Atlas of Human Anatomy in Cross Section: Appendix: Topography of the Thorax and Abdomen
Ronald A. Bergman, Ph.D., Adel K. Afifi, M.D., Jean J. Jew,
M.D., and Paul C. Reimann, B.S.
Peer Review Status: Externally Peer Reviewed
The apex of the right lung may be found at or between the seventh vertebral disk and the first thoracic disk, according to Eycleshymer and Schoemaker. The average position was at the level of the upper third of the first thoracic vertebra. Merkel places it at the level of the first thoracic vertebra and states further that a section passing through the seventh cervical disk does not cut lung tissue. Morris found the apex opposite the seventh cervical vertebra and opposite the first thoracic vertebra. Cunningham found it at the level of the seventh cervical spine.
Langer and Toldt, Joessel, and Corning report that the apex extends to the neck of the first rib, and Merkel and Piersol say that it never extends above this level. Its distance above the level of the sternal end of the first rib is stated by Langer and Toldt to be approximately 3 cm, by Joessel to be 5 cm, by Treves and Cunningham to be 2.5 to 5 cm, and by Piersol to be 3 cm. With reference to its level above the clavicle, there is considerable divergence of opinion: Pansch states I to 3 cm; Joessel, 3 cm; Merkel, 3.5 cm; Corning, 2 to 3 cm; Treves, I to 3 cm; Cunningham, 1.3 to 3.8 cm; and Piersol, 1 cm.
Luschka, Krause, Braune, and Cunningham state that the apex of the right lung is from 0.5 to 1 cm higher than the left. On the other hand, Henle, Pansch, Merkel, and Joessel report no appreciable difference.
The variations in the lowest point of the anterior margin of the base of the right lung range from the ninth thoracic disk to the lower third of the twelfth thoracic vertebra. The average position is at the level of the middle of the eleventh thoracic vertebra, according to Eycleshymer and Schoemaker.
The level of the lower border of the right lung may be indicated by drawing a shallow curved line Joining the sternal end of the sixth rib to the vertebral end of the eleventh rib. As reported by Merkel, Treves, and Cunningham, it lies in the mamillary line at the lower border of the sixth rib. Merkel places it in the axillary line from the seventh to the eighth rib; Cunningham, at the eighth rib after expiration; and Piersol, at the eighth rib. Merkel found it in the scapular line opposite the ninth to the tenth rib. Treves and Cunningham place it opposite the tenth; Morris, opposite the ninth; and Joessel, Corning, and Morris, opposite the eleventh rib. Both Cunningham and Piersol state that the spinous process of the tenth thoracic vertebra is a guide to locate its level.
Eycleshymer and Schoemaker reported that the right lung in their subject extended anteriorly in the mamillary line to the level of the fifth costal cartilage. In the axillary line, it extended to the upper margin of the ninth costal cartilage. In the scapular line, it extended to the tenth intercostal space. Its vertebral extremity reached to the level of the spinous process of the eleventh thoracic vertebra.
The oblique fissure in the Eycleshymer and Schoemaker specimen began at the neck of the fifth rib slightly above the level of the tip of the fourth thoracic spine and opposite the lower third of the fourth thoracic vertebra. It ended opposite the sixth rib at a distance of 5 cm outside the mamillary line. Poirier and Charpy and Testut found it to begin at the level of the vertebral extremity of the third to the fifth rib. The majority of anatomists place its origin on a level with the vertebral extremity of the third or fourth rib, about opposite the base of the spine of the scapula.
According to Anson, the presence of a middle lobe disturbs the symmetry of the right lung. This results from a deep, nearly horizontal fissure that cuts through the right lung somewhat caudal to its middle and extends along the plane of the fourth costal cartilage between the anterior margin of the lung and the main interlobar fissure, reaching the latter at about the level of the midaxillary line. The horizontal fissure in Eycleshymer and Schoemaker's subject began opposite the sixth rib in the axillary line and extended upward and forward, ending at the sternum in the third intercostal space.
The upper margin of the inferior lobe of the right lung began on a level posteriorly with the tip of the fourth thoracic spine and the middle of the neck of the sixth rib.
The apex of the left lung may be found at a level between the seventh cervical disk and the upper third to the lower third of the first thoracic vertebra. The average position is at the level of the middle third of the first thoracic vertebra, according to Eycleshymer and Schoemaker. Cunningham places it at the level of the seventh cervical spine.
Left, Base, Lowest Point
Eycleshymer and Schoemaker reported that the variations in the level of the lowest point of the base of the left lung range from the middle of the ninth to the middle of the twelfth thoracic vertebrae. The average position is at the level of the tenth thoracic disk.
The left lung in Eycleshymer and Schoemaker's subject extended anteriorly in the mamillary line to the level of the fifth intercostal space. In the midaxillary line, it reached to the level of the tenth rib. Its vertebral extremity is was opposite the lower margin of the head of the eleventh rib. The lower margin began at the sixth rib, in the parasternal line, and extended downward in a uniformly curved line to the head of the eleventh rib, according to Joessel.
The fissure of the left lung began posteriorly at the level of the middle third of the second thoracic vertebra and ended opposite the fifth rib about 2 cm outside the mamillary line in Eycleshymer and Schoemaker's specimen. Merkel, Schultze, Spalteholtz, Corning, Poirier and Charpy, Testut, and others state that it ends opposite the junction of the sixth rib with its costal cartilage near the mamillary line. According to Anson, the oblique interlobar fissure of the left lung is variable in its dorsosuperior topography. At this location, the fissure may be placed as far cranial as the third costovertebral level and again as low as the fifth costovertebral junction, rarely lower. At the midaxillary line, the left interlobar fissure commonly follows the fifth rib but may be as far cranial as the fourth rib, again as far caudal as the fifth intercostal space, and thence to the medial margin of the lung.
According to Poirier and Charpy and Cunningham, the distance between the apex of the lungs and the upper margin of the clavicles ranges between 1 and 3 cm. Poirier and Charpy also state that the apex may lie behind the clavicle in strong, forced inspiration. Various authors place the maximal level of the apices of the lungs in relation to the upper margin of the clavicles to be from 1 to 3 cm.
The lower borders of the lungs are approximately equal on both sides and, according to Corning, in moderate respiration may be found as follows: in the mamillary line, at the level of the sixth rib; in the axillary line, at the eighth rib; in the scapular line, at the tenth rib; and at the vertebral column, at the level of the upper half of the eleventh thoracic vertebra. Gerlach gives the following levels in deep inspiration: in the sternal line, the lower border of the sixth rib; in the parasternal line, the superior border of the seventh rib; in the mamillary line, the eighth rib; in the axillary line, the inferior border of the ninth rib; and in the scapular line, the superior border of the eleventh rib.
The average inferior displacement of the lung in the upright position, according to Poirier and Charpy, is 1. 5 to 2 cm in the right parasternal line; 2 to 3 cm in the right mamillary line; and 3 to 4 cm in both the left and right axillary lines. In the scapular line, Well found the displacement to be 2 cm, and Eichorst (cited but not referenced in Eycleshymer and Schoemaker) found it to be displaced 3 cm from the vertebral column. In the recumbent dorsal (supine) position, the lungs descend from 1 to 2 cm lower, according to Gerhardt. In the recumbent lateral position, the lung on the upper side may, in deep inspiration, completely fill the pleural cavity.
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