The carina is the keel-shaped ridge of cartilage at the bottom of the trachea where it divides into the right and left main bronchi. Viewed from inside, it is a sharp vertical ridge separating the two bronchial openings. It is one of the most sensitive areas of the airway.
| Location | Inside the tracheal bifurcation, at about the level of the sternal angle and T4-T5 vertebrae, just above the left atrium. |
|---|---|
| Parts |
|
| Nerve Supply | Vagus nerve (sensory, cough reflex); Pulmonary plexus |
| Blood Supply | Bronchial arteries |
| Lymphatic drainage |
|
Divides airflow between the two lungs and, with its dense sensory supply, triggers a strong cough reflex when foreign material reaches it.
A widened or blunted carina seen at bronchoscopy or on X-ray can indicate enlarged subcarinal lymph nodes, often from lung cancer spread, or an enlarged left atrium. It is a key landmark for checking that an endotracheal tube tip sits above the bifurcation. Tumours involving the carina are technically difficult to remove.
Enlargement of the lymph nodes beneath the carina from cancer, sarcoidosis or infection. It widens the carinal angle and can compress nearby structures.
Advancement of a tracheal tube past the carina, usually into the right main bronchus, ventilating only one lung. It is detected by unequal breath sounds and corrected by withdrawing the tube.
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