Segments on a radiograph. Features of the structure of the lung segments

Date: 04.03.2020

Light, Pulmones. (from Greek. - Pneumon, from here inflammation of the lungs - pneumonia), are located in the chest cavity, Cavitas Thoracis, on the sides of the heart and large vessels, in pleural bags separated from each other Mediastinum, MediaStinum, stretching from the spinal column from behind to the front chest Walls in front.

The right light is more than the left (approximately 10%), at the same time it is somewhat shorter and wider, firstly, due to the fact that the right dome of the diaphragm is standing above the left (the impact of the volume of the routine lobe of the liver), and, The second, the heart is located more left than to the right, thus reducing the width of the left lung.

Each light, Pulmo, has an incorrect cone-shaped shape, with a base, Basis Pulmonis, directed down, and a rounded top, Apex Pulmonis, which will be 3-4 cm above the rib or 2-3 cm above the clavicle in front, rear comes to Level VII cervical vertebra. A small furrow, Sulcus Subclavius, Sulcus Subclavius, is noticeable on the top of the lungs, from the pressure of the connectible artery passing here.

In the lung distinguish three surfaces. Lower, Facies Diaphragmatica, concave according to the convexity of the upper surface of the diaphragm, to which it arrives. Extensive rib Surface, Facies Costalis, convex, respectively, the concavity of the ribs, which, together with the interconnect muscles, are included in the wall of the chest cavity.

MEDIAN SURFACE, FACIES MEDIALIS, Went, repeats in most of the outlines of the pericardium and is divided into the front part adjacent to the mediastinum, Pars MediaStinalis, and the rear, adjacent to the vertebral post, Pars Vertebralis. The surfaces are separated by the edges: the sharp edge of the base is called the Nizhny, Margo Inferior; The edge, also sharp, separating Fades Medialis and Costalis from each other - Margo Anterior.

On the medial surface, the lung gate, Hilus Pulmonis, through which bronchio and pulmonary artery (as well as nerves) are located in the light, and two pulmonary veins (and lymphatic vessels) are located, and the two pulmonary veins (and lymphatic vessels) come out, making it all the lung root, Radix Pulmonis. The root of light bronchine is preserved, the position of the pulmonary artery is not the same on the right and left sides.

In the root of the right light a. Pulmonalis is located below the bronchi, on the left side it crosses the bronchi and lies above it. The pulmonary veins on both sides are located at the root of the lung below the pulmonary artery and bronchi. Rear, at the place of transition to each other, the root and medial surfaces of the lung, the sharp edge is not formed, the rounded part of each lung is placed here in the deepening of the chest cavity on the sides of the spine (Sulci Pulmonales). Every light through the furrows, Fissurae Interlobares, is divided into shares, Lobi. One groove, oblique, Fissura Obliqua, having on both lungs, begins relatively high (by 6-7 cm below the top) and then the cosos descends down to the diaphragmal surface, deeply entering the lung substance. It separates on every light upper share from the bottom. In addition to this furrow, the right lung has another second, horizontal, furrow, Fissura horizontalis, passing at the level of IV ribs. It is eliminating from the upper share of the right lightweight wedge-shaped plot that makes up an average share.

Thus, there are three lobes in the right loss: Lobi Superior, Medius et Inferior. In the left lung distinguish only two stakes: the top, Lobus Superior, to which the top of the lung, and the bottom, Lobus Inferior, is more voluminous than the top. It includes almost the entire diaphragm surface and most of the rear stupid edge of the lung. On the front edge of the left lung, in its lower part, there is a heart clipping, Incisura Cardiaca Pulmonis Sinistri, where light, as if pushed with a heart, leaves a significant part of the pericardium. From below, this clipping is limited to the protrusion of the front edge, called the tongue, Lingula Pulmonus Sinistri. Lingula and adjacent part of the lung correspond to the middle share of the right lung.

The structure of the lungs.Accordingly, the division of lungs on the share of each of the two main bronchi, Bronchus Principalis, coming to the goal of the lung, begins to share on the equity bronchi, Bronchi Lobares. The right upper equity bronchus, heading towards the center of the upper line, passes above the pulmonary artery and is called nadartheric; The remaining equity bronchi of the right lung and all equity broncht left under the artery and are called giving gifts. Equity broncht, entering into a lung substance, give on a number of smaller, tertiary, bronchi, called segmental, Bronchi Segmentales, as they ventilate certain parts of the lung - segments. Segmentary bronchi in turn are divided dichotomically (each for two) into smaller bronchi of the 4th and subsequent orders of magnitude to the final and respiratory bronchiol.

The skeleton of the bronchi is arranged differently out and inside the lungs, respectively, with different conditions of mechanical effect on the walls of the bronchi outside and inside the organ: outside the light skeleton of the bronchi consists of cartilage semi-colts, and cartilage bonds appear between the cartilaginous semirings, as a result of which the structure of their wall appear It becomes lattice. In segmental bronchops and their further branching, the cartilages do not have more shapes of the half-colts, but disintegrated into separate plates, the value of which decreases as the bronchial caliber decreases; In the finite bronchioles, cartilage disappear. The mucous glands disappear in them, but the camber epithelium remains. The muscular layer consists of circularly located knutut from cartilage inescured muscle fibers. In the seats of bronchi division, there are special circular muscle beams that can narrow or completely close the entrance to this or that bronchus.

Macro microscopic structure of the lung.Lung segments consist of secondary fractions, Lobuli Pulmonis secundarii, occupying the periphery of the segment of a layer thick up to 4 cm. The secondary slicer is a pyramidal form of a piece of pulmonary parenchyma to 1 cm in diameter. It is separated by connecting partitions from neighboring secondary poles. An interdolk connecting tissue contains veins and cells of lymphatic capillaries and contributes to the mobility of fractions at the respiratory movements of the lung. It is very often the inhaled coal dust is postponed in it, as a result of which the borders of the poles become clearly noticeable. In the top of each slices, one small (1 mm in diameter) of the bronchus (on average 8th order) is included, which contains even in its walls of cartilage (Dolk Bronch). The number of rolling bronchi in each light reaches 800. Each lolk bronchus branches inside the slicing on 16-18 thinner (0.3-0.5 mm in diameter) of finite bronchioles, Bronchioli Terminales, which do not contain cartilage and glands. All bronets, ranging from the main and ending end bronchioles, make up a single bronchial tree that serves to carry out a jet of air when inhaling and exhale; The respiratory gas exchange between air and blood does not occur in them. End bronchioles, dichotomically branching, give rise to several reaccular bronchiol orders, Bronchioli Respiratorii, characterized by the fact that there are already pulmonary bubbles, or Alveola, Alveoli Pulmonis on their walls. Alveolar moves are departed from each breathing bronchioles, Ductuli Alveolares, ending with blind alveolar bags, Sacculi alveolares. The wall of each of them flies a thick network of blood capillaries. Through the wall of the alveol, gas exchange is performed. Respiratory bronchioles, alveolar moves and alveolar bags with alveoli make up a single alveolar tree, or a lung respiratory parenchyma. The listed structures derived from one finite bronchioles form a functional anatomical unit, called acinus (bunch).

Alveolar moves and bags belonging to one respiratory bronchiolet last order are the primary lobby, Lobulus Pulmonis Primarius. They are about 16 in the acinus. The number of acinuses in both lungs reaches 30,000, and Alveol 300-350 million. The area of \u200b\u200bthe respiratory surface of the lungs ranges from 35 m2 when exhaled up to 100 m2 with deep breath. Of the aggregate of the acinuses, slices are composed, from fractions - segments, from segments - a share, and from a fraction - a whole lung.

Lung functions.The main function of the lungs is gas exchange (blood enrichment with oxygen and the release of carbon dioxide from it). The flow into the light-saturated air and removal of exhaled, saturated air carbon dioxide is provided by the active breathing movements of the chest wall and the diaphragm and the contractile ability of the lighter in combination with the activities of the respiratory tract. At the same time, the diaphragm and lower chest diaphragms and the lower departments of the chest, while ventilation and the change in the volume of the upper fractions are carried out mainly using the movements of the upper chest departure. These features give to surgeons the possibility of differentially approaching the intersection of the diaphragmal nerve when removing the lung fraction. In addition to conventional breathing in lung, collateral breathing is distinguished, i.e., air movement bypass bronchi and bronchiol. It is performed between peculiarly constructed acins, through the pores in the walls of the pulmonary alveol. In the light adults, more often in the old people, mainly in the lower lobes, along with praised structures, there are structural complexes consisting of alveoli and alveolar strokes, fuzzy-separated on pulmonary slices and acins, and forming a heavy trabecular structure. These alveolar chips allow collateral breathing. Since such atypical alveolar complexes are associated with individual bronchopile segments, collateral respiration is not limited to their limits, but spreads broad.

The physiological role of the lungs is not limited to gas exchange. Their complex anatomical device corresponds to both the diversity of functional manifestations: the activity of the bronchi wall in respiration, the secretory and separation function, participation in the metabolism (aqueous, lipid and salt with the regulation of the chlorine balance), which matters in maintaining acid-alkaline equilibrium in the body. It is considered firmly established that the lungs have a powerful developed system of cells that show phagocytic property.

Circulation in the lungs.Due to the function of gas exchange, the lungs receive not only arterial, but also venous blood. The latter flows through the branches of the pulmonary artery, each of which enters the gate of the corresponding lung and then shares respectively the branch of the bronchi. The smallest branches of the pulmonary artery form a network of capillaries, powered by alveoli (respiratory capillaries).

Venous blood flowing to the pulmonary capillaries through the branches of the pulmonary artery, enters into the osmotic exchange (gas exchange) with the air contained in the alveolo: it highlights its carbon dioxide and receives oxygen in return. From the capillaries there are veins carrying blood enriched with oxygen (arterial), and then forming larger venous trunks. The latter merge further in VV. Pulmonales.

Arterial blood is brought into the lungs on RR. Bronchiales (from Aorta, AA. Intercostales Posteriores and a. Subclavia). They feed the wall of the bronchi and the pulmonary tissue. From the capillary network, which is formed by the ramifications of these arteries, the VV is folded. Bronchiales, blowing in part in VV. Azygos et Hemiazygos, and partly in VV. Pulmonales.

Thus, the systems of pulmonary and bronchial veins anastomize among themselves.

The lungs distinguish the surface lymphatic vessels laid in the deep layer of pleura, and deep, inside the pulmonary. The roots of deep lymphatic vessels are lymphatic capillaries, forming networks around respiratory and terminal bronchioles, in interjacinous and interdollastic partitions. These networks continue in the plexus of lymphatic vessels around the branches of the pulmonary artery, veins and bronchi.

The distinguished lymphatic vessels go to the root of light and lying here by the regional bronchopulmonary and further tracheobronchial and near-teachy lymph nodes, NODI Lymphatici Bronchopulmonales et tracheobronchiales. Since the vessels of tracheosobronchial nodes go to the right venous corner, then a significant part of the lymph of the left lung, flowing out of its lower share, enters the right lymphatic duct. The nerves of the lungs occur from Plexus Pulmonalis, which is formed by the branches n. Vagus et truncus sympathicus. Coming out of the named plexus, pulmonary nerves spread in fractions, segments and lobes of lung in the course of the bronchi and blood vessels constituting vascular bronchial beams. In these beams, the nerves form plexuses in which microscopic intraganic nerve nodes are found, where the pregganionic parasympathetic fibers are switched to postganglyonar.

In bronchi, there are three nervous plexuses: in Adventization, in the muscular layer and under the epithelium. Subpitheral plexus reaches Alveol. In addition to the efferent sympathetic and parasympathetic innervation, the lung is equipped with afferent innervation, which is carried out from the bronchi on a wandering nerve, and from visceral pleura - as part of the sympathetic nerves passing through the cervical node.

Segmental lung structure. There are 6 tubular systems in the lungs: bronchi, pulmonary arteries and veins, bronchial arteries and veins, lymphatic vessels. Most of the branches of these systems are parallel to each other, forming vascularly bronchial beams that make up the basis of the inner topography of the lung. Accordingly, the vascular-bronchial beams each share of the lung consists of individual sections called broncho-pulmonary segments.

Bronchopling segment - This is part of the lung corresponding to the primary branch of the shared bronchus and accompanying its branches of the pulmonary artery and other vessels. It is separated from neighboring segments with more or less pronounced connective tissue partitions in which segmental veins are held. These veins have half the territory of each of the neighboring segments.

Easy segments They have the shape of incorrect cones or pyramids, the tops of which are directed to the gates of the lung, and the base is to the surface of the lung, where the boundaries between the segments are sometimes noticeable due to the difference in pigmentation.

Bronchopulmonary segments are functional-morphological units of the lung, within which some pathological processes are initially localized and the removal of which can be limited to in some gentle operations instead of resection of a whole share or all lung. There are many classifications of segments. Representatives of different specialties (surgeons, radiologists, anatomas) allocate different number of segments (from 4 to 12). According to the international anatomical nomenclature, in the right and in the left lung distinguish between 10 segments.

The names of the segments are given according to their topography. There are the following segments.

Right light.

In the upper share of the right lung distinguish the three segments:- Segmentum Apicale (S1) occupies the upper United area of \u200b\u200bthe upper lobe, enters the top hole of the chest and fills the dome of the pleural; - SEGMENTUM POSTERIUS (S2) in its base direction is directed to the dust and the post, borders there with II-IV ribs; The vertex is addressed to Verkhnedol Bronchu; - Segmentum Anterius (S3) takes the base to the front wall of the chest between cartilages I and IV ribs; It goes to the right atrium and the upper hollow vein.

The average share has two segments:- Segmentum Laterale (S4) is directed forward and the duck, and the vertex - up and media; - Segmentum Mediale (S5) comes into contact with the front breast wall near the sternum, between IV-VI ribs; It goes to heart and diaphragm.

In the lower share, 5 segments distinguish:- Segmentum Apicale (SUPERIUS) (S6) occupies a wedge-shaped tip of the lower share and is located in the ocolopotable region; - Segmentum Basale Mediale (Cardiacum) (S7) base occupies mediastinal and partly the diaphragmal surface of the lower share. He goes to the right atria and the lower hollow vein; The base of Segmentum Basale Anterius (S8) is located on the diaphragmal surface of the lower share, and the large side side goes to the thoracic wall in the axillary region between VI-VIII ribs; - Segmentum Basale Laterale (S9) is inclined between other segments of the lower line so that its base comes into contact with the diaphragm, and the lateral side goes to the pectoral wall in the axillary region, between VII and IX ribs; - Segmentum Basale Posterius (S10) is located paravertebral; It lies the stop from all other segments of the lower line, deeply penetrated into the rear department of the rib-diaphragmal sinus pleura. Sometimes Segmentum Subapicale (SUBSUPERIUS) is separated from this segment.

Left light.

The upper share of the left lung has 5 segments: - Segmentum Apicoposterius (S1 + 2) in form and position corresponds to SEG. Apicale and SEG. Posterius top share of the right lung. The base of the segment comes into contact with the rear sites of III-V ribs. The medial segment goes to the aortic and plug-in artery arc. May be in the form of 2 segments; - Segmentum Anterius (S3) is the largest. It occupies a significant part of the root surface of the upper line, between I-IV ribs, as well as part of the mediastinal surface, where it comes into contact with Truncus Pulmonalis; - Segmentum Lingulare Superius (S4) represents a portion of the upper line between III-V edges in front and IV-VI - in the axillary region; - Segmentum Lingulare Inferius (S5) is located below the upper, but almost not comes with a diaphragm. Both tongue segments correspond to the middle share of the right lung; They come into contact with the left ventricle of the heart, penetrating between the pericardium and the thoracic wall in the rib-mediastinal sinus of the pleura.

In the lower share of the left lung distinguish 5 segmentswhich are symmetric the segments of the lower share of the right lung and therefore have the same designations: - Segmentum Apicale (Superius) (S6) occupies a paravertebral position; - Segmentum Basale Mediate (Cardiacum) (S7) in 83% of cases has bronchus, starting with a common trunk with the bronchus of the next segment - Segmentum Basale Antkrius (S8) - the latter is separated from the tongue segments of the top share of Fissura Obliqua and participates in the formation of rib, diaphragmal and mediastinal light surfaces; - Segmentum Basale Laterale (S9) occupies the root surface of the lower share in the axillary area at the level of XII-X ribs; - Segmentum Basale Posterius (S10) represents a large position from other segments of the lower line of the left lung; It comes into contact with VII-X ribs, a diaphragm descending aorta and an esophagus, - Segmentum Subapicale (SUBSUPERIUS) is non-permanent.

Innervation of lungs and bronchi. The afferent paths from visceral pleura are the pulmonary branches of the thoracic premium of the sympathetic barrel, from the parietal pleura - nn. INTERCOSTALES and N. Phrenicus, from bronchi - n. Vagus.

Efferent parasympathetic innervation. Preggangional fibers begin in the dorsal vegetative kernel of the wandering nerve and go in the last and its pulmonary branches to the Plexus Pulmonalis nodes, as well as nodes located along the trachea, bronchi and inside the lungs. Postgangngling fibers are sent from these nodes to muscles and iron bronchial wood.

Function:the narrowing of the lumen of the bronchi and bronchiole and the allocation of mucus.

Efferent sympathetic innervation. Pregganionic fibers come out of the side horns of the spinal cord of the upper chest segments (TH2-TH4) and pass through the relevant Rami Communicantes Albi and a sympathetic barrel to star and upper chest nodes. From the latter, postganglyonary fibers begins, which pass in the composition of pulmonary plexus to bronchial muscles and blood vessels.

Function: expanding the lumen of the bronchi; narrowing.

What doctors to contact for lung surveys:

Pulmologist

Phthisiare

What diseases are linful:

What tests and diagnostics need to pass for the lungs:

X-rays of light

The segment is a plot of a lung share in the form of a cone, which is the base to be addressed to the surface of the lung, and the top - to the root vein venerable by the bronchus of the 3rd order, and consisting of pulmonary lobes. Segments are separated from each other with a connective tissue. In the center of the segment, segmental bronchine and artery are located, and in the connective tissue partition - segmental vein.

According to the international anatomical nomenclature, in the right and in the left luxury is distinguished by 10 segments. The names of the segments reflect their topography and correspond to the names of segmental bronchi.

Right light.

IN top share The right lung distinguish between the 3 segments:

- Upper segment , Segmentum Apicale, it occupies the upper part of the upper lobe, enters the top hole of the chest and fills the dome of the pleura;

- Rear segment , Segmentum Posterius, the ducks and the kice are directed by its base, borders there with II-IV ribs; The vertex is addressed to Verkhnedol Bronchu;

- Front segment , Segmentum Anterius, He takes the base to the front wall of the chest between cartilages I and IV ribs, as well as to the right atrium and the upper hollow vein.

Middle Share Has 2 segments:

– lateral segment, segmentum Laterale, It is directed forward and the duck, and the vertex - up and medial;

- medial segment, segmentum Mediale, comes into contact with the front breast wall near the sternum, between IV-VI ribs; It goes to heart and diaphragm.

Fig. 1.37. Lungs.

1 - Gortan, Larynx; 2 - trachea, trachea; 3 - Lung Top, Apex Pulmonis; 4 - rib surface, facies costalis; 5 - split trachea, bifurcatio tracheae; 6 - the upper share of the lung, Lobus Pulmonis Superior; 7 - Horizontal Right Light Gap, Fissura Horizontalis Pulmonis Dextri; 8 - oblique gap, Fissura Obliqua; 9 - heart clipping left lung, Incisura Cardiaca Pulmonis Sinistri; 10 - the average share of the lung, Lobus Medius Pulmonis; 11 - Lower share of the lung, Lobus Inferior Pulmonis; 12 - a diaphragmal surface, Facies Diaphragmatica; 13 - the base of the lung, Basis Pulmonis.

IN lower share distinguish 5 segments:

– upper segment, segmentumapicale (Superius), occupies a wedge-shaped tip of the lower share and is located in the ocolopotable region;

– medial basal segment, sEGMENTUM BASALE MEDIALE (CARDIACUCU), The base occupies a mediastinal and partly the diaphragm surface of the lower share. He goes to the right atria and the lower hollow vein;

- Front basal segment , Segmentum Basale Anterius, is located on the diaphragmal surface of the lower share, and the large side side goes to the chest wall in the axillary region between VI-VIII ribs;

– lateral basal segment , SEGMENTUM BASALE LATERALE, It is inclined between other segments of the lower line so that the base of it comes into contact with the diaphragm, and the lateral side goes to the pectoral wall in the axillary region, between VII and IX ribs;

- Rear Basal Segment , Segmentum Basale Posterius, Located paravertebral; He lies the stop from all other segments of the lower line, deeply penetrating the rib-diaphragmal sinus of the pleura. Sometimes from this segment is separated .

Left light.

It also distinguishes 10 segments.

The upper share of the left lung has 5 segments:

- Top-rear segment , Segmentum Apicoposterius, in form and position corresponds top segment , Segmentum Apicale, and rear segment , Segmentum Posterius, The upper share of the right lung. The base of the segment comes into contact with the rear sites of III-V ribs. The medial segment goes to an arc of aortic and a subclavian artery; may be in the form of two segments;

– front segment , Segmentum Anterius, is the largest. It occupies a significant part of the root surface of the upper line, between I-IV ribs, as well as part of the mediastinal surface, where it comes with truncus Pulmonalis ;

- upper branch segment, sEGMENTUMLINGULARE SUPERIUS, is a portion of the upper share between III-V edges in front and IV-VI - in the axillary region;

– lower branch segment segmentum Lingulare Inferius, Located below the top, but almost not comes with a diaphragm.

Both tongue segments correspond to the middle share of the right lung;they come into contact with the left ventricle of the heart, penetrating between the pericardomy thoracic wall in the rib-mediastinal sine of the pleura.

In the lower share of the left lung distinguish 5 segmentswhich are symmetrical to the lower share segments of the right lung:

– top segment, segmentum Apicale (Superius), occupies a paravertebral position;

- medial basal segment, segmentum Basale Mediale, In 83% of cases, it has bronchus, which begins with a common barrel with the following segment, segmentum Basale Anterius. The latter is separated from the tongue segments of the upper lobe, fissura Obliqua, and participates in the formation of rib, diaphragmal and mediastinal surfaces of the lung;

– lateral basal segment , SEGMENTUM BASALE LATERALE, It occupies the root surface of the lower share in the axillary region at the level of XII-x ribs;

– rear basal segment segmentum Basale Posterius, It is a major spaced place from other segments of the lower line of the left lung; It comes into contact with VII-x ribs, a diaphragm descending aorta and an esophagus;

– sEGMENTUM Subapicale (Subsuperius) This is not always available.

Pulmonary slices.

Lung segments consist ofsecondary pulmonary lobuli, Lobuli Pulmones Secundarii, ineach of which includes the lolk bronchus (4-6 orders). This is a plot of pulmonary parenchyma of the pyramidal form up to 1.0-1.5 cm in diameter. Secondary slices are located on the periphery of the segment of the layer with a thickness of up to 4 cm and are separated from each other by connecting partitions, which contain veins and lymphocapyllars. In these partitions, dust (coal) is postponed, which makes them clearly visible. In both light secondary rally, there are up to 1 thousand.

5) Histological structure. Alveolar tree arbor Alveolaris..

The pulmonary parenchyma according to the functional and structural features is divided into two departments: conductive is the intramiliary part of the bronchial tree (it is mentioned above) and respiratory, carrying out gas exchange between the blood circulation of venous blood and air in the alveal circulation.

The respiratory department of the lung consists of acinuses, acinus - structural functional units of lung, each of which is derived by one terminal bronchiole. Terminal bronchiola is divided into two respiratory bronchiols, bronchioli Respiratorii. , on the walls of which appear alveola alveoli Pulmones.,- chesch-like structures lined from inside with flat cells, alveoocytes. Elastic fibers are present in the walls of the alveol. At the beginning, in the course of respiratory bronchioles, Alveol Units, but then the number increases them. There are epithelial cells between the alveolis. There are 3-4 generation of dichotomous division of respiratory bronchiol. Respiratory bronchioles, expanding, give rise to alveolar moves, ductuli alveolares. (from 3 to 17), each of which ends blindly alveolar bags sacculi alveolares.. The walls of the alveolar strokes and bags consist only of alveoli, braided with a thick network of blood capillaries. The inner surface of the alveoli addressed to the alveolar air is covered with a film of the surfactant - surfactantwhich aligns the surface tension in the alveoli and prevents the gluing of their walls - atelectaz. In the lungs of an adult, there are about 300 million alveoli, through the walls of which the diffusion of gases is carried out.

Thus, respiratory bronchiols of several branch orders, separating from one end bronchioles, alveolar moves, alveolar bags and alveoli form pulmonary acy acinus Pulmonis . The breathing parenchyma of the lungs has several hundred thousand acinuses and is called an alveolar tree.

End respiratory bronchiolar and separating alveolar moves and bags form primary slicker lobulus Pulmonis Primarius. . They are about 16 in each acinus.

6) age features.Light in the newborn irregular cone shape; top shares relative to small sizes; The average share of the right lung in size is equal to the upper share, and the lower is relatively large. On the 2nd year of the child's life, the magnitude of the lung share relative to each other becomes the same as an adult. Mass of light newborn - 57 g (from 39 to 70 g), volume 67 cm³. The age involution begins after 50 years. The borders of the lungs with age are also changed.

7) developmental anomalies. Lung Agnesia - the disappearance of one or both lungs. In the absence of both light fruit, the fruit is not visceptable. Lung Hypionesis - the underdevelopment of the lungs is often accompanied by respiratory failure. Anomalies of the terminal parts of the bronchial tree - bronchiectasia - incorrect bagpath expansions of terminal bronchioles. The opposite position of the breastside organs, at the same time, the right light contains only two shares, and the left lung consists of three pieces. The opposite position can only be thoracic, only abdominal and total.

8) Diagnostics.With an x-ray study of the chest, two light "pulmonary fields" are clearly visible, according to which the lungs are judged, since due to the presence of air, they easily pass X-rays. Both pulmonary fields are separated from each other intense middle shadow formed by the sternum, spinal column, heart and large vessels. This shadow is the medial boundary of the pulmonary fields; The upper and lateral boundaries are formed by ribs. Bottom is a diaphragm. The upper part of the pulmonary field intersects the clavicle that separates the test area from the subclavian. Below the clavicle on the pulmonary field, intersecting the front and rear parts of the ribs.

The X-ray research method allows to see changes in the ratios of the chest organs occurring during breathing. When inhaling the diaphragm lowers, the duties are flattered, the center moves a few books - the ribs rise, the intercores are wider. The pulmonary fields become lighter, the pulmonary pattern is more distinct. The pleural sines are "enlightening", become noticeable. The position of the heart is approaching the vertical, and it acquires a form close to triangular. With exhalation there are inverse relations. With the help of radiopymemography, you can also study the operation of the diaphragm during breathing, singing, speech, etc.

With layer-by-layer radiography (tomography), the structure of the lung is detected better than with ordinary radiography or x-ray. However, on tomograms, individual structural formations of the lung cannot be differentiated. This becomes possible due to the special method of x-ray research (electrodenterenography). Not only tubular light systems (bronchi and blood vessels) are visible using the latest radiographs, but also the connective light frame of the lung. As a result, it is possible to study on the living person the structure of the parenchyma of the whole lung.

Pleura.

In the chest cavity there are three completely separate serous bags - one for each lung and one, medium, for the heart.

Serous lung shell is called Plever, r1eura. It consists of two sheets:

· Plegre Visceral , Pleura visceralis ;

· Parity Parietal, Priest , Pleura parietalis .

Segment S1 (apical or top) right light. Refers to the upper share of the right lung. Topographically projected on the chest at the front surface of 2 ribs, through the top of the light to the utensil bone.

Segment S2 (rear) right light. Refers to the upper share of the right lung. Topographically projected on the chest at the rear surface of the paravertebrally from the top edge of the blade to its middle.

Segment S3 (front) right light. Refers to the upper share of the right lung. Topographically projected on the chest in front of 2 to 4 Röbembers.

S4 segment (lateral) right light. Refers to the middle share of the right lung. Topographically projected on the chest in the anterior axillary region between 4 and 6 by Rybra.

Segment S5 (medial) right light. Refers to the middle share of the right lung. Topographically projected on the chest between 4 and 6 Ribs closer to the sternum.

Segment S6 (top basal) right light. Refers to the lower share of the right lung. Topographically projected on the chest in the paravertebral area from the middle of the blade to its bottom angle.

S7 segment (medial basal) right light. Refers to the lower share of the right lung. Topographically localized from the inner surface of the right lung, it is located below the root of the right light. It is projected on the chest from 6 ribs before the diaphragm between the sternum and the mid-lines.

S8 segment (front basal) right light. Refers to the lower share of the right lung. Topographically lifted in front of the main interdhep groove, from the bottom of the diaphragm, behind the rear axillary line.

Segment S9 (lateral basal) right light. Refers to the lower share of the right lung. Topographically projected on the chest between the blade and rear axillary lines from the middle of the blades to the diaphragm.

S10 segment (rear basal) right light. Refers to the lower share of the right lung. Topographically projected on the chest from the lower angle of the blade to the diaphragm, is delivered on the sides by the octolate and the blades lines.

Segment S1 + 2 (top-rear) left lung. Represents a combination of C1 and C2 segments, which is due to the presence of common bronchus. Refers to the upper share of the left lung. Topographically projected on the chest along the front surface from 2 ribs and up, through the top to the middle of the blades.

Segment S3 (front) left lung. Refers to the upper share of the left lung. Topographically projected on the chest from front from 2 to 4 ribs.

S4 segment (upper branch) left light. Refers to the upper share of the left lung. Topographically projected on the chest on the front surface from 4 to 5 ribs.

Segment S5 (lower bunch) left light. Refers to the upper share of the left lung. Topographically projected on the chest on the front surface from 5 edges to the diaphragm.

Segment S6 (top basal) left light. Refers to the lower share of the left light. Topographically projected on the chest in the paravertebral area from the middle of the blade to its bottom angle.

Segment S8 (front basal) left lung. Refers to the lower share of the left light. Topographically lifted in front of the main interdhep groove, from the bottom of the diaphragm, behind the rear axillary line.

Segment S9 (lateral basal) left lung. Refers to the lower share of the left light. Topographically projected on the chest between the blade and rear axillary lines from the middle of the blades to the diaphragm.

S10 segment (rear basal) left light. Refers to the lower share of the left light. Topographically projected on the chest from the lower angle of the blade to the diaphragm, is delivered on the sides by the octolate and the blades lines.

In connection with the successful development of surgical methods of treatment of lung diseases, an urgent need for topical diagnosis arose, for which the division of the right lung by three shares, and the left to two were clearly insufficient.

Observations show that the occurrence and distribution of painful processes in the lungs is most often limited to sites that received the name of the segments. This dictates the need for a detailed study of intimacy anatomical relations with which the pathologists should be familiar.

In 1955, an international nomenclature of bronchi and segmetov was adopted at the International Congress of Anatomas in Paris, on which each light consists of 10 segments. Each segment corresponds to its segmental bronchus and a lung artery branch. Large veins pass between segments, denoting their borders.

Segmentary bronchi have accurate designations and numbering.

The lung segments corresponding to segmental bronchoms have the same numbering and the same notation as bronchi. In their form, they are similar to the wrong cones or pyramids, the vertices addressed to the gates of the lungs, and the bases to the surface of the lungs.

So, in every light currently, according to the international nomenclature adopted by the International Congress of Anatoms in Paris in 1955, there are 10 segments, each of which has its own segmental bronchus and a lung artery branch. There are integmentation veins between segments that indicate the boundaries of the segments.

Right light

It distinguishes the following 10 segments (according to D. A. Zhdanov) (Fig. 34, l, b).

1. SEGMENTUM APICALE (the upper segment of the upper line) - the cone-shaped shape of the upper day of the upper lobe, fills the dome of the pleural cavity. The bronchus goes vertically up.

Fig. 34.

(according to D. A. Zhdanov),

A-right light, lateral surface; In right light, medial surface; In left lung, lateral surface; Mr. Light, medial surface.

2. Segmentum Posterius (the rear segment of the upper line) has a view of a wide cone, the base of the facing stop, and the vertex to the topless bronchi. Borders with II and IV ribs.

3. Segmentum Anterius (the front segment of the upper line) is a wide base to arrive at the front of the chest, between cartilages I and IV ribs, and the top is addressed medially from the topless bronchus. It borders with the right atrium and the upper hollow veloy.

4. SEGMENTUM LATERALE (side segment of the middle line) has the appearance of a triangular pyramid, the base is turned forward and outward, and the top and medial.

5. Segmentum Mediate (medium segment of the middle share) borders with a heart and a diaphragm, arrives at the front of the chest near the sternum, between IV and VI ribs.

6. SEGMENTUM APICALE (the uphene segment of the lower line) is represented by a wedge-shaped elite of the lower line and is located in the ocolopotable region.

7. Segmentum Basale Mediate (Cardiacum) (basal medal, heart-shaped, the bottom line) in the form of a pyramid, the base occupies a diaphragmal and mediastinal surface of the lower line, the top is aimed at intermediate bronchi. It borders with the right atrium and the lower hollow veloy.

8. Segmentum Basale Anterius (basal front segment of the lower share) in the form of a truncated pyramid, with a base on the diaphragmal surface of the lower line, and the side side arrives in the thoracic wall in the axillary region between the VI and VIII ribs.

9. Segmentum Basale Laterale (basal side segment of the lower line) as a small pyramid based on the diaphragm surface of the lower share; The side of its surface goes to. the chest between VII and IX ribs in the axillary region.

10. Segmentum Basale Posterius (Basal rear segment of the lower share) lies behind all other segments of the lower line, paravertebrally, entering the rear department of the rear-diaphragmal sine Parietal pleura.

Left light

It also distinguishes 10 segments (Fig. 34, B, d).

1. Segmentum Apicale (upper segment of the upper line) corresponds to the top segment of the upper lobe of the right lung. Borders with aortic arc and a plug-in artery.

2. SEGMENTUM POSTERIUS (rear segment of the upper line) has a view of a cone, the base arrives to the rear cells of the III and V ribs.

3. Segmentum Anterius (the front segment of the upper line), as well as a symmetrical, a wide base in the front of the chest between I-IV ribs, and its mediastinal surface comes into contact with the pulmonary artery trunk.

4. SEGMENTUM Lingulare Superius (upper branch segment) with its base in the form of a wide band goes to the thoracic wall in front between III and V ribs, and in the axillary region to IV-VI ribs. Corresponds to the side segment of the average share of the right lung.

5. Segmentum Lingulare Inferius (Lower Tongue Segment) is below the previous one, but with a diaphragm almost not in contact. Corresponds to the medium segment of the average share of the right lung.

6. SEGMENTUM APICALE (the upheater segment of the lower line) is paravertebral.

7. Segmentum Basale Mediale Cardiacum (basal median heart shaded segment).

8. Segmentum Basale Anterius (Basal Front Segment of the Lower Share). Segments 7 and 8 very often have bronons starting with a common trunk. Segment 8 is separated from the tongue segments (4 and 5) oblique interdole harp and has surfaces - rib, diaphragmal and mediastinal.

9. Segmentum Basale Laterale (Basal side segment of the lower line) is located in the armpit area and arrive to the chest wall between VII and X ribs.

10. Segmentum Basale Posterius (Basal rear segment of the lower line) is a large segment, located the stop from other segments and comes into contact with VIII and X ribs, with a diaphragm, an esophagus and a downward aorta.

A. I. Stovkov and I. M. Kodolov (1959) showed that the newborn segmental structure of the lungs was formed in the same way as in an adult. This is very important, as it makes it possible to conclude about the homogeneity of the prerequisites for the bronchogenic distribution of pathological processes and in children, and in adults.

Features of the segmental structure of the lungs in children consist only that loose connecting interlayers between the segments in children are clearer than adults. This is a good guideline to establish the boundaries of the segments. In the adult borders of the segments, weakly are noticeable and difficult.

At the Department of Pathological Anatomy of the Republic of the Moscow Medical Institute named after I. M. Sechenov, the technique of opening the bronchial tree, which comes down to the next one.

The drug organs of the chest cavity is laid on the preparation table with the front surface of the book, and the back - upwards, to my own. Stupid scissors cut the trachea, main and equity bronchi. Next reveal segmental and subsegimentary bronchi with small scissors in a grooved probe.

In the direction of the probe introduced into segmental bronchus, it is determined by its name and numbering. So inspect all the bronchial wood before its minor branchings.

At the same time, all the pulmonary segments that can be cleaned, focusing by integmentation veins going superficially.

Some researchers are poured in segmental bronons colored or contrasting masses.

The lung segments in children are distinctly allocated for pneumonia, atelectase, bronchogenic tuberculosis and other diseases.

Segment S1 + 2 left lung. Represents a combination of C1 and C2 segments. Refers to the upper share of the left lung. Topographically projected on the chest along the front surface from 2 ribs and up, through the top to the middle of the blades.