boundaries of the pleura are determined one rib below the boundaries of the lungs and extend to the 12th rib along the paravertebral line.

The anterior boundaries of the pleura diverge at the top, forming superior interpleural field, and below inferior interpleural field, triangular in shape to which are adjacent: to the upper - the thymus gland, to the lower - the pericardium and heart.

Mediastinum (mediastinum) sections. Organs of the upper mediastinum.

The mediastinum is a complex of organs located in the chest cavity between the right and left pleural cavities. The boundaries of the mediastinum are in front - the sternum and cartilages of the ribs, behind - the thoracic spine, below - the diaphragm, above - the superior opening of the chest, and on the sides - the mediastinal pleura. The superior mediastinum lies above the horizontal plane, which is drawn from back surface the angle of the sternum to the cartilaginous disc between the IV and V thoracic vertebrae, limited in front by the manubrium of the sternum, behind by the spinal column. Organs of the upper mediastinum: thymus gland, right and left brachiocephalic veins, left common carotid, left subclavian artery, part of the trachea, esophagus and nerves, the upper part of the thoracic lymphatic duct.

Borders and organs of the lower mediastinum.

The inferior mediastinum is the part of the mediastinum limited above by a plane passing from the junction of the manubrium and the body of the sternum to the disc between the 4th and 5th thoracic vertebrae; inferiorly by the tendinous center of the diaphragm. The lower mediastinum is divided into three parts - anterior, middle, posterior. Front lower mediastinum - the space between the sternum and the anterior surface of the pericardium, contains peristernal, prepericardial lymph nodes, internal mammary arteries and veins. Average The lower mediastinum contains the heart in the pericardial sac, intrapericardial sections of large vessels, main bronchi, pulmonary arteries and veins, phrenic nerves, tracheobronchial and lateral pericardial lymph nodes. Rear the lower mediastinum is located between the posterior surface of the pericardium and the spinal column and contains the thoracic aorta, azygos and semi-gyzygos veins, sympathetic trunks, vagus nerves, esophagus, thoracic lymphatic duct, posterior mediastinal, prevertebral lymph nodes.

Kidneys, structure. Renal lobe and cortical lobule. Fixing apparatus of the kidney, blood supply.

The kidney (ren, nephros - Greek) is located in the lumbar region, has surfaces - anterior, posterior, edges - medial, lateral and poles - upper and lower poles. Bud length 10-12cm, width 5-6cm, thickness 3-4cm. The medial edge is concave, there is a depression on it - the renal sinus, here the renal gate is located, where the renal arteries and nerves enter; veins, ureter and lymphatic vessels emerge - all these structures form the renal pedicle. The kidneys are covered with three membranes (fibrous, fatty capsule, renal fascia). Skeletotopy and syntopy of the kidneys, the kidneys are located in the retroperitoneal space on the posterior abdominal wall, on the sides of the spinal column, at the level from the middle of the XI thoracic - to the upper edge of the III lumbar vertebrae, the right kidney is located from the upper edge of the XII vertebra to the middle of the III lumbar vertebra. To the front surface right kidney adjacent to the right lobe of the liver and the right flexure colon, the medial edge is adjacent to the descending part of the duodenum; Adjacent to the left kidney are the stomach, pancreas, and jejunum in front, the spleen on the side, and the left flexure of the colon. Kidney fixation apparatus: renal bed (muscles back wall abdomen), kidney membranes, renal pedicle, turgor of adjacent organs, intra-abdominal pressure, adhesion forces, mesenteries of the small and large intestines, etc.

Along the division of the renal artery, the kidney is divided into 5 segments: upper, lower, anterior-superior, anterior-inferior, and posterior.

A section of the kidney shows layers of parenchyma - the cortex and medulla. The cortex forms a continuous layer 5 cm thick and renal columns that extend deep into the medulla. The medulla is a pyramid, the base faces the cortex, and the apex faces the renal sinus. The pyramid and the adjacent part of the cortex form the renal lobes (about 15-20). IN renal sinus the small and large calyces and the renal pelvis are located. The cortex is located on the periphery and consists of radiate and convoluted parts. One radiate part surrounded by a folded part is called the cortical lobule. The renal lobe contains up to 600 cortical lobes. The cortex consists of nephrons (the structural and functional unit of the kidney), 80% cortical, 20% pericerebral. Each nephron consists of a renal (Malpighian) corpuscle, which is a capsule with a glomerulus, a proximal convoluted tubule, a nephron loop (Henle), and a distal convoluted tubule. The distal convoluted tubules of the nephron empty into the collecting ducts. The convoluted part of the cortex contains the renal corpuscles and proximal and distal convoluted tubules, the radiate part contains the straight renal tubules and the initial sections of the collecting ducts .

Blood supply. The renal arteries (branches of the abdominal aorta), they are successively divided into segmental, interlobar, arcuate, and interlobular arteries, as well as afferent arterioles entering the Shumlyansky-Bowman capsule and efferent arterioles. Venous blood flows through the renal veins into the inferior vena cava.

1. Branches of segmental bronchi, rami bronchioles segmentorum.
2. Muscular membrane, tunica muscuiaris. The muscular layer of the bronchial wall.
3. Submucosa, tela submucosa. A layer of connective tissue under the bronchial mucosa.
4. Mucous membrane, tunica mucosa. Covered with multirow cylindrical ciliated epithelium.
5. Bronchial glands, glL bronchioles. Glands mixed type secretions located under the mucous membrane.
6. Lungs, pubnones. Occupy almost the entire chest. Rice. A B C D.
7. Lung right/left, pulmo dexter/sinister. The right lung is 10% larger than the left. Rice. A B C D.
8. Base of the lung, basis pulmonis (pubnonalis). Facing the diaphragm. Rice. A B C D.
9. Apex of the lung, apex pulmonis (pubnonalis). Occupies the upper aperture of the chest. Rice. A B C D.
10. [[Rib surface, facies costalis]]. Facing the ribs. Rice. A, V.
11. [[Medial surface, facies medians]]. Facing the mediastinum. Rice. B, G.
12. Vertebral part, pars vertebralis. The posterior part of the medial surface adjacent to spinal column. Rice. B, G.
13. Mediastinal surface, facies mediastinalis. It lies in front of the vertebral part and faces the mediastinum. Rice. B, G.
14. Cardiac impression, impressio cardiaca. Located on the medial surface of the lungs; in these places the pericardium is adjacent to them. Rice. B, G.
15. Diaphragmatic surface, facies diaphragmatica. Concave bottom surface lungs, facing the diaphragm. Rice. A B C D.
16. Interlobar surface, facies interlobaris. Facing the interlobar fissure.
17. Anterior edge, margo anterior. The sharp anterior edge of the lung at the junction of the medial and costal surfaces of the lung. Rice. A B C D.
18. Cardiac notch [left lung], incisura cardiaca. Located on the anterior edge of the upper lobe of the left lung. Rice. V, G.
19. Bottom edge, margo inferior. Separates the costal and medial surfaces from the diaphragmatic one. Rice. A B C D.
20. Gate of the lung, hilum pubnonis. They are located on the medial surface and contain the structures of the root of the lung (bronchi and vessels). Rice. B, G.
21. Root of the lung, radix pubnonis. Its main components are the pulmonary vessels and the main bronchus. Rice. B.
22. Lungula of the left lung, lingula pubnonis sinistri. Located between the cardiac notch and the oblique fissure. Rice. B, G. 22a. Apex of the left lung, cubnen pubnonis sinistri. Part of the left lobe without a tongue.
23. Upper lobe, lobus superior. Its lower edge at the back is at the level of the 4th rib. On the right it goes forward almost parallel to the fourth rib, and on the left it reaches the osteochondral junction of the 6th rib. Rice. A B C D.
24. Middle lobe (right lung), lobus medius (pubnonis dextri). Available only in the right lung. Located anterior to the midaxillary line in the space between the fourth and sixth ribs. Rice. A, B.
25. Lower lobe, lobus inferior. Located in the back of the chest. Her top edge goes obliquely down from the level of the fourth rib along the paravertebral line to the intersection of the sixth rib with the midclavicular line. Rice. A B C D.
26. Oblique fissure, fissura obliqua. Lies between the upper and lower lobes of the left lung, the upper, middle and lower lobes of the right lung. It is projected from the fourth rib along the paravertebral line to the sixth - along the midclavicular line. Rice. A B C D.
27. Horizontal fissure (right lung), fissura horizontalis (pubnonis dextri). Separates the middle lobe from the upper lobe. Corresponds to the fourth rib. Rice. A, B.

The bronchial tree is the main system on which breathing is built healthy person. It is known that there are respiratory tracts that supply oxygen to humans. They are naturally structured in such a way that some semblance of a tree is formed. When talking about the anatomy of the bronchial tree, it is imperative to analyze all the functions assigned to it: air purification, humidification. The correct functioning of the bronchial tree provides the alveoli with an influx of easily digestible air masses. The structure of the bronchial tree is an example of nature's minimalism with maximum efficiency: an optimal structure, ergonomic, but coping with all its tasks.

Features of the structure

Different sections of the bronchial tree are known. In particular, there are eyelashes. Their task is to protect the alveoli of the lungs from small particles and dust polluting the air masses. With effective and coordinated work of all sections, the bronchial tree becomes a protector human body from broad spectrum infections.

The functions of the bronchi include the sedimentation of microscopic life forms that have leaked through the tonsils and mucous membranes. At the same time, the structure of the bronchi in children and the older generation is somewhat different. In particular, the length is noticeably longer in adults. The younger the child, the shorter the bronchial tree, which provokes various diseases: asthma, bronchitis.

Protecting yourself from troubles

Doctors have developed methods to prevent inflammation in organs respiratory system. The classic option is rehabilitation. It is performed conservatively or radically. The first option involves therapy with antibacterial medications. To increase effectiveness, medications are prescribed that can make sputum more liquid.

But radical therapy is an intervention using a bronchoscope. The device is inserted through the nose into the bronchi. Released through special channels medicines directly on the mucous membranes inside. To protect the respiratory system from diseases, mucolytics and antibiotics are used.

Bronchi: term and features

Bronchi are branches of the windpipe. An alternative name for the organ is the bronchial tree. The system contains a trachea, which is divided into two elements. The division in female representatives is at the level of the 5th vertebra of the chest, and in the stronger sex it is a level higher - at the 4th vertebra.

After division, the main bronchi are formed, which are also known as left, right. The structure of the bronchi is such that at the point of division they go at an angle close to 90 degrees. The next part of the system is the lungs, into which the bronchi enter.

Right and left: two brothers

The bronchi on the right are slightly wider than on the left, although the structure and structure of the bronchi are generally similar. The difference in size is due to the fact that the lung on the right is also larger than on the left. However, the differences between the “almost twins” are not exhausted: the bronchus on the left relative to the right is almost 2 times longer. The features of the bronchial tree are as follows: on the right, the bronchus consists of 6 rings of cartilage, sometimes eight, but on the left there are usually at least 9, but sometimes the number reaches 12.

The bronchi on the right, in comparison with the left, are more vertical, that is, they actually simply continue the trachea. On the left, under the bronchi, the arcuate aorta passes. To ensure the normal performance of the functions of the bronchi, nature provides for the presence of a mucous membrane. It is identical to the one that covers the trachea, in fact, it continues it.

The structure of the respiratory system

Where are the bronchi located? The system is located in the human sternum. The beginning is at the level of 4-9 vertebrae. Much depends on gender and individual characteristics of the body. In addition to the main bronchi, lobar bronchi also branch off from the tree; these are first-order organs. The second order is composed of zonal bronchi, and from the third to the fifth - subsegmental, segmental. The next step is the small bronchi, occupying levels up to the 15th. The smallest and farthest from the main bronchi are the terminal bronchioles. After them, the following organs of the respiratory system are already starting - respiratory, which are responsible for the exchange of gases.

The structure of the bronchi is not uniform throughout the entire length of the tree, but some general properties observed over the entire surface of the system. Thanks to the bronchi, air flows from the trachea to the lungs, where it fills the alveoli. The processed air masses are sent back the same way. The bronchopulmonary segments are also indispensable in the process of cleaning inhaled volumes. All impurities deposited in the bronchial tree are expelled through it. To get rid of foreign elements and microbes found in the respiratory tract, cilia are used. They can perform oscillatory movements, due to which the secretion of the bronchi moves into the trachea.

We examine: is everything normal?

When studying the walls of the bronchi and other elements of the system, performing bronchoscopy, be sure to pay attention to the colors. Normally, the mucous membrane is gray in color. The cartilage rings are clearly visible. During the study, be sure to check the angle of tracheal divergence, that is, the place where the bronchi originate. Normally, the angle is similar to a ridge protruding above the bronchi. It runs along the midline. During breathing, the system fluctuates somewhat. This happens freely, without tension, pain or heaviness.

Medicine: where and why

Doctors responsible for the respiratory system know exactly where the bronchi are located. If an individual feels that he may have problems with the bronchi, he needs to visit one of the following specialists:

• therapist (he will tell you which doctor will help better than others);
• pulmonologist (treats most diseases respiratory tract);
• oncologist (relevant only in the most severe case - diagnosing malignant neoplasms).

Diseases affecting the bronchial tree:

• asthma;
• bronchitis;
• dysplasia.

Bronchi: how does it work?

It is no secret that a person needs lungs to breathe. Their component parts are called shares. Air enters here through the bronchi and bronchioles. At the end of the bronchiole there is an acinus, actually a collection of bundles of alveoli. That is, the bronchi are a direct participant in the breathing process. It is here that the air warms up or cools down to a temperature that is comfortable for the human body.

Human anatomy was not formed by chance. For example, the division of the bronchi ensures an effective supply of air to all parts of the lungs, even the most distant ones.

Under protection

The human chest is the place where the most important organs. Since damage to them can cause death, nature has provided an additional protective barrier - ribs and a muscle corset. Inside it there are numerous organs, including the lungs and bronchi, connected to each other. At the same time, the lungs are large, and almost the entire surface area of ​​the sternum is allocated for them.

The bronchi and trachea are located almost in the center. They are parallel to the front of the spine. The trachea is located just below the front of the spine. The location of the bronchi is under the ribs.

Bronchial walls

The bronchi contain rings of cartilage. From a scientific point of view, this is called the term “fibrous-muscular-cartilaginous tissue.” Each subsequent branch is smaller. At first these are regular rings, but gradually they become half rings, and the bronchioles do without them. Thanks to the cartilaginous support in the form of rings, the bronchi are held in a rigid structure, and the tree protects its shape, and with it, functionality.

Another important component of the system respiratory organs- muscle corset. When muscles contract, the size of organs changes. This is usually caused by cold air. Compression of organs provokes a decrease in the speed of air passage through the respiratory system. Over a longer period of time, air masses have more opportunities to warm up. At active movements the lumen becomes larger, which prevents shortness of breath.

Respiratory tissues

The bronchial wall consists of large number layers. Following the two described is the epithelial level. Its anatomical structure is quite complex. Different cells are observed here:

• Cilia that can clear air masses of unnecessary elements, push dust out of the respiratory system and move mucus into the trachea.
• Goblet-shaped, producing mucus designed to protect the mucous membrane from negative external influences. When dust ends up on the tissues, secretion is activated, a cough reflex is formed, and the cilia begin to move, pushing the dirt out. Mucus produced by organ tissues makes the air more humid.
• Basal, capable of restoring internal layers when damaged.
• Serous, forming a secretion that allows you to clean the lungs.
• Clara, producing phospholipids.
• Kulchitsky, having a hormonal function (included in the neuroendocrine system).
• The outer ones are actually connective tissue. It is responsible for contact with the environment around the respiratory system.

Throughout the entire volume of the bronchi there is a huge number of arteries supplying blood to the organs. In addition, there are lymph nodes that receive lymph through lung tissue. This determines the range of functions of the bronchi: not only transportation of air masses, but also cleaning.

Bronchi: the focus of medical attention

If a person is admitted to the hospital with suspected bronchial disease, diagnosis always begins with an interview. During the survey, the doctor identifies complaints and determines the factors that affected the patient’s respiratory organs. So, it is immediately obvious where problems with the respiratory system come from if someone who smokes a lot, is often in dusty rooms, or works in chemical production comes to the hospital.

The next step is to examine the patient. Color can say a lot skin asking for help. They check for shortness of breath, cough, and examine the chest to see if it is deformed. One of the signs of a disease of the respiratory system is a pathological form.

Chest: signs of disease

The following types of pathological deformities of the chest are distinguished:

• Paralytic, observed in those who often suffer from pulmonary diseases, pleura. In this case, the cell loses its symmetry, and the spaces between the ribs become larger.
• Emphysematous, appearing, as the name suggests, with emphysema. The shape of the patient's chest resembles a barrel; due to coughing, the upper zone greatly increases.
• Rachitic, characteristic of those who have been ill in childhood rickets. It resembles a bird's keel, protruding forward as the sternum protrudes.
• “Shoemaker”, when the xiphoid process, the sternum, seems to be in the depths of the cage. Usually pathology from birth.
• Scaphoid, when the sternum seems to be in depth. Usually caused by syringomyelia.
• “Round back”, characteristic of those suffering from inflammatory processes in bone tissue. Often affects the performance of the lungs and heart.

Studying the lung system

To check how severe the disturbances in lung function are, the doctor feels the patient’s chest, checking to see if there are any new growths under the skin that are not typical for this area. Voice tremors are also studied - whether it weakens or becomes stronger.

Another method of assessing the condition is listening. To do this, an endoscope is used when the doctor listens to how air masses move in the respiratory system. Assess for the presence of unusual noises and wheezing. Some of them, which are not characteristic of a healthy body, immediately allow one to diagnose a disease, others simply show that something is wrong.

X-rays are the most effective. Such research allows you to get the maximum useful information about the state of the bronchial tree as a whole. If there are pathologies in the cells of organs, the easiest way to identify them is by x-ray. Abnormal narrowings, expansions, thickenings characteristic of certain parts of the tree are reflected here. If there is a tumor or fluid in the lungs, it is the x-ray that most clearly shows the problem.

Features and Research

Perhaps the most in a modern way studies of the respiratory system can be called computed tomography. Of course, such a procedure is usually expensive, so it is not available to everyone - in comparison, for example, with a regular x-ray. But the information obtained during such diagnostics is the most complete and accurate.

Computed tomography has a number of features, due to which other systems for dividing the bronchi into parts were introduced specifically for it. Thus, the bronchial tree is divided into two parts: small and large bronchi. The technique is based on the following idea: small and large bronchi differ in functionality and structural features.

It is quite difficult to determine the border: where the small bronchi end and the large ones begin. Pulmonology, surgery, physiology, morphology, as well as specialists specializing in the bronchi, have their own theories on this matter. Consequently, doctors in different areas interpret and use the terms “large” and “small” differently in relation to the bronchi.

What to look for?

The division of bronchi into two categories is based on the difference in size. So, there is the following position: large ones - those that are at least 2 mm in diameter, that is, they can be studied using a bronchoscope. The walls of this type of bronchi contain cartilage, with the main wall being equipped with hyaline cartilage. Usually the rings do not close.

The smaller the diameter, the more the cartilage changes. At first they are just plates, then the nature of the cartilage changes, and then this “skeleton” disappears altogether. However, it is known that elastic cartilage is found in bronchi whose diameter is less than a millimeter. This leads to the problem of classifying bronchi into small and large.

In tomography, the image of large bronchi is determined by the plane in which the image was taken. For example, in diameter it is only a ring filled with air and bounded by a thin wall. But if you study the respiratory system longitudinally, then you can see a pair of parallel straight lines, between which is an air layer. Usually, longitudinal images are taken of the middle, upper lobes, 2-6 segments, and transverse images are needed for the lower lobe, the basal pyramid.

Lung segments are areas of tissue within a lobe that have a bronchus, which is supplied with blood by one of its branches pulmonary artery. These elements are in the center. The veins that collect blood from them lie in the partitions that separate the areas. The base with the visceral pleura is adjacent to the surface, and the apex to the root of the lung. This division of the organ helps in determining the location of the focus of pathology in the parenchyma.

Existing classification

The most famous classification was adopted in London in 1949 and confirmed and expanded at the 1955 International Congress. According to it, in the right lung it is customary to distinguish ten bronchopulmonary segments:

In the upper lobe there are three (S1–3):

• apical;
• rear;
• front.

In the middle part there are two (S4–5):

• lateral;
• medial.

Five are found at the bottom (S6–10):

• upper;
• cardiac/mediabasal;
• anterobasal;
• laterobasal;
• posterobasal.

On the other side of the body, ten bronchopulmonary segments are also found:

• apical;
• rear;
• front;
• upper reed;
• lower reed.

In the part below, there are also five (S6–10):

• upper;
• mediabasal/inconsistent;
• anterobasal;
• lateralobasal or laterobasal;
• posterobasal/peripheral.

The middle lobe is not defined on the left side of the body. This classification of lung segments fully reflects the existing anatomical and physiological picture. It is used by practitioners around the world.

Features of the structure of the right lung

On the right, the organ is divided into three lobes according to their location.

S1- apical, the front part is located behind the second rib, then to the end of the scapula through the pulmonary apex. It has four borders: two on the outside and two on the edge (with S2 and S3). The composition includes part of the respiratory tract up to 2 centimeters in length, in most cases they are shared with S2.

S2- posterior, passes behind from the angle of the scapula from above to the middle. Localized dorsal to the apical one, it contains five boundaries: with S1 and S6 on the inside, with S1, S3 and S6 on the outside. The airways are localized between the segmental vessels. In this case, the vein is connected to that of S3 and flows into the pulmonary vein. The projection of this segment of the lungs is located at the level of the II–IV rib.

S3- anterior, occupies the area between the II and IV ribs. It has five edges: with S1 and S5 on the inside and with S1, S2, S4, S5 on the outside. The artery is a continuation of the upper branch of the pulmonary, and the vein flows into it, lying behind the bronchus.

Average share

Localized between the IV and VI ribs on the anterior side.

S4- lateral, located in front of armpit. The projection is a narrow strip located above the groove between the lobes. The lateral segment contains five borders: with a medial and anterior one from the inside, three edges with a medial one on the costal side. The tubular branches of the trachea extend back, lying deep, along with the vessels.

S5- medial, located behind the sternum. It is projected on both the external and medial sides. This segment of the lung has four edges, touching the anterior and last medially, from the midpoint of the horizontal groove in front to the extreme point of the oblique, with the anterior along the horizontal groove on the outer part. The artery belongs to a branch of the inferior pulmonary, sometimes coinciding with that in the lateral segment. The bronchus is located between the vessels. The boundaries of the area are located within the IV–VI rib along the segment from the middle of the armpit.

Localized from the center of the scapula to the diaphragmatic dome.

S6- upper, located from the center of the scapula to its lower angle (from III to VII ribs). It has two edges: with S2 (along the oblique groove) and with S8. This segment of the lung is supplied with blood through the artery, which is a continuation of the inferior pulmonary artery, which lies above the vein and tubular branches of the trachea.

S7- cardiac/mediabasal, localized under the pulmonary hilum on the inside, between the right atrium and the branch of the vena cava. Contains three edges: S2, S3 and S4, and is detected in only a third of people. The artery is a continuation of the inferior pulmonary artery. The bronchus departs from the lower lobe and is considered its highest branch. The vein is localized under it and enters the right pulmonary.

S8- front basal segment, localized between the VI–VIII rib along the segment from the middle of the armpit. It has three edges: with the laterobasal (along the oblique groove separating the sections, and in the projection of the pulmonary ligament) and with the upper segments. The vein flows into the inferior cava, and the bronchus is considered a branch of the inferior lobe. The vein is localized below the lung ligament, and the bronchus and artery are in the oblique groove separating the sections, under the visceral part of the pleura.

S9- laterobasal - located between the VII and IX ribs posteriorly along the segment from the armpit. Has three edges: S7, S8 and S10. The bronchus and artery lie in the oblique groove, the vein is located under the pulmonary ligament.

S10- posterior basal segment, adjacent to the spine. Localized between the VII and X rib. Equipped with two borders: S6 and S9. The vessels, together with the bronchus, lie in the oblique groove.

On the left side, the organ is divided into two parts according to their location.

Upper lobe

S1- apical, similar in shape to that in the right organ. The vessels and bronchus are located above the hilum.

S2- posterior, reaches the V accessory bone of the chest. It is often combined with the apical bronchus due to the common bronchus.

S3- anterior, located between the II and IV ribs, has a border with the upper lingular segment.

S4- upper lingular segment, localized on the medial and costal side in the region of the III–V rib along the anterior surface of the chest and along the mid-axillary line from the IV to VI rib.

S5- lower lingular segment, located between the V accessory bone of the chest and the diaphragm. Bottom line runs along the interlobar groove. Anteriorly, between the two reed segments, the center of the cardiac shadow is located.

S6- upper, localization coincides with that on the right.

S7- mediabasal, similar to symmetrical.

S8- anterior basal, located mirror image to the right one of the same name.

S9- laterobasal, localization coincides with the other side.

S10- posterior basal, coincides in location with that in the other lung.

Visibility on X-ray

On an x-ray, normal lung parenchyma is visible as homogeneous tissue, although in life this is not the case. The presence of extraneous lightening or darkening will indicate the presence of pathology. Using the X-ray method, it is not difficult to determine whether there are lung injuries, the presence of fluid or air in pleural cavity, as well as neoplasms.

Clearance zones on an x-ray look like dark spots due to the way the image is developed. Their appearance means increased airiness of the lungs with emphysema, as well as tuberculous cavities and abscesses.

Darkening zones are visible as white spots or general darkening in the presence of fluid or blood in the lung cavity, as well as when large quantities small foci of infection. This is what dense neoplasms, places of inflammation, and foreign bodies in the lung look like.

Lung segments and lobes, as well as medium and small bronchi, alveoli are not visible on the x-ray. Computed tomography is used to identify the pathologies of these formations.

Applications of computed tomography

Computed tomography (CT) is one of the most accurate and modern research methods for any pathological process. The procedure allows you to view each lobe and segment of the lung for the presence of inflammatory process, and also evaluate his character. When conducting research you can see:

• segmental structure and possible damage;
• change of share plots;
• airways of any size;
• intersegmental partitions;
• impaired blood circulation in the vessels of the parenchyma;
• changes in lymph nodes or their displacement.

Computed tomography allows you to measure the thickness of the airways to determine the presence of changes in them, the size of the lymph nodes and view each section of tissue. The images are interpreted by the doctor who gives the patient a final diagnosis.