Bronchopulmonary Segments Ppt Download

Each segment has its own pulmonary arterial branch and thus, the bronchopulmonary segment is a portion of lung supplied by its own bronchus and artery. Each segment is functionally and anatomically discrete allowing a single segment to be surgically resected without affecting its neighboring segments.

There is some form of segmental symmetry between the right and left lungs, even though the left lung is smaller and only contains two lobes. In general, each lung has 10 segments: the upper lobes contain 3 segments, the middle lobe / lingula 2 and the lower lobes 5. Bilaterally, the upper lobes have apical, posterior and anterior segments and the lower lobes superior (apical) and 4 basal segments (anterior, medial, posterior and lateral). With this basic symmetric anatomy shared between the lungs, there are a few differences that can be described:

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A bronchopulmonary segment is a portion of lung supplied by a specific segmental bronchus and its vessels.[1][2] These arteries branch from the pulmonary and bronchial arteries, and run together through the center of the segment. Veins and lymphatic vessels drain along the edges of the segment. The segments are separated from each other by layers of connective tissue that forms them into discrete anatomical and functional units. This separation means that a bronchopulmonary segment can be surgically removed without affecting the function of the others.[3]

There are ten bronchopulmonary segments in the right lung: three in the superior lobe, two in the middle lobe, and five in the inferior lobe. Some of the segments may fuse in the left lung to form usually eight to nine segments (four to five in the upper lobe and four to five in the lower lobe. The delineation of the bronchopulmonary segments was made by Chevalier Jackson and John Franklin Huber at Temple University Hospital.[4]

The continuous demands of every cell within the human body and the constant need to remove waste gases like carbon dioxide are met by the lungs. These paired organs assume their role as the gas exchange organs with the first cry of the neonate and continue working until the end of life. While the functional unit is the capillary-alveoli interface, the lung is divided into segments based on the arborization of the bronchi. The bronchopulmonary segments are the largest functional divisions of the anatomical lobes; each receiving their own air and blood supply.

This article will discuss the development and anatomy of the bronchopulmonary segments. It will also review the anatomy of the lungs, and discuss the function of the organs as well. Further clinical discussion involving disorders of the lung, as well as clinical investigation of pulmonary disorders will also be included.

While the phrase bronchopulmonary segment was coined by American otolaryngologists Rudolph Kramer and Amael Glass, the concept of segmented parts of the lung supplied by individual branches of the bronchi was put forth by British pathologist William Ewart Gye (Bullock). Efforts were made by numerous surgeons and anatomists to simplify the nomenclature associated with these segments. Eventually, an Ad Hoc International Committee came up with an internationally accepted naming system by merging the nomenclature coined by Chevalier Jackson and John Huber with that of Russell Brock.

The superior lobe of the right lung has three bronchopulmonary segments. The pinnacle of the superior lobe forms the apical segment or segment I (S I). Below and posterior to the apical segment is the posterior segment (S II). When viewed from the costal surface, this segment is limited inferiorly by the posterosuperior part of the right oblique fissure and posterior part of the horizontal fissure. As the name suggests, the anterior segment (S III) is anterior to the posterior segment and anteroinferior to the apical segment. It is limited inferiorly by the horizontal fissure.

The middle lobe of the right lung lies between the horizontal (superiorly) and the anteroinferior part of the oblique fissures (inferiorly). It is subdivided into lateral (S IV) and medial (S V) bronchopulmonary segments. The lateral segment is best represented on the costal surface of the lung, while the superficial boundary of the medial segment wraps around the anterior border of the lung. It tapers off at the hilum and is superiorly related to the oblique fissure.

The inferior lobe of the right lung has five bronchopulmonary segments. The superior segment (S VI) is represented on both the costal and mediastinal surfaces of the right lung; as the segment also includes a portion of the posterior border of the right lung. The medial basal segment (S VII) is best represented on the mediastinal surface of the lung, as it lies below the hilum. It is anteriorly related to the posterior basal segment (S X), which abuts the lateral basal segment (S IX) around the posterior border of the lung. The anterior basal segment (S VIII) is limited anteriorly by the caudal part of the oblique fissure and is juxtaposed with the lateral basal segment posteriorly.

An easy way to remember all these segments is by using a mnemonic! Just memorise the phrase ' A PALM Seed Makes Another Little Palm' and the terms it stands for will be much easier to recall:

Although there are only two lobes in the left lung, there is some symmetry among the bronchopulmonary segments bilaterally. However, some segments of the left lung merge. Consequently, there are fewer bronchopulmonary segments on the left than there are on the right.The superior lobe of the left lung contains four bronchopulmonary segments. The apicoposterior segment (S I + II) represents the fusion of the apical and posterior segments. It is limited posteroinferiorly by the superior aspect of the left oblique fissure and is adjacent to the anterior segment (S III) of the superior lobe. Although the lingular lobe of the left lung is considered a part of the superior lobe, it is analogous to the middle lobe of the right lung. Similarly, it is divided into two bronchopulmonary segments, namely the superior (S IV) and inferior (S V) lingular segments. The superior lingular segment is located between the caudal boundary of the anterior segment and the superior boundary of the inferior lingular segment. Both are anterior to the hilum of the left lung, and the inferior segment is limited inferiorly by the inferior half of the oblique fissure.

Although there are fewer segments in the left lung, you might still sometimes struggle to remember them. But worry not, there's a mnemonic to help you out here too! Use the phrase ' ASIA ALPS' to remember the following structures:

The secondary bronchi supply the lobes of the lung, while the segmental branches will deliver oxygen to the respective segments. Superior and inferior bronchi are located on both sides of the chest. On the left, the superior bronchus supplies the superior lobe, while the inferior bronchus supplies the inferior lobe. However, on the right side, the inferior bronchus bifurcates such that the cranial branch supplies the middle lobe, while the caudal branch supplies the inferior lobe. The right superior bronchus supplies the superior lobe of the right lung (just like its left counterpart). Cumulatively, there are 10 right and 8-9 left segmental bronchi that develop in the 7th gestational week. This development is accompanied by a division of the encompassing mesenchyme; which together with the segmental bronchi, develop into the bronchopulmonary segments.

The clinical practice of thoracic surgery requires the surgeon to have intimate knowledge of pulmonary anatomy and of its variations. Attempts to perform thoracic procedures without this knowledge can only result in incomplete operations or technical mishaps. Proper understanding of the anatomy of the pulmonary lobes, segments, and fissures allows the surgeon to correlate imaging, pathologic processes, and possible resectional procedures, thus insuring that each patient gets the best possible operation.

Each of the tertiary bronchi serves a specific bronchopulmonary segment. These segments each have their own artery. Thus, each bronchopulmonary segment is supplied by a segmental bronchus, and two arteries, a pulmonary artery and a bronchial artery which run together through the center of the segment. Veins and lymphatics drain along the edges. 006ab0faaa