The right bronchus is shorter, wider, and more nearly vertical than
its fellow of the opposite side, and is practically the continuation
of the trachea, while the left bronchus might be considered as a
branch. The deviation of the right main bronchus is about 25 degrees,
and its length unbranched in the adult is about 2.5 cm. The deviation
of the left main bronchus is about 75 degrees and its adult length is
about 5 cm. The right bronchus considered as a stem, may be said to
give off three branches, the epiarterial, upper- or superior-lobe
bronchus; the middle-lobe bronchus; and the continuation downward,
called the lower- or inferior-lobe bronchus, which gives off dorsal,
ventral and lateral branches. The left main bronchus gives off first
the upper-or superior-lobe bronchus, the continuation being the
lower-or inferior-lobe bronchus, consisting of a stem with dorsal,
ventral and lateral branches.
[FIG. 44.--Tracheo-bronchial tree. LM, Left main bronchus; SL,
superior lobe bronchus; ML, middle lobe bronchus; IL, inferior lobe
bronchus.]
The septum between the right and left main bronchi, termed the carina,
is situated to the left of the midtracheal line. It is recognized
endoscopically as a short, shining ridge running sagitally, or, as the
patient lies in the recumbent position, we speak of it as being
vertical. On either side are seen the openings of the right and left
main bronchi. In Fig. 44, it will be seen that the lower border of the
carina is on a level with the upper portion of the orifice of the
right superior-lobe bronchus; with the carina as a landmark and by
displacing with the bronchoscope the lateral wall of the right main
bronchus, a second, smaller, vertical spur appears, and a view of the
orifice of the right upper-lobe bronchus is obtained, though a lumen
image cannot be presented. On passing down the right stem bronchus
(patient recumbent) a horizontal partition or spur is found with the
lumen of the middle-lobe bronchus extending toward the ventral surface
of the body. All below this opening of the right middle-lobe bronchus
constitutes the lower-lobe bronchus and its branches.
[FIG. 45.--Bronchoscopic views.
S; Superior lobe bronchus; SL, superior lobe bronchus; I, inferior
lobe bronchus; M, middle lobe bronchus.]
[56] Coming back to the carina and passing down the left bronchus, the
relatively great distance from the carina to the upper-lobe bronchus
is noted. The spur dividing the orifices of the left upper- and
lower-lobe bronchi is oblique in direction, and it is possible to see
more of the lumen of the left upper-lobe bronchus than of its
homologue on the right. Below this are seen the lower-lobe bronchus
and its divisions (Fig. 45).
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