Trachea
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At the time the article was created Laura Smith had no recorded disclosures.
View Laura Smith's current disclosuresAt the time the article was last revised Craig Hacking had the following disclosures:
- Philips Australia, Paid speaker at Philips Spectral CT events (ongoing)
These were assessed during peer review and were determined to not be relevant to the changes that were made.
View Craig Hacking's current disclosures- Trachea anatomy
- Tracheal anatomy
- Windpipe
- Anatomy of the trachea
- Tracheas
The trachea, known colloquially as the windpipe, connects the upper respiratory tract to the lungs via the tracheobronchial tree, enabling gas exchange.
On this page:
Gross anatomy
The trachea is a tube-shaped structure consisting of 15-20 D-shaped cartilage rings anterolaterally bridged by annular ligaments. The trachealis muscle (smooth muscle) encircles the trachea completely but is most prominent posteriorly due to the lack of cartilage 4.
The trachea extends from the inferior margin of the cricoid cartilage (C6) and branches into the right and left main bronchi at the carina, located at the T4 vertebral body level, in the plane of Ludwig. It is usually situated in a midline position and can be displaced slightly to the right at the arch of the aorta 1. In the lateral view, the trachea slants from an anterior position beneath the larynx to a posterior position at the carina 5. The tracheal length is usually between 10-13 cm with a width of 1.5-2 cm and is wider in men than in women 2,3.
Relations
anteriorly: sternum, strap muscles, thyroid isthmus, ascending aorta, brachiocephalic artery, right common carotid artery, superior vena cava, inferior thyroid veins, left brachiocephalic vein 3,5
posteriorly: esophagus 3
laterally: lateral walls of the thyroid gland, left common carotid artery, arch of the azygos vein, right and left recurrent laryngeal nerves, right and left vagus nerves 5
Arterial supply
proximal half: tracheo-esophageal branches of the inferior thyroid artery 5
distal half and carina: superior and middle bronchial arteries 5
Venous drainage
to inferior thyroid venous plexus
Lymphatic drainage
to pretracheal and paratracheal lymph nodes
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Histology
The trachea has three layers 4:
external: loose connective tissue/adventitia: note there is no capsule
middle: fibromusculocartilaginous membrane: tracheal cartilage, annular ligaments, connective tissue and trachealis muscle
internal: respiratory mucous membrane: tracheal glands with a pseudostratified columnar epithelium
Variant anatomy
-
tracheal bronchus or "pig bronchus" 6,7
development of an extra bronchus that usually develops superior to the carina from the trachea, above the right main bronchus and connecting to the right upper lobe
common and can be found in 2% of people
may not present with any symptoms and can be an incidental finding usually via bronchoscopy, however, it may cause problems during intubation
may be associated with chronic atelectasis, bronchiectasis and recurrent pneumonia
-
coronal-to-sagittal ratio of the trachea is >1 giving rise to a lunate-shaped cross-section rather than round or oval
may be associated with COPD and tracheomalacia
-
outpouching of the posterolateral tracheal wall, usually on the right side
majority of patients are asymptomatic although may present with a recurrent respiratory tract infection
tracheal buckling in young infants
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Related pathology
References
- 1. Laroia AT, Thompson BH, Laroia ST et-al. Modern imaging of the tracheo-bronchial tree. World J Radiol. 2010;2 (7): 237-48. doi:10.4329/wjr.v2.i7.237 - Free text at pubmed - Pubmed citation
- 2. Brand-Saberi BE, Schäfer T. Trachea: anatomy and physiology. Thorac Surg Clin. 2014;24 (1): 1-5. doi:10.1016/j.thorsurg.2013.09.004 - Pubmed citation
- 3. Epstein SK. Anatomy and physiology of tracheostomy. Respir Care. 2005;50 (4): 476-82. Pubmed citation
- 4. Kahle W, Leonhardt H, Platzer W. Color atlas and textbook of human anatomy. George Thieme Verlag. ISBN:0865774846. Read it at Google Books - Find it at Amazon
- 5. Grillo HC. Surgery of the Trachea and Bronchi. pmph usa. ISBN:1550090585. Read it at Google Books - Find it at Amazon
- 6. Barat M, Konrad HR. Tracheal bronchus. Am J Otolaryngol. 1987;8 (2): 118-22. Pubmed citation
- 7. O'Sullivan B. CHEST Journal. 1998;113 (2): . doi:10.1378/chest.113.2.537
- 8. Hansell DM, Lynch DA, McAdams HP et-al. Imaging of Diseases of the Chest. Mosby. ISBN:B0054JE9QI. Read it at Google Books - Find it at Amazon
- 9. Han S, Dikmen E, Aydin S et-al. Tracheal diverticulum: a rare cause of dysphagia. Eur J Cardiothorac Surg. 2008;34 (4): 916-7. doi:10.1016/j.ejcts.2008.06.022 - Pubmed citation
- 10. Moore KL, Agur AMR, Dalley AF. Clinically oriented anatomy. LWW. ISBN:1451119453. Read it at Google Books - Find it at Amazon
- 11. Standring S, & Gray H (2008). Gray's anatomy: The anatomical basis of clinical practice. Edinburgh: Churchill Livingstone/Elsevier
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