Lung
Lung | |
---|---|
Details | |
System | Respiratory system |
Identifiers | |
Latin | pulmo |
Greek | πνεύμων (pneumon) |
MeSH | D008168 |
TA98 | A06.5.01.001 |
TA2 | 3265 |
Anatomical terminology |
The lungs are the central
Respiration is driven by different muscular systems in different species. Mammals, reptiles and birds use their different muscles to support and foster breathing. In earlier tetrapods, air was driven into the lungs by the pharyngeal muscles via buccal pumping, a mechanism still seen in amphibians. In humans, the main muscle of respiration that drives breathing is the diaphragm. The lungs also provide airflow that makes vocal sounds including human speech possible.
Humans have two lungs, one on the left and one on the right. They are situated within the
The tissue of the lungs can be affected by a number of respiratory diseases, including pneumonia and lung cancer. Chronic obstructive pulmonary disease includes chronic bronchitis and emphysema, and can be related to smoking or exposure to harmful substances. A number of occupational lung diseases can be caused by substances such as coal dust, asbestos fibres, and crystalline silica dust. Diseases such as bronchitis can also affect the respiratory tract. Medical terms related to the lung often begin with pulmo-, from the Latin pulmonarius (of the lungs) as in pulmonology, or with pneumo- (from Greek πνεύμων "lung") as in pneumonia.
In
Structure
Anatomy
The lungs are located in the chest on either side of the heart in the rib cage. They are conical in shape with a narrow rounded apex at the top, and a broad concave base that rests on the convex surface of the diaphragm.[3] The apex of the lung extends into the root of the neck, reaching shortly above the level of the sternal end of the first rib. The lungs stretch from close to the backbone in the rib cage to the front of the chest and downwards from the lower part of the trachea to the diaphragm.[3]
The left lung shares space with the heart, and has an indentation in its border called the cardiac notch of the left lung to accommodate this.[4][5] The front and outer sides of the lungs face the ribs, which make light indentations on their surfaces. The medial surfaces of the lungs face towards the centre of the chest, and lie against the heart, great vessels, and the carina where the trachea divides into the two main bronchi.[5] The cardiac impression is an indentation formed on the surfaces of the lungs where they rest against the heart.
Both lungs have a central recession called the
The lungs are surrounded by the
Lobes
Right lung | Left lung |
---|---|
Upper
Middle
Lower
|
Upper
Lingula
Lower
|
Each lung is divided into sections called lobes by the infoldings of the visceral pleura as fissures. Lobes are divided into segments, and segments have further divisions as lobules. There are three lobes in the right lung and two lobes in the left lung.
Fissures
The fissures are formed in early prenatal development by invaginations of the visceral pleura that divide the lobar bronchi, and section the lungs into lobes that helps in their expansion.[8][9] The right lung is divided into three lobes by a horizontal fissure, and an oblique fissure. The left lung is divided into two lobes by an oblique fissure which is closely aligned with the oblique fissure in the right lung. In the right lung the upper horizontal fissure, separates the upper (superior) lobe from the middle lobe. The lower, oblique fissure separates the lower lobe from the middle and upper lobes.[3][9]
Variations in the fissures are fairly common being either incompletely formed or present as an extra fissure as in the
Segments
The main or primary bronchi enter the lungs at the hilum and initially branch into secondary bronchi also known as lobar bronchi that supply air to each lobe of the lung. The lobar bronchi branch into tertiary bronchi also known as segmental bronchi and these supply air to the further divisions of the lobes known as bronchopulmonary segments. Each bronchopulmonary segment has its own (segmental) bronchus and arterial supply.[10] Segments for the left and right lung are shown in the table.[7] The segmental anatomy is useful clinically for localising disease processes in the lungs.[7] A segment is a discrete unit that can be surgically removed without seriously affecting surrounding tissue.[11]
Right lung
The right lung has both more lobes and segments than the left. It is divided into three lobes, an upper, middle, and a lower lobe by two fissures, one oblique and one horizontal.
The mediastinal surface of the right lung is indented by a number of nearby structures. The heart sits in an impression called the cardiac impression. Above the hilum of the lung is an arched groove for the
The weight of the right lung varies between individuals, with a standard reference range in men of 155–720 g (0.342–1.587 lb)[13] and in women of 100–590 g (0.22–1.30 lb).[14]
Left lung
The left lung is divided into two lobes, an upper and a lower lobe, by the oblique fissure, which extends from the
The mediastinal surface of the left lung has a large cardiac impression where the heart sits. This is deeper and larger than that on the right lung, at which level the heart projects to the left.[5]
On the same surface, immediately above the hilum, is a well-marked curved groove for the aortic arch, and a groove below it for the descending aorta. The left subclavian artery, a branch off the aortic arch, sits in a groove from the arch to near the apex of the lung. A shallower groove in front of the artery and near the edge of the lung, lodges the left brachiocephalic vein. The esophagus may sit in a wider shallow impression at the base of the lung.[5]
By standard reference range, the weight of the left lung is 110–675 g (0.243–1.488 lb)[13] in men and 105–515 g (0.231–1.135 lb) in women.[14]
Illustrations
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Chest CT (axial lung window)
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Chest CT (coronal lung window)
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Chest CT (axial lung window)
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Chest CT (coronal lung window)
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"Meet the lungs" from Khan Academy
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Pulmonology video
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3D anatomy of the lung lobes and fissures.
Microanatomy
The lungs are part of the
Connective tissue
The connective tissue of the lungs is made up of
Respiratory epithelium
All of the lower respiratory tract including the trachea, bronchi, and bronchioles is lined with
Pulmonary neuroendocrine cells are found throughout the respiratory epithelium including the alveolar epithelium,[24] though they only account for around 0.5 percent of the total epithelial population.[25] PNECs are innervated airway epithelial cells that are particularly focused at airway junction points.[25] These cells can produce serotonin, dopamine, and norepinephrine, as well as polypeptide products. Cytoplasmic processes from the pulmonary neuroendocrine cells extend into the airway lumen where they may sense the composition of inspired gas.[26]
Bronchial airways
In the bronchi there are incomplete
Respiratory zone
The conducting zone of the respiratory tract ends at the terminal bronchioles when they branch into the respiratory bronchioles. This marks the beginning of the terminal respiratory unit called the acinus which includes the respiratory bronchioles, the alveolar ducts,
The unit described as the secondary pulmonary lobule is the lobule most referred to as the pulmonary lobule or respiratory lobule.[27]: 489 [33] This lobule is a discrete unit that is the smallest component of the lung that can be seen without aid.[31] The secondary pulmonary lobule is likely to be made up of between 30 and 50 primary lobules.[32] The lobule is supplied by a terminal bronchiole that branches into respiratory bronchioles. The respiratory bronchioles supply the alveoli in each acinus and is accompanied by a pulmonary artery branch. Each lobule is enclosed by an interlobular septum. Each acinus is incompletely separated by an intralobular septum.[30]
The respiratory bronchiole gives rise to the alveolar ducts that lead to the alveolar sacs, which contain two or more alveoli.[22] The walls of the alveoli are extremely thin allowing a fast rate of diffusion. The alveoli have interconnecting small air passages in their walls known as the pores of Kohn.[22]
Alveoli
Alveoli consist of two types of
Type I are squamous epithelial cells that make up the alveolar wall structure. They have extremely thin walls that enable an easy gas exchange.[34] These type I cells also make up the alveolar septa which separate each alveolus. The septa consist of an epithelial lining and associated basement membranes.[35] Type I cells are not able to divide, and consequently rely on differentiation from Type II cells.[35]
Type II are larger and they line the alveoli and produce and secrete epithelial lining fluid, and lung surfactant.[36][34] Type II cells are able to divide and differentiate to Type I cells.[35]
The alveolar macrophages have an important role in the immune system. They remove substances which deposit in the alveoli including loose red blood cells that have been forced out from blood vessels.[35]
Microbiota
There is a large presence of
Respiratory tract
The
Estimates of the total surface area of lungs vary from 50 to 75 square metres (540 to 810 sq ft);[34][35] although this is often quoted in textbooks and the media being "the size of a tennis court",[35][40][41] it is actually less than half the size of a singles court.[42]
The bronchi in the
Pulmonary stretch receptors in the smooth muscle of the airways initiate a reflex known as the Hering–Breuer reflex that prevents the lungs from over-inflation, during forceful inspiration.
Blood supply
The lungs have a dual blood supply provided by a bronchial and a pulmonary circulation.[6] The bronchial circulation supplies oxygenated blood to the airways of the lungs, through the bronchial arteries that leave the aorta. There are usually three arteries, two to the left lung and one to the right, and they branch alongside the bronchi and bronchioles.[34] The pulmonary circulation carries deoxygenated blood from the heart to the lungs and returns the oxygenated blood to the heart to supply the rest of the body.[34]
The blood volume of the lungs is about 450 millilitres on average, about 9% of the total blood volume of the entire circulatory system. This quantity can easily fluctuate from between one-half and twice the normal volume. Also, in the event of blood loss through hemorrhage, blood from the lungs can partially compensate by automatically transferring to the systemic circulation.[44]
Nerve supply
The lungs are supplied by nerves of the
The action of breathing takes place because of nerve signals sent by the respiratory center in the brainstem, along the phrenic nerve from the cervical plexus to the diaphragm.[47]
Variation
The lobes of the lung are subject to anatomical variations.[48] A horizontal interlobar fissure was found to be incomplete in 25% of right lungs, or even absent in 11% of all cases. An accessory fissure was also found in 14% and 22% of left and right lungs, respectively.[49] An oblique fissure was found to be incomplete in 21% to 47% of left lungs.[50] In some cases a fissure is absent, or extra, resulting in a right lung with only two lobes, or a left lung with three lobes.[48]
A variation in the airway branching structure has been found specifically in the central airway branching. This variation is associated with the development of
Development
The development of the human lungs arise from the laryngotracheal groove and develop to maturity over several weeks in the foetus and for several years following birth.[52]
The
The respiratory tract has a branching structure, and is also known as the respiratory tree. The development of the alveoli is influenced by a different mechanism whereby continued bifurcation is stopped and the distal tips become dilated to form the alveoli.
At the end of the fourth week the lung bud divides into two, the right and left
Vitamin A deficiency
The developing lung is particularly vulnerable to changes in the levels of vitamin A. Vitamin A deficiency has been linked to changes in the epithelial lining of the lung and in the lung parenchyma. This can disrupt the normal physiology of the lung and predispose to respiratory diseases. Severe nutritional deficiency in vitamin A results in a reduction in the formation of the alveolar walls (septa) and to notable changes in the respiratory epithelium; alterations are noted in the extracellular matrix and in the protein content of the basement membrane. The extracellular matrix maintains lung elasticity; the basement membrane is associated with alveolar epithelium and is important in the blood-air barrier. The deficiency is associated with functional defects and disease states. Vitamin A is crucial in the development of the alveoli which continues for several years after birth.[63]
After birth
At birth, the baby's lungs are filled with fluid secreted by the lungs and are not inflated. After birth the infant's central nervous system reacts to the sudden change in temperature and environment. This triggers the first breath, within about 10 seconds after delivery.[64] Before birth, the lungs are filled with fetal lung fluid.[65] After the first breath, the fluid is quickly absorbed into the body or exhaled. The resistance in the lung's blood vessels decreases giving an increased surface area for gas exchange, and the lungs begin to breathe spontaneously. This accompanies other changes which result in an increased amount of blood entering the lung tissues.[64]
At birth the lungs are very undeveloped with only around one sixth of the alveoli of the adult lung present.[52] The alveoli continue to form into early adulthood, and their ability to form when necessary is seen in the regeneration of the lung.[66][67] Alveolar septa have a double capillary network instead of the single network of the developed lung. Only after the maturation of the capillary network can the lung enter a normal phase of growth. Following the early growth in numbers of alveoli there is another stage of the alveoli being enlarged.[68]
Function
Gas exchange
The major function of the lungs is gas exchange between the lungs and the blood.[69] The alveolar and pulmonary capillary gases equilibrate across the thin blood–air barrier.[36][70][71] This thin membrane (about 0.5 –2 μm thick) is folded into about 300 million alveoli, providing an extremely large surface area (estimates varying between 70 and 145 m2) for gas exchange to occur.[70][72]
The lungs are not capable of expanding to breathe on their own, and will only do so when there is an increase in the volume of the thoracic cavity.[73] This is achieved by the muscles of respiration, through the contraction of the diaphragm, and the intercostal muscles which pull the rib cage upwards as shown in the diagram.[74] During breathing out the muscles relax, returning the lungs to their resting position.[75] At this point the lungs contain the functional residual capacity (FRC) of air, which, in the adult human, has a volume of about 2.5–3.0 litres.[75]
During
Protection
The lungs possess several characteristics which protect against infection. The respiratory tract is lined by
The size of the respiratory tract and the flow of air also protect the lungs from larger particles. Smaller particles deposit in the mouth and behind the mouth in the oropharynx, and larger particles are trapped in nasal hair after inhalation.[76]
Other
In addition to their function in respiration, the lungs have a number of other functions. They are involved in maintaining
The lungs also serve a protective role. Several blood-borne substances, such as a few types of
The lungs also play a pivotal role in
Research suggests a role of the lungs in the production of blood platelets.[84]
Gene and protein expression
About 20,000 protein coding genes are expressed in human cells and almost 75% of these genes are expressed in the normal lung.[85][86] A little less than 200 of these genes are more specifically expressed in the lung with less than 20 genes being highly lung specific. The highest expression of lung specific proteins are different surfactant proteins,[36] such as SFTPA1, SFTPB and SFTPC, and napsin, expressed in type II pneumocytes. Other proteins with elevated expression in the lung are the dynein protein DNAH5 in ciliated cells, and the secreted SCGB1A1 protein in mucus-secreting goblet cells of the airway mucosa.[87]
Clinical significance
Lungs can be affected by a number of diseases and disorders.
Inflammation and infection
Alcohol affects the lungs and can cause inflammatory
Blood-supply changes
A
A lung contusion is a bruise caused by chest trauma. It results in hemorrhage of the alveoli causing a build-up of fluid which can impair breathing, and this can be either mild or severe. The function of the lungs can also be affected by compression from fluid in the pleural cavity
Obstructive lung diseases
Many obstructive lung diseases are managed by avoiding triggers (such as
The breakdown of alveolar tissue, often as a result of tobacco-smoking leads to emphysema, which can become severe enough to develop into COPD.
Restrictive lung diseases
Some types of chronic lung diseases are classified as
Cancers
Congenital disorders
Pleural space pressure
A
Examination
As part of a
Function testing
Pulmonary plethysmographs are used to measure functional residual capacity.[104] Functional residual capacity cannot be measured by tests that rely on breathing out, as a person is only able to breathe a maximum of 80% of their total functional capacity.[105] The total lung capacity depends on the person's age, height, weight, and sex, and normally ranges between 4 and 6 litres.[103] Females tend to have a 20–25% lower capacity than males. Tall people tend to have a larger total lung capacity than shorter people. Smokers have a lower capacity than nonsmokers. Thinner persons tend to have a larger capacity. Lung capacity can be increased by physical training as much as 40% but the effect may be modified by exposure to air pollution.[105][106]
Other lung function tests include spirometry, measuring the amount (volume) and flow of air that can be inhaled and exhaled. The maximum volume of breath that can be exhaled is called the vital capacity. In particular, how much a person is able to exhale in one second (called forced expiratory volume (FEV1)) as a proportion of how much they are able to exhale in total (FEV). This ratio, the FEV1/FEV ratio, is important to distinguish whether a lung disease is restrictive or obstructive.[76][103] Another test is that of the lung's diffusing capacity – this is a measure of the transfer of gas from air to the blood in the lung capillaries.
Human uses
Mammal lung is one of the main types of
Other animals
Birds
The lungs of birds are relatively small, but are connected to 8 or 9
The lungs of birds contain millions of tiny parallel passages called
The air sacs, which hold air, do not contribute much to gas exchange, despite being thin-walled, as they are poorly vascularised. The air sacs expand and contract due to changes in the volume in the thorax and abdomen. This volume change is caused by the movement of the sternum and ribs and this movement is often synchronised with movement of the flight muscles.[111]
Parabronchi in which the air flow is unidirectional are called paleopulmonic parabronchi and are found in all birds. Some birds, however, have, in addition, a lung structure where the air flow in the parabronchi is bidirectional. These are termed neopulmonic parabronchi.[110]
Reptiles
The lungs of most reptiles have a single bronchus running down the centre, from which numerous branches reach out to individual pockets throughout the lungs. These pockets are similar to alveoli in mammals, but much larger and fewer in number. These give the lung a sponge-like texture. In tuataras, snakes, and some lizards, the lungs are simpler in structure, similar to that of typical amphibians.[111]
Snakes and limbless lizards typically possess only the right lung as a major respiratory organ; the left lung is greatly reduced, or even absent.
Both
Amphibians
The lungs of most frogs and other amphibians are simple and balloon-like, with gas exchange limited to the outer surface of the lung. This is not very efficient, but amphibians have low metabolic demands and can also quickly dispose of carbon dioxide by diffusion across their skin in water, and supplement their oxygen supply by the same method. Amphibians employ a positive pressure system to get air to their lungs, forcing air down into the lungs by buccal pumping. This is distinct from most higher vertebrates, who use a breathing system driven by negative pressure where the lungs are inflated by expanding the rib cage.[115] In buccal pumping, the floor of the mouth is lowered, filling the mouth cavity with air. The throat muscles then presses the throat against the underside of the skull, forcing the air into the lungs.[116]
Due to the possibility of respiration across the skin combined with small size, all known lungless
The lungs of amphibians typically have a few narrow internal walls (septa) of soft tissue around the outer walls, increasing the respiratory surface area and giving the lung a honeycomb appearance. In some salamanders even these are lacking, and the lung has a smooth wall. In caecilians, as in snakes, only the right lung attains any size or development.[111]
Fish
Lungs are found in three groups of fish; the coelacanths, the bichirs and the lungfish. Like in tetrapods, but unlike fish with swim bladder, the opening is at the ventral side of the esophagus. The coelacanth has a nonfunctional and unpaired vestigial lung surrounded by a fatty organ.[120] Bichirs, the only group of ray-finned fish with lungs, have a pair which are hollow unchambered sacs, where the gas-exchange occurs on very flat folds that increase their inner surface area. The lungs of lungfish show more resemblance to tetrapod lungs. There is an elaborate network of parenchymal septa, dividing them into numerous respiration chambers.[121][122] In the Australian lungfish, there is only a single lung, albeit divided into two lobes. Other lungfish, however, have traditionally been considered having two lungs, but newer research defines paired lungs as bilateral lung buds that arise simultaneously and are both connected directly to the foregut, which is only seen in tetrapods.[123] In all lungfish, including the Australian, the lungs are located in the upper dorsal part of the body, with the connecting duct curving around and above the esophagus. The blood supply also twists around the esophagus, suggesting that the lungs originally evolved in the ventral part of the body, as in other vertebrates.[111]
Invertebrates
A number of invertebrates have lung-like structures that serve a similar respiratory purpose to true vertebrate lungs, but are not evolutionarily related and only arise out of convergent evolution. Some arachnids, such as spiders and scorpions, have structures called book lungs used for atmospheric gas exchange. Some species of spider have four pairs of book lungs but most have two pairs.[124] Scorpions have spiracles on their body for the entrance of air to the book lungs.[125]
The coconut crab is terrestrial and uses structures called branchiostegal lungs to breathe air.[126] Juveniles are released into the ocean, however adults cannot swim and possess an only rudimentary set of gills. The adult crabs can breathe on land and hold their breath underwater.[127] The branchiostegal lungs are seen as a developmental adaptive stage from water-living to enable land-living, or from fish to amphibian.[128]
Evolutionary origins
The lungs of today's terrestrial
See also
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Further reading
- Dr D.R. Johnson: Introductory anatomy, respiratory system, leeds.ac.uk
- Franlink Institute Online: The Respiratory System, sln.fi.edu
- Avian lungs and respiration, people.eku.edu