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Respiratory System: Bronchial Tree

Larynx, trachea, and bronchial tree (anterior aspect). Organization and positions of respiratory organs

(schematic drawing).

Mediastinal dissection of the bronchial tree, pulmonary veins, and pulmonary arteries of right lung (left) and left lung (right)

(medial aspect). The bronchopulmonary segments are numbered 1–10.

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248 Respiratory System: Projections of Lungs and Pleura

Surface projections of lungs and pleura on the thoracic wall. Left: anterior aspect; right: right-lateral aspect.

Red = margins of the lung; blue = margins of pleura. The numbers indicate ribs.

Surface projections of lungs and pleura on the thoracic wall. Left: posterior aspect; right: left-lateral aspect.

Red = margins of lung; blue = margins of pleura. The numbers indicate ribs.

1 Apex of lung

2 Upper lobe of right lung

3 Horizontal fissure of right lung

4 Middle lobe of right lung

5 Oblique fissures of lungs

6 Lower lobe of right lung

7 Upper lobe of left lung

8 Cardiac notch of left lung

9 Lower lobe of left lung

10 Infrasternal angle

11 Costal margin

12 Spine of scapula

13 First lumbar vertebra

14 Space between border of lung and pleura

(costodiaphragmatic recess)

Respiratory System: Lungs 249

Right lung (lateral aspect). Left lung (lateral aspect).

Right lung (medial aspect). Left lung (medial aspect).

1 Apex of lung

2 Upper lobe of right lung

3 Horizontal fissure of right lung

4 Oblique fissure of right lung

5 Middle lobe of right lung

6 Lower lobe of right lung

7 Inferior border

8 Upper lobe of left lung

9 Impressions of ribs

10 Oblique fissure of left lung

11 Lower lobe of left lung

12 Groove of subclavian artery

13 Groove of azygos arch

14 Branches of right pulmonary artery

15 Bronchi

16 Right pulmonary veins

17 Pulmonary ligament

18 Diaphragmatic surface

19 Groove of aortic arch

20 Left pulmonary artery

21 Branches of left pulmonary veins

22 Left secondary bronchi

23 Groove of thoracic aorta

24 Groove of esophagus

25 Cardiac impression

26 Lingula

250 Respiratory System: Bronchopulmonary Segments

Right lung (medial aspect). Left lung (medial aspect).

Right lung (lateral aspect). Left lung (lateral aspect).

The bronchopulmonary segments of the lungs are differ -

entiated by the various colors. Notice that there is no

segment in the left lung that corresponds to the seventh

segment of the right lung. Compare with the schematic

drawing on the facing page.

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Respiratory System: Bronchopulmonary Segments 251

Distribution of bronchopulmonary segments of the lungs and their relation to the bronchial tree (after J. F. Huber).

The bronchopulmonary segments are morphologically and

functionally separate, independent respiratory units of the

lung tissue. Each segment is surrounded by connective

tissue that is continuous with the visceral pleura. The

segmental bronchi are centrally located in each segment

and are closely accompanied by branches of the pulmonary

arteries, whereas the tributaries of the pulmonary veins run

between the segments. Thus, the veins serve two adjacent

segments that drain for the most part into more than one

vein. A bronchopulmonary segment is therefore not a

complete vascular unit, but segmentation is the result of a

specific architecture of the lung vasculature.

Right lung Left lung

1 Apical segment Upper lobe 1+2 Apicoposterior Superior 2 Posterior segment bronchus segment division 3 Anterior segment 3 Anterior segment Upper lobe

bronchus

4 Lateral segment Middle lobe 4 Superior lingular segment Inferior

5 Medial segment bronchus 5 Inferior lingular segment division

6 Superior (apical) segment 6 Superior (apical) segment

7 Medial basal segment Lower lobe 7 Absent Lower lobe 8 Anterior basal segment bronchus 8 Anteromedial basal segment bronchus 9 Lateral basal segment 9 Lateral basal segment

10 Posterior basal segment 10 Posterior basal segment

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Heart

Heart of 30-year-old woman (anterior aspect).

Position of heart and its vessels within the thorax

(schematic drawing).

Heart of 30-year-old woman (oblique-posterior view).

1 Left subclavian artery

2 Left common carotid artery

3 Brachiocephalic trunk

4 Superior vena cava

5 Ascending aorta

6 Bulb of the aorta

7 Right auricle

8 Right atrium

9 Coronary sulcus

10 Right ventricle

11 Aortic arch

12 Ligamentum arteriosum

13 Left pulmonary veins

14 Left auricle

15 Pulmonary trunk

16 Sinus of pulmonary trunk

17 Anterior interventricular sulcus

18 Left ventricle

19 Apex of the heart

20 Left atrium

21 Epicardial fat overlying coronary sinus

22 Posterior interventricular sulcus

23 Right pulmonary artery

24 Right pulmonary veins

25 Inferior vena cava

1 Right brachiocephalic vein

2 Superior vena cava

3 Ascending aorta

4 Right atrium

5 Right ventricle

6 Inferior vena cava

7 Left internal jugular vein

8 Left common carotid artery

9 Left axillary artery and vein

10 Left brachiocephalic vein

11 Pulmonary trunk

12 Left auricle

13 Left ventricle

14 Descending aorta

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Heart

Heart with related vessels. Dissection of coronary arteries (anterior aspect,

systolic phase of heart action).

1 Brachiocephalic trunk

2 Right pulmonary artery

3 Superior vena cava

4 Right pulmonary veins

5 Ascending aorta

6 Right atrium

7 Right coronary artery

8 Right ventricle

9 Left common carotid artery and left

subclavian artery

10 Descending aorta (thoracic part)

11 Ligamentum arteriosum (remnant of

ductus arteriosus Botalli)

12 Left pulmonary artery

13 Aortic arch

14 Left pulmonary veins

15 Pulmonary trunk

16 Left atrium

17 Left coronary artery

18 Diagonal branch of left coronary artery

19 Interventricular branch of left coronary

artery

20 Left ventricle

21 Right brachiocephalic vein

22 Thoracic wall

23 Liver

24 Aortic valve

25 Chordae tendineae

26 Papillary muscles

27 Stomach

Coronal section through the thorax

at the level of the ascending aorta

(MRI scan, courtesy of Prof. W. Bautz and

R. Janka, M. D., University of Erlangen,

Germany).

254 Heart

1 Ascending aorta

2 Right coronary artery

3 Right ventricle

4 Left atrium

5 Pulmonary trunk

6 Septal branch of left coronary artery

7 Diagonal branch

8 Anterior interventricular branch of left

coronary artery

9 Left ventricle

10 Aortic root

11 Superior vena cava

12 Circumflex branch of left coronary artery

13 Sternum

1 Courtesy of Drs. W. Moshage, S. Achenbach,

and D. Ropers, Dept. of Internal Medicine II,

University of Erlangen-Nürnberg, Germany.

Human heart (3-D reconstruction of electron beam CT scans as “Shaded Surface

Display”1

).

Electron beam tomographic image of the human heart (axial section after

injection of contrast medium1

).

Heart 255

1 Larynx (thyroid cartilage)

2 Sternocleidomastoid muscle

(divided)

3 Trachea (divided) and right

internal jugular vein

4 Vagus nerve

5 Right common carotid

artery and cephalic vein

6 Esophagus

7 Right axillary vein

8 Right and left

brachiocephalic veins

9 Superior vena cava

10 Right auricle

11 Right coronary artery

12 Right atrium

13 Diaphragm

14 Pericardium (cut edges)

15 Costal margin

16 Omohyoid muscle

17 Left common carotid artery

18 Left internal jugular vein

19 Clavicle (divided)

20 Left recurrent laryngeal

nerve

21 Subclavian vein

22 Pericardial reflection

23 Pulmonary trunk

24 Ascending aorta

25 Anterior interventricular

sulcus and anterior

interventricular branch of

left coronary artery

26 Right ventricle

27 Left ventricle

28 Aortic valve

29 Tricuspid or right

atrioventricular valve

30 Inferior vena cava

31 Pulmonary veins

32 Pulmonary valve

33 Left atrioventricular

(bicuspid or mitral) valve

Heart in situ. Position of valves (anterior aspect). (Schematic drawing.)

Heart and related vessels in situ (anterior aspect). Anterior thoracic wall, pericardium, and

epicardium have been removed; trachea divided.

256 Heart

1 Brachiocephalic trunk

2 Superior vena cava

3 Sulcus terminalis

4 Right auricle

5 Right atrium

6 Aortic valve

7 Conus arteriosus (interventricular septum)

8 Right atrioventricular (tricuspid) valve

9 Anterior papillary muscle

10 Myocardium of right ventricle

11 Left common carotid artery

12 Left subclavian artery

13 Aortic arch

14 Ligamentum arteriosum (remnant of ductus

arteriosus)

15 Thoracic aorta (descending aorta)

16 Ascending aorta

17 Left pulmonary vein

18 Pulmonary trunk

19 Left auricle

20 Pulmonic valve

21 Anterior papillary muscle with chordae

tendineae

22 Myocardium of left ventricle

23 Posterior papillary muscle

24 Interventricular septum

25 Right and left brachiocephalic veins

26 Chordae tendineae

27 Papillary muscles of right ventricle

28 Left atrium

29 Infundibulum

30 Anterior papillary muscle of left ventricle

31 Left atrioventricular (bicuspid or mitral) valve

and chordae tendineae

32 Apex of heart

33 Inferior vena cava

34 Liver

35 Aorta (pars abdominalis)

Anterior aspect of the heart. Dissection of the four valves.

MRI scan of the heart (coronal section at the level of the

left atrium; courtesy of Prof. W. Bautz and R. Janka, M. D.,

University of Erlangen, Germany).

Circulation within the heart (anterior aspect).

Arrows = direction of blood flow.

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Heart: Myocardium

1 Internal jugular vein

2 Common carotid artery

3 Brachiocephalic trunk

4 Ascending aorta

5 Right lung

6 Right auricle

7 Right coronary artery

8 Myocardium of right ventricle

9 Diaphragm

10 Costal margin

11 Thyroid gland and internal jugular vein

12 Trachea and left common carotid artery

13 Left brachiocephalic vein

14 Left lung

15 Pericardium (cut edge)

16 Pulmonary trunk

17 Anterior interventricular artery

18 Myocardium of left ventricle

19 Muscular vortex (right ventricle)

20 Posterior interventricular sulcus

21 Anterior interventricular sulcus

22 Muscular vortex (left ventricle)

23 Aortic arch

24 Left atrium

25 Coronary sinus

26 Superior vena cava

27 Right pulmonary vein

28 Right atrium

29 Inferior vena cava

30 Coronary sulcus

31 Myocardium of left ventricle

32 Left pulmonary artery

33 Left pulmonary vein

34 Apex of heart

Heart in situ. Myocardium and coronary arteries

(anterior aspect).

Heart (posterior aspect). The myocardium of the left ventricle has

been fenestrated to show the muscle fiber bundles of the deeper

layer with their more circular course.

Vortex of cardiac muscle fibers (from below).

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Heart: Valves

1 Superior vena cava

2 Crista terminalis

3 Fossa ovalis

4 Opening of inferior vena cava

5 Opening of coronary sinus

6 Right auricle

7 Right coronary artery and coronary sulcus

8 Anterior cusp of tricuspid valve

9 Chordae tendineae

10 Anterior papillary muscle

11 Myocardium

12 Pulmonary trunk

13 Ascending aorta

14 Pulmonic valve

15 Conus arteriosus (interventricular septum)

16 Septal papillary muscles

17 Septomarginal trabecula or moderator band

18 Apex of heart

19 Left auricle

20 Aortic valve

21 Left ventricle

22 Pulmonary veins

23 Position of fossa ovalis

24 Left atrium

25 Left atrioventricular (bicuspid or mitral) valve

26 Right atrium

27 Pericardium

28 Posterior papillary muscle

29 Right ventricle

30 Interventricular septum

Right heart (anterior aspect). Anterior wall of right atrium and

ventricle removed.

Heart, left ventricle with mitral valve, papillary muscles, and

aortic valve (anterior portion of the heart removed).

Heart, left ventricle, and atrium (opened) showing the

posterior part of the mitral valve with papillary muscles.

Heart: Valves 259

1 Pulmonic valve

2 Sinus of pulmonary trunk

3 Left coronary artery

4 Great cardiac vein

5 Left atrioventricular (mitral) valve

6 Coronary sinus

7 Aortic valve

8 Right coronary artery

9 Right atrioventricular (tricuspid)

valve

10 Bulb of aorta

11 Anterior semilunar cusp of

pulmonic valve

12 Left semilunar cusp of pulmonic

valve

13 Right semilunar cusp of pulmonic

valve

14 Left semilunar cusp of aortic valve

15 Right semilunar cusp of aortic

valve

16 Posterior semilunar cusp of aortic

valve

17 Right atrium

18 Anterior cusp of tricuspid valve

19 Chordae tendineae

20 Trabeculae carneae

21 Interventricular septum

22 Septal cusp of tricuspid valve

23 Anterior papillary muscle

24 Myocardium of right ventricle

Valves of heart (superior aspect). Left and right atria removed. Dissection of coronary arteries.

Above: anterior wall of the heart.

Pulmonic and aortic valves (from above). Anterior wall of the

heart at the top. Both valves are closed.

Right atrioventricular (tricuspid) valve (anterior aspect after

removal of the anterior wall of the right ventricle).

260 Heart: Function

1 Ascending aorta

2 Superior vena cava

3 Right auricle

4 Right atrium

5 Coronary sulcus

6 Right ventricle

7 Pulmonary trunk

8 Left auricle

9 Anterior interventricular sulcus

10 Left ventricle

11 Right pulmonary artery

12 Sulcus terminalis with sinu-atrial node

13 Line indicating plane of position of valves

14 Myocardium of right atrium

15 Inferior vena cava

16 Valve of pulmonary trunk

17 Tricuspid valve

18 Myocardium of right ventricle

Heart, fixed in diastole (anterior aspect). The ventricles are relaxed, atria

contracted.

Heart, fixed in systole (antero-lateral aspect). The ventricles are contracted,

atria dilated.

Morphological changes during heart movements.

Note the changes in position of the valves (red arrows). Contracted portions of heart are indicated in

black.

A. Diastole: muscles of the ventricles relaxed,

atrioventricular valves open, semilunar valves closed.

B. Systole: muscles of ventricles contracted,

atrioventricular valves closed, semilunar valves open.

Heart: Conducting System 261

Right ventricle, dissection of atrioventricular node, atrio -

ventricular bundle (bundle of His), and right limb or bundle

branch (probes).

Right atrium, anterior wall, showing the location of the

sinu-atrial node (arrows).

Left ventricle, dissection of left limb or bundle branch of

conducting system (probes).

Conducting system of the heart (schematic drawing).

1 Superior vena cava

2 Sulcus terminalis

3 Bulb of aorta

4 Sinu-atrial node (arrows)

5 Muscle fiber bundles of right atrium

6 Coronary sulcus (with right coronary artery)

7 Aortic sinus

8 Entrance to left coronary artery

9 Aortic valve

10 Branches of left bundle branch

11 Purkinje fibers

12 Left auricle

13 Interventricular septum

14 Papillary muscles

15 Ascending aorta

16 Right atrium

17 Opening of coronary sinus

18 Atrioventricular node

19 Septal cusp of tricuspid valve

20 Pulmonary trunk

21 Atrioventricular bundle (bundle of His)

22 Bifurcation of atrioventricular bundle

23 Right bundle branch

24 Inferior vena cava

25 Left atrium

26 Left bundle branch

27 Papillary muscles with Purkinje fibers

262 Heart: Arteries and Veins

Coronary arteries (anterior aspect). The epicardium and

subepicardial fatty tissue have been removed. The arteries

have been injected with red resin from the aorta.

Vessels of the heart. Coronary arteries (red) and veins (blue)

of the heart (anterior aspect).

Right coronary artery and veins of the heart (dorsal aspect).

The epicardium and subepicardial fatty tissue have been removed.

1 Ascending aorta

2 Aortic bulb and (in the above specimen) sinu-atrial branch

of right coronary artery

3 Right auricle

4 Right coronary artery

5 Right atrium

6 Coronary sulcus

7 Right ventricle

8 Left auricle

9 Pulmonary trunk

10 Circumflex branch of left coronary artery

11 Left coronary artery

12 Diagonal branch of left artery

13 Great cardiac vein

14 Anterior interventricular artery

15 Anterior interventricular sulcus

16 Left ventricle

17 Apex of heart

18 Right pulmonary vein

19 Left atrium

20 Left pulmonary veins

21 Oblique vein of left atrium (Marshall’s vein)

22 Coronary sinus

23 Great cardiac vein

24 Coronary sulcus (posterior portion)

25 Posterior vein of left ventricle

26 Middle cardiac vein

27 Left pulmonary artery

28 Inferior vena cava

29 Right atrium

30 Posterior interventricular branch of right coronary artery

31 Posterior interventricular sulcus

32 Superior vena cava

33 Right marginal branch

34 Branch of sinu-atrial node

35 Minimal cardiac veins

36 Small cardiac vein

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