Anatomy III: Blood and the Cardiovascular and Respiratory Systems

Anatomy III: Blood and the Cardiovascular and Respiratory Systems

Lesson 10: Arteries, Veins, Lymphatic Vessels and Nerves of the Lung

CEU
Universidad
Cardenal Herrera
Anatomy III: Blood and the
Cardiovascular and Respiratory
Systems
Dr. José Luis Monroy Antón
6 CMLesson 10
Arteries, veins, lymphatic vessels
and nerves of the lung

CEU
Universidad
Cardenal Herrera
2Scheme of the lesson
We have seen most of the circulatory system of the lung in previous
lessons:

• Pulmonary arteries and veins: seen on lesson of the
  tracheobronchial tree, but summarized in the next slides
• Bronchial arteries and veins: unseen
• Lymphatics of the lungs: unseen. We will see them again in
  the lesson about the lymphatics of the mediastinum
• Nerves of the lungs: unseen

CEU
Universidad
Cardenal Herrera
3Pulmonary arteries

• Each lung has normally one pulmonary artery supplying blood to it and two
  pulmonary veins draining blood from it
• At the hilum they divide into secondary lobar arteries:
  - Right and left superior lobar arteries to the superior lobes. They are the first
  arteries to arise, before the entry of the hilum
  - Intermediate artery that will divide into middle and inferior lobar arteries of the
  right lung or only inferior in the left lung
• Lobar arteries divide into tertiary segmental arteries, branching simultaneously with
  the segmentary bronchi
• Usually, the artery is located on the anterior aspect of the corresponding bronchus.

CEU
Universidad
Cardenal Herrera
4Pulmonary veins

• Two pulmonary veins, a superior and an
  inferior pulmonary vein on each lung,
  carry oxygen-rich arterial blood from
  corresponding lobes of each lung to the
  left atrium of the heart
• The middle lobe vein drains at the right
  superior pulmonary vein
• The pulmonary veins run independently
  of the arteries and bronchi in the lung,
  coursing between and receiving blood
  from adjacent bronchopulmonary
  segments as they run toward the hilum

CEU
Universidad
Cardenal Herrera
5Bronchial arteries
Bronchial arteries supply blood to:

• The structures of the root of the lungs
• The supporting tissue of the lung
• Visceral pleura
  Arch of aorta
  Right superior
  posterior
  intercostal
  artery
  Left superior
  intercostal artery
  Bronchial arteries
  Right 3rd
  intercostal
  artery
  Esophageal artery
  Thoracic aorta
• Left bronchial arteries: two arteries that arise from the thoracic aorta
• Right bronchial artery: single artery that can rise from:
  - Aorta
  - One of the upper posterior intercostal arteries
  - Common trunk with the left superior bronchial artery

CEU
Universidad
Cardenal Herrera
6Bronchial artery and vein
Bronchial arteries

• Bronchial arteries are very small in size
• First, they provide some branches for the esophagus
• Then, they pass along the posterior surface of the main
  bronchi, supplying them until the respiratory bronchioles
• The most distal branches anastomose with branches of
  the pulmonary arteries in the walls of the bronchioles and
  in the visceral pleura
• The parietal pleura is supplied by the arteries that supply
  the thoracic wall: anterior intercostal, posterior intercostal,
  collateral, etc.
  0

CEU
Universidad
Cardenal Herrera
7Bronchial veins

• They drain only part of
  the blood supplied to
  the lungs by the
  bronchial arteries
• Bronchial veins also
  receive some blood
  from esophageal
  veins
  Right
  brachiocephalic
  vein
  Left superior
  intercostal vein
  Left
  brachiocephalic
  vein
  Superior
  vena cava
  Left
  bronchial veins
  Right bronchial
  veins
  Accessory
  hemi-azygos vein
  Azygos vein
  Hemi-azygos vein

CEU
Universidad
Cardenal Herrera
8Bronchial veins

• Right bronchial vein:
  drains into the azygos vein
• Left bronchial vein: can
  drain into:
  - Accesory hemi-
  azygos vein, or
  - Left superior
  intercostal vein
• Pulmonary veins: drain:
  - Visceral pleura
  - Peripheral regions of
  the lung
  Right
  brachiocephalic
  vein
  Left superior
  intercostal vein
  Left
  brachiocephalic
  vein
  Superior
  vena cava
  Left
  bronchial veins
  Right bronchial
  veins
  Azygos vein
  Accessory
  hemi-azygos vein
  Hemi-azygos vein

CEU
Universidad
Cardenal Herrera
9Pulmonary lymphatic drainage
Inferior deep cervical (scalene) node
Trachea
Esophagus
Tracheal (paratracheal) node
Right internal jugular vein
Inferior deep cervical
(scalene) node
Right lymphatic duct
Left internal jugular vein
Supraclavicular nodes
Left jugular lymphatic trunk
Right subclavian lymphatic trunk
Supraclavicular nodes
Right subclavian vein
Left subclavian
lymphatic trunk
Right bronchomediastinal trunk
Thoracic duct
Superior tracheobronchial
node
Left subclavian vein
Bronchopulmonary (hilar)
nodes
Left bronchomediastinal
trunk
Aortic arch node
Pulmonary (intrapulmonary)
nodes
Inferior tracheobronchial
(carinal) node
Subpleural lymphatic
plexus
Bronchopulmonary
(hilar) nodes
Interlobular lymphatic
vessels
Pulmonary nodes
Drainage from
bronchopulmonary
lymphatic plexus

CEU
Universidad
Cardenal Herrera
10Pulmonary lymphatic plexus

• Lymph from the parietal pleura will drain at the thoracic wall
  lymph nodes: intercostal, parasternal, mediastinal, and
  phrenic
  - Lymph from the cervical zone of parietal pleura can drain
  directly into the axillary lymph nodes.
  The lymphatic vessels of the lung begin from:
• 1. Superficial subpleural plexus, that appears deep to the
  visceral pleura
  - It receives the lymph from lung itself and visceral pleura
  - It will drain into the bronchopulmonary lymph nodes,
  located at the hilum

CEU
Universidad
Cardenal Herrera
11Pulmonary lymphatic plexus
2. Deep bronchopulmonary plexus: located in the submucosa
layer of bronchi and the connective tissue that surrounds them

• It will receive the lymph from the pulmonary arteries, veins and
  bronchi
• It will drain into the intrinsic pulmonary lymph nodes, that are
  located throughout the lobar bronchi
• The pulmonary lymph nodes are going to drain through lymph
  vessels to the bronchopulmonary lymph nodes. Here is going
  to meet the lymph received by the superficial subpleural plexus

CEU
Universidad
Cardenal Herrera
12Pulmonary lymphatic plexus

• Once collected all the lymph together at the bronchopulmonary lymph nodes,
  it is going to drain into two group of nodes:
  - Superior tracheobronchial lymph nodes: located superior to carina
  - Inferior tracheobronchial lymph nodes: located inferior to carina
• The whole right lung will drain into the right tracheobronchial lymph nodes
• The left lung is divided in two zones:
  - The superior lobe drains to the left tracheobronquial nodes
  - The inferior lobe drains to the right tracheobronquial nodes

CEU
Universidad
Cardenal Herrera
13Pulmonary lymphatic plexus
The tracheobronchial lymph nodes drain into the bronchomediastinal lymph trunks

• The right bronchomediastinal trunk merges with other lymphatic trunks forming the right
  lymphatic duct.
• The left bronchomediastinal trunk ends at the thoracic duct
  Inferior deep cervical (scalene) node
  Trachea
  Esophagus
  Tracheal (paratracheal) node
  Right internal jugular vein
  Inferior deep cervical
  (scalene) node
  Right lymphatic duct
  Left internal jugular vein
  Supraclavicular nodes
  Left jugular lymphatic trunk
  Right subclavian lymphatic trunk
  Supraclavicular nodes
  Right subclavian vein
  Left subclavian
  1
  lymphatic trunk
  Right bronchomediastinal trunk
  Thoracic duct
  Left subclavian vein
  Left bronchomediastinal
  trunk

CEU
Universidad
Cardenal Herrera
14Nerves of the lungs

• Pulmonary plexus: nerves of the
  lungs and visceral pleura that are
  located anterior and posterior to the
  roots of the lungs
• They contain different kinds of
  innervation:
  - Parasympathetic
  - Sympathetic
  - Visceral afferent fibers
  Middle cervical
  ganglion
  Left recurrent
  laryngeal nerve
  Left vagus
  nerve
  Trachea
  Cervicothoracic
  (stellate)
  ganglion
  Paravertebral
  ganglia of
  sympathetic
  trunk
  Right
  pulmonary
  plexus
  Left
  pulmonary
  plexus
  Intercostal
  nerve
  Cardiac
  plexus
  Sympathetic
  trunk
  Esophagus
  Esophageal
  plexus
  Anterior
  vagal
  trunk
  Splanchnic
  nerves:
  Posterior
  vagal
  trunk
  Greater
  Lesser
  Least
  Thoracic
  aorta

CEU
Universidad
Cardenal Herrera
15
Right vagus
nerveNerves of the lungs
Parasympathetic fibers:

• Presynaptic fibers: they come with the vagus nerve
• Postynaptic fiber: the synapsis is at the parasympathetic ganglion
  cells in the pulmonary plexuses. They will follow the branches of the
  bronchial tree
• The fibers are:
  - Motor for the smooth muscle: bronchoconstrictor
  - Inhibitory to the pulmonary vessels: vasodilator
  - Secretory to the glands of the bronchial tree: secretomotor
• After contributing to the posterior pulmonary plexus, the vagus nerves
  continue inferiorly and become part of the esophageal plexus

CEU
Universidad
Cardenal Herrera
16Nerves of the lungs
Sympathetic fibers

• They are postsynaptic fibers whose bodies
  are in the sympathetic ganglion cells in the
  paravertebral sympathetic ganglia
  - Inhibitory to the bronchial muscle:
  bronchodilator
  - Motor to the pulmonary vessels:
  vasoconstrictor
  - Inhibitory to the alveolar glands type II
  Left recurrent
  laryngeal nerve
  Left vagus
  nerve
  Trachea
  Paravertebral
  ganglia of
  sympathetic
  trunk

CEU
Universidad
Cardenal Herrera
17Nerves of the lungs
Visceral afferent fibers: Two types: reflexive and nociceptive
1. Reflexive: subconscious sensations associated with reflexes

• Cell bodies in the sensory ganglion of the X Vagus nerve,
  accompanying the parasympathetic fibers to achieve the:
  - Bronchial mucosa: cough reflexes
  - Bronchial muscles: stretch reception
  - Interalveolar connective tissue: Hering-Breuer reflex
  - Pulmonary arteries: blood pressure receptors
  - Pulmonary veins: chemoreceptors sensitive to blood gas
  levels

CEU
Universidad
Cardenal Herrera
18Visceral afferent fibers:
2. Nociceptive:
Pain impulses generated
to chemical irritants,
ischemia or excessive
stretch
Cervical cardiac nerves
Left recurrent laryngeal nerve
Left vagus nerve
Right vagus nerve
Ligamentum arteriosum
Anterior pulmonary plexus
Sympathetic trunk
Esophageal plexus

CEU
Universidad
Cardenal Herrera
19

• From the trachea:
  they accompany the
  parasympathetic
  fibers through the
  vagus nerve
• From the bronchi:
  they accompany the
  sympathetic fibers
  through the
  sympathetic trunk
  Posterior pulmonary plexusBibliography

Moore Clinically oriented anatomy 8th edition / Moore, Keith L.
Published 2018

• Moore Essential Cllinical anatomy 6th edition. Published 2019
• Gray's Anatomy for students / Drake, Richard L. 4th Edition
  Published 2019
• Color atlas of anatomy 7h edition, Rohen, Yokochi
• Manual de embriología y anatomía general. V Smith Agreda
• Anatomía: estructura y morfología del cuerpo humano, 4ª
  Edición, Lippert

CEU
Universidad
Cardenal Herrera
20