Trachea and Bronchi

Dr.Hassan Shaibah

Tracheobronchial anatomy

3Tracheal Displacement Due to Goiter

Images downloaded from From www.vh.org

a mobile cartilaginous and membranous tube

Right bronchs•Wider•Shorter C6C6

T4/5T4/5

Left bronchus•Narrower•Longer•More horizontal

• C shaped rings of hyaline cartilages

• Free Posteriorly. Cartilages are connected by a muscle

11.25 cm

TrachealisMuscle

LTMain

bronchus

RTMain

bronchusLT

Upper lobar

bronchus

LTlower lobar

bronchus

RTlower lobar

bronchus

RTUpper lobar

bronchus

RTmiddle lobar

bronchus

Cricoid Cartilage

Main carina: Concepts of anterior and posterior

RTSegmantal

bronchiLT

Segmantal bronchi

Relations of the Trachea

At Level of superior Mediastinum• Anteriorly: The sternum, thymus, left brachio-

cephalic v., origins of the brachiocephalic and left common carotid a., & arch of the aorta

• Posteriorly: esophagus & left recurrentlaryngeal n.

• Right side: azygos v., right vagus n., & the pleura

• Left side: arch of the aorta, left common carotid &left subclavian a., the left vagus & left phrenic n., & the pleura.

sternum

thymus

LT brachiocephalic v.

Brachiocephalic truck

LT common carotid a.

Anterior the level of T1

Posteriorly at level of T1

esophagus

LTRecurrent

laryngeal N

Right at level of T1

RT vagus n.

Pleura

Left at level of T1

Pleura

LT common carotid a

LT subclavian a.

left vagus n.

LT phrenic n.

The sternum

thymus

LT brachiocephalic v.

BrachiocephalicTrunk

LT common carotid a.

The sternum

thymus

LT brachiocephalic v.

BrachiocephalicTrunk

LT common carotid a.

anterior

Left at level of T1

Pleura

LT common carotid a

LT subclavian a.

left vagus n.

LT phrenic n.

Right

RT vagus n.

Pleura

sternumthymus

Arch of aorta

Anterior at level of T4

Left at level of T1

Pleura

Arch of aorta

left vagus n.

LT phrenic n.

Right at level of T1

RT vagus n.

Pleura

Azygos v.

Posterior at level of T4

At level T4

At level T3

At Level of the neck• Anterior: thyroid gland, inf. Thyroid vein with some neck

muscles• Posterior : right and left recurrent laryngeal nerve• Lateral: lobes of the thyroid gland and carotid sheath

thyroid gland

inf. Thyroid vein

Posterior• right and left recurrent laryngeal nerve

Lateral

Lobes of the thyroid gland & carotid sheath

48

Intraluminal disease and extrinsic compression

• Tumor invading through posterior wall.

• Tumor invading left and right main bronchi

• Narrowing of lower third of trachea

BI,

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ight

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50

Tracheal appearances

A

B

C

D

E

F

Saber sheath Dynamic collapse Crescent shape collapse

Normal shape expansion during inhalation circumferential collapse

Nerve Supply of the Trachea

• sensory nerve supply is from the vagi and the recurrent laryngeal nerves.

• Sympathetic nerves supply the trachealis muscle

Blood Supply of the Trachea

• upper 2/3 are supplied by the inferior thyroid arteries • lower 1/3 is supplied by the bronchial arteries.