Trachea and Esophagus in relation to vertebral and sternal levels

The trachea, or windpipe , which has cervical and thoracic parts, extends from the inferior end of the larynx (C6 vertebra) to its point of bifurcation (between T5 and 7 vertebral level). It is about 9 to 15 cm in length. The trachea descends anterior to the esophagus, enters the superior mediastinum, and divides into right and left main bronchi. The trachea is a median structure but, near its lower end, deviates slightly to the right, resulting in the left main bronchus crossing anterior to the esophagus. Owing to the translucency of the air within it, the trachea is usually visible above the arch of the aorta in radiographs.

The trachea has 15 to 20 C-shaped bars of hyaline cartilage that prevent it from collapsing. Longitudinal elastic fibers enable the trachea to stretch and descend with the roots of the lungs during inspiration. When a subject is in the erect position, the trachea divides between the T5 and T7 vertebral levels. The carina is the upward-directed ridge seen internally at the bifurcation and is a landmark during bronchoscopy.

The trachea and esophagus in relation to vertebral and sternal levels in a subject in the erect position.

The arch of the aorta is at first anterior to the trachea and then on its left side immediately superior to the left main bronchus. Other close relations include the brachiocephalic and left common carotid arteries. The trachea is supplied mainly by the inferior thyroid arteries. Its smooth muscle is supplied by parasympathetic and sympathetic fibers, and pain fibers are carried by the vagi.