Pleural cavity - structure and functions. Boundaries of the lungs and pleura Sections of the parietal pleura

A similar study is carried out on persons over 18 years of age. The frequency of this is no more than once a year. This rule applies only to fluorography of healthy lungs, when further examination is not required.

It is believed that fluorography of the lungs is not a sufficiently informative examination, but the data obtained with its help make it possible to identify changes in the structure of the lung tissue and become a reason for further more detailed examination.

The organs of the chest absorb radiation differently, so the image appears heterogeneous. The heart, bronchi and bronchioles look like light spots; if the lungs are healthy, fluorography will show the lung tissue homogeneous and uniform. But if there is inflammation in the lungs, on fluorography, depending on the nature of the changes in the inflamed tissue, either darkening will be visible - the density of the lung tissue is increased, or lightened areas will be noticed - the airiness of the tissue is quite high.

Fluorography of a smoker's lungs

It has been established that changes in the lungs and respiratory tract occur imperceptibly even after the first cigarette smoked. Therefore, smokers, people at increased risk for pulmonary diseases, are strongly recommended to undergo lung fluorography annually.

Fluorography of a smoker’s lungs will not always be able to show the development of a pathological process at an early stage - in most cases it begins not with the lungs, but with the bronchial tree, but, nevertheless, such a study allows us to identify tumors and compactions in the lung tissue that have appeared in the cavities of the lungs fluid, thickening of the walls of the bronchi.

It is difficult to overestimate the importance of a smoker undergoing such an examination: pneumonia detected in a timely manner using fluorography makes it possible to prescribe the necessary treatment as early as possible and avoid serious consequences.

Interpretation of the fluorogram after undergoing fluorography of the lungs

The results of fluorography usually take several days to prepare, after which the resulting fluorogram is examined by a radiologist, and if fluorography of healthy lungs was performed, the patient is not sent for further examination. Otherwise, if the radiologist detects changes in the lung tissue, the person may be sent for radiography or to a tuberculosis dispensary to clarify the diagnosis.

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Good afternoon, Olga.

With the results of the analysis, your father needs to contact a pulmonologist in person.

Hello. The chapter “Deciphering a fluorogram after undergoing fluorography of the lungs” in the article under which you asked a question is at your service.

A sealed sinus is a consequence of an inflammatory process, pleurisy, that was suffered in the past. The numbers are for the doctor.

Our kidneys are capable of purifying three liters of blood in one minute.

An educated person is less susceptible to brain diseases. Intellectual activity promotes the formation of additional tissue that compensates for the disease.

Human bones are four times stronger than concrete.

It was previously believed that yawning enriches the body with oxygen. However, this opinion has been refuted. Scientists have proven that yawning cools the brain and improves its performance.

People who eat breakfast regularly are much less likely to be obese.

74-year-old Australian resident James Harrison has donated blood about 1,000 times. He has a rare blood type whose antibodies help newborns with severe anemia survive. Thus, the Australian saved about two million children.

In an effort to get the patient out, doctors often go too far. For example, a certain Charles Jensen in the period from 1954 to 1994. survived more than 900 operations to remove tumors.

Most women are able to derive more pleasure from contemplating their beautiful body in the mirror than from sex. So, women, strive to be slim.

The well-known drug Viagra was originally developed for the treatment of arterial hypertension.

If your liver stopped working, death would occur within 24 hours.

Scientists from Oxford University conducted a series of studies in which they came to the conclusion that vegetarianism can be harmful to the human brain, as it leads to a decrease in its mass. Therefore, scientists recommend not completely excluding fish and meat from your diet.

There are very interesting medical syndromes, for example, compulsive swallowing of objects. One patient suffering from this mania had 2,500 foreign objects in her stomach.

According to statistics, on Mondays the risk of back injuries increases by 25%, and the risk of a heart attack by 33%. Be careful.

In the UK there is a law according to which a surgeon can refuse to perform an operation on a patient if he smokes or is overweight. A person must give up bad habits, and then, perhaps, he will not need surgical intervention.

The first vibrator was invented in the 19th century. It was powered by a steam engine and was intended to treat female hysteria.

The German healthcare system is considered one of the best in Europe and throughout the world. Oncologists in Germany have achieved particular success. After therapy in clinics of the countries.

Decoding an X-ray of the lungs: all the subtleties

A competent interpretation of a chest X-ray allows one to identify not only the subtleties of pathological processes in the chest, but also to study the effect of the disease on surrounding tissues (within the cutting ability of the method).

When analyzing an X-ray image, it is necessary to understand that the image is formed by diverging beams of x-rays, therefore the obtained sizes of objects do not correspond to the actual ones. As a result, radiology specialists analyze an extensive list of darkening, clearing and other radiological symptoms before issuing a conclusion.

How to correctly interpret lung x-rays

In order for the interpretation of lung x-rays to be correct, an analysis algorithm must be created.

In classic cases, specialists study the following features of the image:

• quality of execution;
• shadow picture of the chest organs (pulmonary fields, soft tissues, skeletal system, location of the diaphragm, mediastinal organs).

Quality assessment involves identifying features of placement and mode that may affect the interpretation of the x-ray picture:

1. Asymmetrical body position. It is assessed by the location of the sternoclavicular joints. If it is not taken into account, rotation of the thoracic vertebrae can be detected, but this will be incorrect.
2. The hardness or softness of the image.
3. Additional shadows (artifacts).
4. The presence of concomitant diseases affecting the chest.
5. Completeness of coverage (a normal x-ray of the lungs should include the apices of the lung fields above and the costophrenic sinuses below).
6. In a correct photograph of the lungs, the shoulder blades should be located outward from the chest, otherwise they will create distortions when assessing the intensity of radiological symptoms (clearing and darkening).
7. Clarity is determined by the presence of single-contour images of the anterior segments of the ribs. If there is dynamic blurring of their contours, it is obvious that the patient was breathing during exposure.
8. The contrast of an x-ray is determined by the presence of color shades of black and white. That is, when deciphering, it is necessary to compare the intensity of the anatomical structures that produce darkening with those that create clearing (pulmonary fields). The difference between shades indicates the level of contrast.

It is also necessary to take into account possible image distortions when examining a person under different directions of X-rays (see figure).

Figure: distorted image of a ball when examined with a direct beam (a) and with an oblique position of the receiver (b)

Protocol for describing a chest x-ray by a doctor

The protocol for deciphering the image of the chest organs begins with the description: “on the presented radiograph of the chest organs in a direct projection.” The direct (posterior-anterior or anteroposterior) projection involves taking a radiograph with the patient standing with his face or back to the beam tube with a central path of rays.

Then we continue the description: “in the lungs without visible focal and infiltrative shadows.” This standard phrase indicates the absence of additional shadows caused by pathological conditions. Focal shadows occur when:

• tuberculosis;
• tumors;
• occupational diseases (silicosis, talcosis, asbestosis).

Infiltrative darkening indicates diseases accompanied by inflammatory changes in the lungs. These include:

The pulmonary pattern is not deformed, clear - this phrase indicates the absence of disturbances in the blood supply, as well as pathogenetic mechanisms causing vascular deformation:

• circulation disturbances in the small and large circles;
• cavitary and cystic X-ray negative formations;
• stagnation.

The roots of the lungs are structural, not expanded - this description of the OGK image indicates that in the area of ​​the roots the radiologist does not see additional shadows that can change the course of the pulmonary artery or enlarge the lymph nodes of the mediastinum.

Poor structure and deformation of the roots of the lungs is observed with:

• sarcoidosis;
• enlarged lymph nodes;
• mediastinal tumors;
• stagnation in the pulmonary circulation.

If the mediastinal shadow is without features, it means that the doctor has not identified additional formations emerging from behind the sternum.

The absence of “plus shadows” on a direct x-ray of the lungs does not mean the absence of tumors. It should be understood that the X-ray image is summative and is formed based on the intensity of many anatomical structures that are superimposed on each other. If the tumor is small and not from a bone structure, it overlaps not only the sternum, but also the heart. In such a situation, it cannot be identified even on a side image.

The diaphragm is not changed, the costophrenic sinuses are free - the final stage of the descriptive part of deciphering an x-ray of the lungs.

All that remains is the conclusion: “in the lungs without visible pathology.”

Above we have given a detailed description of a normal lung x-ray so that readers have an idea of ​​what the doctor sees in the image and what the protocol for his conclusion is based on.

Below is an example of a transcript if a patient has a lung tumor.

Description of an X-ray of the lungs with a tumor

Schematic representation of a node in the S3 segment of the left lung

An overview p-gram of the chest organs visualizes a nodular formation in the upper lobe of the left lung (segment S3) against the background of a deformed pulmonary pattern about 3 cm in diameter, polygonal in shape with wavy clear contours. From the node a path is traced to the left root and cords to the interlobar pleura. The structure of the formation is heterogeneous, which is due to the presence of centers of decay. The roots are structural, the right one is somewhat expanded, probably due to enlarged lymph nodes. The cardiac shadow is without features. The sinuses are free, the diaphragm is not changed.

Conclusion: X-ray picture of peripheral cancer in S3 of the left lung.

Thus, in order to decipher a chest x-ray, the radiologist has to analyze many symptoms and reunite them into a single picture, which leads to the formation of a final conclusion.

Features of lung field analysis

Correct analysis of lung fields creates opportunities to identify many pathological changes. The absence of darkening and clearing does not yet exclude lung diseases. However, to correctly interpret a chest image (CH), the doctor must know the numerous anatomical components of the X-ray symptom “pulmonary field”.

Features of the analysis of pulmonary fields on an x-ray:

• the right margin is wide and short, the left is long and narrow;
• the median shadow is physiologically expanded to the left due to the heart;
• For a correct description, the pulmonary fields are divided into 3 zones: lower, middle and upper. Similarly, 3 zones can be distinguished: internal, middle and external;
• the degree of transparency is determined by air and blood filling, as well as the volume of parenchymal lung tissue;
• the intensity is influenced by the superposition of soft tissue structures;
• in women, the image may be obscured by the mammary glands;
• the individuality and complexity of the pulmonary pattern requires highly qualified physicians;
• Normally, the pulmonary pleura is not visible. Its thickening is observed during inflammation or tumor growth. The pleural sheets are more clearly visualized on a lateral radiograph;
• each lobe consists of segments. They are distinguished based on the special structure of the bronchovascular bundle, which branches separately in each lobe. There are 10 segments in the right lung, 9 in the left lung.

Thus, interpreting lung x-rays is a complex task that requires extensive knowledge and long-term practical experience. If you have an x-ray that needs to be described, please contact our radiologists. We'll be happy to help!

What does the description on the x-ray mean, the roots of the lungs are compacted

X-ray is one of the most effective and accessible methods for diagnosing a disease such as tuberculosis. However, it cannot be said that it always produces a 100% correct result. An X-ray examination can reveal pathologies in tissues, such as lumps or the appearance of tumors.

Characteristics of the roots of the lungs

When performing a chest x-ray, doctors first look at the condition of the roots of the lungs. This is the so-called “gate” to the main respiratory organ. If there are no problems with them, then in the picture they will be in normal condition, without compactions. The location of the roots is also of great importance.

They are divided into three parts: upper, middle and lower sectors. The right root is shaped like a curved ribbon, tapering downwards; it is poorly expressed in the photographs. Its upper part is located at the level of the second intercostal space. The vertex of the left root is one edge higher than the right one. The root itself partially hides the shadow from the heart.

External structure of the lungs

The roots of the lungs are divided into two categories:

• Main, having an impressive head, most of which is the pulmonary artery;
• The roots are crumbly and have a large branched system of vessels turning into cords.

Often in practice you can encounter the following situation: the picture shows the presence of deviations, while the person feels good. The reason may be the characteristics of the body, the presence of previous injuries, or a poorly executed x-ray (the person stood in the wrong position or moved during the “photographing” process).

Do not forget about the degree of hardness and softness of the image; in the first case, it is impossible to see small details, and in the second, you will get a blurry image.

It's worth knowing! X-rays can detect not only lung problems, but also bone diseases. For example, diaphragm injury or scoliosis.

Fluorography results

In addition to the above-described deviations from the norm, in the written opinions of doctors you can see characteristics that can become signs of the presence of pathology: the roots of the lungs are compacted and expanded, heavy and strengthened.

What does it mean if the root of the lung is compacted? Most often, the cause is swelling of the bronchi, vasodilatation or enlarged lymph nodes. The tissues of the roots compact and expand synchronously; if the roots of the lungs are only compacted, this means that a chronic process has started in the body. On X-ray photographs, compacted roots have blurry outlines and are large in size.

Heavy roots symbolize the beginning of a chronic or acute inflammatory process. Most often, the cause of such deviation is occupational or protracted illnesses. On an x-ray, they look “jagged” and dense, this is explained by the fact that the volume of connective tissue has increased.

Important! In smokers, bronchitis does not appear until a couple of years after smoking. It belongs to the category of chronic diseases, which is caused by the reaction of the lungs to a constant irritant in the form of tar.

The main danger is that bronchitis can easily develop into tuberculosis, since a smoker's lungs contain a huge amount of mucus - an excellent microflora for the development of pathogenic bacteria.

Is there a connection between root abnormalities and tuberculosis?

Some pathologies of the pulmonary roots can become symptoms of tuberculosis disease. For example, their compaction and enlargement of the lymph nodes are clear signs of the disease; the body reacts to the infection, and inflammatory processes begin in the tissues. Tuberculosis microbacteria, spreading through the lungs, decalcify the lymph nodes, calcium salts begin to accumulate in them and they begin to harden.

Do not forget that an x-ray does not provide a 100% diagnosis of the presence of tuberculosis. X-ray photographs must be interpreted by a radiologist who knows all the subtleties and nuances and has extensive experience in this area.

It's worth knowing! Having received the radiologist’s report, you can see there a mention of fibrous tissue, it replaces the lost areas in the internal organs. Its presence indicates a previous operation or penetrating trauma affecting the organ. It is not functional, it helps the body maintain the integrity of its organs.

If, after an x-ray, the doctor has doubts about the patient’s health, he will refer him for a comprehensive examination to confirm the diagnosis or refute it. This usually includes blood, urine and sputum tests. Sometimes doctors prescribe a bronchoscopy, which helps determine the internal condition of the root, and a computed tomogram to obtain a 3D image of the lungs.

Don’t despair or panic if you find abnormalities in the pulmonary roots. Modern medicine can work miracles, and a disease detected at an early stage is much easier to cure.

Good afternoon, I was treated for obstruction of the lungs, I was in the hospital for a month, they kicked me out, they said everything was fine, go back to work, after three months I was checked smartly in the place where the obstruction was, they said I need to do an operation to find out the reason, I refused

Treatment at home

According to statistics, every hour in Russia one person dies from tuberculosis. A routine examination, especially if a person is at risk, can detect the disease in time, which means that prescribed therapy can prevent complications.

Today we will look at the most common results of fluorography, the decoding of which will allow us to find out what they mean, what we should pay special attention to when we receive information about a chest x-ray.

Doctors write very illegibly, some people believe that this is because the patient does not understand what kind of disease he has. This may be so, but it is surprising that at the same time they parse and understand what their colleague wrote.

What is fluorography

Fluorography is an examination of the chest using X-ray irradiation, with the results of the examination recorded on film. The technique is already somewhat outdated, but is still the cheapest way to check your lungs for any pathologies.

Principle of obtaining results

The radiologist visually distinguishes changes in the density of lung tissue on photographic film. Those places where the density is higher than in healthy lungs indicate some problems in the tissues. The connective tissue, growing, replaces the lung tissue and appears as lighter areas on fluorography.

Much of the results depend on the qualifications and experience of the doctor. There was even such a curious case when a young doctor saw a shadow in the left half of the lungs, began to sound the alarm, but it turned out that it was the heart! But, of course, this is from the category of medical legends.

What can you see in the photographs

There are adhesions, fibrosis, layers, shadows, sclerosis, heaviness, radiance, cicatricial changes. All these abnormalities, if present, are visible on films of the lungs.

If a person has asthma, then the image will show that the walls of his bronchi are thickened, this is due to the fact that they bear a higher load. The images can also identify cysts, abscesses and cavities, calcifications, emphysema, and cancer.

The most common conclusions after fluorography

Please note that if you really have any serious problems in your lungs, you will be told about this immediately when you come to collect your results. If you weren’t sent to a tuberculosis clinic or for an x-ray to clarify the disease, then everything is more or less fine. Now let's look at the most common lung problems.

The roots are expanded and compacted

The roots of the lungs are the main bronchus, bronchial arteries, pulmonary artery and pulmonary vein. This is one of the most common diagnoses and indicates some chronic processes occurring in the lungs. Chronic bronchitis, edema, pneumonia, pneumonia. If your report says “the roots are compacted and expanded,” then this indicates that you have a chronic inflammatory process in the lungs. Experienced smokers often have this exact fluorography result.

The roots are heavy

This is also a common result of fluorography. All the same problems are to blame for its manifestation - chronic or acute processes in the lungs. Most often, the heaviness of the pulmonary pattern or the heaviness of the roots of the lungs is detected in smokers, as well as with bronchitis. It may also indicate an occupational disease associated with stress on the lungs, for example, when working in hazardous industries.

If the results only say “heaviness of the roots of the lungs,” do not panic, everything is within the acceptable range, especially if you were not referred anywhere. But it is important to take into account the signal and monitor the condition of your lungs, avoiding exacerbation of chronic processes.

Increased vascular or pulmonary pattern

The pulmonary pattern is the shadows on the fluorogram, “cast” by the veins and arteries piercing the lungs. It is also called vascular pattern. If such an item is written in the results, it means that in some part of the lungs there is an area into which blood flows more intensely through the arteries. It is recorded in some acute inflammatory processes, bronchitis, pneumonia, and may also indicate pneumonitis, and requires a repeat image to make sure there is no oncology.

Fibrous tissue, fibrosis

This is evidence of some previous pulmonary disease. This may be evidence of a previous operation, an old injury, or a previous infection. Fibrous tissue belongs to the connective tissue and serves to replace damaged lung cells. Fibrosis in the lungs indicates that everything has healed and there is no threat.

Calcifications

These are isolated cells affected by tuberculosis or pneumonia. The body seems to stick a substance similar to bone tissue around the problem area. Round shadows are visible in the photo. If a person has a lot of calcifications, this indicates that the body has overcome the infection and the disease has not developed. Therefore, if you are found to have calcifications in your lungs, there should be no concern.

Another thing is aortic calcification

Calcinosis is the gradual accumulation of insoluble calcium salts on the walls of the aorta. As a rule, calcified plaques are visible on fluorography; this, in principle, is not a pulmonary problem, but it is diagnosed by fluoroscopy. These plaques themselves are dangerous both because they can come off and clog the vessels, and also because the vessels themselves become brittle, as if they were made of crystal.

I advise you to take this diagnosis very seriously. Any increase in pressure can become critical. It is necessary to consult a specialist and limit the intake of calcium into the body. If calcium is deposited on the walls of blood vessels, it means that there is an excess amount of it. calcium is deposited in tissues and blood vessels. This happens when there is an excess of calcium in the blood.

Focal shadow - lesions

Focal shadows, or foci, are darkening of the lung field, a fairly common symptom. The size of the shadows is usually up to 1 cm.

If you or your child have shadows in the middle or lower parts of the lungs, this indicates the presence of focal pneumonia.

Signs of active inflammation may include uneven edges, increased pulmonary pattern, and merging of shadows. If the focal shadows have smooth and dense contours, it means that the inflammation is ending. But consultation with a therapist is necessary. Probably, pneumonia, which turned into pneumonia, “settled” deep in the lung tissue.

If focal shadows are found in the upper parts of the lungs, then this indicates possible tuberculosis and requires clarification.

Pleuroapical layers, adhesions

After inflammation, adhesions may occur; these are also connective structures that isolate the area of ​​inflammation from healthy tissue. If you see adhesions in the picture, then there is no cause for concern.

Pleuroapical layers are compactions of the pleura of the pulmonary apices. The layers may indicate some kind of inflammatory process that occurred relatively recently. Most often about tuberculosis infection. However, if the doctor does not consider the picture serious, then there should be no reason to worry.

Pneumosclerosis

This increase in connective tissue in the lungs may be the result of disease. Such as bronchitis, pneumonia, tuberculosis, working in dusty industries, smoking.

Tissues lose elasticity and become denser. The structure of the bronchi may change, the lung tissue itself becomes similar to dried fruit - it decreases in size. It is also one of the diseases requiring observation. Staying in dry, thin mountain air is indicated. Resorts in the Caucasus are highly recommended. For example, in Teberda it is very good for pulmonary patients; I have been to these parts myself. If possible, then go and live there in both summer and winter.

Sinus sealed or free

Pleural sinuses are cavities formed by pleural folds. A healthy person has free sinuses. But if there are any problems, then liquid accumulates there. If your sinus is sealed, then this means that there are adhesions, probably after pleurisy. There is no reason to worry.

Changes from the diaphragm

Diaphragm anomaly is quite common. Other similar names are dome high, dome relaxation, diaphragm dome flattening. The reasons may be: disturbances in the gastrointestinal tract, liver problems, pleurisy, excess weight, oncology. This sign is interpreted based on other available data, analyzes and studies.

Examples of results and their interpretation

They regularly send me pictures of radiologists' reports by email. I decided to add the illegible handwriting of the doctors and give a transcript. Maybe by looking at examples you can identify your diagnosis. I would be grateful to everyone who replenishes the database.

Conclusion of a radiologist - Pneumosclerosis. Aortic calcification.

conclusions

Annual fluorography will allow you to identify lung problems, if any, at an early stage. At many enterprises, employees are routinely sent for examinations, but those who neglect this procedure risk unexpectedly finding out that they have some difficulties, God forbid, of course.

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Help me decipher my husband’s fluorography. The root of the left lung is expanded due to enlarged intrathoracic lymph nodes, pronouncedly branched, pulled upward. Recommended TMG of the left lung through the root, consultation with a phthisiatrician. Works as a miller.

Hello. Help me decipher the result of fluorography: high position of the diaphragm on the left without shadows of pneumatization in the stomach and intestines

Blood supply and innervation of the lungs. Pathways of lymph outflow from the right and left lungs, their regional lymph nodes.

Vessels and nerves of the lungs. Arterial blood to nourish the lung tissue and bronchial walls enters the lungs through the bronchial branches from the thoracic aorta. Blood from the walls of the bronchi through the bronchial veins flows into the tributaries of the pulmonary veins, as well as into the azygos and semi-gypsy veins. Through the left and right pulmonary arteries, venous blood enters the lungs, which, as a result of gas exchange, is enriched with oxygen, releases carbon dioxide and becomes arterial. Arterial blood from the lungs flows through the pulmonary veins into the left atrium. The lymphatic vessels of the lungs drain into the bronchopulmonary, lower and upper tracheobronchial lymph nodes.

The innervation of the lungs is carried out from the vagus nerve and from the sympathetic trunk, the branches of which in the region of the root of the lung form pulmonary plexus,plexus pulmonalis. The branches of this plexus penetrate the lungs through the bronchi and blood vessels. In the walls of large bronchi there are plexuses of nerve fibers in the adventitia, muscular and mucous membranes.

Pleura; its departments, boundaries; pleural cavity, pleural sinuses.

Pleura,pleura, being the serous membrane of the lung, it is divided into visceral (pulmonary) and parietal (parietal). Each lung is covered with pleura (pulmonary), which along the surface of the root passes into the parietal pleura, lining the walls of the chest cavity adjacent to the lung and delimiting the lung from the mediastinum. Visceral (pulmonary) pleura,pleura viscerdlis (pulmondlis), tightly fuses with the tissue of the organ and, covering it on all sides, enters the cracks between the lobes of the lung. Down from the root of the lung, the visceral pleura, descending from the anterior and posterior surfaces of the lung root, forms a vertically located pulmonary ligament,llg. pulmonary, lying in the frontal plane between the medial surface of the lung and the mediastinal pleura and descending down almost to the diaphragm.

Parietal (parietal) pleura,pleura parietdlls, It is a continuous sheet that fuses with the inner surface of the chest wall and in each half of the chest cavity forms a closed sac containing the right or left lung, covered with visceral pleura (Fig. 242). Based on the position of the parts of the parietal pleura, it is divided into the costal, mediastinal and diaphragmatic pleura. Costal pleura [part], pleura costdlis, covers the inner surface of the ribs and intercostal spaces and lies directly on the intrathoracic fascia. In front near the sternum and behind at the spinal column, the costal pleura passes into the mediastinal pleura. Mediastinal pleura [part], pleura mediastindlls, adjacent to the mediastinal organs on the lateral side, located in the anteroposterior direction, extending from the inner surface of the sternum to the lateral surface of the spinal column. The mediastinal pleura on the right and left is fused with the pericardium; on the right it also borders with the superior vena cava and azygos vein, with the esophagus, on the left with the thoracic aorta. In the area of ​​the root of the lung, the mediastinal pleura covers it and passes into the visceral pleura. Above, at the level of the superior aperture of the chest, the costal and mediastinal pleura pass into each other and form dome of pleura,cupula pleurae bounded on the lateral side by the scalene muscles. Behind the dome of the pleura are the head of the 1st rib and the longus colli muscle, covered with the prevertebral plate of the cervical fascia, to which the dome of the pleura is fixed. The subclavian artery and vein are adjacent to the dome of the pleura anteriorly and medially. Above the dome of the pleura is the brachial plexus. Below, the costal and mediastinal pleura passes into the diaphragmatic pleura [part], pleura diaphragmdtica, which covers the muscular and tendon parts of the diaphragm, with the exception of its central sections; where the pericardium is fused with the diaphragm. Between the parietal and visceral pleura there is a slit-like closed space - pleural cavity,cdvitas pleurdlis. The cavity contains a small amount of serous fluid, which moistens the adjacent smooth layers of pleura covered with mesothelial cells and eliminates friction between them. When breathing, increasing and decreasing the volume of the lungs, the moistened visceral pleura slides freely along the inner surface of the parietal pleura.

In the places where the costal pleura transitions into the diaphragmatic and mediastinal pleura, depressions of greater or lesser size are formed - pleural sinuses,recessus pleurdles. These sinuses are reserve spaces of the right and left pleural cavities, as well as receptacles in which pleural (serous) fluid can accumulate if the processes of its formation or absorption are disrupted, as well as blood, pus in case of damage or diseases of the lungs and pleura. Between the costal and diaphragmatic pleura there is a clearly visible deep costophrenic sinus, recessus costodiaphragmaticus, reaching its greatest size at the level of the midaxillary line (here its depth is about 9 cm). At the point where the mediastinal pleura transitions into the diaphragmatic pleura there is a not very deep, sagittally oriented diaphragmome-diastinal sinus, recessus phrenicomediastinalis. A less pronounced sinus (depression) is present at the place where the costal pleura (in its anterior section) transitions into the mediastinal pleura. Here it is formed costomediastinal sinus, recessus costomediastinalis.

The dome of the pleura on the right and left reaches the neck of the 1st rib, which corresponds to the level of the spinous process of the 7th cervical vertebra (posteriorly). In front, the dome of the pleura rises 3-4 cm above the first rib (1-2 cm above the collarbone). The anterior border of the right and left costal pleura extends differently (Fig. 243). On the right, the anterior border from the dome of the pleura descends behind the right sternoclavicular joint, then goes behind the manubrium to the middle of its connection with the body and from here descends behind the body of the sternum, located to the left of the midline, to the VI rib, where it goes to the right and passes into the lower border pleura. The lower border of the pleura on the right corresponds to the line of transition of the costal pleura to the diaphragmatic pleura. From the level of the junction of the cartilage of the VI rib with the sternum, the lower border of the pleura is directed laterally and downwards, along the mid-clavicular line it crosses the VII rib, along the anterior axillary line - the VIII rib, along the mid-axillary line - the IX rib, along the posterior axillary line - the X rib, along scapular line - XI rib and approaches the spinal column at the level of the neck of the XII rib, where the lower border passes into the posterior border of the pleura. On the left, the anterior border of the parietal pleura from the dome goes, just like on the right, behind the sternoclavicular joint (left). Then it is directed behind the manubrium and the body of the sternum down to the level of the cartilage of the IV rib, located closer to the left edge of the sternum; here, deviating laterally and downwards, it crosses the left edge of the sternum and descends near it to the cartilage of the VI rib (runs almost parallel to the left edge of the sternum), where it passes into the lower border of the pleura. The lower border of the costal pleura on the left is located slightly lower than on the right side. In the back, as well as on the right, at the level of the 12th rib it becomes the posterior border. The posterior border of the pleura (corresponds to the posterior line of transition of the costal pleura to the mediastinal) descends from the dome of the pleura down along the spinal column to the head of the XII rib, where it passes into the lower border (Fig. 245). The anterior borders of the costal pleura on the right and left are located unequally: along the length from the II to IV rib they run behind the sternum parallel to each other, and at the top and bottom they diverge, forming two triangular spaces free from the pleura - the upper and lower interpleural fields. Superior interpleural area with its apex facing downwards, it is located behind the manubrium of the sternum. In the area of ​​the upper space in children lies the thymus gland, and in adults - the remains of this gland and fatty tissue. Lower interpleural field, located with its apex upward, it is located behind the lower half of the body of the sternum and the adjacent anterior sections of the fourth and fifth left intercostal spaces. Here the pericardial sac is in direct contact with the chest wall. The boundaries of the lung and pleural sac (both right and left) basically correspond to each other. However, even with maximum inhalation, the lung does not completely fill the pleural sac, since it is larger than the organ located in it. The boundaries of the pleural dome correspond to the boundaries of the apex of the lung. The posterior border of the lungs and pleura, as well as their anterior border on the right, coincide. The anterior border of the parietal pleura on the left, as well as the lower border of the parietal pleura on the right and left, differ significantly from these borders in the right and left lungs.

69. Mediastinum: sections, their topography; mediastinal organs.

Mediastinum,mediastinum is a complex of organs located between the right and left pleural cavities (Fig. 247). The mediastinum is limited in front by the sternum, in the back by the thoracic spine, and on the sides by the right and left mediastinal pleura. At the top, the mediastinum extends to the superior thoracic aperture, and at the bottom to the diaphragm. Currently, the mediastinum is conventionally divided into two sections: the superior mediastinum and the inferior mediastinum. superior mediastinum,mediastinum superius, is located above the conventional horizontal plane drawn from the junction of the manubrium of the sternum with its body (in front) to the intervertebral cartilage between the bodies of the IV and V thoracic vertebrae (in the back). In the upper mediastinum are the thymus (thymus gland), the right and left brachiocephalic veins, the upper part of the superior vena cava, the aortic arch and the vessels extending from it (brachiocephalic trunk, left common carotid and left subclavian arteries), trachea, upper part of the esophagus and corresponding sections thoracic (lymphatic) duct, right and left sympathetic trunks, vagus and phrenic nerves.

inferior mediastinum,mediastinum inferius, is below the conventional horizontal plane. It is divided into anterior, middle and posterior mediastinum. Anterior mediastinum, mediastinum anterius, lying between the body of the sternum in front and the anterior wall behind, contains internal mammary vessels (arteries and veins), parasternal, anterior mediastinal and prepericardial lymph nodes. In the middle mediastinum, mediastinum medium, there are the pericardium with the heart located in it and the intracardial sections of large blood vessels, the main bronchi, pulmonary arteries and veins, the phrenic nerves with the accompanying diaphragmatic-pericardial vessels, the lower tracheobronchial and lateral pericardial lymph nodes. posterior mediastinum, mediastinum posterius, bounded by the pericardial wall anteriorly and the spine posteriorly. The organs of the posterior mediastinum include the thoracic part of the descending aorta, the azygos and semi-gypsy veins, the corresponding sections of the left and right sympathetic trunks, splanchnic nerves, vagus nerves, esophagus, thoracic lymphatic duct, posterior mediastinal and prevertebral lymph nodes.

In clinical practice, the mediastinum is often divided into two sections: anterior mediastinum, mediastinum anterius, And posterior mediastinum, mediastinum posterius. They are separated by a frontal plane, conventionally drawn through the roots of the lungs and the trachea. In the anterior mediastinum there are the heart with large vessels leaving and entering it, the pericardium, aortic arch, thymus, phrenic nerves, phrenic-pericardial blood vessels, internal thoracic blood vessels, parasternal, mediastinal and superior phrenic lymph nodes. In the posterior mediastinum there are the esophagus, thoracic aorta, thoracic lymphatic duct, azygos and semi-gypsy veins, right and left vagus and splanchnic nerves, sympathetic trunks, posterior mediastinal and prevertebral lymph nodes.

Lungs covered pleura, pleura (fig.; see fig.,). It, like the peritoneum, is a smooth, shiny serous membrane, tunica serosa. Distinguish parietal pleura, pleura parietalis, And visceral (pulmonary), pleura visceralis (pulmonalis), between which a gap is formed - pleural cavity, cavitas pleuralis filled with a small amount of pleural fluid.

Visceral(pulmonary) pleura directly covers the parenchyma of the lung and, being tightly fused with it, extends into the depths of the interlobar grooves.

Parietal the pleura is fused with the walls of the chest cavity and forms costal pleura, pleura costalis, And diaphragmatic pleura, pleura diaphragmatica, as well as laterally limiting the mediastinum mediastinal pleura, pleura mediastinalis(see fig.,). In the area of ​​the hilum of the lung, the parietal pleura passes into the pulmonary pleura, covering the root of the lung with a transitional fold in front and behind.

Below the root of the lung, the transitional fold of the pleura forms a duplication - pulmonary ligament, lig. pulmonary.

In the area of ​​the apex of the lungs, the parietal pleura forms dome of pleura, which in the upper sections is adjacent dorsally to the head of the first rib, and with its anterolateral surface adjoins the scalene muscles.

Parts of the pleural cavity in the form of an acute angle between two parietal layers, passing from one wall to another, are called pleural sinuses, recessus pleurales(see fig.).

The following sines are distinguished:

1. costophrenic sinus, recessus costodiaphragmaticus, located at the transition point of the costal pleura to the diaphragmatic pleura;
2. costomediastinal sinuses, recessus costomediastinales, are formed at the junction of the costal pleura into the mediastinal; the anterior sinus is behind the sternum, the posterior sinus, less pronounced, is in front of the spinal column;
3. diaphragmomediastinal sinus, recessus phrenicomediastinalis, lies at the transition point of the mediastinal pleura to the phrenic pleura.

The lower boundaries of the lungs do not coincide with the boundaries of the parietal pleura (see Fig. , , , ).

The lower border of the parietal pleura passes: along the linea mediana anterior - on the VI-VII rib; along the linea medioclavicularis (mamillaris) – on the VII rib (lower edge); along linea axillaris media – on the X rib; along the linea scapularis - on the XI-XII rib; along the linea paravertebralis - on the XII rib.

Thus, the depth of the costophrenic sinus is greatest along the linea axillaris media.

The anterior border of the parietal pleura of both lungs runs from the sternoclavicular joints down behind the manubrium and body of the sternum to the lower edge of the sternal ends of the fourth ribs. Here, the anterior edge of the pleura of the right lung continues down to the intersection of the VI rib with the linea mediana anterior, and the left lung at the level of the IV rib turns to the left and, describing the arc of the cardiac notch, follows down to the intersection of the VII rib with the linea medioclavicularis.

Respiratory system. General information………………………………………………………...4

Nose………………………………………………………………………………………..5

Larynx………………………………………………………………………………...7

Trachea………………………………………………………………………………...13

Main bronchi………………………………………………………...15

Lung………………………………………………………………………………...15

Pleura………………………………………………………………………………...21

Mediastinum………………………………………………………………………………...24

Urinary system. Male reproductive system. Female reproductive system. General information………………………………………………………..………………….26

Urinary organs…………………………………………………………………………………27

Kidney………………………………………………………………………………28

Ureter………………………………………………………………………………..33

Bladder………………………………………………………..35

Female urethra……………………………………37

Male genital organs………………………………………………………37

Internal male genital organs…………………………………..37

External male genitalia……………………………………44

Female genital organs……………………………………………………….48

Internal female genital organs…………………………………..48

External female genitalia…………………………………….53

Crotch………………………………………………………………………………..55

Questions of test self-control of knowledge……………………………………...59

Situational tasks………………………………………………………...74

Standards of correct answers……………………………………………………………..83

Respiratory system

General information

Respiratory system, sistema respiratorium ensures gas exchange between inhaled air and blood, and is also the main part of the voice-formation apparatus. The respiratory system consists of the respiratory tract and the respiratory organ itself – the lungs.

The airways are hollow organs that conduct air to the pulmonary alveoli. There are upper respiratory tracts - the external nose, nasal cavity and pharynx, and lower respiratory tracts - larynx, trachea, bronchi.

Development. During the process of phylogenesis, the respiratory organs of terrestrial vertebrates are formed in the form of an outgrowth of the intestinal tube. The nasal cavity is separated in the class of reptiles from the oral cavity as a result of the formation of the palate. These same processes are repeated in the development of the human embryo. The formation of the palate occurs in the 2nd month of the embryonic period. At the same time, a nasal septum is formed, which divides the nasal cavity into right and left parts. The external nose is formed from the median, medial and lateral nasal protrusions on the fetal face. The larynx and trachea are formed on the ventral wall of the primary pharynx in the form of a laryngeal-tracheal groove, which is separated from the primary esophagus and forms the laryngeal-tracheal tube - the rudiment of the larynx and trachea. In the larynx primordium, laryngeal cartilages are formed from the cartilages of the III-IV branchial arches.

The distal end of the laryngeal-tracheal tube expands to form the pulmonary kidney. The latter is divided into the rudiments of the right and left main bronchi. By budding, lobar bronchi are formed first (3 in the right and 2 in the left lung), and then bronchi of the third and next orders. As a result, the bronchial tree is formed. The respiratory parenchyma of the lungs is formed from the mesenchyme that surrounds the bronchi. Serous pleural cavities form around the lungs. Starting from the 5th month of the intrauterine period, pulmonary alveoli are formed, and the lungs can provide breathing for the fetus outside the mother’s body.

There is a distinction between the external nose and the nasal cavity (internal nose).

External nose, nasus externus , (Greek – rhis, rhinos ) It has:

1) root, radix nasi ;

2) backrest, backsum nasi ;

3) top, apex nasi ;

4) wings, alae nasi .

The lower edges of the wings of the nose limit the openings leading from the outside into the nasal cavity - the nostrils, nares. The bony basis of the external nose is formed by the nasal bones and the frontal processes of the upper jaws. The bony skeleton is supplemented by nasal cartilages, cartilagines nasi:

A) lateral nasal cartilage, cartilage nasi lateralis ;

b) large and small cartilages of the wings,cartilagines alares major et minores ;

V) accessory nasal cartilages, cartilagines nasalis accesoriae ;

G) nasal septum cartilage, cartilage septi nasi .

The external nose is a specific feature of humans; it is not expressed even in anthropoids. Nose shapes and sizes vary across race and ethnicity and are highly variable individually. The sizes are divided into large and small; by weight - thin and thick; in shape - narrow, wide, curved. The line of the back of the nose can be straight, convex (humpbacked nose) or concave (saddle nose). The base of the nose can be horizontal, raised (snub) or downturned.

Nasal cavity, cavitas nasi , steam room, separated nasal septum, septum nasi . In the partition there are:

1) the membranous part, which is adjacent to the nostrils;

2) the cartilaginous part, the basis of which is the cartilage of the nasal septum;

3) the bone part, which consists of a perpendicular plate of the ethmoid bone, vomer, sphenoid and palatine ridges.

The part of the nasal cavity adjacent to the nostrils is called vestibule of the nose, vestibulum nasi ; it is separated from the nasal cavity proper protruding threshold, limen nasi ; covered with skin that contains sweat and sebaceous hair glands - vibrissae. The nasal cavity itself is divided into two parts - olfactory, pars olfactoria , And respiratory, pars respiratoria . The olfactory region occupies the superior turbinate and the upper part of the nasal septum. This is where the olfactory receptor cells are located and where the olfactory nerves begin. The respiratory region covers the rest of the nasal cavity. It is lined with ciliated epithelium and contains numerous serous and mucous glands, blood and lymphatic vessels. In the submucosa of the middle and inferior turbinates there are cavernous venous plexuses; damage to the mucous membrane in this part of the nasal cavity can lead to severe nosebleeds.

The mucous membrane of the nasal cavity continues into the mucous membrane lining the paranasal sinuses, which open into the nasal passages. In newborns, the nasal cavity is low and narrow, the nasal turbinates are thick, the nasal passages are short and narrow; Of the paranasal sinuses, only the maxillary sinus is expressed; the rest are in their infancy and form in childhood. In old age, atrophy of the mucous membrane and its glands occurs.

Functions of the nasal cavity:

1) conducting air during breathing;

2) humidification of inhaled air;

3) purification of air from foreign particles.

Anomalies of the external nose and nasal cavity

1. Arinia – congenital absence of the nose.

2. Dirynia - doubling of the nose, most often its apex is split.

3. Deviation of the nasal septum. Leads to difficulty in nasal breathing and the outflow of fluid from the paranasal sinuses.

4. Choanal atresia. Makes nasal breathing impossible, observed in some hereditary congenital malformations (syndromes).

Larynx

Larynx, larynx, belongs to the lower respiratory tract and is a voice-forming organ.

Topography

Holotopia: The larynx is located in the middle part of the anterior region of the neck; it protrudes under the skin, forming laryngeal protrusion, prominentia laryngis , more pronounced in men (Adam's apple).

Skeletotopia: in adults, the larynx is located at the level of the IV-VI cervical vertebrae.

Syntopy: at the top the larynx is suspended from the hyoid bone, at the bottom it continues into the trachea. The thyroid gland lies in front and to the sides of it. The main neurovascular bundle of the neck (carotid arteries, internal jugular vein and vagus nerve) runs laterally. In front, the larynx is not completely covered by the sublingual muscles with the pretracheal plate of the cervical fascia. The laryngeal part of the pharynx is located at the back. Here it is entrance to the larynx, aditus laryngis ; it is limited by the epiglottis and two folds of the mucous membrane that extend from the epiglottis downward and posteriorly. At the posterior end of these folds protrudes horn-shaped tubercle, tuberculum corniculatum , And wedge-shaped tubercle, tuberculum cuneiforme , which correspond to the cartilages of the same name located in the thickness of the fold.

From the upper edge of the epiglottis, the unpaired median and paired lateral glossoepiglottic folds, plicae glossoepiglotticae mediana et laterales, go to the root of the tongue. They limit the fossae of the epiglottis, valleculae epiglotticae.

Structure of the larynx

The skeleton of the larynx is formed by unpaired and paired cartilages.

Thyroid cartilage, cartilago thyroidea , unpaired, hyaline. It consists of two plates that converge at an angle to each other. For men this angle is acute. At the junction of the plates on top there is tenderloin, incisura thyroidea . From the rear edge of each plate, the upper horns, cornu superior, are long and narrow, and the lower horns, cornu inferior, are short and wide. The inferior horns connect to the cricoid cartilage. Visible on the outer surface of the thyroid cartilage oblique line, linea oblique , – the place of attachment of the sternothyroid and thyrohyoid muscles.

Cricoid cartilage, cartilago cricoidea , unpaired, hyaline, lies at the base of the larynx. Its front part forms an arc, the back part – a plate. On the sides of the plate there is a paired articular surface for articulation with the thyroid cartilage, and in its upper part there is a paired surface for articulation with the arytenoid cartilages.

Arytenoid cartilage, cartilago arytenoidea , paired, hyaline, pyramid-shaped. It has a top and a base. At the base there is an articular surface for articulation with the cricoid cartilage. Two branches extend from the base:

2) muscular process, processus muscularis , - the place of attachment of the muscles of the larynx, is built of hyaline cartilage.

Epiglottis, epiglottis , unpaired, elastic. At the bottom it narrows, forming stalk, petiolus .

Wedge-shaped and cornicular cartilages, cartilagines cuneiformis et corticulatae , paired, elastic, located above the apex of the arytenoid cartilages.

The cartilages of the larynx are connected to each other and to neighboring formations through ligaments, membranes and joints.

Between the larynx and the hyoid bone is located thyrohyoid membrane, membrana thyrohyoidea , in which the median and paired lateral thyrohyoid ligaments are distinguished. The latter arise from the superior horns of the thyroid cartilage. The epiglottis fixes two ligaments:

1) sublingual-epiglottic, lig. hyoepiglotticum;

2) thyroid-epiglottic, lig. thyroepiglotticum .

The thyroid cartilage is connected to the arch of the cricoid cartilage through cricothyroid ligament, lig. cricothyroideum . The cricoid cartilage connects to the trachea cricotracheal ligament, lig. cricatracheale . Located under the mucous membrane fibro-elastic membrane of the larynx, membrana fibroelastica laryngis ; in the upper part of the larynx it forms quadrangular membrane, membrane quadrangularis , and in the lower part – elastic cone, cone elasticus . The lower edge of the quadrangular membrane forms a steam room vestibular ligament, lig. vestibulare , and the upper edge of the elastic cone is the steam room vocal cord, lig. vocal , which is stretched between the angle of the thyroid cartilage and the vocal process of the arytenoid cartilage.

The joints of the larynx are paired, combined:

1. cricothyroid joint, art. cricothyroidea , formed by the articulation of the articular surfaces of the cricoid cartilage with the lower horns of the thyroid cartilage. Has one transverse axis of rotation. When the thyroid cartilage moves forward, the vocal folds lengthen and tighten, and when it moves backward, they relax.

2. Cricoarytenoid joint, art. cricoarytenoidea , formed by the articulation of the articular surfaces of the cricoid cartilage with the articular surfaces of the arytenoid cartilages. Has a vertical axis of rotation. When the arytenoid processes rotate inward, the vocal cords come closer together (the glottis narrows), and when they rotate outward, they move away from each other (the glottis widens).

The muscles of the larynx are striated, voluntary, move the cartilages of the larynx relative to each other, change the size of the glottis and the tension of the vocal cords (folds). There are external and internal muscles of the larynx.

According to function, the muscles of the larynx are divided into three groups.

A) lateral cricoarytenoid muscle, m. crycoarytenoideus lateralis.

Start: upper edge of the cricoid cartilage arch.

Attachment: muscular process of the arytenoid cartilage.

Function: rotates the arytenoid cartilage around a vertical axis; in this case, the vocal process moves medially and the vocal cords come closer together.

b) thyroarytenoid muscle , m. thyroarytenoideus .

Start: inner surface of the lamina of the thyroid cartilage.

Attachment: anterolateral surface of the arytenoid cartilage.

Function: similar to the previous muscle.

V) transverse arytenoid muscle, m. arytenoideus transversus.

G) oblique arytenoid muscle, m. arytenoideus obliquus .

Start and Attachment: posterior surfaces of the arytenoid cartilages.

Function: Both muscles bring the arytenoid cartilages closer to the midplane, promoting closure of the glottis.

d) aryepiglottic mouse, m. aryepiglotticus , is a continuation of the oblique arytenoid muscle, passes in the fold of the same name.

Function: narrows the entrance to the larynx and the vestibule of the larynx, pulls the epiglottis back and down, covering the entrance to the larynx when swallowing.

A) posterior cricoarytenoid , m. cricoarytenoideus posterior .

Start: posterior surface of the cricoid cartilage plate.

Attachment: muscular process of the arytenoid cartilage.

Function: rotates the arytenoid cartilage around a vertical axis, turning the vocal processes laterally, while the glottis expands.

A) cricothyroid muscle, m. cricothyroideus.

Start: arch of cricoid cartilage.

Attachment: the lower edge of the thyroid cartilage and its lower horn.

Function: tilts the thyroid edge forward, increasing the distance between it and the vocal process, while the vocal cords lengthen and stretch;

Start: inner surface of the thyroid cartilage.

Function: the muscle contains longitudinal, vertical, and oblique fibers. Longitudinal fibers shorten the vocal cord, vertical fibers strain it, and oblique fibers strain individual parts of the vocal cord.

Laryngeal cavity, cavitas laryngis , resembles an hourglass and is divided into three sections: the vestibule of the larynx, the interventricular part and the subglottic cavity.

Vestibule of the larynx, vestibulum laryngis , extends from the entrance to the larynx to the vestibular folds, which include the vestibular ligaments.

Interventricular part, pars interventricularis , located from the vestibule to the vocal folds, the narrowest place of the larynx, up to 1 cm high. Vocal folds, plicae vocals , contain in their posterior part the vocal processes of the arytenoid cartilages, and in the anterior part - the elastic vocal fold and vocal muscle. Both vocal folds limit the glottis, rima glottidis s. vocalis . It distinguishes the back - intercartilaginous part, pars intercartilaginea , and the front - intermembranous part, pars intermembranacea . Between the vestibular and vocal folds on each side there is a depression - ventricle of the larynx , ventriculus laryngis .

Subglottic cavity, cavitas infraglottica , extends from the vocal folds to the beginning of the trachea. The mucous membrane of the larynx is lined with stratified ciliated epithelium. The exception is the vocal folds, which are covered with stratified squamous epithelium.

The function of the larynx as a respiratory and vocal organ. The muscles attached to the hyoid bone (supra- and hyoid) raise, lower, or fix the larynx. When swallowing, the larynx is raised by the action of the suprahyoid muscles, the root of the tongue moves posteriorly and presses on the epiglottis so that it covers the entrance to the larynx. This is facilitated by the contraction of the thyroepiglottic and aryepiglottic muscles.

With quiet breathing and whispering, the intermembranous part of the glottis is closed, and the intercartilaginous part is open in the form of a triangle by the action of the lateral cricoarytenoid muscle. During deep breathing, both parts of the glottis are opened in a diamond shape by the action of the posterior cricoarytenoid muscle. At the beginning of vocal production, the glottis closes and the vocal cords become tense. The flow of exhaled air causes vibrations in the vocal folds, resulting in sound waves. The strength of sound is determined by the strength of the air flow, which depends on the lumen of the glottis, and the timbre of the voice is determined by the frequency of vibration of the vocal folds. The installation of the vocal folds is carried out by the cricothyroid muscle and the muscles attached to the muscular process, and more precisely, it is modeled by the vocal muscle.

The resonators of sound produced by the vocal apparatus are the pharynx, oral and nasal cavities, and paranasal sinuses. The pitch of the voice depends on the individual structural features of the sound resonators. Due to the position of the larynx in a person, the sounding air flow is directed to the speech organs - palate, tongue, teeth and lips. When coughing, a closed glottis opens with expiratory impulses.

Age characteristics. In newborns, the larynx is located at the level of the II-IV cervical vertebrae. The epiglottis touches the uvula. The larynx is short and wide, its cavity is funnel-shaped, and there is no laryngeal prominence. The vocal folds are short, the ventricles of the larynx are shallow. Rapid growth of the larynx occurs in children 3 years old, at 5-7 years old, and especially during puberty. At 12-13 years old, the length of the vocal folds in girls increases by 1/3, and in boys at 13-15 years old, by 2/3. This causes a mutation (fracture) of the voice in boys. In men, growth of the vocal folds continues until the age of 30. Gender differences in voice are due to the greater length of the vocal folds and glottis in men. In old age, the cartilage of the larynx becomes calcified, the vocal cords become less elastic, which leads to a change in voice.

Anomalies of the larynx

1. Atresia, stenosis.

2. Formation of septa in the laryngeal cavity.

3. Aplasia of the epiglottis. In this case, the entrance to the larynx is not closed.

4. Laryngeal-esophageal fistulas. They are formed when the laryngeal primordium is incompletely separated from the digestive tube.

Trachea

Trachea, trachea , (windpipe), - an unpaired tubular organ, serves to conduct air.

Topography

Holotopia: cervical part, pars cervicalis, is located in the lower part of the anterior cervical region; The thoracic part, pars thoracica, lies in the anterior part of the upper mediastinum.

Skeletotopia: in adults it begins at the level of the VI cervical vertebra and ends at the level of the V thoracic vertebra (2-3 rib), where it forms a bifurcation, bifurcatio tracheae , that is, it is divided into two main bronchi.

Syntopy: the thyroid gland is adjacent to the cervical part in front and on the sides, and the hypoglossal muscles are also located. There is a gap between the edges of the muscles in the midline, where the trachea is covered only by the pretracheal plate of the cervical fascia. Between this plate and the trachea there is a pretracheal cellular space that communicates with the mediastinum. The thoracic part of the trachea borders in front with the aortic arch, brachiocephalic trunk, left brachiocephalic vein, left common carotid artery, thymus gland, laterally with the mediastinal pleura, behind with the esophagus throughout the trachea.

Structure of the trachea

The tracheal skeleton is 16-20 hyaline half rings, cartilagines tracheales . They are connected to each other by fibrous annular ligaments, ligg. anularia . At the top, the trachea is connected to the cricoid cartilage of the larynx by the cricotracheal ligament. The cartilages of the trachea form the anterior and lateral walls, the posterior wall of the trachea - membranous, paries membranaceus , contains connective tissue, circular and longitudinal bundles of smooth muscles. The tracheal cavity is lined with a mucous membrane with stratified ciliated epithelium; it contains branched mucous glands and lymphatic follicles. Externally, the trachea is covered with an adventitial membrane.

Age characteristics. In newborns, the trachea begins at the level of the IV cervical vertebra, and its bifurcation projects to the III thoracic vertebra. Tracheal cartilages and glands are poorly developed. The growth of the trachea occurs most intensively in the first 6 months after birth and during puberty. The final position of the trachea is established after 7 years. In old age, atrophy of the mucous membrane, glands, lymphoid tissue, and calcification of cartilage are observed.

Tracheal anomalies

1. Atresia and stenosis.

2. Deformation and splitting of cartilage.

3. Tracheo-esophageal cartilages.

Main bronchi

Main bronchi, right and left, bronchi principales dexter et sinister , depart from the bifurcation of the trachea and go to the gates of the lungs. The right main bronchus has a more vertical direction, wider and shorter than the left bronchus. The right bronchus consists of 6-8 cartilaginous half-rings, the left - 9-12 half-rings. Above the left bronchus lie the aortic arch and the pulmonary artery, below and anteriorly there are two pulmonary veins. The right bronchus is surrounded by the azygos vein from above, and the pulmonary artery and pulmonary veins pass below. The mucous membrane of the bronchi, like the trachea, is lined with stratified ciliated epithelium and contains mucous glands and lymphatic follicles. At the hilum of the lungs, the main bronchi are divided into lobar bronchi. Further branching of the bronchi occurs inside the lungs. The main bronchi and their branches form the bronchial tree. Its structure will be discussed when describing the lungs.

Lung

Lung, pulmo (Greek pneumonia ), is the main organ of gas exchange. The right and left lungs are located in the chest cavity, occupying its lateral sections together with their serous membrane - the pleura. Each lung has top, apex pulmonis , And base, basis pulmonis . The lung has three surfaces:

1) costal surface, facies costalis , adjacent to the ribs;

2) diaphragmatic surface, facies diaphragmatica , concave, facing the diaphragm;

3) medial surface, facies medialis . The medial surface in its anterior part borders mediastinum – pars mediastinalis , and in its rear part – with spinal column, pars vertebralis .

Separates the costal and medial surfaces anterior edge of the lung, margo anterior ; in the left lung the anterior edge forms heart tenderloin, incisura cardiaca , which is bounded below uvula of the lung, lingula pulmonis . The costal and medial surfaces are separated from the diaphragmatic surface the lower edge of the lung, margo inferior . Each lung is divided into lobes by interlobar fissures, fissurae interlobares. Oblique slot, fissura obliqua , begins on each lung 6-7 cm below the apex, at the level of the III thoracic vertebra, separating the upper from the lower lung lobes, lobus pulmonissuperior et inferior . Horizontal slot , fissura horizontalis , present only in the right lung, located at the level of the IV rib, and separates the upper lobe from the middle lobe, lobus medius . The horizontal gap is often not expressed throughout its entire length and may be completely absent.

The right lung has three lobes - upper, middle and lower, and the left lung has two lobes - upper and lower. Each lobe of the lungs is divided into bronchopulmonary segments, which are the anatomical and surgical unit of the lung. Bronchopulmonary segment- this is a section of lung tissue surrounded by a connective tissue membrane, consisting of individual lobules and ventilated by a segmental bronchus. The base of the segment faces the surface of the lung, and the apex faces the root of the lung. In the center of the segment there are a segmental bronchus and a segmental branch of the pulmonary artery, and in the connective tissue between the segments there are pulmonary veins. The right lung consists of 10 bronchopulmonary segments - 3 in the upper lobe (apical, anterior, posterior), 2 in the middle lobe (lateral, medial), 5 in the lower lobe (upper, anterior basal, medial basal, lateral basal, posterior basal). The left lung has 9 segments - 5 in the upper lobe (apical, anterior, posterior, superior lingular and inferior lingular) and 4 in the lower lobe (superior, anterior basal, lateral basal and posterior basal).

On the medial surface of each lung at the level of the V thoracic vertebra and II-III ribs are located gate of the lungs , hilum pulmonis . Gate of the lungs- this is the place where the root of the lung enters, radix pulmonis, formed by a bronchus, vessels and nerves (main bronchus, pulmonary arteries and veins, lymphatic vessels, nerves). In the right lung, the bronchus occupies the highest and dorsal position; the pulmonary artery is located lower and more ventral; even lower and more ventral are the pulmonary veins (PAV). In the left lung, the pulmonary artery is located highest, lower and dorsal is the bronchus, and even lower and ventral are the pulmonary veins (PV).

Bronchial tree, arbor bronchialis , forms the basis of the lung and is formed by the branching of the bronchus from the main bronchus to the terminal bronchioles (XVI-XVIII orders of branching), in which air movement occurs during breathing (Fig. 1).

The total cross-section of the respiratory tract increases from the main bronchus to the bronchioles by 6,700 times, so as air moves during inhalation, the speed of the air flow decreases many times. The main bronchi (1st order) at the gates of the lung are divided into lobar bronchi, btonchi lobares . These are the bronchi of the second order. The right lung has three lobar bronchi - upper, middle, lower. The right upper lobar bronchus lies above the pulmonary artery (epiarterial bronchus), all other lobar bronchi lie below the corresponding branches of the pulmonary artery (hypoarterial bronchi).

The lobar bronchi are divided into segmental bronchi(3 orders), bronchi segmentales , ventilating bronchopulmonary segments. Segmental bronchi are divided dichotomously (each into two) into smaller bronchi of 4-9 orders of branching; included in the lobules of the lung, these are lobular bronchi, bronchi lobulares . lobe of lung, lobules pulmonis, is a section of lung tissue limited by a connective tissue septum, with a diameter of about 1 cm. There are 800-1000 lobules in both lungs. The lobular bronchus, having entered the lung lobule, gives off 12-18 terminal bronchioles, bronchiole terminales . Bronchioles, unlike bronchi, do not have cartilage and glands in their walls. Terminal bronchioles have a diameter of 0.3-0.5 mm; smooth muscles are well developed in them, with the contraction of which the lumen of the bronchioles can decrease by 4 times. The mucous membrane of the bronchioles is lined with ciliated epithelium.

Each terminal bronchiole is divided into respiratory bronchioles, bronchiole respiratorii , on the walls of which pulmonary vesicles appear, or alveoli, alveolae pulmonales . The respiratory bronchioles form 3-4 orders of branching, after which they are radially divided into alveolar ducts, ductuli alveolares . The walls of the alveolar ducts and sacs consist of pulmonary alveoli with a diameter of 0.25-0.3 mm. The alveoli are separated by septa in which networks of blood capillaries are located. Through the wall of the alveoli and capillaries, exchange takes place between blood and alveolar air. The total number of alveoli in both lungs is about 300 million in an adult, and their surface is about 140 m2. Respiratory bronchioles, alveolar ducts and alveolar sacs with alveoli make up alveolar tree, or respiratory parenchyma of the lung. The functional and anatomical unit of the lung is considered acini. It is part of the alveolar tree into which one terminal bronchiole branches (Fig. 2). Each lung lobe contains 12-18 acini. The total number of branches of the bronchial and alveolar tree from the main bronchus to the alveolar sacs is 23-25 ​​orders of magnitude in an adult.

The structure of the lung ensures that during breathing movements there is a constant change of air in the alveoli and contact of alveolar air with blood. This is achieved by respiratory excursions of the chest, contraction of the respiratory muscles, contraction of the respiratory muscles, including the diaphragm, as well as the elastic properties of the lung tissue itself.

Age characteristics. The lungs of a non-breathing fetus differ from the lungs of a newborn baby in their specific gravity. In the fetus it is above one, and the lungs drown in water. The specific gravity of a breathing lung is 0.49, and it does not sink in water. The lower borders of the lungs in newborns and infants are located one rib lower than in adults. In the lungs, elastic tissue and interlobar septa are well developed, so the boundaries of the lobules are clearly visible on the surface of the lung.

After birth, lung capacity increases rapidly. The vital capacity of a newborn is 190 cm 3 , by the age of 5 it increases five times, by the age of 10 – ten times. Up to 7-8 years, new alveoli are formed and the number of branching orders of the alveolar tree increases. The dimensions of the alveoli are 0.05 mm in a newborn, 0.2 mm in an 8-year-old child, and 0.3 mm in an adult.

In old and senile age, atrophy of the mucous membrane of the bronchi, glands and lymphoid formations occurs, the cartilage in the walls of the bronchi becomes calcified, the elasticity of the connective tissue decreases, and ruptures of the interalveolar septa are observed.

Anomalies of the bronchi and lungs

1. Agenesis and aplasia of the main bronchus and lung.

2. Absence of one of the lobes of the lung along with the lobar bronchus.

3. Bronchial atresia with congenital atelectasis (collapse) of the corresponding part of the lung (lobe or segment).

4. Accessory lobes located outside the lung, not connected to the bronchial tree and not involved in gas exchange.

5. Unusual division of the lung into lobes in the absence of a horizontal fissure in the right lung or when the upper part of the lower lobe is separated by an additional fissure.

6. An abnormal lobe of the azygos vein, lobus venae azygos, is formed when the azygos vein passes through the apex of the right lung.

7. The origin of the right upper lobe bronchus directly from the trachea (tracheal bronchus).

8. Broncho-esophageal fistulas. They have the same origin as tracheal-esophageal fistulas.

9. Bronchopulmonary cysts are congenital dilatations of the bronchi (bronchiectasis) with liquid contents.

Pleura

Pleura, pleura , is the serous membrane of the lung, consisting of visceral and parietal plates. Visceral(pulmonary) pleura, pleura visceralis (pulmonalis), fuses with the lung tissue and extends into the interlobar fissures. Forms pulmonary ligament, lig. Pulmonale , which goes from the root of the lung to the diaphragm. It has villi that secrete serous fluid. This liquid adheres the visceral pleura to the parietal pleura, reduces friction of the surfaces of the lungs during breathing, and has bactericidal properties. At the root of the lung, the visceral pleura transforms into the parietal pleura.

parietal pleura, pleure parietalis , fuses with the walls of the chest cavity, it has microscopic openings (stomata), through which serous fluid is absorbed into the lymphatic capillaries.

The parietal pleura is topographically divided into three parts:

1) costal pleura, pleura costalis , covers the ribs and intercostal spaces;

2) diaphragmatic pleura, pleura diaphragmatica covers the diaphragm;

3) mediastinal pleura, pleura mediastinalis , goes in the sagittal cavity, limiting the mediastinum. Above the apex of the lung, the parietal pleura forms the pleural dome.

In places where one part of the parietal pleura transitions to another, depressions are formed - pleural sinuses, sinus pleuralis . These are reserve spaces into which the lungs enter when inhaling deeply. Serous fluid can also accumulate in them during inflammation of the pleura, when the processes of its formation or absorption are disrupted.

1. Costophrenic sinus, recessus costodiafragmaticus , paired, formed at the transition of the costal pleura to the mediastinal pleura, expressed on the left in the area of ​​the cardiac notch of the lung.

2. Phrenic-mediastinal sinus, recessus phrenicomediastinalis , paired, located at the transition of the mediastinal pleura to the diaphragmatic one.

3. Costomedial sinus , recessus costomediastinalis , located at the point of transition of the costal pleura (in its anterior section) into the mediastinal; poorly expressed.

Pleural cavity, cavitas pleurae, - this is a slit-like space between two visceral or between two parietal layers of the pleura with a minimal amount of serous fluid.

Boundaries of the lungs and pleura

There are upper, anterior, lower and posterior borders of the lungs and pleura.

Upper the border is the same for the right and left lungs and the dome of the pleura is 2 cm above the collarbone or 3-4 cm above the first rib; posteriorly it is projected at the level of the spinous process of the VII cervical vertebra.

Front the border passes behind the sternoclavicular joint to the junction of the manubrium and the body of the sternum and from here descends along the sternum line to the cartilage of the VI rib on the right and the cartilage of the IV rib on the left. On the right, at the level of the cartilage of the sixth rib, the anterior border becomes the lower border.

On the left, the border of the lung runs horizontally behind the IV rib to the midclavicular line, and the border of the pleura is at the same level to the parasternal line. From here, the borders of the left lung and hymen descend vertically down to the VI rib, where they pass into their lower borders.

Two triangular spaces are formed between the anterior borders of the right and left pleura:

1) superior interpleural space field, area interpleurica superior , located behind the manubrium of the sternum, the thymus gland is located here;

2) inferior interpleural field, area interpleurica inferior , located behind the lower third of the sternum, here between the right and left pleura lies the heart with the pericardium.

The lower border of the right lung crosses the VI rib along the midclavicular line, the VII rib along the anterior axillary line, the VIII rib along the middle axillary line, the IX rib along the posterior axillary line, the X rib along the scapular line, and the paravertebral line ends at the level of the neck of the XI rib. (Table 1). The lower border of the left lung is basically the same as on the right, but approximately the width of the rib below (along the intercostal spaces). The lower border of the pleura corresponds to the junction of the costal pleura and the diaphragmatic pleura. On the left it is also located slightly lower than on the right, crossing the VII-XI intercostal spaces along the lines described above.

Table 1

Lower borders of the right lung and pleura

The discrepancy between the lower boundaries of the pleura and lungs is caused by the costophrenic sinuses. The lower borders of the lungs and pleura are individually variable. With a brachymorphic body type with a wide chest, they can be located higher than in people of a dolichomorphic type with a narrow, long chest.

Posterior border in both lungs it goes the same way. The posterior blunt edge of the organ is projected along the spinal column from the neck of the 11th rib to the head of the 2nd rib.

Mediastinum

Mediastinum, mediastinum , is a complex of organs located in the chest cavity between the right and left pleural cavities. In front it is limited by the sternum and costal cartilages; behind – thoracic vertebrae; on the right and left – mediastinal pleura; from below - the diaphragm. At the top, the mediastinum communicates with the neck region through the superior thoracic aperture.

The greatest clinical significance is the division of the mediastinum into front and back, mediastinum anterius et posterius . They are separated by a frontal plane, conventionally drawn through the trachea and roots of the lungs.

To the organs front The mediastinum includes the heart with the pericardial sac and the beginning of large vessels, the thymus gland, phrenic nerves, pericardial-phrenic vessels, internal thoracic blood vessels, and lymph nodes.

IN rear The mediastinum contains the esophagus, the thoracic part of the descending aorta, the thoracic lymphatic duct, the azygos and semi-gypsy veins, the right and left vagus and splanchnic nerves, sympathetic trunks, and lymph nodes.

There is another classification that involves dividing the mediastinum into upper and lower. The boundary between them is a conventional horizontal plane, passing in front through the junction of the manubrium with the body of the sternum, in the back - through the disc between the IV and V thoracic vertebrae, i.e. at the level of the tracheal bifurcation.

IN upper mediastinum, mediastinum superior located: the thymus gland, large pericardial vessels, vagus and phrenic nerves, sympathetic trunk, thoracic lymphatic duct, upper part of the thoracic esophagus.

In the bottom mediastinum mediastinum inferior , in turn, the anterior, middle and posterior mediastinum are distinguished. The border between them runs along the anterior and posterior surfaces of the pericardial sac:

· anterior mediastinum, mediastinum anterior , contains fatty tissue and blood vessels;

· middle mediastinum,mediastinum medius , corresponds to the location of the heart with the pericardium, large pericardial vessels and roots of the lungs. The phrenic nerves also pass here, accompanied by the phrenic-pericardial vessels, and the lymph nodes of the lung root are located;

· posterior mediastinum, mediastinum posterior , contains the thoracic part of the descending aorta, azygos and semi-gypsy veins, right and left sympathetic trunks, vagus, splanchnic nerves, thoracic lymphatic duct, middle and lower parts of the thoracic esophagus, lymph nodes.

This is a serous membrane that covers the lungs on all sides. Pleura covering the lungs - le gas room or visceral pleura , coming along the root of the lung and passes to the walls of the chest cavity, forming a closed loop around each lung pleural sac-right and left. Priste night , or parietal the pleura lines the walls of the chest cavity. In the parietal pleura there are costal pleura, adjacent to the ribs diaphragmnew pleura And mediastinal (mediastinal) pleura. There is a narrow gap between the parietal and visceral pleura - pleural cavity , containing a small amount of serous fluid. This fluid wets the contacting surfaces of the visceral and parietal pleura, facilitating the sliding of the lungs during breathing.

At the junction of one pleura to another there are spaces - pleural sinuses , into which the edges of the lungs enter only with maximum inspiration. The deepest sinus is costodiaphragmny sinus.

Boundaries of the lungs and pleural cavities.

Tops the lungs in front are located 3-4 cm above the first rib or 2 cm above the collarbone.

Front border . It goes from its top through the sternoclavicular joint, then through the middle of the connection of the manubrium and the body of the sternum, then down: at right lung to the cartilage of the 6th rib, at left lung to the cartilage of the 4th rib. Here the border of the left deviates to the left by 4-5 cm, forming cardiac tenderloin. At the level of the cartilage of the 6th and 4th ribs, the anterior border of the lungs passes into the lower one.

Lower border. It is determined taking into account vertical lines:

1) parasternalwhethernia - runs along the edge of the sternum on both sides;

2) midclavicular line - passes vertically through the middle of the collarbone;

3) frontaxillaryline - passes along the anterior axillary fold;

4) middle axillaryline- goes down from the deepest point of the axillary fossa; 5) posterior axillary line- runs along the posterior axillary fold;

6) scapularline- passes through the lower angle of the scapula;

7) paravertebral line - runs along the spinal column.

Bottom line lung along the midclavicular line it crosses the VI rib, along the midaxillary line - the VIII rib, along the scapular line - the X rib, along the paravertebral line - the XI rib, here the lower border passes into back border, going up along the spine. The lower border of the left lung is located slightly below the border of the right lung.

Top and front pleural boundaries coincide with the same boundaries of the lungs. The lower border of the pleura is determined along the same lines as the lungs, only one rib lower.

Mediastinum

Mediastinum called a complex of organs located in the chest cavity between the right and left lungs. The mediastinum is limited in front by the posterior surface of the sternum, in the back by the thoracic spine, and below by the diaphragm. At the top, the mediastinum communicates with the neck region through the superior aperture of the thoracic cavity. The mediastinum contains the heart and pericardium, aorta, superior vena cava, thymus, trachea and main bronchi, esophagus, thoracic lymphatic duct and mediastinal lymph nodes, vagus and phrenic, as well as other arteries, veins, and nerves.