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BI, All Rights Reserved, 2005 1 2B:Normal Anatomy of The Trachea Prepared By Bronchoscopy...
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Transcript of BI, All Rights Reserved, 2005 1 2B:Normal Anatomy of The Trachea Prepared By Bronchoscopy...
BI, All Rights Reserved, 2005BI, All Rights Reserved, 2005 11
2B:2B: Normal Anatomy of The Normal Anatomy of The TracheaTrachea
Prepared ByPrepared ByBronchoscopy Bronchoscopy InternationalInternational
Contact us at Contact us at [email protected]@bronchoscopy.org
BRONCHATLAS©
Series of Web-based Bronchoscopic Images
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Tracheal and subglottic Tracheal and subglottic anatomyanatomy
The trachea is a cylindrical tube that projects onto the spine from C6 to the level of T5. As it passes downwards, it follows the curvature of the spine, and courses slightly backward. Near the tracheal bifurcation, it deviates slightly to the right.
The subglottis ends 2 cm below the level of the vocal cords. This corresponds cranially to the inferior margin of the cricoid cartilage, which is the inferior margin of the larynx and forms the only complete cartilage ring in the airway.
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Tracheobronchial anatomyTracheobronchial anatomy
Tracheal Displacement Due to Goiter
Images downloaded from From www.vh.org
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Anatomy of the tracheaAnatomy of the trachea
Length: 9-15 cmLength: 9-15 cm Outer diameter: 21-27 mmOuter diameter: 21-27 mm Internal diameter: 12-18 mmInternal diameter: 12-18 mm Distance infracricoid-carina about 11 cmDistance infracricoid-carina about 11 cm
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Anatomy of the tracheaAnatomy of the trachea
18-22 cartilaginous rings18-22 cartilaginous rings There are 2.1 rings/cmThere are 2.1 rings/cm Becomes intrathoracic at 6Becomes intrathoracic at 6thth
cartilaginous ringcartilaginous ring Intrathoracic portion: 6-15 cmIntrathoracic portion: 6-15 cm
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Anatomy of the tracheaAnatomy of the trachea
Cross-section area of Cross-section area of women about 40% less women about 40% less than men.than men.
From Oho and Matsukawa,
Olympus Co.
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The membranous posterior membrane allows esophageal expansion during
deglutition
Contains glands, small
arteries, nerves, lymph
vessels and elastic fibers
Trachealis muscle overlies
esophageal muscle and epithelium
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Tracheal dimensionsTracheal dimensionsTracheaTrachea Average cross-sectional Average cross-sectional
area of the male adult area of the male adult trachea is approximately trachea is approximately 2.8 cm22.8 cm2
Transverse (lateral)Transverse (lateral) diameter of 25 mmdiameter of 25 mm and and sagittal sagittal (anteroposterior) (anteroposterior) diameter of 27 mmdiameter of 27 mm are the are the upper limits of normal upper limits of normal (males) (males)
The lower limit of normal for The lower limit of normal for both transverse and sagittal both transverse and sagittal diameters is about diameters is about 13 mm in 13 mm in menmen and and 10 mm in women 10 mm in women
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The average cross-sectional area of the The average cross-sectional area of the trachea trachea
in a 30-year-old male isin a 30-year-old male is
A.A. 1.5 cm1.5 cm22
B.B. 2.8 cm2.8 cm22
C.C. 3.2 cm3.2 cm22
D.D. 5.0 cm5.0 cm22
Click for correct answer: B
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CricoidCricoid
Cricoid Cartilage
Cricothyroid membrane
Thyroid glandThyroid
cartilage
Cricoid cartilage
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The carinaThe carina
Posterior
From the head
From the front
Posterior
Note vertical RMB
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Main carina: Main carina: Concepts of anterior and Concepts of anterior and
posteriorposterior
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Widened main carinaWidened main carina
Large subcarinal adenopathy
present
Posterior membrane
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The cervical segment (extrathoracic) ends at the sternal manubrium and encompasses about the first six tracheal rings.
The U-shaped trachea is probably the most frequent shape found.
A man’s cross sectional tracheal area is usually about 40 percent larger than a woman’s.
In women, the lower limit of normal for transverse and sagittal diameters is about 10 mm.
Some facts about tracheal anatomy
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Tracheal morphologiesTracheal morphologies
A saber-sheath or scabbard trachea is defined as a trachea with excessive transverse narrowing and widened sagittal diameter of the intrathoracic portion of the trachea. This is very different from the C-shaped trachea seen in about 49% of normal adults. The saber sheath trachea has been described in up to 5 % of elderly men.
Women tend to preserve a round configuration, while men tend to have some sagittal widening and transverse narrowing.
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NORMAL Dynamic Airway NORMAL Dynamic Airway Collapse Collapse
During normal During normal respiration, there is respiration, there is narrowing of the narrowing of the airway caliber due to airway caliber due to bulging of the bulging of the posterior membrane.posterior membrane.
The mean decrease in The mean decrease in cross sectional area cross sectional area between inspiration between inspiration and expiration is up to and expiration is up to 40%.40%.
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Morphologic normal variantsMorphologic normal variants
U-shaped trachea (27%)U-shaped trachea (27%)
C-shaped trachea (49%)C-shaped trachea (49%)
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Saber-sheath tracheaSaber-sheath trachea
Tracheal Index (TI) defined Tracheal Index (TI) defined as (transverse/saggital as (transverse/saggital diameter)<0.6diameter)<0.6
5% of elderly men with 5% of elderly men with COPDCOPD
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Horseshoe tracheaHorseshoe trachea
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Tracheal appearancesTracheal appearances
A
B
C
D
E
F
Saber sheath Dynamic collapse Crescent shape collapse
Normal shape expansion during inhalation circumferential collapse
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Dynamic abnormalitiesDynamic abnormalities
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TracheobronchomalaciaTracheobronchomalacia
A condition that causes the airways to narrow during exhalation because of weakness of the cartilaginous structures.
Crescent-Shaped TracheomalaciaClick to
continue
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Excessive Dynamic Airway Excessive Dynamic Airway CollapseCollapse
Excessive bulging Excessive bulging of the posterior of the posterior membrane causing membrane causing narrowing of the narrowing of the cross-sectional cross-sectional area to 50% or area to 50% or more.more.
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Fixed abnormalitiesFixed abnormalities
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Intraluminal disease and Intraluminal disease and extrinsic compressionextrinsic compression
Tumor invading Tumor invading through posterior through posterior wall.wall.
Tumor invading Tumor invading left and right left and right main bronchimain bronchi
Narrowing of Narrowing of lower third of lower third of tracheatrachea
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ComplexComplexstenosisstenosis
Web-likeWeb-likestenosisstenosis
Courtesy C. Marquette
Simple and complex Simple and complex stricturesstrictures
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Example of fixed stricture at Example of fixed stricture at previous tracheostomy siteprevious tracheostomy site
Note partial collapse of
anterior-lateral tracheal wall
Classic triangular shape of stomal
stricture
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Measuring an abnormalityMeasuring an abnormality
1 2 3 4 5 6 7 8 9 10 11 12
First we measure the distance from the inferior aspect of vocal cords to the abnormality.
3.0 cm
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Measuring an abnormalityMeasuring an abnormality
1 2 3 4 5 6 7 8 9 10 11
1.5 cm
1 2 3 4 5 6 7 8 9 10 11 12
Next we measure the length of the abnormality itself
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Measuring an abnormalityMeasuring an abnormality
1 2 3 4 5 6 7 8 9 10 11
8.0 cm
1 2 3 4 5 6 7 8 9 10 11 12
Finally, we measure the distance from the distal extremity of the abnormality to the carina
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This presentation is part of a This presentation is part of a comprehensive curriculum for comprehensive curriculum for
Flexible Bronchoscopy. Our Flexible Bronchoscopy. Our goals are to help health care goals are to help health care
workers become better at what workers become better at what they do, and to decrease the they do, and to decrease the burden of procedure-related burden of procedure-related
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A new curriculumA new curriculum
1.1. Web-based Self-learning study guide.Web-based Self-learning study guide.2.2. Computer-based simulations, didactic Computer-based simulations, didactic
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exercises, skills and tasks, competency exercises, skills and tasks, competency testing.testing.
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Bronchoscopy International: BronchAtlasBronchoscopy International: BronchAtlas©©, an Electronic On-, an Electronic On-Line Multimedia Slide Presentation. Line Multimedia Slide Presentation. http://www.Bronchoscopy.org/Bronchatlas/htm. Published http://www.Bronchoscopy.org/Bronchatlas/htm. Published 2005 (Please add “Date Accessed”).2005 (Please add “Date Accessed”).
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