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Anatomy

Thorax

Question 119 of 180

A 5 year old girl is brought in to ED having inhaled a small plastic object. Where in the tracheobronchial tree is the object most likely to lodge:

Answer:

The right main bronchus is the shorter, wider and more vertical bronchus and therefore this is most often the location that foreign objects will lodge.

Tracheobronchial Tree

Anatomy / Thorax / Pleura and Lungs

Last Updated: 28th January 2019

The trachea bifurcates into a left and right main bronchus at the level of vertebra T4/T5. At the bifurcation of the main bronchi, a ridge of cartilage called the carina runs anteroposteriorly between the openings of the two bronchi.

Each main bronchus enters the root of a lung and passes through the hilum into the lung itself. The right main bronchus is wider and takes a more vertical course through the root and hilum than the left main bronchus, therefore inhaled foreign bodies are more likely to lodge on the right than the left.

The main bronchus divides into lobar bronchi (secondary bronchi) which each supply a lobe. The lobar bronchi further divided into segmental bronchi (tertiary bronchi) which supply bronchopulmonary segments (the functional unit of the lung).

Within each bronchopulmonary segment, the segmental bronchi give rise to multiple generations of divisions and ultimately to bronchioles (in order, conducting bronchioles, terminal bronchioles, respiratory bronchioles). The respiratory bronchioles continue as alveolar ducts and sacs, the walls of which form alveoli.

By LadyofHats [Public domain], via Wikimedia Commons

Tracheobronchial Tree. (Image by LadyofHats [Public domain], via Wikimedia Commons)

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  • Biochemistry
  • Blood Gases
  • Haematology
Biochemistry Normal Value
Sodium 135 – 145 mmol/l
Potassium 3.0 – 4.5 mmol/l
Urea 2.5 – 7.5 mmol/l
Glucose 3.5 – 5.0 mmol/l
Creatinine 35 – 135 μmol/l
Alanine Aminotransferase (ALT) 5 – 35 U/l
Gamma-glutamyl Transferase (GGT) < 65 U/l
Alkaline Phosphatase (ALP) 30 – 135 U/l
Aspartate Aminotransferase (AST) < 40 U/l
Total Protein 60 – 80 g/l
Albumin 35 – 50 g/l
Globulin 2.4 – 3.5 g/dl
Amylase < 70 U/l
Total Bilirubin 3 – 17 μmol/l
Calcium 2.1 – 2.5 mmol/l
Chloride 95 – 105 mmol/l
Phosphate 0.8 – 1.4 mmol/l
Haematology Normal Value
Haemoglobin 11.5 – 16.6 g/dl
White Blood Cells 4.0 – 11.0 x 109/l
Platelets 150 – 450 x 109/l
MCV 80 – 96 fl
MCHC 32 – 36 g/dl
Neutrophils 2.0 – 7.5 x 109/l
Lymphocytes 1.5 – 4.0 x 109/l
Monocytes 0.3 – 1.0 x 109/l
Eosinophils 0.1 – 0.5 x 109/l
Basophils < 0.2 x 109/l
Reticulocytes < 2%
Haematocrit 0.35 – 0.49
Red Cell Distribution Width 11 – 15%
Blood Gases Normal Value
pH 7.35 – 7.45
pO2 11 – 14 kPa
pCO2 4.5 – 6.0 kPa
Base Excess -2 – +2 mmol/l
Bicarbonate 24 – 30 mmol/l
Lactate < 2 mmol/l

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