bronchopulmonary segments. Segmental structure of the lungs (human anatomy) Lingular segment of the left lung what proportion

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general description

Infiltrative tuberculosis is usually considered as the next stage in the progression of miliary pulmonary tuberculosis, where the leading symptom is already infiltration, represented by an exudative-pneumonic focus with caseous decay in the center and an intense inflammatory reaction along the periphery.

Women are less susceptible to tuberculosis infection: they get sick three times less than men. In addition, in men, the trend towards a higher increase in the incidence remains. Tuberculosis occurs more often in men aged 20-39 years.

Acid-resistant bacteria of the genus Mycobacterium are considered responsible for the development of the tuberculosis process. There are 74 species of such bacteria and they are found everywhere in the human environment. But not all of them become the cause of tuberculosis in humans, but the so-called human and bovine species of mycobacteria. Mycobacteria are extremely pathogenic and are characterized by high resistance in the external environment. Although pathogenicity can vary significantly under the influence of environmental factors and the state of the defenses of the human body that has been infected. The bovine type of the pathogen is isolated during illness in rural residents, where infection occurs through the alimentary route. Avian tuberculosis affects persons with immunodeficiency states. The overwhelming majority of primary infections of a person with tuberculosis occurs by aerogenic route. Alternative ways of introducing infection into the body are also known: alimentary, contact and transplacental, but they are very rare.

Symptoms of pulmonary tuberculosis (infiltrative and focal)

  • Subfebrile body temperature.
  • Torrential sweats.
  • Cough with gray sputum.
  • Coughing may cause blood to come out or blood to come out of the lungs.
  • Pain in the chest is possible.
  • The frequency of respiratory movements is more than 20 per minute.
  • Feeling of weakness, fatigue, emotional lability.
  • Bad appetite.

Diagnostics

  • Complete blood count: slight leukocytosis with a neutrophilic shift to the left, a slight increase in the erythrocyte sedimentation rate.
  • Analysis of sputum and bronchial washings: Mycobacterium tuberculosis is detected in 70% of cases.
  • Radiography of the lungs: infiltrates are more often localized in segments 1, 2 and 6 of the lung. From them to the root of the lung goes the so-called path, which is a consequence of peribronchial and perivascular inflammatory changes.
  • Computed tomography of the lungs: allows you to get the most reliable information about the structure of the infiltrate or cavity.

Treatment of pulmonary tuberculosis (infiltrative and focal)

Tuberculosis must begin to be treated in a specialized medical institution. Treatment is carried out with special first-line tuberculostatic drugs. Therapy ends only after complete regression of infiltrative changes in the lungs, which usually takes at least nine months, or even several years. Further anti-relapse treatment with appropriate drugs can be carried out already in the conditions of dispensary observation. In the absence of a long-term effect, the preservation of destructive changes, the formation of foci in the lungs, sometimes collapse therapy (artificial pneumothorax) or surgery is possible.

Essential drugs

There are contraindications. Specialist consultation is required.

  • (Tubazid) - anti-tuberculosis, antibacterial, bactericidal agent. Dosage regimen: the average daily dose for an adult is 0.6-0.9 g, it is the main anti-tuberculosis drug. The drug is produced in the form of tablets, powder for the preparation of sterile solutions and ready-made 10% solution in ampoules. Isoniazid is used throughout the entire period of treatment. In case of intolerance to the drug, ftivazid is prescribed - a chemotherapy drug from the same group.
  • (semi-synthetic broad-spectrum antibiotic). Dosage regimen: taken orally, on an empty stomach, 30 minutes before meals. The daily dose for an adult is 600 mg. For the treatment of tuberculosis, it is combined with one anti-tuberculosis drug (isoniazid, pyrazinamide, ethambutol, streptomycin).
  • (broad-spectrum antibiotic used in the treatment of tuberculosis). Dosage regimen: the drug is used in a daily dose of 1 ml at the beginning of treatment for 2-3 months. and more daily or 2 times a week intramuscularly or in the form of aerosols. In the treatment of tuberculosis, the daily dose is administered in 1 dose, with poor tolerance - in 2 doses, the duration of treatment is 3 months. and more. Intratracheally, adults - 0.5-1 g 2-3 times a week.
  • (antituberculous bacteriostatic antibiotic). Dosage regimen: taken orally, 1 time per day (after breakfast). It is prescribed in a daily dose of 25 mg per 1 kg of body weight. It is used orally daily or 2 times a week in the second stage of treatment.
  • Ethionamide (synthetic anti-tuberculosis drug). Dosage regimen: administered orally 30 minutes after meals, 0.25 g 3 times a day, with good tolerance of the drug and a body weight of more than 60 kg - 0.25 g 4 times a day. The drug is used daily.

What to do if you suspect a disease

  • 1. Blood test for tumor markers or PCR diagnostics of infections
  • 4. CEA test or Complete blood count

  • Blood test for tumor markers

    In tuberculosis, the concentration of CEA is within 10 ng / ml.

  • PCR diagnostics of infections

    A positive result of PCR diagnostics for the presence of the causative agent of tuberculosis with a high degree of accuracy indicates the presence of this infection.

  • Blood chemistry

    In tuberculosis, an increase in the level of C-reactive protein can be observed.

  • Biochemical study of urine

    Tuberculosis is characterized by a decrease in the concentration of phosphorus in the urine.

  • CEA analysis

    In tuberculosis, the level of CEA (cancer-embryonic antigen) is increased (70%).

  • General blood analysis

    In tuberculosis, the number of platelets (Plt) (thrombocytosis) is increased, relative lymphocytosis (Lymph) (more than 35%) is noted, monocytosis (Mono) is more than 0.8 × 109 /l.

  • Fluorography

    The location of focal shadows (foci) in the picture (shadows up to 1 cm in size) in the upper parts of the lungs, the presence of calcifications (rounded shadows, comparable in density to bone tissue) is typical for tuberculosis. If there are many calcifications, then it is likely that the person had a fairly close contact with a patient with tuberculosis, but the disease did not develop. Signs of fibrosis, pleuroapical layers in the picture may indicate past tuberculosis.

  • General sputum analysis

    With a tuberculous process in the lung, accompanied by tissue breakdown, especially in the presence of a cavity communicating with the bronchus, a lot of sputum can be secreted. Bloody sputum, consisting almost of pure blood, is most often observed in pulmonary tuberculosis. In pulmonary tuberculosis with cheesy decay, sputum is rusty or brown in color. Fibrinous convolutions consisting of mucus and fibrin can be found in sputum; rice bodies (lentils, Koch lenses); eosinophils; elastic fibers; Kurschmann spirals. An increase in the content of lymphocytes in sputum is possible with pulmonary tuberculosis. Determination of protein in sputum can be helpful in the differential diagnosis between chronic bronchitis and tuberculosis: in chronic bronchitis, traces of protein are determined in sputum, while in pulmonary tuberculosis, the protein content in sputum is higher, and it can be quantified (up to 100-120 g /l).

  • Rheumatoid factor test

    The indicator of rheumatoid factor is above the norm.

Peripheral lung cancer is a neoplasm in the respiratory tract, formed from epithelial cells, which is not difficult to distinguish from other oncology of the bronchi and lungs. Neoplasm can develop from the epithelium of the bronchial mucosa, pulmonary alveoli and glands of bronchioles. Most often, small bronchi and bronchioles are affected, hence the name - peripheral cancer.

Symptoms

In the initial stages, this disease is very difficult to determine. Later, when the tumor grows into the pleura, into the large bronchi, when it passes from the periphery into the central lung cancer, more vivid signs of a malignant neoplasm begin. There is shortness of breath, pain in the chest area (on the side where the tumor is localized), a strong cough interspersed with blood and mucus. Further symptoms and signs:

  1. Difficulty swallowing.
  2. Hoarse, hoarse voice.
  3. Pancoast syndrome. It manifests itself when the tumor grows and touches the vessels of the shoulder girdle, is characterized as weakness in the muscles of the hands, with further atrophy.
  4. Increased subfebrile temperature.
  5. vascular insufficiency.
  6. Sputum with blood.
  7. neurological disorders. Manifested when metastatic cells enter the brain, affecting the phrenic, recurrent and other nerves of the chest cavity, causing paralysis.
  8. Effusion in the pleural cavity. It is characterized by effusion of exudate into the chest cavity. When the fluid is removed, the exudate appears much faster.

The reasons

  1. Smoking comes first. The constituents of tobacco smoke contain many carcinogenic chemicals that can cause cancer.
  2. "Chronicle" - chronic lung pathology. Constant damage to the lung walls by viruses and bacteria causes them to become inflamed, which increases the risk of developing abnormal cells. Also, tuberculosis, pneumonia can develop into oncology.
  3. Ecology. It's no secret that in Russia the environment is the precursor of all diseases, polluted air, poor quality water, smoke, dust from the thermal power plant, which is released into the external environment - all this leaves an imprint on health.
  4. A work sickness manifests itself when people work at "harmful" enterprises, constant inhalation of dust causes the development of sclerosis of the tissues of the bronchi and lungs, which can lead to oncology.
  5. Heredity. Scientists have not yet proven the fact that people are able to transmit this disease to their blood relatives, but such a theory has a place to be, and statistics confirm this.
  6. Pneumoconiosis (asbestosis) is a disease caused by asbestos dust.

Sometimes peripheral lung cancer can be secondary disease. This happens when a malignant tumor is already developing in the body and metastasizes to the lungs and bronchi, so to speak, "settling" on them. The metastatic cell enters the bloodstream, touching the lung, and begins the growth of a new tumor.

Stages of the disease


  1. Biological. From the onset of tumor development to the appearance of the first visible symptoms, which will be officially confirmed by diagnostic studies.
  2. Preclinical. During this period, there are no signs of the disease, this fact reduces the likelihood of getting to the doctor, and therefore diagnosing the disease in the early stages.
  3. Clinical. From the appearance of the first symptoms and the initial visit to the doctors.

Also, the rate of development depends on the type of cancer itself.

Types of peripheral lung cancer

Non-small cell cancer grows slowly, if the patient does not go to the doctor, then the life span will be about 5-8 years, it includes:

  • adenomacarcinoma;
  • Large cell cancer;
  • Squamous.

Small cell cancer develops aggressively and without appropriate treatment, the patient can live up to about two years. With this form of cancer, there are always clinical signs and most often a person does not pay attention to them or confuses them with other diseases.

Forms

  1. cavity form- This is a tumor in the central part of the body with a cavity. During the development of a malignant formation, the central part of the tumor disintegrates, as there are not enough nutritional resources for further development. The tumor reaches at least 10 cm. Clinical symptoms of peripheral localization are practically asymptomatic. The strip form of peripheral cancer is easily confused with cysts, tuberculosis and abscesses in the lungs, since they are very similar on x-rays. This form is diagnosed late, so the survival rate is not high.
  2. Cortico-pleural form is a form of squamous cell carcinoma. A tumor of a round or oval shape, located in the subpleural space and penetrating into the chest, and more precisely into adjacent ribs and into the thoracic vertebrae. With this form of the tumor, pleurisy is observed.

Peripheral cancer of the left lung

The tumor is localized in the upper and lower lobes.

  1. Peripheral cancer of the upper lobe of the right lung. Cancer of the upper lobe of the left lung on X-ray, the differentiation of the contours of the neoplasm is clearly expressed, the tumor itself has a diverse shape and heterogeneous structure. The vascular trunks of the roots of the lungs are dilated. Lymph nodes are within the physiological norm.
  2. Peripheral cancer of the lower lobeleft lung- the tumor is also clearly expressed, but in this case, the supraclavicular, intrathoracic and prescalene lymph nodes are enlarged.

Peripheral cancer of the right lung

The same localization as in the left lung. It occurs an order of magnitude more often than cancer of the left lung. The characteristic is exactly the same as in the left lung.

  1. Nodal shape- at the beginning of formation, the site of localization is the terminal bronchioles. Symptoms appear when the tumor invades the lungs and soft tissues themselves. An X-ray shows a clearly differentiated neoplasm with a bumpy surface. If a deepening is visible on the x-ray, then this indicates the germination of the vessel into the tumor.
  2. Pneumonia-like peripheral (glandular cancer) - the neoplasm originates from the bronchus, spreading throughout the lobe. The primary symptoms are subtle: dry cough, sputum is separated, but in small quantities, then it becomes liquid, abundant and foamy. When bacteria or viruses enter the lungs, symptoms are characteristic of recurrent pneumonia. For an accurate diagnosis, it is necessary to take sputum for the study of exudate.
  3. Pancoast syndrome- localized in the apex of the lung, with this form, a cancerous tumor affects the nerves and blood vessels.
  4. Horner's syndrome- this is a triad of symptoms, most often observed together with Pancoast syndrome, characterized by drooping or retraction of the upper eyelid, retraction of the eyeball and atypical pupillary constriction.

stages

First of all, what the doctor needs to find out is the stage of cancer in order to specifically determine the treatment of the patient. The earlier cancer was diagnosed, the better the prognosis in therapy.

1 stage

  • 1A- education no more than 30 mm in diameter.
  • 1B- the cancer does not reach more than 50 mm.

At this stage, the malignant formation does not metastasize and does not affect the lymphatic system. The first stage is more favorable, since the neoplasm can be removed and there are chances for a full recovery. Clinical signs are not yet manifest, which means that the patient is unlikely to turn to a specialist, and the chances of recovery are reduced. There may be symptoms such as sore throat, mild cough.


2 stage

  • 2A- the size is about 50 mm, the neoplasm approaches the lymph nodes, but does not affect them.
  • 2B- The cancer reaches 70 mm, the lymph nodes are not affected. Metastases are possible in nearby tissues.

Clinical symptoms are already manifesting such as fever, cough with sputum, pain syndrome, rapid weight loss. Survival in the second stage is less, but it is possible to surgically remove the mass. With proper treatment, a patient's life can be extended up to five years.

3 stage

  • 3A— The size is more than 70 mm. Malignant formation affects the regional lymph nodes. Metastases affect the organs of the chest, vessels going to the heart.
  • 3B- The size is also more than 70 mm. Cancer is already beginning to penetrate the lung parenchyma and affect the lymphatic system as a whole. Metastases reach the heart.

In the third stage, treatment practically does not help. Clinical signs are pronounced: sputum with blood, severe pain in the chest area, continuous cough. Doctors prescribe narcotic drugs to alleviate the suffering of the patient. The survival rate is critically low - about 9%.

4 stage

Cancer is not curable. Metastases through the bloodstream have reached all organs and tissues, and concomitant oncological processes are already appearing in other parts of the body. The exudate is constantly pumped out, but it rapidly reappears. Life expectancy is reduced to zero, no one knows how long a person with lung cancer in stage 4 will live, it all depends on the resistance of organisms and, of course, on the method of treatment.

Treatment

The method of treatment depends on the type, form and stage of the disease.


Modern methods of treatment:

  1. Radiation therapy. It gives positive results at the first and second stages, is also used in combination with chemotherapy, at stages 3 and 4 and achieves the best results.
  2. Chemotherapy. When using this method of treatment, complete resorption is rarely observed. Apply 5-7 courses of chemotherapy with an interval of 1 month, at the discretion of the pulmonologist. The interval may change.
  3. Surgical removal - more often, the operation is done at stages 1 and 2, when it is possible to completely remove the neoplasm with a prognosis for complete recovery. At stages 3 and 4, with metastasis, it is useless to remove the tumor and it is dangerous for the patient's life.
  4. Radiosurgery - a fairly recent method, which is also called the "Cyber ​​Knife". Without incisions, the tumor is burned out by radiation exposure.

There may be complications after any treatment: violation of swallowing, germination of the tumor further into neighboring organs, bleeding, tracheal stenosis.

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bronchopulmonary segments.

Lungs subdivided into bronchopulmonary segments, segmenta bronchopulmonalia.

The bronchopulmonary segment is a section of the lung lobe ventilated by one segmental bronchus and supplied by one artery. The veins that drain blood from the segment pass through the intersegmental septa and are most often common to two adjacent segments. The segments are separated from one another by connective tissue septa and have the shape of irregular cones and pyramids, with the apex facing the hilum and the base facing the surface of the lungs. According to the International Anatomical Nomenclature, both the right and left lungs are divided into 10 segments. The bronchopulmonary segment is not only a morphological, but also a functional unit of the lung, since many pathological processes in the lungs begin within one segment.

AT right lung There are ten bronchopulmonary segments, segmenta bronchopulmonalia.

The upper lobe of the right lung contains three segments, to which segmental bronchi are suitable, extending from the right upper pain bronchus, bronchus lobaris superior dexter, which is divided into three segmental bronchi:

1) the apical segment (CI), segmentum apicale (SI), occupies the upper medial portion of the lobe, filling the dome of the pleura;

2) the posterior segment (СII), segmentum рosterius (SII), occupies the dorsal part of the upper lobe, adjacent to the dorsolateral surface of the chest at the level of II-IV ribs;

3) the anterior segment (CIII), segmentum anterius (SIII), is part of the ventral surface of the upper lobe and is adjacent to the base of the anterior chest wall (between the cartilages of the I and IV ribs).

The middle lobe of the right lung consists of two segments, which are approached by segmental bronchi from the right middle lobe bronchus, bronchus lobaris medius dexter, originating from the anterior surface of the main bronchus; heading anteriorly, downwards and outwards, the bronchus is divided into two segmental bronchi:

1) lateral segment (CIV), segmentum laterale (SIV), with its base facing the anterolateral costal surface (at the level of IV-VI ribs), and its apex upward, posteriorly and medially;

2) the medial segment (CV), segmentum mediale (SV), is part of the costal (at the level of IV-VI ribs), medial and diaphragmatic surfaces of the middle lobe.

The lower lobe of the right lung consists of five segments and is ventilated by the right lower lobar bronchus, bronchus lobaris interior dexter, which gives off one segmental bronchus on its way and, reaching the basal sections of the lower lobe, is divided into four segmental bronchi:

1) the apical (upper) segment (CVI), segmentum apicale (superior) (SVI), occupies the apex of the lower lobe and is adjacent to the base of the posterior chest wall (at the level of V-VII ribs) and to the spine;

2) the medial (cardiac) basal segment (СVII), segmentum basale mediale (cardiacum) (SVII), occupies the lower medial part of the lower lobe, reaching its medial and diaphragmatic surfaces;

3) the anterior basal segment (СVIII), segmentum basale anterius (SVIII), occupies the anterolateral part of the lower lobe, goes to its costal (at the level of VI-VIII ribs) and diaphragmatic surface;

4) the lateral basal segment (CIX), segmentum basale laterale (SIX), occupies the mid-lateral part of the base of the lower lobe, partially participating in the formation of the diaphragmatic and costal (at the level of VII-IX ribs) of its surfaces;

5) the posterior basal segment (CX), segmentum basale posterius (SX), occupies part of the base of the lower lobe, has a costal (at the level of VIII-X ribs), diaphragmatic and medial surfaces.

AT left lung distinguish nine bronchopulmonary segments, segmenta bronchopulmonalia.

The upper lobe of the left lung contains four segments ventilated by segmental bronchi from the left upper lobar bronchus, bronchus lobaris superior sinister, which is divided into two branches - apical and reed, due to which some authors divide the upper lobe into two parts corresponding to these bronchi:

1) apical-posterior segment (CI+II), segmentum apicopos- terius (SI+II), topography approximately corresponds to the apical and posterior segments of the upper lobe of the right lung;

2) anterior segment (CIII). segmentim anterius (SIII), is the largest segment of the left lung, it occupies the middle part of the upper lobe;

3) the upper reed segment (СIV), segmentum lingulare superius (SIV), occupies the upper part of the uvula of the lung and the middle sections of the upper lobe;

4) the lower reed segment (CV), segmentum lingulare inferius (SV), occupies the lower anterior part of the lower lobe.


The lower lobe of the left lung consists of five segments, which are approached by segmental bronchi from the left lower lobar bronchus, bronchus lobaris inferior sinister, which in its direction is actually a continuation of the left main bronchus.

The bronchopulmonary segments are part of the parenchyma, which includes the segmental bronchus and artery. On the periphery, the segments are fused with each other and, in contrast to the pulmonary lobules, do not contain clear layers of connective tissue. Each segment has a conical shape, the apex of which faces the gates of the lung, and the base - to its surface. Branches of the pulmonary veins pass through the intersegmental junctions. In each lung, 10 segments are distinguished (Fig. 310, 311, 312).

310. Schematic arrangement of segments of the lung.
A-G - surfaces of the lungs. Segments are marked with numbers.


311. Normal bronchial tree of the right lung in direct projection (according to BK Sharov).
TP - trachea; GB - main bronchus; PRB - intermediate bronchus; VDV - upper lobar bronchus; NDB - lower lobe bronchus; 1 - apical segmental bronchus of the upper lobe; 2 - posterior segmental bronchus of the upper lobe; 3 - anterior segmental bronchus of the upper lobe; 4 - lateral segmental bronchus (upper tongue bronchus for the left lung); 5 - medial segmental bronchus of the middle lobe (lower lingular bronchus of the length of the left lung); 6 - apical segmental bronchus of the lower lobe; 7 - medial basal segmental bronchus of the lower lobe; 8 - anterior basal bronchus of the lower lobe; 9 - lateral basal segmental bronchus of the lower lobe; 10 - posterior basal segmental bronchus of the lower lobe.


312. Bronchial tree of the left lung in direct projection. The designations are the same as in Fig. 311.

Segments of the right lung

Segments of the upper lobe.

1. The apical segment (segmentum apicale) occupies the apex of the lung and has four intersegmental borders: two on the medial and two on the costal surface of the lung between the apical and anterior, apical and posterior segments. The area of ​​the segment on the costal surface is somewhat smaller than on the medial. Structural elements of the hilum of the segment (bronchus, artery and vein) can be approached after dissection of the visceral pleura in front of the hilum of the lungs along the phrenic nerve. The segmental bronchus is 1-2 cm long, sometimes departs in a common trunk with the posterior segmental bronchus. On the chest, the lower border of the segment corresponds to the lower edge of the 11th rib.

2. The posterior segment (segmentum posterius) is located dorsal to the apical segment and has five intersegmental boundaries: two are projected on the medial surface of the lung between the posterior and apical, posterior and upper segments of the lower lobe, and three boundaries are distinguished on the costal surface: between the apical and posterior, posterior and anterior, posterior and upper segments of the lower lobe of the lung. The border formed by the posterior and anterior segments is oriented vertically and ends at the bottom at the junction of fissura horizontalis and fissura obliqua. The border between the posterior and upper segments of the lower lobe corresponds to the posterior part of the fissura horizontalis. The approach to the bronchus, artery and vein of the posterior segment is carried out from the medial side when dissecting the pleura on the posterior surface of the gate or from the side of the initial section of the horizontal sulcus. The segmental bronchus is located between an artery and a vein. The vein of the posterior segment merges with the vein of the anterior segment and flows into the pulmonary vein. On the surface of the chest, the posterior segment is projected between the II and IV ribs.

3. The anterior segment (segmentum anterius) is located in the anterior part of the upper lobe of the right lung and has five intersegmental boundaries: two - pass on the medial surface of the lung, separating the anterior and apical anterior and medial segments (middle lobe); three borders run along the costal surface between the anterior and apical, anterior and posterior, anterior, lateral and medial segments of the middle lobe. The anterior segment artery arises from the superior branch of the pulmonary artery. The segmental vein is a tributary of the superior pulmonary vein and is located deeper than the segmental bronchus. The vessels and bronchus of the segment can be ligated after dissection of the medial pleura in front of the hilum of the lung. The segment is located at the level of II - IV ribs.

Middle share segments.

4. The lateral segment (segmentum laterale) from the side of the medial surface of the lung is projected only in the form of a narrow strip above the oblique interlobar groove. The segmental bronchus is directed backward, so the segment occupies the posterior part of the middle lobe and is visible from the side of the costal surface. It has five intersegmental borders: two - on the medial surface between the lateral and medial, lateral and anterior segments of the lower lobe (the last border corresponds to the final part of the oblique interlobar groove), three borders on the costal surface of the lung, limited by the lateral and medial segments of the middle lobe (the first border goes vertically from the middle of the horizontal groove to the end of the oblique groove, the second - between the lateral and anterior segments and corresponds to the position of the horizontal groove; the last border of the lateral segment is in contact with the anterior and posterior segments of the lower lobe).

Segmental bronchus, artery and vein are located deep, they can only be approached along an oblique furrow below the gate of the lung. The segment corresponds to the space on the chest between the IV-VI ribs.

5. The medial segment (segmentum mediale) is visible both on the costal and medial surfaces of the middle lobe. It has four intersegmental borders: two separate the medial segment from the anterior segment of the upper lobe and the lateral segment of the lower lobe. The first border coincides with the anterior part of the horizontal furrow, the second - with the oblique furrow. There are also two intersegmental boundaries on the costal surface. One line starts in the middle of the anterior part of the horizontal furrow and descends to the end of the oblique furrow. The second border separates the medial segment from the anterior segment of the upper lobe and coincides with the position of the anterior horizontal sulcus.

The segmental artery arises from the inferior branch of the pulmonary artery. Sometimes, together with the artery 4 segments. Under it is a segmental bronchus, and then a vein 1 cm long. Access to the segmental stalk is possible below the gate of the lung through an oblique interlobar groove. The border of the segment on the chest corresponds to the IV-VI ribs along the midaxillary line.

Segments of the lower lobe.

6. The upper segment (segmentum superius) occupies the top of the lower lobe of the lung. The segment at the level of the III-VII ribs has two intersegmental borders: one between the upper segment of the lower lobe and the posterior segment of the upper lobe runs along an oblique groove, the second - between the upper and lower segments of the lower lobe. To determine the border between the upper and lower segments, it is necessary to conditionally continue the anterior part of the horizontal sulcus of the lung from the place of its confluence with the oblique sulcus.

The upper segment receives an artery from the lower branch of the pulmonary artery. Below the artery is the bronchus, and then the vein. Access to the gates of the segment is possible through an oblique interlobar furrow. The visceral pleura is dissected from the side of the costal surface.

7. The medial basal segment (segmentum basale mediale) is located on the medial surface below the gate of the lungs, in contact with the right atrium and the inferior vena cava; has borders with the anterior, lateral and posterior segments. Occurs only in 30% of cases.

The segmental artery arises from the inferior branch of the pulmonary artery. The segmental bronchus is the highest branch of the lower lobe bronchus; the vein is located below the bronchus and flows into the lower right pulmonary vein.

8. Anterior basal segment (segmentum basale anterius) is located in front of the lower lobe. On the chest corresponds to the VI-VIII ribs along the mid-axillary line. It has three intersegmental borders: the first passes between the anterior and lateral segments of the middle lobe and corresponds to the oblique interlobar sulcus, the second - between the anterior and lateral segments; its projection on the medial surface coincides with the beginning of the pulmonary ligament; the third border runs between the anterior and upper segments of the lower lobe.

The segmental artery originates from the lower branch of the pulmonary artery, the bronchus - from the branch of the lower lobe bronchus, the vein flows into the lower pulmonary vein. The artery and bronchus can be observed under the visceral pleura at the bottom of the oblique interlobar groove, and the vein under the pulmonary ligament.

9. The lateral basal segment (segmentum basale laterale) is visible on the costal and diaphragmatic surfaces of the lung, between the VII-IX ribs along the posterior axillary line. It has three intersegmental borders: the first - between the lateral and anterior segments, the second - on the medial surface between the lateral and medial, the third - between the lateral and posterior segments. The segmental artery and bronchus are located at the bottom of the oblique groove, and the vein is located under the pulmonary ligament.

10. The posterior basal segment (segmentum basale posterius) lies in the back of the lower lobe, in contact with the spine. It occupies the space between the VII-X ribs. There are two intersegmental borders: the first - between the posterior and lateral segments, the second - between the posterior and upper. Segmental artery, bronchus and vein are located in the depth of the oblique furrow; it is easier to approach them during the operation from the medial surface of the lower lobe of the lung.

Segments of the left lung

Segments of the upper lobe.

1. The apical segment (segmentum apicale) practically repeats the shape of the apical segment of the right lung. Above the gate are the artery, bronchus and vein of the segment.

2. The posterior segment (segmentum posterius) (Fig. 310) with its lower border descends to the level of the V rib. The apical and posterior segments are often combined into one segment.

3. The anterior segment (segmentum anterius) occupies the same position, only its lower intersegmental border runs horizontally along the third rib and separates the upper reed segment.

4. The upper reed segment (segmentum linguale superius) is located on the medial and costal surfaces at the level of the III-V ribs in front and along the midaxillary line between the IV-VI ribs.

5. The lower reed segment (segmentum linguale inferius) is below the previous segment. Its lower intersegmental border coincides with the interlobar sulcus. On the front edge of the lung between the upper and lower reed segments there is a center of the cardiac notch of the lung.

Segments of the lower lobe coincide with the right lung.
6. Upper segment (segmentum superius).
7. The medial basal segment (segmentum basale mediale) is unstable.
8. Anterior basal segment (segmentum basale anterius).
9. Lateral basal segment (segmentum basale laterale).
10. Posterior basal segment (segmentum basale posterius)

S1+2 segment of the left lung. Represents a combination of C1 and C2 segments. Refers to the upper lobe of the left lung. It is topographically projected onto the chest along the anterior surface from the 2nd rib and up, through the apex to the middle of the scapula.

S3 segment (anterior) of the left lung. Refers to the upper lobe of the left lung. Topographically projected onto the chest in front from 2 to 4 ribs.

S4 segment (superior lingual) of the left lung. Refers to the upper lobe of the left lung. It is topographically projected onto the chest along the anterior surface from 4 to 5 ribs.

S5 segment (lower lingual) of the left lung. Refers to the upper lobe of the left lung. It is topographically projected onto the chest along the anterior surface from the 5th rib to the diaphragm.

S6 segment (superior basal) of the left lung. Refers to the lower lobe of the left lung. It is topographically projected onto the chest in the paravertebral region from the middle of the scapula to its lower angle.

S8 segment (anterior basal) of the left lung. Refers to the lower lobe of the left lung. It is topographically delimited in front by the main interlobar sulcus, below by the diaphragm, and behind by the posterior axillary line.

S9 segment (lateral basal) of the left lung. Refers to the lower lobe of the left lung. It is topographically projected onto the chest between the scapular and posterior axillary lines from the middle of the scapula to the diaphragm.

S10 segment (posterior basal) of the left lung. Refers to the lower lobe of the left lung. It is topographically projected onto the chest from the lower angle of the scapula to the diaphragm, delimited on the sides by the paravertebral and scapular lines.

S1 segment (apical or apical) of the right lung. Refers to the upper lobe of the right lung. It is topographically projected onto the chest along the anterior surface of the 2nd rib, through the apex of the lung to the spine of the scapula.

S2 segment (posterior) of the right lung. Refers to the upper lobe of the right lung. It is topographically projected onto the chest along the posterior surface paravertebral from the upper edge of the scapula to its middle.

S3 segment (anterior) of the right lung. Refers to the upper lobe of the right lung. Topographically projected onto the chest in front of 2 to 4 ribs.

S4 segment (lateral) of the right lung. Refers to the middle lobe of the right lung. It is topographically projected onto the chest in the anterior axillary region between the 4th and 6th ribs.

S5 segment (medial) of the right lung. Refers to the middle lobe of the right lung. It is topographically projected onto the chest with 4 and 6 ribs closer to the sternum.

S6 segment (superior basal) of the right lung. Refers to the lower lobe of the right lung. It is topographically projected onto the chest in the paravertebral region from the middle of the scapula to its lower angle.

S7 segment of the right lung. Topographically localized from the inner surface of the right lung, located below the root of the right lung. It is projected onto the chest from the 6th rib to the diaphragm between the sternal and midclavicular lines.

S8 segment (anterior basal) of the right lung. Refers to the lower lobe of the right lung. It is topographically delimited in front by the main interlobar sulcus, below by the diaphragm, and behind by the posterior axillary line.

S9 segment (lateral basal) of the right lung. Refers to the lower lobe of the right lung. It is topographically projected onto the chest between the scapular and posterior axillary lines from the middle of the scapula to the diaphragm.

Segment S10 (posterior basal) of the right lung. Refers to the lower lobe of the right lung. It is topographically projected onto the chest from the lower angle of the scapula to the diaphragm, delimited on the sides by the paravertebral and scapular lines.

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