12 The pulmonary vessels

12.1 Anatomy

The pulmonary vasculature can be divided into two circulatory pathways:

• the vasa publica – part of the circulation serving the interests of the whole body

• the vasa privata – arising from the systemic circulation and serving an organ.

12.1.1 Vasa publica

The pulmonary trunk splits into two pulmonary arteries sending deoxygenated blood to the pulmonary alveolae for reoxygenation.

These vessels are located anterior to the main bronchi.

12.1.2 Vasa privata

The pulmonary tissue of the left lung is irrigated by the bronchial branches of the thoracic aorta.

The parenchyma of the right lung is irrigated by the third and fourth posterior intercostal arteries, which supply the bronchial arteries. It is for this reason that our pressure is deeper for the right artery.

12.1.3 Pulmonary hilum

Located on the medial surface of the lung, the pulmonary hilum is narrow, being no more than 4–5 cm in height and 4 cm wide. It is at equal distance from the base and the apex of the lung, but more posterior in the sagittal plane.

On the right, the pulmonary hilum is larger but not as high as on the left. The hilum projects posteriorly and superiorly to the cephalad edge of the fourth rib, and inferiorly as far as the cephalad border of the sixth rib.

12.1.4 Comments

One can note three features when viewing the pulmonary vascular trunks:

1 They are located anterior to the trachea and the bronchi.

2 They are covered in large part by the heart.

3 They are clearly transverse in orientation.

For these reasons:

• We avoid the cardiac region with our two points of contact.

• We stretch the pulmonary hilum laterally.

12.2 Precautions

One must be cautious of osteoporosis when applying costochondral pressure.

In the case of vascular fragility, especially venous, it is advisable to observe the facial coloration of patients during the maneuver. At no time should the patient feel ill at ease.

In addition, the following elements call for circumspection before vascular pulmonary manipulations:

• fever

• weight loss

• subcutaneous emphysema

• retroclavicular and axillary lymph nodes

• unexplained cough

• change in a pre-existing cough

• dysphonia

• dysphagia

• dyspnea without precise cause

• unusual palor

• tachycardia when resting

• costal pain on a deep inhalation (without previous trauma)

• intercostal cutaneous vesicles

• sudden onset of expectoration

• cervicobrachial neuralgia without mechanical cause.

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