Left Main Bronchus
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A bronchus is a passage or airway in the
lower respiratory tract The respiratory tract is the subdivision of the respiratory system involved with the process of respiration in mammals. The respiratory tract is lined with respiratory epithelium as respiratory mucosa. Air is breathed in through the nose to th ...
that conducts
air The atmosphere of Earth is the layer of gases, known collectively as air, retained by Earth's gravity that surrounds the planet and forms its planetary atmosphere. The atmosphere of Earth protects life on Earth by creating pressure allowing f ...
into the
lung The lungs are the primary organs of the respiratory system in humans and most other animals, including some snails and a small number of fish. In mammals and most other vertebrates, two lungs are located near the backbone on either side of t ...
s. The first or primary bronchi pronounced (BRAN-KAI) to branch from the
trachea The trachea, also known as the windpipe, is a Cartilage, cartilaginous tube that connects the larynx to the bronchi of the lungs, allowing the passage of air, and so is present in almost all air-breathing animals with lungs. The trachea extends ...
at the
carina Carina may refer to: Places Australia * Carina, Queensland, a suburb in Brisbane * Carina Heights, Queensland, a suburb in Brisbane * Carina, Victoria, a locality in Mildura Serbia * Carina, Osečina, a village in the Kolubara District ...
are the right main bronchus and the left main bronchus. These are the widest bronchi, and enter the right lung, and the left lung at each hilum. The main bronchi branch into narrower secondary bronchi or lobar bronchi, and these branch into narrower tertiary bronchi or segmental bronchi. Further divisions of the segmental bronchi are known as 4th order, 5th order, and 6th order segmental bronchi, or grouped together as subsegmental bronchi. The bronchi, when too narrow to be supported by cartilage, are known as
bronchiole The bronchioles or bronchioli (pronounced ''bron-kee-oh-lee'') are the smaller branches of the bronchial airways in the lower respiratory tract. They include the terminal bronchioles, and finally the respiratory bronchioles that mark the start ...
s. No
gas exchange Gas exchange is the physical process by which gases move passively by Diffusion#Diffusion vs. bulk flow, diffusion across a surface. For example, this surface might be the air/water interface of a water body, the surface of a gas bubble in a liqui ...
takes place in the bronchi.


Structure

The
trachea The trachea, also known as the windpipe, is a Cartilage, cartilaginous tube that connects the larynx to the bronchi of the lungs, allowing the passage of air, and so is present in almost all air-breathing animals with lungs. The trachea extends ...
(windpipe) divides at the
carina Carina may refer to: Places Australia * Carina, Queensland, a suburb in Brisbane * Carina Heights, Queensland, a suburb in Brisbane * Carina, Victoria, a locality in Mildura Serbia * Carina, Osečina, a village in the Kolubara District ...
into two main or primary bronchi, the left bronchus and the right bronchus. The carina of the trachea is located at the level of the sternal angle and the fifth
thoracic vertebra In vertebrates, thoracic vertebrae compose the middle segment of the vertebral column, between the cervical vertebrae and the lumbar vertebrae. In humans, there are twelve thoracic vertebrae and they are intermediate in size between the cervical ...
(at rest). The right main bronchus is wider, shorter, and more vertical than the left main bronchus,Alt URL
/ref> its mean length is 1.09 cm. It enters the root of the right lung at approximately the fifth thoracic vertebra. The right main bronchus subdivides into three secondary bronchi (also known as lobar bronchi), which deliver oxygen to the three lobes of the right lung—the superior, middle and inferior lobe. The
azygos vein The azygos vein is a vein running up the right side of the thoracic vertebral column draining itself towards the superior vena cava. It connects the systems of superior vena cava and inferior vena cava and can provide an alternative path for blood ...
arches over it from behind; and the right pulmonary artery lies at first below and then in front of it. About 2 cm from its commencement it gives off a branch to the superior lobe of the right lung, which is also called the
eparterial bronchus The eparterial bronchus (right superior lobar bronchus) is a branch of the right main bronchus given off about 2.5 cm from the bifurcation of the trachea. This branch supplies the superior lobe of the right lung and is the most superior of a ...
. ''Eparterial'' refers to its position above the right
pulmonary artery A pulmonary artery is an artery in the pulmonary circulation that carries deoxygenated blood from the right side of the heart to the lungs. The largest pulmonary artery is the ''main pulmonary artery'' or ''pulmonary trunk'' from the heart, and ...
. The right bronchus now passes below the artery, and is known as the ''hyparterial'' branch which divides into the two lobar bronchi to the middle and lower lobes. The left main bronchus is smaller in caliber but longer than the right, being 5 cm long. It enters the root of the left lung opposite the sixth thoracic vertebra. It passes beneath the
aortic arch The aortic arch, arch of the aorta, or transverse aortic arch () is the part of the aorta between the ascending and descending aorta. The arch travels backward, so that it ultimately runs to the left of the trachea. Structure The aorta begins ...
, crosses in front of the
esophagus The esophagus (American English) or oesophagus (British English; both ), non-technically known also as the food pipe or gullet, is an organ in vertebrates through which food passes, aided by peristaltic contractions, from the pharynx to the ...
, the
thoracic duct In human anatomy, the thoracic duct is the larger of the two lymph ducts of the lymphatic system. It is also known as the ''left lymphatic duct'', ''alimentary duct'', ''chyliferous duct'', and ''Van Hoorne's canal''. The other duct is the righ ...
, and the
descending aorta In human anatomy, the descending aorta is part of the aorta, the largest artery in the body. The descending aorta begins at the aortic arch and runs down through the chest and abdomen. The descending aorta anatomically consists of two portions o ...
, and has the left pulmonary artery lying at first above, and then in front of it. The left bronchus has no
eparterial branch The eparterial bronchus (right superior lobar bronchus) is a branch of the right main bronchus given off about 2.5 cm from the bifurcation of the trachea. This branch supplies the superior lobe of the right lung and is the most superior of al ...
, and therefore it has been supposed by some that there is no upper lobe to the left lung, but that the so-called upper lobe corresponds to the middle lobe of the
right lung The lungs are the primary Organ (anatomy), organs of the respiratory system in humans and most other animals, including some snails and a small number of fish. In mammals and most other vertebrates, two lungs are located near the vertebral co ...
. The left main bronchus divides into two secondary bronchi or lobar bronchi, to deliver air to the two lobes of the left lung—the superior and the inferior lobe. The secondary bronchi divide further into tertiary bronchi, (also known as segmental bronchi), each of which supplies a
bronchopulmonary segment A bronchopulmonary segment is a portion of lung supplied by a specific segmental bronchus and its vessels. These arteries branch from the pulmonary and bronchial arteries, and run together through the center of the segment. Veins and lymphatic vess ...
. A bronchopulmonary segment is a division of a lung separated from the rest of the lung by a
septum In biology, a septum (Latin for ''something that encloses''; plural septa) is a wall, dividing a cavity or structure into smaller ones. A cavity or structure divided in this way may be referred to as septate. Examples Human anatomy * Interatri ...
of
connective tissue Connective tissue is one of the four primary types of animal tissue, along with epithelial tissue, muscle tissue, and nervous tissue. It develops from the mesenchyme derived from the mesoderm the middle embryonic germ layer. Connective tiss ...
. This property allows a bronchopulmonary segment to be surgically removed without affecting other segments. Initially, there are ten segments in each lung, but during development with the left lung having just two lobes, two pairs of segments fuse to give eight, four for each lobe. The tertiary bronchi divide further in another three branchings known as 4th order, 5th order and 6th order segmental bronchi which are also referred to as subsegmental bronchi. These branch into many smaller
bronchiole The bronchioles or bronchioli (pronounced ''bron-kee-oh-lee'') are the smaller branches of the bronchial airways in the lower respiratory tract. They include the terminal bronchioles, and finally the respiratory bronchioles that mark the start ...
s which divide into
terminal bronchiole The bronchioles or bronchioli (pronounced ''bron-kee-oh-lee'') are the smaller branches of the bronchial airways in the lower respiratory tract. They include the terminal bronchioles, and finally the respiratory bronchioles that mark the start o ...
s, each of which then gives rise to several
respiratory bronchiole The bronchioles or bronchioli (pronounced ''bron-kee-oh-lee'') are the smaller branches of the bronchial airways in the lower respiratory tract. They include the terminal bronchioles, and finally the respiratory bronchioles that mark the start o ...
s, which go on to divide into two to eleven alveolar ducts. There are five or six
alveolar sac A pulmonary alveolus (plural: alveoli, from Latin ''alveolus'', "little cavity"), also known as an air sac or air space, is one of millions of hollow, distensible cup-shaped cavities in the lungs where oxygen is exchanged for carbon dioxide. Al ...
s associated with each alveolar duct. The
alveolus Alveolus (; pl. alveoli, adj. alveolar) is a general anatomical term for a concave cavity or pit. Uses in anatomy and zoology * Pulmonary alveolus, an air sac in the lungs ** Alveolar cell or pneumocyte ** Alveolar duct ** Alveolar macrophage * Mam ...
is the basic anatomical unit of gas exchange in the lung. The main bronchi have relatively large lumens that are lined by
respiratory epithelium Respiratory epithelium, or airway epithelium, is a type of ciliated columnar epithelium found lining most of the respiratory tract as respiratory mucosa, where it serves to moisten and protect the airways. It is not present in the vocal cords o ...
. This cellular lining has cilia departing towards the mouth which removes dust and other small particles. There is a
smooth muscle Smooth muscle is an involuntary non-striated muscle, so-called because it has no sarcomeres and therefore no striations (''bands'' or ''stripes''). It is divided into two subgroups, single-unit and multiunit smooth muscle. Within single-unit mus ...
layer below the epithelium arranged as two ribbons of muscle that spiral in opposite directions. This smooth muscle layer contains
seromucous gland Exocrine glands are glands that secrete substances on to an epithelial surface by way of a duct. Examples of exocrine glands include sweat, salivary, mammary, ceruminous, lacrimal, sebaceous, prostate and mucous. Exocrine glands are one of ...
s, which secrete
mucus Mucus ( ) is a slippery aqueous secretion produced by, and covering, mucous membranes. It is typically produced from cells found in mucous glands, although it may also originate from mixed glands, which contain both serous and mucous cells. It ...
, in its wall. Hyaline cartilage is present in the bronchi, surrounding the smooth muscle layer. In the main bronchi, the cartilage forms C-shaped rings like those in the trachea, while in the smaller bronchi, hyaline cartilage is present in irregularly arranged crescent-shaped plates and islands. These plates give structural support to the bronchi and keep the airway open. The bronchial wall normally has a thickness of 10% to 20% of the total bronchial diameter.


Microanatomy

The
cartilage Cartilage is a resilient and smooth type of connective tissue. In tetrapods, it covers and protects the ends of long bones at the joints as articular cartilage, and is a structural component of many body parts including the rib cage, the neck an ...
and
mucous membrane A mucous membrane or mucosa is a membrane that lines various cavities in the body of an organism and covers the surface of internal organs. It consists of one or more layers of epithelial cells overlying a layer of loose connective tissue. It is ...
of the main bronchus (primary bronchi) are similar to those in the trachea. They are lined with
respiratory epithelium Respiratory epithelium, or airway epithelium, is a type of ciliated columnar epithelium found lining most of the respiratory tract as respiratory mucosa, where it serves to moisten and protect the airways. It is not present in the vocal cords o ...
, which is classified as ciliated pseudostratified columnar epithelium. The epithelium in the main bronchi contains goblet cells, which are glandular, modified simple columnar epithelial cells that produce
mucins Mucins () are a family of high molecular weight, heavily glycosylated proteins (glycoconjugates) produced by epithelial tissues in most animals. Mucins' key characteristic is their ability to form gels; therefore they are a key component in most ...
, the main component of mucus. Mucus plays an important role in keeping the airways clear in the
mucociliary clearance Mucociliary clearance (MCC), mucociliary transport, or the mucociliary escalator, describes the self-clearing mechanism of the airways in the respiratory system. It is one of the two protective processes for the lungs in removing inhaled particl ...
process. As branching continues through the bronchial tree, the amount of hyaline cartilage in the walls decreases until it is absent in the bronchioles. As the cartilage decreases, the amount of smooth muscle increases. The mucous membrane also undergoes a transition from ciliated pseudostratified columnar epithelium, to simple ciliated cuboidal epithelium, to simple
squamous epithelium Epithelium or epithelial tissue is one of the four basic types of animal tissue, along with connective tissue, muscle tissue and nervous tissue. It is a thin, continuous, protective layer of compactly packed cells with a little intercellula ...
in the alveolar ducts and alveoli


Variation

In 0.1 to 5% of people there is a right superior lobe bronchus arising from the main stem bronchus prior to the carina. This is known as a tracheal bronchus, and seen as an
anatomical variation An anatomical variation, anatomical variant, or anatomical variability is a presentation of body structure with morphological features different from those that are typically described in the majority of individuals. Anatomical variations are categ ...
. It can have multiple variations and, although usually asymptomatic, it can be the root cause of pulmonary disease such as a recurrent infection. In such cases resection is often curative. The cardiac bronchus has a prevalence of ≈0.3% and presents as an accessory bronchus arising from the bronchus intermedius between the upper lobar bronchus and the origin of the middle and lower lobar bronchi of the right main bronchus. An accessory cardiac bronchus is usually an asymptomatic condition but may be associated with persistent infection or
hemoptysis Hemoptysis is the coughing up of blood or blood-stained mucus from the bronchi, larynx, trachea, or lungs. In other words, it is the airway bleeding. This can occur with lung cancer, infections such as tuberculosis, bronchitis, or pneumonia, a ...
. In about half of observed cases the cardiac bronchus presents as a short dead-ending bronchial stump, in the remainder the bronchus may exhibit branching and associated aerated
lung parenchyma Parenchyma () is the bulk of functional substance in an animal organ or structure such as a tumour. In zoology it is the name for the tissue that fills the interior of flatworms. Etymology The term ''parenchyma'' is New Latin from the word π ...
.


Function

The bronchi function to carry
air The atmosphere of Earth is the layer of gases, known collectively as air, retained by Earth's gravity that surrounds the planet and forms its planetary atmosphere. The atmosphere of Earth protects life on Earth by creating pressure allowing f ...
that is breathed in through to the functional tissues of the lungs, called alveoli. Exchange of gases between the air in the lungs and the blood in the
capillaries A capillary is a small blood vessel from 5 to 10 micrometres (μm) in diameter. Capillaries are composed of only the tunica intima, consisting of a thin wall of simple squamous endothelial cells. They are the smallest blood vessels in the body: ...
occurs across the walls of the alveolar ducts and alveoli. The
alveolar ducts A pulmonary alveolus (plural: alveoli, from Latin ''alveolus'', "little cavity"), also known as an air sac or air space, is one of millions of hollow, distensible cup-shaped cavities in the lungs where oxygen is exchanged for carbon dioxide. Al ...
and alveoli consist primarily of simple
squamous epithelium Epithelium or epithelial tissue is one of the four basic types of animal tissue, along with connective tissue, muscle tissue and nervous tissue. It is a thin, continuous, protective layer of compactly packed cells with a little intercellula ...
, which permits rapid diffusion of
oxygen Oxygen is the chemical element with the symbol O and atomic number 8. It is a member of the chalcogen group in the periodic table, a highly reactive nonmetal, and an oxidizing agent that readily forms oxides with most elements as wel ...
and
carbon dioxide Carbon dioxide (chemical formula ) is a chemical compound made up of molecules that each have one carbon atom covalently double bonded to two oxygen atoms. It is found in the gas state at room temperature. In the air, carbon dioxide is transpar ...
.


Clinical significance

Bronchial wall thickening, as can be seen on CT scan, generally (but not always) implies
inflammation Inflammation (from la, wikt:en:inflammatio#Latin, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or Irritation, irritants, and is a protective response involving im ...
of the bronchi (
bronchitis Bronchitis is inflammation of the bronchi (large and medium-sized airways) in the lungs that causes coughing. Bronchitis usually begins as an infection in the nose, ears, throat, or sinuses. The infection then makes its way down to the bronchi. ...
). Normally, the ratio of the bronchial wall thickness and the bronchial diameter is between 0.17 and 0.23.Page 112
in:


Bronchitis

Bronchitis is defined as inflammation of the bronchi, which can either be
acute Acute may refer to: Science and technology * Acute angle ** Acute triangle ** Acute, a leaf shape in the glossary of leaf morphology * Acute (medicine), a disease that it is of short duration and of recent onset. ** Acute toxicity, the adverse eff ...
or chronic. Acute bronchitis is usually caused by viral or
bacterial infections Pathogenic bacteria are bacteria that can cause disease. This article focuses on the bacteria that are pathogenic to humans. Most species of bacteria are harmless and are often beneficial but others can cause infectious diseases. The number of t ...
. Many sufferers of
chronic bronchitis Bronchitis is inflammation of the bronchi (large and medium-sized airways) in the lungs that causes coughing. Bronchitis usually begins as an infection in the nose, ears, throat, or sinuses. The infection then makes its way down to the bronchi. ...
also suffer from
chronic obstructive pulmonary disease Chronic obstructive pulmonary disease (COPD) is a type of progressive lung disease characterized by long-term respiratory symptoms and airflow limitation. The main symptoms include shortness of breath and a cough, which may or may not produce ...
(COPD), and this is usually associated with
smoking Smoking is a practice in which a substance is burned and the resulting smoke is typically breathed in to be tasted and absorbed into the bloodstream. Most commonly, the substance used is the dried leaves of the tobacco plant, which have bee ...
or long-term exposure to irritants.


Aspiration

The left main bronchus departs from the trachea at a greater angle than that of the right main bronchus. The right bronchus is also wider than the left and these differences predispose the right lung to aspirational problems. If food, liquids, or foreign bodies are aspirated, they will tend to lodge in the right main bronchus.
Bacterial pneumonia Bacterial pneumonia is a type of pneumonia caused by bacterial infection. Types Gram-positive ''Streptococcus pneumoniae'' () is the most common bacterial cause of pneumonia in all age groups except newborn infants. ''Streptococcus pneumoniae'' ...
and
aspiration pneumonia Aspiration pneumonia is a type of lung infection that is due to a relatively large amount of material from the stomach or mouth entering the lungs. Signs and symptoms often include fever and cough of relatively rapid onset. Complications may inc ...
may result. If a
tracheal tube A tracheal tube is a catheter that is inserted into the trachea for the primary purpose of establishing and maintaining a patent airway and to ensure the adequate exchange of oxygen and carbon dioxide. Many different types of tracheal tubes are ...
used for
intubation Intubation (sometimes entubation) is a medical procedure involving the insertion of a tube into the body. Patients are generally anesthetized beforehand. Examples include tracheal intubation, and the balloon tamponade with a Sengstaken-Blake ...
is inserted too far, it will usually lodge in the right bronchus, allowing ventilation only of the right lung.


Asthma

Asthma Asthma is a long-term inflammatory disease of the airways of the lungs. It is characterized by variable and recurring symptoms, reversible airflow obstruction, and easily triggered bronchospasms. Symptoms include episodes of wheezing, cou ...
is marked by hyperresponsiveness of the bronchi with an inflammatory component, often in response to
allergen An allergen is a type of antigen that produces an abnormally vigorous immune response in which the immune system fights off a perceived threat that would otherwise be harmless to the body. Such reactions are called allergies. In technical terms ...
s. In asthma, the constriction of the bronchi can result in difficulty in breathing giving
shortness of breath Shortness of breath (SOB), also medically known as dyspnea (in AmE) or dyspnoea (in BrE), is an uncomfortable feeling of not being able to breathe well enough. The American Thoracic Society defines it as "a subjective experience of breathing disc ...
; this can lead to a lack of oxygen reaching the body for cellular processes. In this case, an
inhaler An inhaler (also known as a puffer, pump or allergy spray) is a medical device used for delivering medicines into the lungs through the work of a person's breathing. This allows medicines to be delivered to and absorbed in the lungs, which prov ...
can be used to rectify the problem. The inhaler administers a
bronchodilator A bronchodilator or broncholytic (although the latter occasionally includes secretory inhibition as well) is a substance that dilates the bronchi and bronchioles, decreasing resistance in the respiratory airway and increasing airflow to the lung ...
, which serves to soothe the constricted bronchi and to re-expand the airways. This effect occurs quite quickly.


Bronchial atresia

Bronchial atresia is a rare congenital disorder that can have a varied appearance. A bronchial atresia is a defect in the development of the bronchi, affecting one or more bronchi – usually segmental bronchi and sometimes lobar. The defect takes the form of a blind-ended bronchus. The surrounding tissue secretes mucus normally but builds up and becomes distended. This can lead to regional emphysema. The collected mucus may form a mucoid impaction or a bronchocele, or both. A
pectus excavatum Pectus excavatum is a structural deformity of the anterior thoracic wall in which the sternum and rib cage are shaped abnormally. This produces a caved-in or sunken appearance of the chest. It can either be present at birth or develop after pubert ...
may accompany a bronchial atresia.


Additional images

File:Bronchi.JPG, Cross-section of secondary bronchus File:Relations of the aorta, trachea, esophagus and other heart structures.png, The left and right main bronchi sit behind the heart, shown here.


Citations


Sources

* Moore, Keith L. and Arthur F. Dalley. ''Clinically Oriented Anatomy, 4th ed.'' (1999). .


External links

{{Authority control Respiratory system Thorax (human anatomy)