Pleura & pleural cavities

Developmental..
?? Where did it come from

The pleural cavities

The thoracic cavity, the space enclosed by the thoracic walls, has three compartments Two lateral compartments are the pulmonary cavities that contain the lungs and pleurae (lining membranes) & central compartment the It is important to note that the lungs are not within the pleural cavity. The cavity is the space between the visceral and parietal layers of pleura. The lungs are surrounded by the pleurae, a serous membrane which folds back upon itself to form a twolayered, membrane structure. The thin space between the two pleural layers is known as the pleural space

Pleural
A thin serous membrane invaginated by the lung. Intimately related to lung Continuous over the root of the lung with parietal pleura. The Fist in glove model

The pleura..
The visceral pleura (pulmonary pleura)
covers the lungs and is adherent to all its surfaces, including the surfaces within the horizontal and oblique fissures, it cannot be dissected from the lungs.

The parietal pleura

lines the pulmonary cavities, adhering to the thoracic wall, the mediastinum, and the diaphragm.

The pleura
The parietal pleura consists Costal part (pleura)
covers the internal surfaces of the thoracic wall (sternum, ribs, costal cartilages, intercostal muscles and membranes, and side of thoracic vertebrae) separated from the wall by endothoracic fascia.

Diaphragmatic part (pleura)

covers the superior or thoracic surface of the diaphragm on each side of the mediastinum.

Cervical pleura
extends through the superior thoracic aperture into the root of the neck 2-3 cm superior to the level of the medial third of the clavicle at the level of the neck of the 1st rib, forming a cup-shaped dome over the apex of the lung. reinforced by a fibrous extension of the endothoracic fascia, the suprapleural membrane (Sibson fascia) spanning between the 1st rib and C7 vertebra.

Mediastinal part (pleura)

covers the lateral aspects of the mediastinum (the central compartment of the thoracic cavity).

The pleura
Parietal pleura
Cervical Costal Diaphragmatic Mediastinal

Visceral pleura

The recesses
Costodiaphragmatic recesses
diaphragmatic pleura in contact with the lowermost part of the costal pleura. The potential space pleura lined surround the upward convexity of the diaphragm inside the thoracic wall

The costomediastinal recesses

the smaller pleural recesses posterior to the sternum w costal pleura in contact with the mediastinal pleura. the left recess is potentially larger (less occupied) because of the cardiac notch in the left lung. The inferior borders of the lungs move farther into the pleural recesses during deep inspiration and retreat from them during expiration.

The recesses..
Lungs doesnt strictly fits into the pleura space- extra space for expansion.

 Fist invaginating model -


Pulmonary ligament.
Inferior to the root of the lung, this continuity between parietal and visceral pleura forms the pulmonary ligament extending between the lung and the mediastinum.

Pleural reflection
The cervical pleurae and apices

through the superior thoracic aperture into the root of the neck & posterior to the clavicles.
The anterior borders of the lungs anterior line of reflection of

left pleural reflection

laterally & inferiorly at the cardiac notch to reach 6th costal cartilage.

the parietal pleura between the 2nd and 4th costal cartilages.

The anterior border of the left lung

deeply indented by its cardiac notch.

reflections
On the right pleural
reflection continues inferiorly from the 4th to the 6th costal cartilage, paralleled anterior border of the right lung.

Both pleural reflections pass laterally and reach

the midclavicular line at 8th costal cartilage, 10th rib at the midaxillary line, 12th rib at the scapular line, to T12 vertebra.

Parietal pleura extends approximately two ribs inferior to the lung.

Vasculature..
The veins from the parietal pleura join the systemic veins in adjacent parts of the thoracic wall. The veins from the visceral pleura drain into the pulmonary veins. Lymphatics-

Vasculature..Lympahtics
The superficial (subpleural) lymphatic plexus drains lymph from the visceral pleura. Lymph from the parietal pleura drains into the lymph nodes of the thoracic wall
(intercostal, parasternal, mediastinal, and phrenic).

A few lymphatic vessels from the cervical pleura drain into the axillary lymph nodes.

Vasculature.. nerves
Visceralpleura pleura nerve supply derive from the pulmonary plexuses located anterior and (mainly) posterior to the roots of the lungs These nerve networks contain parasympathetic fibers from the vagus nerves (CN X) and sympathetic fibers from the sympathetic trunks.

Parietal
Somatic intercostals nerves&phrenic

Functional anatomy
The pleural cavity, with its associated pleurae, aids optimal functioning of the lungs during respiration. The pleurae are coated with lubricating pleural fluid which allows the pleurae to slide effortlessly against each other during ventilation. Surface tension of the pleural fluid also leads to close apposition of the lung surfaces with the chest wall. This physical relationship allows for optimal inflation of the alveoli during respiration. Movements of the chest wall, particularly during heavy breathing, are coupled to movements of the lungs since the closely opposed chest wall transmits pressures to the visceral pleural surface and, hence, to the lung itself.


Pleural fluid Pleural fluid is a serous fluid produced by the pleurae. A normal 70 kg human has approximately 12-15 mL of pleural fluid. In normal pleurae, most fluid is produced by the parietal circulation (intercostal arteries) via bulk flow and reabsorbed by the lymphatic system. pleural fluid is continuously produced and reabsorbed. The rate of reabsorption may increase up to 40x before significant amounts of fluid accumulate within the pleural space. In humans, there is no anatomical connection between the left and right pleural cavities, so in cases of pneumothorax, the other hemithorax will still function normally.

Functional anatomy..
Physiological
Movements of membranesserous, smoothen

Injury to Pleurae
The visceral pleura is insensitive to pain innervation is autonomic (motor and visceral afferent). The autonomic nerves reach the visceral pleura in company with the bronchial vessels. The visceral pleura receives no nerves of general sensation. The parietal pleura is sensitive to pain, particularly the costal pleura, because it is richly supplied by branches of the somatic intercostal and phrenic nerves.

Irritation of the parietal pleura produces local pain and referred pain to the areas sharing innervation by the same segments of the spinal cord. Irritation of the costal and peripheral parts of the diaphragmatic pleura - local pain and referred pain along the intercostal nerves to the thoracic and abdominal walls.

Irritation of the mediastinal and central diaphragmatic areas of the parietal pleura pain - referred to the root of the neck and over the shoulder

Functional, Injury ..
Cervical pleura
Prone to stab injuries & surgeons knife Niddle at 4th&5th ICS by pass the pleural to pericardium. Pleural below 12th rib in the medial may be opened in the loin (adrenal/renal surgery)

Pleural effusion Empyema thoracis Decortication Tumours (mesotheliomas)