Surgical Anatomy Surgical Anatomy of the Lungsof the Lungs
Trachea bifurcation: 7th thoracic vertebTrachea bifurcation: 7th thoracic vertebrara
Right main bronchus: sharper angle, moRight main bronchus: sharper angle, more direct line with tracheare direct line with trachea
RMB: 1.2 cmRMB: 1.2 cmBronchus intermedius: 1.7-2.0 cm Bronchus intermedius: 1.7-2.0 cm
Left main bronchus: 4-6 cmLeft main bronchus: 4-6 cm0.5 cm distal to the LUL orifice0.5 cm distal to the LUL orifice→superio→superio
r segment of LULr segment of LULDistal to superior segment of LUL: 1.5 cDistal to superior segment of LUL: 1.5 c
m as single trunk m as single trunk
The right main pulmonary artery is longThe right main pulmonary artery is longer than the left, but its extrapericardial er than the left, but its extrapericardial length up to its first branch is less than length up to its first branch is less than of the leftof the left
Branches to LUL: 2-7, four is most comBranches to LUL: 2-7, four is most commonmon
Right SPV: drain the upper and middle Right SPV: drain the upper and middle lobelobe
Anomalous Unilateral Single Anomalous Unilateral Single Pulmonary Vein (Pulmonary Vein (AUSPVAUSPV): right ): right lung(65%)lung(65%)
left lung(35%)left lung(35%)
more often as a single more often as a single IPVIPV
Intrapericardial anatomyIntrapericardial anatomy
RPA: pass behind ascending aorta and RPA: pass behind ascending aorta and SVCSVC
Right PV: enter into left atrium Right PV: enter into left atrium separatelyseparately
Left PV: the two vein form a common Left PV: the two vein form a common trunk in one of four personstrunk in one of four persons
Bronchial arteries and Bronchial arteries and veinsveins
Bronchial arterial system: systemic circuBronchial arterial system: systemic circulation, 1% of the cardiac outputlation, 1% of the cardiac output
From aorta, intercostal arteries, subclaviFrom aorta, intercostal arteries, subclavian or innominate arteriesan or innominate arteries
Main into the pulmonary veins, Main into the pulmonary veins,
Significance of the Significance of the Lymphatic Drainage Lymphatic Drainage
PatternsPatternsThe drainage from the right lung is esseThe drainage from the right lung is esse
ntially unilateral and crossover to lymntially unilateral and crossover to lymph nodes in the contralateral mediastiph nodes in the contralateral mediastinum is infrequent.num is infrequent.
Nohl-Oser(1972), Greschuchna and MaasNohl-Oser(1972), Greschuchna and Maassen(1973): contralateral metastasis sen(1973): contralateral metastasis
RUL: 5%, 7%RUL: 5%, 7% RLL : 7%, 5%RLL : 7%, 5%
Contralateral mediastinal drainage from Contralateral mediastinal drainage from the left lung is relative common, occurthe left lung is relative common, occurring most frequently through the subcring most frequently through the subcarinal nodes.arinal nodes.
Nohl-Oser(1972), Greschuchna and MaasNohl-Oser(1972), Greschuchna and Maassen(1973): contralateral metastasissen(1973): contralateral metastasis
LUL: 22%, 21%LUL: 22%, 21% LLL: 40%, 33%LLL: 40%, 33%
Skip metastasesSkip metastases: direct lymphatic chann: direct lymphatic channels from either lung drain to the mediaels from either lung drain to the mediastinal lymph nodes, bypassing the brostinal lymph nodes, bypassing the bronchopulmonary nodesnchopulmonary nodes
RUL to superior tracheobronchial nodes:RUL to superior tracheobronchial nodes: most frequently most frequently
Superior mediastinum continues to scalSuperior mediastinum continues to scalene lymph nodes: right >left ene lymph nodes: right >left