Lung

Anatomy In humans, the lungs are located in the chest on either side of the heart in the rib cage. They are conical in shape with a narrow rounded apex at the top, and a broad concave base that rests on the convex surface of the diaphragm. The left lung shares space with the heart, and has an indentation in its border called the cardiac notch of the left lung to accommodate this. The right lung is divided into three lobes by a horizontal fissure, and an oblique fissure. The left lung is divided into two lobes by an oblique fissure which is closely aligned with the oblique fissure in the right lung. In the right lung the upper horizontal fissure, separates the upper (superior) lobe from the middle lobe. The lower, oblique fissure separates the lower lobe from the middle and upper lobes. Segments for the left and right lung are shown in the table. The segmental anatomy is useful clinically for localising disease processes in the lungs. Right lung The right lung has both more lobes and segments than the left. It is divided into three lobes, an upper, middle, and a lower lobe by two fissures, one oblique and one horizontal. The upper, horizontal fissure, separates the upper from the middle lobe. It begins in the lower oblique fissure near the posterior border of the lung, and, running horizontally forward, cuts the anterior border on a level with the sternal end of the fourth costal cartilage; on the mediastinal surface it may be traced back to the hilum. The weight of the right lung varies between individuals, with a standard reference range in men of and in women of . Left lung The left lung is divided into two lobes, an upper and a lower lobe, by the oblique fissure, which extends from the costal to the mediastinal surface of the lung both above and below the hilum. There are two bronchopulmonary segments of the lingula: superior and inferior. The trachea and bronchi have plexuses of lymph capillaries in their mucosa and submucosa. The smaller bronchi have a single layer of lymph capillaries, and they are absent in the alveoli. The lungs are supplied with the largest lymphatic drainage system of any other organ in the body. Each lung is surrounded by a serous membrane of visceral pleura, which has an underlying layer of loose connective tissue attached to the substance of the lung. Connective tissue from the visceral pleura (outer lining) of lung image of collagen fibres in a cross sectional slice of mammalian lung tissue The connective tissue of the lungs is made up of elastic and collagen fibres that are interspersed between the capillaries and the alveolar walls. Elastin is the key protein of the extracellular matrix and is the main component of the elastic fibres. Elastin gives the necessary elasticity and resilience required for the persistent stretching involved in breathing, known as lung compliance. It is also responsible for the elastic recoil needed. Elastin is more concentrated in areas of high stress such as the openings of the alveoli, and alveolar junctions. Pulmonary neuroendocrine cells are found throughout the respiratory epithelium including the alveolar epithelium, though they only account for around 0.5 percent of the total epithelial population. PNECs are innervated airway epithelial cells that are particularly focused at airway junction points. Bronchial airways In the bronchi there are incomplete tracheal rings of cartilage and smaller plates of cartilage that keep them open. Bronchioles are too narrow to support cartilage and their walls are of smooth muscle, and this is largely absent in the narrower respiratory bronchioles which are mainly just of epithelium. Respiratory zone The conducting zone of the respiratory tract ends at the terminal bronchioles when they branch into the respiratory bronchioles. This marks the beginning of the terminal respiratory unit called the acinus which includes the respiratory bronchioles, the alveolar ducts, alveolar sacs, and alveoli. An acinus measures up to 10 mm in diameter. Thus, it includes the alveolar ducts, sacs, and alveoli but not the respiratory bronchioles. The unit described as the secondary pulmonary lobule is the lobule most referred to as the pulmonary lobule or respiratory lobule. This lobule is a discrete unit that is the smallest component of the lung that can be seen without aid. The respiratory bronchiole gives rise to the alveolar ducts that lead to the alveolar sacs, which contain two or more alveoli. Fungal genera that are commonly found as mycobiota in the microbiota include Candida, Malassezia, Saccharomyces, and Aspergillus. Respiratory tract The lower respiratory tract is part of the respiratory system, and consists of the trachea and the structures below this including the lungs. The trachea receives air from the pharynx and travels down to a place where it splits (the carina) into a right and left primary bronchus. These supply air to the right and left lungs, splitting progressively into the secondary and tertiary bronchi for the lobes of the lungs, and into smaller and smaller bronchioles until they become the respiratory bronchioles. These in turn supply air through alveolar ducts into the alveoli, where the exchange of gases take place. and carbon dioxide diffuses from the blood into the lungs to be breathed out. Estimates of the total surface area of lungs vary from ; although this is often quoted in textbooks and the media being "the size of a tennis court", it is actually less than half the size of a singles court. The bronchi in the conducting zone are reinforced with hyaline cartilage in order to hold open the airways. The bronchioles have no cartilage and are surrounded instead by smooth muscle. in a process called mucociliary clearance. Pulmonary stretch receptors in the smooth muscle of the airways initiate a reflex known as the Hering–Breuer reflex that prevents the lungs from over-inflation, during forceful inspiration. Blood supply of a high-resolution CT scan of the thorax. The anterior thoracic wall, the airways and the pulmonary vessels anterior to the root of the lung have been digitally removed in order to visualise the different levels of the pulmonary circulation. The lungs have a dual blood supply provided by a bronchial and a pulmonary circulation. The bronchial circulation supplies oxygenated blood to the airways of the lungs, through the bronchial arteries that leave the aorta. There are usually three arteries, two to the left lung and one to the right, and they branch alongside the bronchi and bronchioles. Nerve supply The lungs are supplied by nerves of the autonomic nervous system. Input from the parasympathetic nervous system occurs via the vagus nerve. The lungs also have a sympathetic tone from norepinephrine acting on the beta 2 adrenoceptors in the respiratory tract, which causes bronchodilation. The action of breathing takes place because of nerve signals sent by the respiratory center in the brainstem, along the phrenic nerve from the cervical plexus to the diaphragm. Variation The lobes of the lung are subject to anatomical variations. A horizontal interlobar fissure was found to be incomplete in 25% of right lungs, or even absent in 11% of all cases. An accessory fissure was also found in 14% and 22% of left and right lungs, respectively. An oblique fissure was found to be incomplete in 21% to 47% of left lungs. In some cases a fissure is absent, or extra, resulting in a right lung with only two lobes, or a left lung with three lobes. == Development ==

The development of the human lungs arise from the laryngotracheal groove and develop to maturity over several weeks in the foetus and for several years following birth. The larynx, trachea, bronchi and lungs that make up the respiratory tract, begin to form during the fourth week of embryogenesis from the lung bud which appears ventrally to the caudal portion of the foregut. The respiratory tract has a branching structure, and is also known as the respiratory tree. In the embryo this structure is developed in the process of branching morphogenesis, and is generated by the repeated splitting of the tip of the branch. In the development of the lungs (as in some other organs) the epithelium forms branching tubes. The lung has a left-right symmetry and each bud known as a bronchial bud grows out as a tubular epithelium that becomes a bronchus. Each bronchus branches into bronchioles. The branching is a result of the tip of each tube bifurcating. During the fifth week, the right bud branches into three secondary bronchial buds and the left branches into two secondary bronchial buds. These give rise to the lobes of the lungs, three on the right and two on the left. Over the following week, the secondary buds branch into tertiary buds, about ten on each side. From week 16 to week 26, the bronchi enlarge and lung tissue becomes highly vascularised. Bronchioles and alveolar ducts also develop. By week 26, the terminal bronchioles have formed which branch into two respiratory bronchioles. During the period covering the 26th week until birth the important blood–air barrier is established. Specialised type I alveolar cells where gas exchange will take place, together with the type II alveolar cells that secrete pulmonary surfactant, appear. The surfactant reduces the surface tension at the air-alveolar surface which allows expansion of the alveolar sacs. The alveolar sacs contain the primitive alveoli that form at the end of the alveolar ducts, and their appearance around the seventh month marks the point at which limited respiration would be possible, and the premature baby could survive. After birth At birth, the baby's lungs are filled with fluid secreted by the lungs and are not inflated. After birth the infant's central nervous system reacts to the sudden change in temperature and environment. This triggers the first breath, within about ten seconds after delivery. Before birth, the lungs are filled with fetal lung fluid. After the first breath, the fluid is quickly absorbed into the body or exhaled. The resistance in the lung's blood vessels decreases giving an increased surface area for gas exchange, and the lungs begin to breathe spontaneously. This accompanies other changes which result in an increased amount of blood entering the lung tissues. Alveolar septa have a double capillary network instead of the single network of the developed lung. Only after the maturation of the capillary network can the lung enter a normal phase of growth. Following the early growth in numbers of alveoli there is another stage of the alveoli being enlarged. == Function ==

Gas exchange The major function of the lungs is gas exchange between the lungs and the blood. The alveolar and pulmonary capillary gases equilibrate across the thin blood–air barrier. This thin membrane (about 0.5 –2 μm thick) is folded into about 300 million alveoli, providing an extremely large surface area (estimates varying between 70 and 145 m2) for gas exchange to occur. in expanding the rib cage The lungs are not capable of expanding to breathe on their own, and will only do so when there is an increase in the volume of the thoracic cavity. This is achieved by the muscles of respiration, through the contraction of the diaphragm, and the intercostal muscles which pull the rib cage upwards as shown in the diagram. During breathing out the muscles relax, returning the lungs to their resting position. At this point the lungs contain the functional residual capacity (FRC) of air, which, in the adult human, has a volume of about 2.5–3.0 litres. The lungs are involved in the blood's acid–base homeostasis by expelling carbon dioxide when breathing. The lungs also serve a protective role. Several blood-borne substances, such as a few types of prostaglandins, leukotrienes, serotonin and bradykinin, are excreted through the lungs. The lungs filter out small blood clots from veins and prevent them from entering arteries and causing strokes. and other paralanguage communications such as sighs and gasps. Research suggests a role of the lungs in the production of blood platelets. == Gene and protein expression ==

About 20,000 protein coding genes are expressed in human cells and almost 75% of these genes are expressed in the normal lung. A little less than 200 of these genes are more specifically expressed in the lung with less than 20 genes being highly lung specific. The highest expression of lung specific proteins are different surfactant proteins, == Clinical significance ==

Lungs can be affected by a number of diseases and disorders. Pulmonology is the medical speciality that deals with respiratory diseases involving the lungs and respiratory system. Cardiothoracic surgery deals with surgery of the lungs including lung volume reduction surgery, lobectomy, pneumectomy and lung transplantation. Inflammation and infection Inflammatory conditions of the lung tissue are pneumonia, of the respiratory tract are bronchitis and bronchiolitis, and of the pleurae surrounding the lungs pleurisy. Inflammation is usually caused by infections due to bacteria or viruses. When the lung tissue is inflamed due to other causes it is called pneumonitis. One major cause of bacterial pneumonia is tuberculosis. In the US certain species of rat can transmit a hantavirus to humans that can cause untreatable hantavirus pulmonary syndrome with a similar presentation to that of acute respiratory distress syndrome (ARDS). Alcohol affects the lungs and can cause inflammatory alcoholic lung disease. Acute exposure to alcohol stimulates the beating of cilia in the respiratory epithelium. However, chronic exposure has the effect of desensitising the ciliary response which reduces mucociliary clearance (MCC). MCC is an innate defense system protecting against pollutants and pathogens, and when this is disrupted the numbers of alveolar macrophages are decreased. A subsequent inflammatory response is the release of cytokines. Another consequence is the susceptibility to infection. Blood-supply changes of the lung due to a pulmonary embolism A pulmonary embolism is a blood clot that becomes lodged in the pulmonary arteries. The majority of emboli arise because of deep vein thrombosis in the legs. Pulmonary emboli may be investigated using a ventilation/perfusion scan, a CT scan of the arteries of the lung, or blood tests such as the D-dimer. Obstructive lung diseases Asthma, bronchiectasis, and chronic obstructive pulmonary disease (COPD) that includes chronic bronchitis, and emphysema, are all obstructive lung diseases characterised by airway obstruction. This limits the amount of air that is able to enter alveoli because of constriction of the bronchial tree, due to inflammation. Obstructive lung diseases are often identified because of symptoms and diagnosed with pulmonary function tests such as spirometry. Many obstructive lung diseases are managed by avoiding triggers (such as dust mites or smoking), with symptom control such as bronchodilators, and with suppression of inflammation (such as through corticosteroids) in severe cases. A common cause of chronic bronchitis, and emphysema, is smoking; and common causes of bronchiectasis include severe infections and cystic fibrosis. The definitive cause of asthma is not yet known, but it has been linked to other atopic diseases. The breakdown of alveolar tissue, often as a result of tobacco-smoking leads to emphysema, which can become severe enough to develop into COPD. Elastase breaks down the elastin in the lung's connective tissue that can also result in emphysema. Elastase is inhibited by the acute-phase protein, alpha-1 antitrypsin, and when there is a deficiency in this, emphysema can develop. With persistent stress from smoking, the airway basal cells become disarranged and lose their regenerative ability needed to repair the epithelial barrier. The disorganised basal cells are seen to be responsible for the major airway changes that are characteristic of COPD, and with continued stress can undergo a malignant transformation. Studies have shown that the initial development of emphysema is centred on the early changes in the airway epithelium of the small airways. Restrictive lung diseases Some types of chronic lung diseases are classified as restrictive lung disease, because of a restriction in the amount of lung tissue involved in respiration. These include pulmonary fibrosis which can occur when the lung is inflamed for a long period of time. Fibrosis in the lung replaces functioning lung tissue with fibrous connective tissue. This can be due to a large variety of occupational lung diseases such as Coalworker's pneumoconiosis, autoimmune diseases or more rarely to a reaction to medication. Congenital disorders Congenital disorders include cystic fibrosis, pulmonary hypoplasia (an incomplete development of the lungs) The lung cannot expand against the air pressure inside the pleural space. An easy to understand example is a traumatic pneumothorax, where air enters the pleural space from outside the body, as occurs with puncture to the chest wall. Similarly, scuba divers ascending while holding their breath with their lungs fully inflated can cause air sacs (alveoli) to burst and leak high pressure air into the pleural space. Examination As part of a physical examination in response to respiratory symptoms of shortness of breath, and cough, a lung examination may be carried out. This exam includes palpation and auscultation. The areas of the lungs that can be listened to using a stethoscope are called the lung fields, and these are the posterior, lateral, and anterior lung fields. The posterior fields can be listened to from the back and include: the lower lobes (taking up three quarters of the posterior fields); the anterior fields taking up the other quarter; and the lateral fields under the axillae, the left axilla for the lingual, the right axilla for the middle right lobe. The anterior fields can also be auscultated from the front. An area known as the triangle of auscultation is an area of thinner musculature on the back which allows improved listening. Abnormal breathing sounds heard during a lung exam can indicate the presence of a lung condition; wheezing for example is commonly associated with asthma and COPD. Function testing Lung function testing is carried out by evaluating a person's capacity to inhale and exhale in different circumstances. The volume of air inhaled and exhaled by a person at rest is the tidal volume (normally 500–750 mL); the inspiratory reserve volume and expiratory reserve volume are the additional amounts a person is able to forcibly inhale and exhale respectively. The summed total of forced inspiration and expiration is a person's vital capacity. Not all air is expelled from the lungs even after a forced breath out; the remainder of the air is called the residual volume. Together these terms are referred to as lung volumes. Functional residual capacity cannot be measured by tests that rely on breathing out, as a person is only able to breathe a maximum of 80% of their total functional capacity. Other lung function tests include spirometry, measuring the amount (volume) and flow of air that can be inhaled and exhaled. The maximum volume of breath that can be exhaled is called the vital capacity. In particular, how much a person is able to exhale in one second (called forced expiratory volume (FEV1)) as a proportion of how much they are able to exhale in total (FEV). This ratio, the FEV1/FEV ratio, is important to distinguish whether a lung disease is restrictive or obstructive. Another test is that of the lung's diffusing capacity – this is a measure of the transfer of gas from air to the blood in the lung capillaries. == Culinary uses ==

lung and rice sausage Mammal lung is one of the main types of offal, or pluck, alongside the heart and trachea, and is consumed as a foodstuff around the world in dishes such as Scottish haggis. The United States Food and Drug Administration legally prohibits the sale of animal lungs due to concerns such as fungal spores or cross-contamination with other organs, although this has been criticised as unfounded. == Other animals ==

Birds in the lungs of birds. Air is forced from the air sacs unidirectionally (from left to right in the diagram) through the parabronchi. The pulmonary capillaries surround the parabronchi in the manner shown (blood flowing from below the parabronchus to above it in the diagram). Blood or air with a high oxygen content is shown in red; oxygen-poor air or blood is shown in various shades of purple-blue. The lungs of birds are relatively small, but are connected to eight or nine air sacs that extend through much of the body, and are in turn connected to air spaces within the bones. On inhalation, air travels through the trachea of a bird into the air sacs. Air then travels continuously from the air sacs at the back, through the lungs, which are relatively fixed in size, to the air sacs at the front. From here, the air is exhaled. These fixed size lungs are called "circulatory lungs", as distinct from the "bellows-type lungs" found in most other animals. The lungs of birds contain millions of tiny parallel passages called parabronchi. Small sacs called atria radiate from the walls of the tiny passages; these, like the alveoli in other lungs, are the site of gas exchange by simple diffusion. Parabronchi in which the air flow is unidirectional are called paleopulmonic parabronchi and are found in all birds. Some birds, however, have, in addition, a lung structure where the air flow in the parabronchi is bidirectional. These are termed neopulmonic parabronchi. The now extinct pterosaurs have seemingly even further refined this type of lung, extending the airsacs into the wing membranes and, in the case of lonchodectids, Tupuxuara, and azhdarchoids, the hindlimbs. Reptilian lungs typically receive air via expansion and contraction of the ribs driven by axial muscles and buccal pumping. Crocodilians also rely on the hepatic piston method, in which the liver is pulled back by a muscle anchored to the pubic bone (part of the pelvis) called the diaphragmaticus, which in turn creates negative pressure in the crocodile's thoracic cavity, allowing air to be moved into the lungs by Boyle's law. Turtles, which are unable to move their ribs, instead use their forelimbs and pectoral girdle to force air in and out of the lungs. In buccal pumping, the floor of the mouth is lowered, filling the mouth cavity with air. The throat muscles then presses the throat against the underside of the skull, forcing the air into the lungs. Due to the possibility of respiration across the skin combined with small size, all known lungless tetrapods are amphibians. The majority of salamander species are lungless salamanders, which respirate through their skin and tissues lining their mouth. This necessarily restricts their size: all are small and rather thread-like in appearance, maximising skin surface relative to body volume. Other known lungless tetrapods are the Bornean flat-headed frog and Atretochoana eiselti, a caecilian. The lungs of amphibians typically have a few narrow internal walls (septa) of soft tissue around the outer walls, increasing the respiratory surface area and giving the lung a honeycomb appearance. In some salamanders, even these are lacking, and the lung has a smooth wall. In caecilians, as in snakes, only the right lung attains any size or development. Bichirs, the only group of ray-finned fish with lungs, have a pair which are hollow unchambered sacs, where the gas-exchange occurs on very flat folds that increase their inner surface area. The lungs of lungfish show more resemblance to tetrapod lungs. There is an elaborate network of parenchymal septa, dividing them into numerous respiration chambers. In the Australian lungfish, there is only a single lung, albeit divided into two lobes. Other lungfish, however, have traditionally been considered having two lungs, but newer research defines paired lungs as bilateral lung buds that arise simultaneously and are both connected directly to the foregut, which is only seen in tetrapods. In all lungfish, including the Australian, the lungs are located in the upper dorsal part of the body, with the connecting duct curving around and above the oesophagus. The blood supply also twists around the oesophagus, suggesting that the lungs originally evolved in the ventral part of the body, as in other vertebrates. Scorpions have spiracles on their body for the entrance of air to the book lungs. The coconut crab is terrestrial and uses structures called branchiostegal lungs to breathe air. Juveniles are released into the ocean, however adults cannot swim and possess an only rudimentary set of gills. The adult crabs can breathe on land and hold their breath underwater. The branchiostegal lungs are seen as a developmental adaptive stage from water-living to enable land-living, or from fish to amphibian. Pulmonates are mostly land snails and slugs that have developed a simple lung from the mantle cavity. An externally located opening called the pneumostome allows air to be taken into the mantle cavity lung. == Evolutionary origins ==

The lungs of today's terrestrial vertebrates and the gas bladders of today's fish are believed to have evolved from simple sacs, as outpocketings of the oesophagus, that allowed early fish to gulp air under oxygen-poor conditions. These outpocketings first arose in the bony fish. In most of the ray-finned fish, the sacs evolved into closed off gas bladders, while a number of carp, trout, herring, catfish, and eels have retained the physostome condition with the sac being open to the oesophagus. In more basal bony fish, such as the gar, bichir, bowfin and the lobe-finned fish, the sacs have evolved to primarily function as lungs. == See also ==