Art of the Lungs

The Lungs

The Common Vein Copyright 2009

Ashley Davidoff MD 

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Lungs and The Common Vein
The image shows some of the major components of the lung that when bonded create a new and powerful unit – a vital organ. In the center is an example of the airways and parenchyma making up the 2 lungs. At 12 oclock the tracheo-bronchial tree with segmental and subsegmental airways. At 1 o’cloclock, is a cross section of the lungs showing some of the segments of the lung. At 5o’clock a cross section shows the arteries and veins of the lungs. At 7o’clock the drawing shows the pleura and pleural space of the lungs. At 9o’clock, a coronal reformat of the tracheobronchial tree shows the lymph node stations of the lungs. At 11 o’clock is the golden alveolus, the epicentral unit where gas exchange takes place
Ashley Davidoff MD TheCommonVein.net lungs-0696-lo res

Alveolus
Parts and Bonds
Ashley Davidoff MD

 

Talking about grapes 
This artistic rendition of the heart and lungs uses the shape of fruit and vegetables to create an image of the chest. The lungs are made of grapes, the pulmonary arteries are made of carrots, the ribs are made of banana peel and the heat is made of a red pepper. 02032p Ashley Davidoff MD 02032p
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COLLAGE – PARTS OF THE LUNG
by Ashley Davidoff MD TheCommonVein.net

 

The polygonal shape of the secondary lobule can be seen all around you when you start looking
This is a series of images demonstrating the shape of the secondary lobule. The first image (1) is a post mortem specimen with congested lungs showing the interlobular septa, while the next (2), is an overlay of the septa in white showing their polygonal shape. The next drawing reveals side-by-side secondary lobules with central bronchovascular bundles and peripheral lympho-vascular bundles. Image 4 is a CT image through the apex of the lung showing thickened secondary lobules in a patient with mild emphysema, and 5 shows marked thickening of the interlobular septa in a patient with end stage sarcoidosis. 6,7,8 show the shape of the secondary lobules in the skin of a giraffe, the bark of a pine, and the ripples of the water respectively.
Ashley Davidoff MD TheCommonVein.net  31866collage

 

This collage reflects the range of the respiratory system from the macroscopic and anatomic to the microscopic – a continuum of structure. Image 2 is a post-mortem specimen taken from the front and slightly above. It shows the trachea and bronchi supplying the two lungs above, with the aortic arch and cardiac structures in the middle and below. Note how pink the lungs are in this specimen from an unfortunate baby with congenital heart disease. Image 3, the chest X-ray, shows the lucent lungs within the thoracic cavity while image 4 is a diagram of the trilobed right lung and the bilobed left lung. Two respiratory units of the lung are shown in the next image each called a pulmonary lobule (5). The lobule consists of a central bronchiole (light blue) and pulmonary arteriole (dark blue), surrounded by the air filled acinus (teal) with its peripheral venules. (red) The acinus is magnified in the next image (6), showing first the tubular terminal bronchiole branching into the respiratory bronchioles, alveolar sacs, and finally the grape like alveoli. The organization of the connective tissues of the lung is shown in image 7. Finally we get down to the grapes or alveoli of the lung with surrounding vessels (8), and a single alveolus is seen in 9. It seems a long way for the air to travel but the system can deliver the air to and from the outside in a single breath, and exchange the gases at the capillary level even more rapidly. It is a remarkable system.
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Ashley Davidoff TheCommonVein.net
Parts of the lungs
82738p chest lung connective tissue pulmonary artery pulmonary vein axial interstitial tissue secondary lobule lobes segments trachea bronchi interlobular septa polygonal Ashley Davidoff MD
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CT Rendering of the Pulmonary Parenchyma in Blue
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THE LUNGS AND THE TRACHEOBRONCHIAL TREE
CT Rendering of Lungs and Airways in Blue and Red
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CT Rendering of Lungs and Airways in Brown
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The Alveolus – The Centre of the Pulmonary Universe
The five major layers that keep the air moving include the outer bony cage, the muscular layer represented in maroon, the pleural complex (orange yellow orange) the lung (blue) and surfactant within the alveolus. (pink)
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Ashley Davidoff MD
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The lungs – as they live and breathe
The chest is surrounded by a ring of muscle (maroon) made up of a various groups which work in concert. The diaphragm is the workhorse of the respiratory muscles and is shown as a thick maroon band inferiorly. 42530b05b09b14 Ashley Davidoff MD
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Breathing Lungs within the Chest Wall
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THE LUNGS AND THE TRACHEOBRONCHIAL TREE

Cupola – shape of the apex
This cupola or dome was photographed in the church of the Villa Melzi gardens in Bellagio, Italy.  If you imagine yourself in the chest cavity and you look up towards the neck, this is what you will see – the dome shaped structure of the apex of the lung and pleura. 
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The Inverted Chest – A Wineglass
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Pyramidal Shape of the Lungs in Nature
Two leaves of the coleus plant, with a pyramidal or conical shape that reminded the photographer of a set of lungs. The branching system originates from the hilum of the leaf almost at its center, but unlike the tracheobronchial tree it is not irregularly dichotomous.
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The Lungs Together – The Shape of a Bell
The chest quietly expands and contracts under basal conditions in order to serve the alveoli. At first glance it seems like a simple bellows-like process, but as one delves into the layers of detail, the complexity of the structural design unfolds as a combination of physical and chemical forces.
 
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Lung Segments
The axial CT through the level of the heart shows a few of the right and left pulmonary segments including parts of the middle lobe, lingula and of the lung bases
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Gingko Chest
Tracheobronchial Tree
 Tree, flower, tracheobronchial tree, trachea bronchi lung
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Ashley Davidoff MD
TheCommonVein.net
Evolution of the Gingko Chest
Tracheobronchial Tree
lung bronchus tracheobronchial tree airway tree the common vein applied biology
Ashley Davidoff MD
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Pulmonary Trunk
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Pulmonary Trunk
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Pulmonary Trunk
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Ashley Davidoff MD
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Lungs and the X-Ray
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Ashley Davidoff MD
TheCommonVein.net
Tubes of the Body
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Hearing with your eyes
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Ashley Davidoff MD
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CELLS OF THE ALVEOLI
There are two types of cells lining the alveoli: Type I alveolar cells (pneumocytes) are squamous cells. They enable gas exchange. Type 2 alveolar cells ,are cuboidal in shape and they secrete surfactant.
by Ashley Davidoff MD
Asbestos bodies – an artistic impression
Ashley Davidoff MD
TheCommonVein.net.
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Normal Alveoli or Grapes of the lung
This diagram illustrates the branching pattern of the tracheobronchial tree that extends from the bronchi to the terminal bronchioles transitioning into the alveoli via the alveolar sacs.
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Ashley Davidoff MD
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Tracheobronchial Tree
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Ashley Davidoff MD
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Dyspnea and COPD Ashley Davidoff

Pulmonary Artery Tree
Art image derived from a parasagittal view of a reconstructed CT scan – CTA of the chest
Ashley Davidoff MD Copyright 2018
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Pulmonary Tree and a Summer Sky
Art image derived from a parasagittal view of a reconstructed CT scan – CTA of the chest
Ashley Davidoff MD Copyright 2018
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Derivation of the Pulmonary Tree
Art image derived from a parasagittal view of a reconstructed CT scan – CTA of the chest
Ashley Davidoff MD Copyright 2018
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ARTERIES AND VEINS
by Ashley Davidoff MD
SEGMENTS OF THE LUNGS
The secondary lobules, connect, and unite, linked through the airways, blood vessels, lymphatics and nerves, to form segments in the lungs
There are ten bronchopulmonary segments in the right lung: three in the upper lobe, two in the middle lobe, and five in the lowerlobe. Some of the segments may fuse in the left lung to form usually eight to nine segments (four to five in the upper lobe and four to five in the lower lobe.
Ashley Davidoff MD
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Secondary lobule
This picture shows us on the left with a white ring around us (we were the tallest) and the other couples who looked so much like us (also ringed). We called our tribe the “bronchovascular bundle” with the one part of the bundle being the progeny of the bronchus and the other the progeny of the pulmonary artery.  In the distance at the periphery we could see the pairs from the other friendly tribe – the red pulmonary vein with its smaller yellow buddy the lymphatic.  Behind them we could see the transparent window membrane through which we had peaked earlier. Oh my goodness!!!  Look what has happened to my body!!!!!!!……  Ashley Davidoff MD. The Common Vein.net 42447b03b01

 

At this time we were already up in the air and on our journey. This is a picture of me, the terminal bronchiole in teal blue in the centre and my buddy the pulmonary arteriole in royal blue at the doorway of the polyhedral secondary lobule. We were told by our guide to prepare ourselves for a “centrilobular” entrance since our entry point was to be through the centre of this doorway. 42448b03 code lung pulmonary secondary lobule pulmonary lobule polyhedral septa interstitium normal anatomy histology
Ashley Davidoff MD TheCommonVein.net
Secondary lobule
Here is a picture of the outside of the polyhedral pulmonary lobule from the side.  It looked quite futuristic.  Through the transparent side window  we saw a couple similar to ourselves.  From this vantage point the morphing did not look too different from what we had already been through – division after division – leaner and meaner. Ashley Davidoff MD. The Common Vein.net  42449b02

 

The diagram shows the structure of the airways and alveoli at the level of the secondary lobule. The terminal bronchiole (tb- pink) enters the secondary lobule and terminates in the respiratory bronchiole (rb purple) which lies in the center of the the secondary lobule (centrilobular). It gives rise to alveolar duct (ad yellow)which gives rise to the alveolar sac (as, teal blue. Finally the as terminates in the alveoli (a white)
Courtesy Ashley Davidoff MD
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Secondary lobule
This picture was taken just before the real drama started.  The image gives a sense of what was to come.  You can see here in the house of the lobule that we were all dividing into smaller parts and were getting smaller and the picture was quite colorful and rosy.  I fully expected to have intimate contact with the arteriole… but it did not happen as I expected…… Ashley Davidoff MD. The Common Vein.net 42447b05b02
The Secondary Lobule
The secondary lobule is housed in a connective tissue framework in which run the lymphatic and venular tributaries . Together these 3 structures form the interlobular septum.
The lobar arteriole enters the framework, accompanied by the lobar bronchiole, and they all run together and form the interlobular septa. This structure measures between .5cms and 2cms and is visible on CT scan.
It is important in clinical radiology since many of the structures can be identified in health, and more particularly in disease, enabling the identification and characterization of many pathological processes.
Courtesy Ashley Davidoff MD The CommonVein.net
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Secondary Lobule – Lymphatics and Venules Travelling Together
The arteries and airways pair up and travel together from the interlobular septa to the hilum.   The pulmonary lobule, also called the secondary lobule is a structural unit surrounded by a membrane of connective tissue, and it is smaller than a subsegment of lung but larger than an acinus. This diagram shows two secondary lobules lying side by side. The pulmonary arteriole (royal blue) and bronchiole (pink) are shown together in the centre of the lobule (“centrilobular”), while the oxygenated pulmonary venules (red) and lymphatics (yellow) are peripheral and also form a formidable and almost inseparable pair.
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Ashley Davidoff MD
TheCommonVein.net
The Secondary Lobule
Between 10 and 30 acini combine to form a secondary lobule which is between .5- 2 cms in diameter. It is subtended by a single lobar bronchiole (lb), and is accompanied by arterioles, venules, lymphatics and connective tissue. It is important in clinical radiology since many of the structures can be identified in health, and more particularly in disease, enabling the identification and characterization of many disease processes.
Courtesy Ashley Davidoff MD
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The Acinus
The acinus is defined as a unit of lung consisting of a single first order respiratory bronchiole that subtending a cluster of alveoli reminiscent of a bunch of grapes or berries (acinus in Latin means berry) .  The lobular bronchiole (lb) branches into the terminal bronchiole (tb), which then branches into the first order respiratory bronchiole (rb).  Subsequent branching  after the respiratory bronchiole,  includes in order, the  alveolar duct (ad), alveolar sac (as), and then finally the berry like alveoli.
Courtesy Ashley Davidoff 2019
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The Terminal Bronchiole
This artistic rendition of the small parts of the lung shows the beginning of the peripheral system just before it enters the acinus. This duct is called the terminal duct and it is the last part of the ductal system that has no ability for  gas exchange. After its first division, the bronchioles become the respiratory bronchioles, and they are the first in the system to have an ability to both transport the gases as well as enable gas exchange.
Ashley Davidoff
TheCommonVein.net
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Acinus.
The acinus with its arborizations is shaped more like a bunch of grapes.
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Emphysema
A drawing showing the normal acinus in teal and the abnormal emphysematous acinus in green characterised by destruction of the septal walls, enlargement of the alveoli, and loss of elasticity. The absence of involvement of the respiratory bronchiole makes the pathological diagnosis of centrilobular emphysema. Ashley Davidoff MD
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The Alveolus
Alveoli of the Lung – Factory Workers
This is a drawing of a cluster of alveoli surrounded by the capillary network, fed by an arteriole in blue, and drained by a venule in red. The second image shows the exchange of life giving oxygen for the by product of  metabolic activity – carbon dioxide
Ashley Davidoff MD
TheCommonVein.net
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The alveolus – the center of the pulmonary universe
The five major layers that keep the air moving include the outer bony cage, the muscular layer represented in maroon, the pleural complex (orange yellow orange) the lung (blue) and surfactant within the alveolus. (pink)  42530b05b09b01a08
Ashley Davidoff art
by Ashley Davidoff MD
Alveolus Cells and Capillaries of the Lung
“Alveolus Cells and Capillaries of the Lung” shows an alveolus with single cell lining and associated arteriole, capillary and venous circulation. The cool fresh air flows into the alveolus, and oxygen flows into the blue blooded arteriole converting into a red blooded venule. A breeze of carbon dioxide flows through the single celled alveolus and into the airways for expiration
by Ashley Davidoff MD
Alveolus Cells and Capillaries of the Lung
“Alveolus Cells and Capillaries of the Lung” shows an alveolus with single cell lining and associated arteriole, capillary and venous circulation. The cool fresh air flows into the alveolus, and oxygen flows into the blue blooded arteriole converting into a red blooded venule. A breeze of carbon dioxide flows through the single celled alveolus and into the airways for expiration
by Ashley Davidoff MD
Alveolus Cells and Capillaries of the Lung
“Alveolus Cells and Capillaries of the Lung” shows an alveolus with single cell lining and associated arteriole, capillary and venous circulation. The cool fresh air flows into the alveolus, and oxygen flows into the blue blooded arteriole converting into a red blooded venule. A breeze of carbon dioxide flows through the single celled alveolus and into the airways for expiration
by Ashley Davidoff MD
by Ashley Davidoff MD

 

 

Alveolus at a Cytologic Level
The diagram shows an alveolus (a) above, lined by a single layer of squamous cells, surrounded by a capillary with red cells which is also lined by a single layer of squamous endothelial cells . The images below show progressive magnification of the alveolar wall demonstrating the two thin layer of the alveolar membrane .
Courtesy Ashley Davidoff 2019
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Type I Pneumocyte –
Squamous Cell
Ashley Davidoff MD
Type II Pneumocyte
Ashley Davidoff MD
Macrophage
Ashley Davidoff MD

Links and References