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