Section: USMLE

9) While lying supine in bed eating, a child aspirates a peanut. Which of the following bronchopulmonary segments would this foreign object most likely enter?

1. Apical segment of the left upper lobe
2. Apical segment of the right upper lobe
3. Medial segment of the right middle lobe
4. Posterior basal segment of the left lower lobe
5. Superior segment of the right lower lobe

Because the right main bronchus is wider and more vertical than the left, foreign objects are more likely to be aspirated into the right main bronchus. The superior segmental bronchus of the lower lobar bronchus is the only segmental bronchus that exits from the posterior wall of the lobar bronchi. Therefore, if a patient is supine at the time of aspiration, the object is most likely to enter the superior segmental bronchus of the lower lobe.

None of the segmental bronchi of the left lung are likely to receive the object because the object is less likely to enter the left main bronchus.

The apical segment of the right upper lobe is not likely to receive the foreign object because of the sharp angle that the upper lobar bronchus makes with the right main bronchus, and the sharp angle that the apical segmental bronchus makes with the lobar bronchus.

The medial segmental bronchus of the right middle lobe arises from the anterior wall of the right middle lobar bronchus. Therefore, when the patient is supine, the effect of gravity will tend to prevent the object from entering this segmental bronchus.