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Lungs ribs: thoracic cavity | Description, Anatomy, & Physiology

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Your Lungs & Respiratory System (for Kids)

Your lungs work with your respiratory system to allow you to take in fresh air, get rid of stale air, and even talk. Let’s take a tour of the lungs!

Locate Those Lungs

Your lungs are in your chest, and are so big that they take up most of the space in there. You have two lungs, but they aren’t the same size the way your eyes or nostrils are. Instead, the lung on the left side of your body is a bit smaller than the lung on the right. This extra space on the left leaves room for your heart.

Your lungs are protected by your rib cage, which is made up of 12 sets of ribs. These ribs are connected to your spine in your back and go around your lungs to keep them safe. Beneath the lungs is the diaphragm (say: DY-uh-fram), a dome-shaped muscle that works with your lungs to allow you to inhale (breathe in) and exhale (breathe out) air.

You can’t see your lungs, but it’s easy to feel them in action: Put your hands on your chest and breathe in very deeply. You will feel your chest getting slightly bigger. Now breathe out the air, and feel your chest return to its regular size. You’ve just felt the power of your lungs!

A Look Inside the Lungs

From the outside, lungs are pink and a bit squishy, like a sponge. But the inside contains the real lowdown on the lungs! At the bottom of the trachea (say: TRAY-kee-uh), or windpipe, there are two large tubes. These tubes are called the main stem bronchi (say: BRONG-kye), and one heads left into the left lung, while the other heads right into the right lung.

Each main stem bronchus (say: BRONG-kuss) — the name for just one of the bronchi — then branches off into tubes, or bronchi, that get smaller and even smaller still, like branches on a big tree. The tiniest tubes are called bronchioles (say: BRONG-kee-oles), and there are about 30,000 of them in each lung. Each bronchiole is about the same thickness as a hair.

At the end of each bronchiole is a special area that leads into clumps of teeny tiny air sacs called alveoli (say: al-VEE-oh-lie). There are about 600 million alveoli in your lungs and if you stretched them out, they would cover an entire tennis court. Now that’s a load of alveoli! Each alveolus (say: al-VEE-oh-luss) — what we call just one of the alveoli — has a mesh-like covering of very small blood vessels called capillaries (say: KAP-ill-er-ees). These capillaries are so tiny that the cells in your blood need to line up single file just to march through them.

Every time you inhale air, dozens of body parts work together to help get that air in there without you ever thinking about it.

As you breathe in, your diaphragm contracts and flattens out. This allows it to move down, so your lungs have more room to grow larger as they fill up with air. And the diaphragm isn’t the only part that gives your lungs the room they need. Your rib muscles also lift the ribs up and outward to give the lungs more space.

At the same time, you inhale air through your mouth and nose, and the air heads down your trachea, or windpipe. On the way down the windpipe, tiny hairs called cilia (say: SILL-ee-uh) move gently to keep mucus and dirt out of the lungs. The air then goes through the series of branches in your lungs, through the bronchi and the bronchioles.

Thank You, Alveoli!

The air finally ends up in the 600 million alveoli. As these millions of alveoli fill up with air, the lungs get bigger.

It’s the alveoli that allow oxygen from the air to pass into your blood. All the cells in the body need oxygen every minute of the day. Oxygen passes through the walls of each alveolus into the tiny capillaries that surround it. The oxygen enters the blood in the tiny capillaries, hitching a ride on red blood cells and traveling through layers of blood vessels to the heart. The heart then sends the oxygenated (filled with oxygen) blood out to all the cells in the body.

Waiting to Exhale

When it’s time to exhale (breathe out), everything happens in reverse: Now it’s the diaphragm’s turn to say, “Move it!” Your diaphragm relaxes and moves up, pushing air out of the lungs. Your rib muscles become relaxed, and your ribs move in again, creating a smaller space in your chest.

By now your cells have used the oxygen they need, and your blood is carrying carbon dioxide and other wastes that must leave your body. The blood comes back through the capillaries and the wastes enter the alveoli. Then you breathe them out in the reverse order of how they came in — the air goes through the bronchioles, out the bronchi, out the trachea, and finally out through your mouth and nose.

The air that you breathe out not only contains wastes and carbon dioxide, but it’s warm too! As air travels through your body, it picks up heat along the way. You can feel this heat by putting your hand in front of your mouth or nose as you breathe out. What is the temperature of the air that comes out of your mouth or nose?

With all this movement, you might be wondering why things don’t get stuck as the lungs fill and empty! Luckily, your lungs are covered by two really slick special layers called pleural (say: PLOO-ral) membranes. These membranes are separated by a fluid that allows them to slide around easily while you inhale and exhale.

Time for Talk

Your lungs are important for breathing . . . and also for talking! Above the trachea (windpipe) is the larynx (say: LAIR-inks), which is sometimes called the voice box. Across the voice box are two tiny ridges called vocal cords, which open and close to make sounds. When you exhale air from the lungs, it comes through the trachea and larynx and reaches the vocal cords. If the vocal cords are closed and the air flows between them, the vocal cords vibrate and a sound is made.

The amount of air you blow out from your lungs determines how loud a sound will be and how long you can make the sound. Try inhaling very deeply and saying the names of all the kids in your class — how far can you get without taking the next breath? The next time you’re outside, try shouting and see what happens — shouting requires lots of air, so you’ll need to breathe in more frequently than you would if you were only saying the words.

Experiment with different sounds and the air it takes to make them — when you giggle, you let out your breath in short bits, but when you burp, you let swallowed air in your stomach out in one long one! When you hiccup, it’s because the diaphragm moves in a funny way that causes you to breathe in air suddenly, and that air hits your vocal cords when you’re not ready.

Love Your Lungs

Your lungs are amazing. They allow you to breathe, talk to your friend, shout at a game, sing, laugh, cry, and more!

Keeping your lungs looking and feeling healthy is a smart idea, and the best way to keep your lungs pink and healthy is not to smoke. Smoking isn’t good for any part of your body, and your lungs especially hate it.

You can also show your love for your lungs by exercising! Exercise is good for every part of your body, and especially for your lungs and heart.

How Do I Know If I Injured My Lung?

In and out. In and out. No matter what you’re doing, your lungs are always moving air to every organ and cell. Breathing is something you do without a thought, yet it’s vital to every part of our body.

Ribs provide protection, but lung injuries can occur. Trauma causes fluid (and often air) to leak into the lungs. When this happens, your lungs can’t give your body the oxygen it needs to survive.

What Causes Lung Injuries?

The causes of lung injuries fall into two categories: direct or indirect.

Direct lung injuries can be brought on by:

  • Aspiration (breathing stomach contents into the lung)
  • Bruising from trauma, like a car accident
  • High altitude
  • Near-drowning
  • Severe pneumonia
  • Shock
  • Smoke inhalation from a fire

Indirect lung injuries can result from:

Am I at Risk?

Doctors can’t really tell who’ll develop lung injuries. But they’ve pinpointed some things that can increase your risk. They include:

What Are the Symptoms?

Depending on the cause of the lung injury, symptoms can be mild or intense. Look for these warning signs:

  • Bluish coloring around nails and lips, which means there’s a lack of oxygen in the blood
  • Chest pain, often when you inhale
  • Cough
  • Fever
  • Fast heart rate
  • Shortness of breath

If you notice any symptoms, call your doctor. If they’re severe, call 911.

How Is It Diagnosed?

Most of the time, doctors find lung injuries after patients have been admitted to the hospital for trauma or illness.

There’s no specific test to identify lung injuries. After checking your symptoms and vital signs, your doctor may order a chest X-ray. This will determine the amount of fluid in different parts of your lungs. Since lung injuries and heart problems often share symptoms, this test can also show if your heart is enlarged.

You may also have a CT scan. That’ll give doctors a better look at your heart and lungs.

Using blood from an artery (in your wrist, elbow, or groin), doctors can check your oxygen level. Other blood tests can show if you have an infection or anemia (low red blood cell count).

How Is It Treated?

The goal is to give the body as much support as possible so the lung can heal. Organs need oxygen to work well. If you have mild lung injuries, you may receive oxygen through a mask or through a tube called a nasal cannula. If your injuries are more serious, you’ll need a breathing machine to force air into the lungs and push fluid out.

Depending on the injury, doctors will position you on your back or face-down. This can improve oxygen levels in the blood.

You may receive medication for pain, infections, clots or gastric reflux. If you’re on a breathing machine, you might be uncomfortable and restless. Your doctor may give you drugs to help you keep still and calm.

What Does Recovery Look Like?

Whether it’s mild or severe, any injury to the lung is serious. Younger patients and those whose injuries were caused by trauma or blood infusions often have a better chance at recovery.

Even after treatment, weakness can be an issue. Follow these tips to keep your lungs as healthy and strong as possible:

Rib Fracture and Pneumothorax Complication

By Terry Zeigler, EdD, ATC 

A rib fracture or broken rib is one of the more common injuries to the chest with rib fractures as the most common thoracic injury from blunt force trauma. Uncomplicated single rib fractures can be managed easily. However, multiple rib fractures may result in a pneumothorax, a life-threatening emergency.

There are 12 pairs of ribs that circle the chest for the primary purpose of protecting the heart and lungs. All of the ribs have a posterior attachment to the spine, but only 10 of the ribs have an anterior attachment to the sternum via costal cartilage. The flexible costal cartilage allows for the rib cage to expand during inspiration.

The last two ribs are known as “floating” ribs because they do not have an anterior attachment. Because these two ribs remain unattached, a fracture to these ribs may result in associated damage to the kidneys, liver, or spleen.

Located between each rib are small external and internal intercostal muscles. These muscles are responsible for elevating and then returning the ribs to their natural position during breathing. These muscles can also be injured during a chest injury.

 

What types of rib injuries are there?

There are a number of possible injuries involving the ribs including stress fractures, nondisplaced simple fractures, displaced multiple fractures, and costochondral separation (separation between the costochondral cartilage and the rib).

Rib stress fractures can be seen in athletes with a history of violent muscle contractions as can be seen in the sport of weightlifting. Stress fractures can also be seen in golfers, rowers, and baseball pitchers.

stress fracture is a small partial fracture in the bone. These can be painful, but are not dangerous and have a good prognosis with rest and time for healing.

Simple nondisplaced rib fractures are most commonly seen in ribs five through nine from blunt force to the front or back of the body. A simple nondisplaced fracture means that there is a break through the bone, but the bone ends remain in their original position. These types of fractures also have a good prognosis with rest.

However, displaced multiple fractures can be life-threatening. Displaced multiple fractures can leave sharp bony fragments that may puncture the pleural sac surrounding the lungs. This can lead to a pneumothorax or a collapsed lung. These types of injuries are the most serious with the athlete needing immediate emergency medical treatment.

The last common injury in and around the ribs is a separation of the anterior rib from its costochondral attachment. The costochondral cartilage attaches the anterior rib to the sternum. This type of injury can occur during a collision or as the result of a severe twisting motion of the thorax.

This type of injury can either result in a tear between the sternum and the costochondral cartilage or a tear between the costochondral cartilage and the rib. The tear may be accompanied by a “popping” sound with localized sharp pain for a few days. Unfortunately, this type of injury may result in chronic pain.

 

Rib fracture complications

The most severe and critical complication of displaced rib fractures is a pneumothorax. A displaced rib fracture can puncture the lungs and the pleural sac surrounding the lungs effectively deflating the lung on the side of the pleural puncture. As the lung deflates, the athlete will have increasing pain and difficulty breathing.

A pneumothorax should be suspected if an athlete exhibits any of the following signs and or symptoms:

• Anxiety/restlessness
• Painful breathing
• Increased heart rate
• Cyanosis
• Distended neck veins
• Severe chest pain
• Decreased or absent breath sounds of affected lung
• Decreased blood pressure
• Asymmetric chest expansion

If a pneumothorax is suspected, emergency medical services should be immediately called. The athlete should be kept calm and quiet with a focus on slow and controlled breathing.

 

Symptoms for Rib fracture

If the mechanism of injury for the athlete involves a direct blow to the ribs or an indirect force resulting in the compression of the broken rib cage, the presence of the following signs and symptoms may indicate a rib fracture:

• Localized swelling
• Discoloration
• Increased pain on deep inspiration
• Pain on palpation of injured area
• Visible deformity
• Shallow breathing
• Increased pain on trunk rotation and lateral flexion away from fracture site
• Cyanosis
• Rapid, weak pulse and low blood pressure with multiple fractures
• Individual may lean towards injured side

 

Rib fracture Pain

A rib fracture or broken rib can be very painful because your ribs may move when you breathe, cough, and shift your upper body. Strong pain in your chest area will happen when you breathe or when you do any simple movements.  The area of the fracture will be very tender and you may feel the need to lean to the injured side or hold it with your arm and hand.

 

How is a rib fracture diagnosed? 

Because the symptoms of a bruised rib, fractured rib, and broken rib are very similar, an x-ray should be ordered to rule out a fracture. The diagnosis should also include a thorough medical history, physical examination, and auscultation (exam with a stethoscope to listen for breath sounds).

 

Who gets rib fractures? 

Single and multiple rib fractures or broken ribs have the highest incidence in collision sports including wrestling and football and contact sports such as basketball and soccer. Stress fractures can be seen in athletes with repetitive upper extremity motions as seen in the sports of throwing athletes, golfers, and rowers.

 

Causes of rib fractures 

Rib fractures can be caused by both direct and indirect forces. Direct forces would include being hit, kicked, or punched with the resulting fracture at the site of contact.

An indirect force can cause rib fractures through general compression of the rib cage as when a football player is compressed by another player during a tackle. The weight of the opposing player can compress the injured player against a hard surface. If the external force is stronger than the tensile force of the ribs, the bones can be fractured.

 

Prevention of rib fracture 

Rib injuries often occur through accidental injury in sports or recreation. However, when it applies, protective gear should be properly fitted and worn.

 

Treatment for Rib fracture   

The length of recovery depends on the severity of the injury.  Sports injury treatment using the P.R.I.C.E. principle – Protection, Rest, Icing, Compression, Elevation can be utilized as well as the use of anti-inflammatory or pain medication.

Unlike other fractures in which the bone is immobilized to reduce pain and enhance the healing process, the ribs cannot be effectively immobilized because they need to expand in order for the individual to breathe. Because of this, pain medication is used to make the athlete more comfortable.

There appears to be some controversy as to whether to strap or tape fractured ribs. Some sources suggest taping while others state that the taping is not recommended because it may aggravate the injury.

 

Rib Fracture Healing Time

Return to sport will depend on a number of factors including the number of ribs fractured or broken rib and the severity of the fractures. Simple fractures should heal within 4 – 6 weeks. However, each athlete is unique and return to sports should be individually determined.  Pain relief is important during this time helps you to breathe and cough properly. Trying to deal with the pain without medication is not a good idea, as it can lead to shallow breathing, lack of coughing and chest infections.

A sports medicine physician can determine if the fracture has healed through the use of a post-injury x-ray. This is especially important for athletes competing in collision or contact sports.

Physicians may allow the athlete to begin noncontact activity sooner if the athlete is pain-free during deep inspirations and rotatory and lateral movements.

When Can I Return to Play? 

An athlete can return to competition when he/she has been released by his/her personal physician to return to sports and when the athlete is pain-free with all trunk movements.

For athletes returning to football, a flak jacket or rib vest can be worn to protect the area from re-injury.

 

Getting a Second Opinion

A second opinion should be considered when deciding on a high-risk procedure like surgery or you want another opinion on your treatment options.  It will also provide you with peace of mind.  Multiple studies make a case for getting additional medical opinions.

In 2017, a Mayo Clinic study showed that 21% of patients who sought a second opinion left with a completely new diagnosis, and 66% were deemed partly correct, but refined or redefined by the second doctor.

You can ask your primary care doctor for another doctor to consider for a second opinion or ask your family and friends for suggestions.  Another option is to use a Telemedicine Second Opinion service from a local health center or a Virtual Care Service.

 

SportsMD’s Second Opinion and Telehealth Service

SportsMD offers Second Opinion and Telehealth appointments with a top sports medicine doctor to confirm a diagnosis and/or learn about different treatment options.

Please reach out to us at [email protected] if you need help finding a top sports doctor for a second opinion or Telehealth appointment in NY, NJ or CT.

We’ll do our best to connect you with a top sports medicine doctor who specializes in your injury area.

 

References

  • Anderson, M.K., Parr, G.P., & Hall, S.J. (2009). Foundations of Athletic Training: Prevention, Assessment, and Management. (4th Ed.). Lippincott Williams & Wilkins: Baltimore, MD.
  • Arnheim, D. & Prentice, W. (2000). Principles of Athletic Training. (10th Ed.). McGraw-Hill: Boston, MA.
  • Bahr, R. & Maehlum, S. (2004). Clinical Guide to Sports Injuries. Human Kinetics: Champaign, IL.
  • Rouzier, P. (1999). The Sports Medicine Advisor. SportsMed Press: Amherst, MA.

Fractured Rib | HealthLink BC

Topic Overview

What is a fractured rib?

A rib fracture is a crack or break in one of the bones of the rib cage. A break in the thick tissue (cartilage) that connects the ribs to the breastbone may also be called a fractured rib, even if the bone itself is not broken.

The most common cause of a fractured rib is a direct blow to the chest, often from a car crash or a fall. Coughing hard can also fracture a rib. This is more likely to happen if you have a disease that has made your bones weak, such as osteoporosis or cancer.

What happens when you break a rib?

Your ribs have two main jobs:

  • They protect the organs in your chest.
  • They help you breathe by keeping space open inside your chest while the muscles you use to breathe squeeze in, or contract. This leaves plenty of space for your lungs to fill up with air.

The muscles used for breathing pull on the ribs, so breathing may be very painful when you have a fractured rib.

It is important to see a doctor after a rib injury. A blow that is hard enough to fracture a rib could also injure your lungs, spleen, blood vessels, or other parts of your body. A common injury when you have a fractured rib is a punctured or collapsed lung (pneumothorax).

Flail chest is a serious problem that happens when three or more ribs are broken in more than one place. If you have flail chest, the broken area can’t hold its shape when you take a breath. This leaves less space in your chest for your lungs to open and air to flow in. It also makes it harder for the muscles to work well, so it’s harder to take a breath.

What are the symptoms?

A fractured rib may cause:

  • Mild to severe pain in the injured area.
  • Pain when you breathe.
  • Pain around the fracture when someone pushes on your breastbone.

If you can’t breathe normally because of your injuries, you may:

  • Feel short of breath.
  • Feel anxious, restless, or scared.
  • Have a headache.
  • Feel dizzy, tired, or sleepy.

How is a fractured rib diagnosed?

Your doctor will ask questions about your injury and do a physical examination. The doctor may:

  • Push on your chest to find out where you are hurt.
  • Watch you breathe and listen to your lungs to make sure air is moving in and out normally.
  • Listen to your heart.
  • Check your head, neck, spine, and belly to make sure there are no other injuries.

You may need to have an X-ray or other imaging test if your doctor isn’t sure about your symptoms. But rib fractures don’t always show up on X-rays. So you may be treated as though you have a fractured rib even if an X-ray doesn’t show any broken bones.

How is it treated?

Most fractured ribs are treated at home and will heal on their own over time. Home treatment will help you manage the pain while you heal. Pain relief can help you feel better and let you take deeper breaths.

A fractured rib usually takes at least 6 weeks to heal. To help manage the pain while the fracture heals:

While you are healing, it is important to cough or take the deepest breath you can at least once an hour. This may help prevent pneumonia or a partial collapse of the lung tissue.

If you have fractured your ribs and you have not injured your neck or back, it is a good idea to lie on your injured side. This may seem odd at first, but it will let you take deeper breaths.

In the past, it was common to tape or tightly wrap the injured rib area. But you should not do this, even if it eases your pain. It can keep you from taking deep breaths, and it could cause parts of your lung to collapse or could increase your risk for pneumonia.

Rib Fractures – Brigham and Women’s Hospital

Rib fractures are commonly caused by trauma to the chest wall. Extremely painful, rib fractures can represent an isolated injury or be part of a larger multi-system injury. A rib may be fractured in one place, two places (flail), or be shattered.

Rib fractures are most commonly caused by blunt injuries to the chest caused by a car accident, fall or assault. Penetrating injuries such as gunshot wounds are a less frequent cause. When severe, rib fractures can lead to flail chest (open chest wound) and cause breathing issues, pulmonary contusion, bleeding and pneumothorax. When untreated, rib fractures will lead to serious short-term consequences such as severe pain when breathing, pneumonia and, rarely, death. Long-term consequences include chest wall deformity, chronic pain and decreased lung function.

The Lung Center at Brigham and Women’s Hospital offers proven treatments for patients with fractured ribs. Our board-certified thoracic surgeons use rib plating, a pioneering technique for repairing broken ribs that dramatically reduces pain and recovery time. Although most broken ribs heal without surgery, a severely crushed chest with many broken ribs will likely benefit from this new operative technique.

What are the risk factors for pneumothorax?

There are several known causes of pneumothorax:

  • Chest injury (blunt or penetrating)
  • Medical procedures involving insertion of needles into the chest
  • Underlying lung diseases, such as:
    • Asthma
    • COPD
    • Cystic fibrosis
    • Pneumonia
    • Tuberculosis
    • Whooping Cough
  • Smoking: the more you smoke, and the longer you have smoked both increase your risk
  • Male
  • Genetics: some types of pneumothorax run in families
  • Being tall and thin
  • History of previous pneumothorax

What are the symptoms of pneumothorax?

If you have these symptoms, you should seek immediate attention either at your doctor’s office or in an emergency room where you will likely have a thoracic surgery consultation.

There are clear warning signs of a collapsed lung:

  • Sudden, sharp chest pain, which worsens with coughing or taking a deep breath
  • Shortness of breath

If the leak in the lung is a large one, more severe symptoms can occur:

  • Skin turns a bluish color due to lack of oxygen
  • Tightness in the chest
  • Fatigue
  • Rapid heart rate
  • Nasal flaring

How is pneumothorax diagnosed?

After taking your medical history and performing a careful physical examination, your Lung Center team may order the following tests to confirm a pneumothorax:

  • Chest CT scan uses a combination of X-rays and computer technology to produce horizontal, or axial, images of any part of the body, including the bones, muscles, fat and organs.
  • Chest X-ray uses invisible electromagnetic energy beams to produce images of internal tissues, bones and organs on film or digital media.

What are the treatment options for pneumothorax?

Depending on the severity of your pneumothorax, there are several treatment options:

  • Observation: If your lung collapse is small, your condition will be monitored with a series of chest X-rays, usually in the hospital. You may need to use supplemental oxygen. Sometimes the air can be reabsorbed and your lung returns to normal after a week or two.
  • Needle or chest tube insertion: If your lung collapse is larger, or air continues to leak, a needle or chest tube is inserted to remove the air.
  • Minimally invasive surgical treatment: If the needle or chest tube does remove the air successfully, video-assisted thoracic surgery (VATS) may be required to close the leak particularly when this is a recurrent problem. A small telescope is inserted and the source of the air leak is stapled closed. After surgery, you can expect to stay in the hospital for a few days recovering.

What should you expect?

When you become a patient of The Lung Center, you will meet many members of the team who specialize in pneumothorax. You will receive a thorough diagnostic evaluation and careful monitoring.

If you have had a pneumothorax in the past that was treated without surgery, it is recommended that you do not participate in sports that involve changes in barometric pressure (scuba diving, mountain climbing, sky diving). If you would like to participate in these sports, but have had a pneumothorax in the past, specialists at The Lung Center can assess your risk for participating in such sports.

Team-based care

Pneumothorax patients benefit from the wide range of specialists at the Lung Center, including pulmonologists, thoracic surgeons, cardiovascular medicine physicians and thoracic imaging experts. This multidisciplinary collaboration ensures comprehensive evaluation and treatment. If your medical team discovers an underlying illness or concern, you will be referred to a BWH physician for an expert evaluation.

Any surgery recommended will be performed by an experienced, board-certified thoracic surgeon, in collaboration with a pulmonologist and anesthesiologist, as well as nurses and physicians, all of whom are experts in taking care of patients with pneumothorax.

Where are you located?

What are some additional resources I can read?

Go to our online health library to learn more about thoracic diseases and tests.

Visit the Kessler Health Education Library in the Bretholtz Center for Patients and Families to access computers and knowledgeable staff.

Access a complete directory of patient and family services.

The Lungs – Position – Structure

The lungs are the organs of respiration. They are located in the thorax, either side of the mediastinum.

The function of the lungs is to oxygenate blood. They achieve this by bringing inspired air into close contact with oxygen-poor blood in the pulmonary capillaries.

In this article, we shall look at the anatomy of the lungs – their anatomical relations, neurovascular supply and clinical correlations.

Fig 1 – Anatomical position of the lungs.

Anatomical Position and Relations

The lungs lie either side of the mediastinum, within the thoracic cavity. Each lung is surrounded by a pleural cavity, which is formed by the visceral and parietal pleura.

They are suspended from the mediastinum by the lung root – a collection of structures entering and leaving the lungs. The medial surfaces of both lungs lie in close proximity to several mediastinal structures:

Left Lung Right Lung
  • Heart
  • Arch of aorta
  • Thoracic aorta
  • Oesophagus
  • Oesophagus
  • Heart
  • Inferior vena cava
  • Superior vena cava
  • Azygous vein

Lung Structure

The lungs are roughly cone shaped, with an apex, base, three surfaces and three borders. The left lung is slightly smaller than the right – this is due to the presence of the heart.

Each lung consists of:

  • Apex – The blunt superior end of the lung. It projects upwards, above the level of the 1st rib and into the floor of the neck.
  • Base – The inferior surface of the lung, which sits on the diaphragm.
  • Lobes (two or three) – These are separated by fissures within the lung.
  • Surfaces (three) – These correspond to the area of the thorax that they face. They are named costal, mediastinal and diaphragmatic.
  • Borders (three) – The edges of the lungs, named the anterior, inferior and posterior borders.

Lobes

The right and left lungs do not have an identical lobular structure.

The right lung has three lobes; superior, middle and inferior. The lobes are divided from each other by two fissures:

  • Oblique fissure – Runs from the inferior border of the lung in a superoposterior direction, until it meets the posterior lung border.
  • Horizontal fissure– Runs horizontally from the sternum, at the level of the 4th rib, to meet the oblique fissure.

The left lung contains superior and inferior lobes, which are separated by a similar oblique fissure.

Fig 2 – The lobes and fissures of the lungs. The oblique fissures are similar in both lungs

Surfaces

There are three lung surfaces, each corresponding to an area of the thorax.

The mediastinal surface of the lung faces the lateral aspect of the middle mediastinum. The lung hilum (where structures enter and leave the lung) is located on this surface.

The base of the lung is formed by the diaphragmatic surface. It rests on the dome of the diaphragm, and has a concave shape. This concavity is deeper in the right lung, due to the higher position of the right dome overlying the liver.

The costal surface is smooth and convex. It faces the internal surface of the chest wall. It is related to the costal pleura, which separates it from the ribs and innermost intercostal muscles.

Borders

The anterior border of the lung is formed by the convergence of the mediastinal and costal surfaces. On the left lung, the anterior border is marked by a deep notch, created by the apex of the heart. It is known as the cardiac notch.

The inferior border separates the base of the lung from the costal and mediastinal surfaces.

The posterior border is smooth and rounded (in contrast to the anterior and inferior borders, which are sharp). It is formed by the costal and mediastinal surfaces meeting posteriorly.

Root and Hilum

The lung root is a collection of structures that suspends the lung from the mediastinum. Each root contains a bronchus, pulmonary artery, two pulmonary veins, bronchial vessels, pulmonary plexus of nerves and lymphatic vessels.

All these structures enter or leave the lung via the hilum – a wedge shaped area on its mediastinal surface.

Fig 3 – The parietal and viscera pleura, and the pleural cavity. Note how the two layers of pleura are continuous at the hilum of the lung.

Bronchial Tree

The bronchial tree is a series of passages that supplies air to the alveoli of the lungs. It begins with the trachea, which divides into a left and right bronchus.

Note: The right bronchus has a higher incidence of foreign body inhalation due to its wider shape and more vertical course.

Each bronchus enters the root of the lung, passing through the hilum. Inside the lung, they divide to form lobar bronchi – one supplying each lobe.

Each lobar bronchus then further divides into several tertiary segmental bronchi. Each segmental bronchus provides air to a bronchopulmonary segment – these are the functional units of the lungs.

The segmental bronchi give rise to many conducting bronchioles, which eventually lead into terminal bronchioles. Each terminal bronchiole gives off respiratory bronchioles, which feature thin walled outpocketings that extend from their lumens. These are the alveoli – the site of gaseous exchange.

Fig 4 – Overview of the tracheobronchial tree. Key: Green – upper lobe, yellow – middle lobe, blue – lower lobe

Vasculature

The lungs are supplied with deoxygenated blood by the paired pulmonary arteries. Once the blood has received oxygenation, it leaves the lungs via four pulmonary veins (two for each lung).

The bronchi, lung roots, visceral pleura and supporting lung tissues require an extra nutritive blood supply. This is delivered by the bronchial arteries, which arise from the descending aorta.

The bronchial veins provide venous drainage. The right bronchial vein drains into the azygos vein, whilst the left drains into the accessory hemiazygos vein.

Fig 5 – The vasculature of the lungs. Note that the arteries carry deoxygenated blood, and the veins carry oxygenated blood.

Nerve Supply

The nerves of the lungs are derived from the pulmonary plexuses. They feature sympathetic, parasympathetic and visceral afferent fibres:

  • Parasympathetic – derived from the vagus nerve. They stimulate secretion from the bronchial glands, contraction of the bronchial smooth muscle, and vasodilation of the pulmonary vessels.
  • Sympathetic – derived from the sympathetic trunks. They stimulate relaxation of the bronchial smooth muscle, and vasoconstriction of the pulmonary vessels.
  • Visceral afferent – conduct pain impulses to the sensory ganglion of the vagus nerve.

Lymphatic Drainage

The lymphatic vessels of the lung arise from two lymphatic plexuses:

  • Superficial (subpleural) – drains the lung parenchyma.
  • Deep – drains the structures of the lung root.

Both these plexuses empty into the trachebronchial nodes – located around the bifurcation of the trachea and the main bronchi. From here, lymph passes into the right and left bronchomediastinal trunks.

[start-clinical]

Clinical Relevance – Pulmonary Embolism

A pulmonary embolism refers to the obstruction of a pulmonary artery by a substance that has travelled from elsewhere in the body. The most common emboli are:

  • Thrombus – responsible for the majority of cases and usually arises in a distant vein.
  • Fat – following a bone fracture or orthopaedic surgery.
  • Air – following cannulation in the neck.

The effect of a pulmonary embolism is a reduction in lung perfusion. This results in decreased blood oxygenation, and the accumulation of blood in the right ventricle of the heart. Clinical features include dyspnoea, chest pain, cough, haemoptysis and tachypnoea. In clinical medicine, the Wells’ score is used to assess the probability of PE.

Definitive treatment involves anticoagulation and thrombolytic therapy. This reduces the size of the embolus, and prevents further clotting.

[end-clinical]

Self-Care for Sticky Lungs – Sundown Healing Arts

Healthy breathing is a relaxed symphony of movement. On inhalation, the diaphragm widens and flattens. Each rib traces an arc up and out. The spine gathers to support the ribs. The lungs, anchored at the top near the collarbones, slide down easily along the chest walls to fill the increased space, pulling in a fresh breath.

On exhalation, the diaphragm releases back into a dome. The ribs return down and in. The spine lengthens. The lungs slide back up to their initial positions, expelling air. This brief MRI video of breathing shows the movement.

Lung structure and development
The lungs fill the torso from front to back, and extend from collarbones to diaphragm, whose dome rises as high as the sixth rib and the bottom of the sternum (see side view). The lungs have three lobes on the right and only two on the left to make room for the heart (see front view, below). The individual lobes can also slide along each other. This allows us to twist our torso without straining delicate lung tissue.

In a developing embryo, the intestines and stomach develop first. The esophagus grows up from the stomach, and then turns back down to become the trachea. At the level of the fourth ribs, the trachea divides to become the two bronchi to the lungs, which divide again to become the secondary bronchi that enter each lobe, and then continue dividing to develop into the tiny bronchioles and alveoli where oxygen exchange occurs. Blood vessels and nerves grow in tandem with the developing bronchial tree.

Slippery membranes
The inner chest wall is coated with a membrane called the parietal pleura. The lung lobes are covered with a similar membrane called the visceral pleura. A layer of slippery interstitial fluid between the two membranes allows them to move along each other as needed.

Sticky adhesions
When the body repairs an injury, extra fibers might attach between adjacent membranes, causing an adhesion that locally sticks them together, impeding smooth motion. Extra fibers can also reduce elasticity within tissue, which is called a contracture. Lung adhesions and contractures can result from an impact to the torso, or by breathing air contaminated with industrial byproducts, car exhaust, tobacco smoke, forest fire smoke, or other pollutants. Adhesions can also result from acute and chronic illnesses such as bronchitis, pneumonia, Covid-19, asthma, and emphysema.

When adhesions or contractures impede inner sliding, nerves detect the strain, and muscles tighten protectively in the area to keep lung tissue from tearing. Our “bad” posture, chronic muscular knots, or lack of flexibility might be caused by a deeper restriction.

Gentle separation
Where tissues have stuck together, we can gently encourage adhesions to separate and restore healthy movement.

Note: If you currently have or are recovering from an acute illness or injury, allow several weeks of healing before attempting to release adhesions. Your body is busy and does not need additional input. If you have a chronic condition that causes fragile bones, blood vessels, or lung tissue, such as osteoporosis, vascular Ehlers-Danlos Syndrome, or emphysema, consult your doctor and be cautious with this technique.

Get comfortable
Find a position where your torso is comfortably supported, lying down or sitting against a back rest or standing against a wall or closed door. Check in with your body’s needs. Perhaps you need a drink of water or a bathroom break before continuing. Loosen tight clothing. Add pillows for support and a blanket if you feel cold.

Sense into your hands, along each finger and palm and back of the hands. Give each hand a little massage, and sense both the giving and receiving hand. Invite your hands to be warm and relaxed.

Breathe
As you settle in, bring your attention to your breathing. Observe quietly, riding along with the in-breath and out-breath. Notice where your body moves with breathing, and where it is still. Notice what feels flexible, and what feels stiff. Slowly move your attention along your front from collarbones to the bottom of your ribs, around to the sides, and along your back. Sense from the inside, and with your eyes, and with your hands resting on your body.

Relaxed touch
Let a hand move to an area over your lungs that wants attention, perhaps somewhere that feels immobile, stiff, or tender. If nothing specific calls to you, choose a place on one of your sides, since they often receive less attention than the front or back.

Let your relaxed hand sink in to contact skin, muscle, and bone, and sense for the inner chest wall and lung underneath. You can turn so your body weight pushes your ribs into your hand. For example, if you are touching your right side, turn to lie on your right side. Alternatively, you can put a weight on your hand such as a book or a yoga sandbag so it can sink in while remaining relaxed. The area you are touching might feel tender, but it should not hurt so much that you tense up. If it hurts, lighten your pressure or choose a different spot.

Breath adds movement
With your hand as an anchor, your relaxed breathing provides movement to gradually stretch and release adhesions. Ride along with your breath for a while, resting into your hand. Check that your hand is relaxed, rather than pushing or tensing.

You might feel some unwinding, where the impulse toward motion comes from the place that is releasing. Allow movement to arise from the inside, rather than imposing a stretch or pull from the outside. Allow sounds to arise as well.

Stay with this spot until you feel done, or until you get a sign of release like a deeper breath or sigh, twitches, increased movement with breathing, or a wave of emotion. It can be both a relief and a challenge to breath more freely and take up more space. Grief and other emotions can flow more easily with more room to breathe.

When one adhesion releases, another one might become more evident. You can follow your inner sense to a new spot and repeat the process: make contact, rest your body weight over your hand, and allow your breath to add gentle movement. After three or four releases, give yourself some time to rest before getting up.

You might feel increased lightness, spaciousness, ease, and flow. You might feel sore where something is newly moving. (A bath with epsom salts can help.) Or, it might feel like nothing much changed. Over the next few days, increased movement in one area allows other areas to work themselves free. You might notice improved mobility in your back, shoulders, or neck. You might notice that your voice is more full or has a wider range.

Gradual change
Give your body plenty of time to adapt, and wait a couple of weeks before addressing any further adhesions. Gradual change is more sustainable as well as more comfortable.

Learn more


Copyright Sonia Connolly. Ask for permission to repost more than a paragraph. Always attribute quotes with the author’s name and a link.


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90,000 MSCT of the chest organs (lungs, mediastinum, ribs, scapula, clavicle, sternum)

MSCT of the chest organs (lungs, mediastinum, ribs, scapula, clavicle, sternum)