1. Iman Galal, MDIman Galal, MD
Pulmonary Medicine DepartmentPulmonary Medicine Department
Ain Shams UniversityAin Shams University
CLINICALCLINICAL
ANATOMY OFANATOMY OF
LUNG & PLEURALUNG & PLEURA
2. Page 2
Borders of the lung:Borders of the lung:
The apexThe apex is about 2-3 cms (1 inch) above the medial 1/3 of theis about 2-3 cms (1 inch) above the medial 1/3 of the
clavicle, thenclavicle, then the anterior border of both lungsthe anterior border of both lungs run downwards &run downwards &
medially meeting each other in the middle line behind the angle ofmedially meeting each other in the middle line behind the angle of
Louis.Louis.
The anterior border of right lung continues running downwards till theThe anterior border of right lung continues running downwards till the
66thth
costochondral junction.costochondral junction.
The anterior border of left lung continues running downwards till theThe anterior border of left lung continues running downwards till the
44thth
costal cartilage then curves laterally ½ inch forming the cardiaccostal cartilage then curves laterally ½ inch forming the cardiac
notch then descends downwards till the 6notch then descends downwards till the 6thth
costochondral junction.costochondral junction.
3. Page 3
Borders of the lung:Borders of the lung:
The lower border of the lungsThe lower border of the lungs represented by a linerepresented by a line
starting from 6starting from 6thth
rib in the MCL, 8rib in the MCL, 8thth
rib in the MAL & 10rib in the MAL & 10thth
ribrib
in the scapular line.in the scapular line.
5. Page 5
Lung Fissures:Lung Fissures:
Oblique fissureOblique fissure (Right & Left):(Right & Left):
It starts at theIt starts at the 33rdrd
thoracic spinethoracic spine while the arms are elevated, descendswhile the arms are elevated, descends
downwards, laterally & anteriorly along the medial border of the scapuladownwards, laterally & anteriorly along the medial border of the scapula
touching the inferior angle of the scapula) cutting the midaxillary line intouching the inferior angle of the scapula) cutting the midaxillary line in
the 5the 5thth
rib & ending at the 6rib & ending at the 6thth
costal cartilage 3 inches from the midline.costal cartilage 3 inches from the midline.
In cadaver it arise at the 2In cadaver it arise at the 2ndnd
thoracic spine.thoracic spine.
The transverse fissureThe transverse fissure (Right):(Right):
It arises at theIt arises at the 44thth
costal cartilagecostal cartilage, runs horizontally to meet the, runs horizontally to meet the
oblique fissure in the midaxillary line in the 5oblique fissure in the midaxillary line in the 5thth
rib.rib.
20. Page 20
The borders of the Pleura:The borders of the Pleura:
The pleura runs close to the lung except at the lowerThe pleura runs close to the lung except at the lower
border which extends for 3-5 cm below it both anteriorlyborder which extends for 3-5 cm below it both anteriorly
& posteriorly & 9-10 cm below in the axilla.& posteriorly & 9-10 cm below in the axilla.
The lower border cuts the 8The lower border cuts the 8thth
rib in MCL, 10rib in MCL, 10thth
rib in MALrib in MAL
and 12and 12thth
rib in Scapular line.rib in Scapular line.
23. Page 23
Parietal PleuraParietal Pleura
Costal pleura:Costal pleura:
Lines thoracic wall (ribs, intercostalLines thoracic wall (ribs, intercostal
spaces)spaces)
Mediastinal pleura:Mediastinal pleura:
Lines corresponding surface ofLines corresponding surface of
mediastinum; reflected over root of lungmediastinum; reflected over root of lung
& becomes continuous with visceral& becomes continuous with visceral
pleura around hilumpleura around hilum
Cervical pleura:Cervical pleura:
Extends into neck about 2 inches aboveExtends into neck about 2 inches above
11stst
costal cartilage & one inch abovecostal cartilage & one inch above
medial 1/3 clavicle; covers apex of lungmedial 1/3 clavicle; covers apex of lung
Diaphragmatic pleura:Diaphragmatic pleura:
Lines superior surface of diaphragmLines superior surface of diaphragm
26. Page 26
Traube’s area:Traube’s area:
4 points:4 points:
Left 6Left 6thth
rib in the MCL to 8rib in the MCL to 8thth
costal cartilage in thecostal cartilage in the
parasternal line ,then along the left costal margin to the 11parasternal line ,then along the left costal margin to the 11thth
rib in the MAL, then the 9rib in the MAL, then the 9thth
rib in the MAL.rib in the MAL.
27. Page 27
Kronig’s Isthmus :Kronig’s Isthmus :
It is a band of resonance representing lung apex.It is a band of resonance representing lung apex.
LaterallyLaterally it is marked by a line joining 2 points:it is marked by a line joining 2 points:
1.1. The junction of the medial 2/3 of the clavicle with theThe junction of the medial 2/3 of the clavicle with the
lateral 1/3.lateral 1/3.
2.2. The junction of the medial 1/3 of the scapular spine withThe junction of the medial 1/3 of the scapular spine with
the lateral 2/3.the lateral 2/3.
MediallyMedially marked by a line between the sternal end ofmarked by a line between the sternal end of
clavicle and the 7clavicle and the 7thth
cervical spine.cervical spine.
28. Page 28
Bare area of the heart :Bare area of the heart :
Medial border: left lateral border of the sternumMedial border: left lateral border of the sternum
Lateral border: left parasternal lineLateral border: left parasternal line
Superior border: lower border of Lt 4Superior border: lower border of Lt 4thth
rib.rib.
Inferior border: upper border of Lt 6Inferior border: upper border of Lt 6thth
ribrib
29. Page 29
Surface anatomy of liver:Surface anatomy of liver:
Upper border:Upper border:
It starts from the left 6It starts from the left 6thth
ribrib just inside the MCL, passing tojust inside the MCL, passing to
the Rt and slightly upwards to the 5the Rt and slightly upwards to the 5thth
rib in the MCL, thenrib in the MCL, then
the 7the 7thth
rib in anterior axillary line, to the 9rib in anterior axillary line, to the 9thth
rib in mid-axillaryrib in mid-axillary
line.line.
