A bronchus is a passage or airway in the lower respiratory tract that conducts air 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 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 bronchioles. 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

(windpipe) divides at the carina 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 The sternal angle (also known as the angle of Louis, angle of Ludovic or manubriosternal junction) is the synarthrotic joint formed by the articulation of the manubrium and the body of the sternum. The sternal angle is a palpable clinical landma ...

and the fifth thoracic vertebra (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 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. ''Eparterial'' refers to its position above the right pulmonary artery. 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 a ...

, 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 right ...

, and the descending aorta, and has the left pulmonary artery lying at first above, and then in front of it. The left bronchus has no eparterial branch, 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 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 ...

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 bronchioles which divide into terminal bronchioles, 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 duct 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. There are five or six alveolar sacs 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 two ...

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 is ...

, in its wall.

Hyaline cartilage Hyaline cartilage is the glass-like (hyaline) and translucent cartilage found on many joint surfaces. It is also most commonly found in the ribs, nose, larynx, and trachea. Hyaline cartilage is pearl-gray in color, with a firm consistency and has ...

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 of the main bronchus (primary bronchi) are similar to those in the trachea. They are lined with

, which is classified as ciliated pseudostratified columnar epithelium. The epithelium in the main bronchi contains

goblet cell Goblet cells are simple columnar epithelial cells that secrete gel-forming mucins, like mucin 5AC. The goblet cells mainly use the merocrine method of secretion, secreting vesicles into a duct, but may use apocrine methods, budding off their secre ...

s, which are

gland In animals, a gland is a group of cells in an animal's body that synthesizes substances (such as hormones) for release into the bloodstream (endocrine gland) or into cavities inside the body or its outer surface (exocrine gland). Structure De ...

ular, 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 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 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. 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 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 occurs across the walls of the alveolar ducts and alveoli. The alveolar ducts and alveoli consist primarily of simple squamous epithelium, 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 thickness (T) and diameter (D)

Bronchial wall thickening, as can be seen on

CT scan A computed tomography scan (CT scan; formerly called computed axial tomography scan or CAT scan) is a medical imaging technique used to obtain detailed internal images of the body. The personnel that perform CT scans are called radiographers ...

, 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). 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 Acute bronchitis, also known as a chest cold, is short-term bronchitis – inflammation of the bronchi (large and medium-sized airways) of the lungs. The most common symptom is a cough. Other symptoms include coughing up mucus, wheezing, shortne ...

is usually caused by

viral Viral means "relating to viruses" (small infectious agents). Viral may also refer to: Viral behavior, or virality Memetic behavior likened that of a virus, for example: * Viral marketing, the use of existing social networks to spread a marke ...

or bacterial infections. Many sufferers of chronic bronchitis 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 and aspiration pneumonia may result. If a tracheal tube used for intubation 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 can be used to rectify the problem. The inhaler administers a bronchodilator, 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 A bronchocele is a segment of bronchus that is filled with mucus and completely enclosed so the mucus cannot drain out. This segment is usually dilated. It is also referred to as bronchial mucocele. If there is no obstruction to the flow of mucus, ...

, or both. A pectus excavatum 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)