Skip to Main Content

++

Approach: nasal/oral (if not intubated) or via ETT/LMA/tracheostomy tube.

++

Indications: therapeutic/diagnostic/intubation aid.

++

The airways follow a branching tree pattern of approximately 23 generations from the trachea to the alveolar sacs. Only four to five can be visualized via bronchoscopy.

++
Table Graphic Jump Location
Favorite Table | Download (.pdf) | Print
Segmentation of the Lungs
Right lungLeft lung
Lobes (3)Segments (10)Lobes (2)Segments (8)
Upper lobeApicalUpper lobeApicoposterior
Posterior
AnteriorAnterior
Middle lobeMedialSuperior lingula
LateralInferior lingula
Lower lobeSuperiorLower lobeSuperior
Medial basalAnteromedial basal
Anterior basal
Lateral basalLateral basal
Posterior basalPosterior basal

The lingula on the left corresponds to the right middle lobe. There are multiple variations, especially within the basal segments.

++
Figure 202-1. Upside-Down Schematic of the Tracheobronchial Tree
Graphic Jump Location

Reproduced with permission from Doherty GM. Current Diagnosis & Treatment: Surgery. 13th ed. New York: McGraw-Hill; 2010. Figure 18-7. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.

++
Table Graphic Jump Location
Favorite Table | Download (.pdf) | Print
Bronchoscopic View of the Tracheobronchial Tree
Trachea
  • From the inferior margin of the cricoid cartilage to the main carina
  • Dimensions: length–newborns ˜5.7 cm; adults ˜11 cm for males and 10 cm for females
  • Diameter–newborns ˜4–5 mm; adults ˜2.5 cm
  • Anterior wall (cartilaginous)–18–24 incomplete cartilaginous rings, open posteriorly
  • Posterior wall (membranous)–trachealis muscle

Figure 202-2

Image not available.

Main carinaSharp anteroposterior cartilaginous ridge at the bifurcation of the trachea

Figure 202-3

Image not available.

Right mainstem bronchus
  • Short, approximately 2 cm, runs more vertically than the left mainstem bronchus, it diverges at a 25–30° angle from midline
  • A foreign body will most likely enter here
Right upper lobe
  • The first branch off the lateral side of the right mainstem bronchus
  • It quickly trifurcates into three segments: apical, anterior, and posterior

Figure 202-4

Image not available.

Bronchus intermedius
  • The distal continuation of the right mainstem bronchus past the origin of the RUL
  • It runs for 2 cm and it bifurcates into the RML and RLL

Figure 202-5

Image not available.

Right middle lobe
  • It originates from the anterior and medial wall of the distal bronchus intermedius
  • It further bifurcates into the middle and lateral segments

Figure 202-6

Image not available.

Right lower lobe
  • Its superior segment takes off from the distal bronchus intermedius, on the posterior aspect, opposite from the origin of the RML
  • Descending past the superior segment, you will encounter the four basilar segments. First the medial basal segment (medial origin), and the other three segments on the lateral side in the A–L–P order: anterior, lateral, and posterior basal

Figure 202-7

Image not available.

Left mainstem bronchus
  • Diverges at a 45° angle from the midline
  • It is longer (4–5 cm) and narrower than the right mainstem bronchus
  • Distally, there is the left mainstem carina, which marks the bifurcation into the LUL and LLL

Figure 202-8

Image not available.

Left upper lobe
  • Appears superior to the left mainstem carina
  • It further subdivides ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessAnesthesiology Full Site: One-Year Subscription

Connect to the full suite of AccessAnesthesiology content and resources including procedural videos, interactive self-assessment, real-life cases, 20+ textbooks, and more

$995 USD
Buy Now

Pay Per View: Timed Access to all of AccessAnesthesiology

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.