Univerzita Karlova v Praze - 1.
Lékařská fakulta
Respiratory System
Institute of Anatomy
Author: David Sedmera
Subject: Anatomy 1
Date: January 2015
Division of respiratory system
• Upper respiratory tract:
- external nose
- nasal cavity & paranasal sinuses
- pharynx
• Lower respiratory tract:
- larynx
- trachea (windpipe)
- bronchi (down to respiratory
bronchioli)
- lungs
• Significance: ENT vs. pneumology
URTI vs. pneumonia
Nasal passages and paranasal sinuses
Nasal cavity and paranasal
sinuses
• Common colds are common
• Spatial relationships (syntopies) are
important for spread of infection
• Complications: meningitis, teeth, orbit,
mediootitis, mastoiditis, sinusitis…
Nasal cavity and paranasal
sinuses
• Why do we have them (other than to
keep ENT doctors in business)
• Maxillary, frontal, sphenoidal,
ethmoidal
• Surface projections, visible and X-ray
examination - sinusitis
Surface projection of pasanasal sinuses
H
Lateral X-ray
Frontal X-ray
Frontal CT
Horizontal CT
Postnatal growth
of paranasal
sinuses
(pneumatization)
Histology of airways
Taken from and see more in: Junquiera’s Histology!
The Pharynx - crossing of breathing
and swallowing pathways
Laryngeal cartilages
Thyroid cartilage – left + right lamina, superior + inferior notch,
superior + inferior horn, oblique line, cricoid articular surface
Cricoid cartilage - arch, lamina, arytenoid + cricoid articular surface
Arytenoid cartilage - base, apex, muscular + vocal process, cricoid
articular surface,
Epiglottis, Cuneiform + Corniculate + Triticeal cartilages
The Larynx - muscles
Anterior posterior lateral
The Larynx - development
The Larynx - sagittal view
The Larynx - vocal cord
movements
anterior
posterior
The Larynx - frontal view
The Larynx - examination
(laryngoscopy)
indirect direct
The Trachea - cross section
Histology of the Trachea
Epithelium (cylindrical
with cilia and goblet cells)
Connective tissue
Glands in lamina propria
Hyaline cartilage covered
by perichondrium
Smooth (trachealis) muscle
The trachea and segmental bronchi
Starts at C6
Bifurcation at Th4-5
Length: 13 cm
Diameter: 2.5 cm
Coniotomy and tracheotomy
Coniotomy and tracheotomy
coniotomy
Superior tracheotomy
Inferior tracheotomy
Syntopy of the cervical part of trachea
Blood supply
• Nasal cavity - ethmoidal and sphenopalatine
artery
• Larynx -superior and inferior laryngeal
artery
• Trachea - branches from thyroid arteries or
thoracic aorta
Innervation
• Nasal cavity - I, V1, V2; parasympathetic
fibers from VII
• Larynx -superior and recurrent laryngeal
nerve (from X)
• Trachea - X, cervical sympathetics
Lymphatic drainage
The Lungs & Pleura - projections
Borders of Lungs & Pleura
Borders of Lungs & Pleura
The Lungs & Pleura - projections
Pleural recesses
• Costodiphragmatic recess -
accumulation of fluids
• recessus phrenicomediastinalis
• recessus costomediastinalis
The Pleural Cavity
Pneumothorax
• Penetration of the
pleural cavity equalizes
pressure
• This results in the
collapse of the affected
lung
• Could be classified as
open, closed, or tension
• Treatment is by
drainage that facilitates
air resorption
Pneumothorax - X-ray
The lungs
The lungs
Syntopies of the trachea and
main bronchi
The bronchopulnonary segments
Histology of the Bronchi
Epithelium (cylindrical
with cilia and goblet cells)
Connective tissue
Glands in lamina propria
Hyaline cartilage
(discontinuous)
Smooth muscle
Histology of the Bronchi
Bronchography
Blood supply & innervation
• Pulmonary artery and branches - functional
• Rr. bronchiales from thoracic aorta or intercostal
arteries - nutritive
• Pulmonary vein, anastomoses
• Parasympathetic: left and right vagus
• Sympathetic: inferior and middle cervical ganglia,
rami from the first four thoracic ganglia; almost no
pain (only parietal pleura via intercostal nerves)
Lymphatic drainage
Lymphatic drainage
The Bronchioli
No cartilage, just smooth muscle => bronchocostriction in
asthma!
The Lung Lobes - projections
Terminal bronchioli and Clara cells
Histology of lung
tissue - respiratory
bronchioli, alveolar
ducts, alveoli
Branching ~23 bifurcations, 300-400 mil alveoli
surface area: 40-80 sq. m., air-blood barrier 0.2-0.5 µm
Alveolar wall: Capillaries, type I & II alveolar cells, macrophages
The muscles of respiration
Diaphragma (C3-C5)
Intercostal mm. - bucket handle action
Accessory respiratory muscles
Mechanism of breathing
• Piston
&
syringe
Respiratory movements of the diaphragm
Abdominal press
• Simultaneous contraction of
diaphragm and abdominal
muscles
• Increased abdominal pressure
useful during miction,
defecation, parturition
• If the pelvic diaphragm is
contracted as well, supports the
lumbar spine (muscular corset)
Pleural cavity dx., sin.
Parietal pleura
Costal part
Mediastinal part
Diaphragmatic part
Pleural cupula (dome))
Pleural recesses:
costodiaphragmatic
costomediastinal
phrenicomediastinal
Pulmonary lig.
bronchopericardial
membrane
Mediastinum
Superior, Inferior –
anterior, middle,
posterior
The Pleura
Lined by mesothelium (M) secreting pleural fluid
(WHY this is NOT an epithelium?)
The connective tissue is rich in both collagen and elastic fibers and
contains both blood vessels (V) and lymphatics (L).
Mediastinum (interpleural space)
superius, inferius – anterius, medium, posterius
Mediastinum
Space in thorax between the left
and right pleural cavities,
filled by vessels, organs,
fatty tissue
Borders:
• cranial – apertura thoracis
superior
• caudal – diaphragm
• ventral – sternum and ribs
• dorsal – vertebral column
Posterior mediastinum
• esophagus
• n. vagus dexter et sinister
(plexus oesophageus)
• Aortic arch (end)
• aorta thoracica
• ductus thoracicus
• v. azygos
• v hemiazygos et
hemiazygos accessoria
• truncus sympaticus dexter
et sinister
• Lymph nodes
Anterior mediastinum
Anterior superior mediastinum
• thymus
• Venous layer – vv.
brachiocephalicae, v. cava sup.,
plexus thyroideus impar
• Arterial layer – aortic arch and
its branches
• Trachea, bronchi, recurrent
laryngeal nerve
Anterior inferiror (middle)
mediastinum
• Heart in pericardium
• n. phrenicus
What is that?
What is that?
The thymus
• Lympho-epithelial organ
• Primary lymphatic organ
• Left and right lobe
• Lobules, cortex & medulla
• (accessory lobules)
• Fibrous capsule
• Proportionally large at birth
(12-14g)
• With ageing undergoes
involution and replacement by
fatty tissue
• Residues still discernible at
the old age (watch out during
dissections when opening the
chest cavity!)
Located in the superior
mediastinum behind the
sternum
30-40 g
• Involution after puberty
• Replaced by fat after 50 years
• Possible site of thymoma (cancer from white
blood cells)
Development of the thymus
Development of thymus
w ventral process of the 3rd
branchial pouch
w mediocaudal descensus
w endodermal proliferation
w stem cell colonization in
the 10th week /lymphocytes/
derived from blood island,
liver, bone marow
w ingrowth of the
mesenchymal septa (fibrous
tissue)
Parathyroid tissue in
the mediastinum can
be everywhere
thymus could be
including
mediastinal fat
Residual thymus tissue
after standard
thymectomy, based upon
50 clinico-anatomical
studies
THORACIC AORTA
SUPERIOR VENA CAVA
• Formed by the confluence of the
brachiocephalic veins
• tributaries:
– v. thyroidea inf.
– v. vertebralis
- v. intercostalis suprema, intercosalis sup. sin.
• v. azygos
• v. thoracica interna
• Visceral branches of the mediastinal organs
Cranial tributaries of
the superior vena cava
References
• Cihak: Anatomie 2: Splanchnologia
• Netter’s Atlas of Human Anatomy
• Grim, Nanka: Anatomy atlas vol. II.
• Sobotta: Anatomy
• Junquiera’s Histology
• www.netanatomy.com
