Pleura

Pleura is a serous membrane covering of the lungs

[Serous membrane
•An epithelial membrane
•Lines the coleomic cavities (cavities in the body that don’t open to
outside )and covers the organs located within the cavities
•The epithelium is simple squamous epithelium
The epithelium is derived from mesoderm and known as mesothelium
•Mesothelium lines the inside and connective tissue lines outside of
the serous membrane
•serous fluid is secreted by the cells of mesothelium
•serous fluid lubricates the membrane and reduces abrasions and
frictions between organs
•serous membranes are identified according to location

Coelomic cavity Serous membrane

In thoracic cavity
In abdominal cavity
]
Pleura which covers lung,
pericardium which covers heart
Peritoneum which covers the
abdominal organs
Pleura has two layers
Inner visceral pleura
covers lungs and extends into the inter lobar fissures
closely adherent to the lung and cannot be peeled off
Also known as pulmonary pleura
Outer parietal pleura
It lines the
– chest wall= lines ribs, costal cartilage, intercostal spaces sides of

vertebral body and back of sternum

– lateral surfaces of mediastinum

– upper/thoracic surface of diaphragm

It is divided according to the region it lines

and the surfaces it covers
● Cervical

● Costal

● Mediastinal

● Diaphragmatic

Cervical pleura
● Forms a cup like dome
 ● Over the apex of lung costal and mediastinal pleura adjoin to from
this dome of the pleura. This is also known as the cupulae pleurae
● Extends into the root of the neck. It reaches a level 2.5 to 4cm

above the medial 1/3 rd of the clavicle on both sides

● This covers the apex of the lung

● Lines the under surface of supra-pleural membrane.

[Supra-pleural membrane=Sibson fascia

Extensions of endothoracic fascia
Is attached to inner margin of first rib and transverse process of
seventh cervical vertebrae
Scalenus minimus muscle fibres inserted into membrane ]
● This region is only protected by soft tissue and vulnerable to injury

Costal pleura
● Lines the inner surface of chest wall

● Endothoracic fascia (= extra-pleural layers of loose connective

tissue ) separates it from the bones in the thoracic cage.It provides

a natural cleavage plane for the surgical separation of pleura from
the thoracic wall
 Mediastinal pleura
● It covers and forms the lateral aspect of mediastinum

● It is continuous with the costal pleura anteriorly and posteriorly and

with the diaphragmatic pleura inferiorly.

Superiority it extends into the root of the neck as cervical pleura
Diaphragmatic pleura
● It covers the diaphragm

Both visceral and parietal pleura are continuous each other at the hilum
of lungs.The parietal mediastinal pleura joins with the visceral pleura
on the medial aspects of lung at the hilum.
Before joining the parietal pleura , the
visceral pleura ??forms an almost circular sleeves which enclosed the
structures of hilum
Below the hilum the reflections of mediastinal pleura projects downward
as tappering double layered pulmonary ligament
It provides a dead space into which pulmonary vein can expand during
increased venous return
The lung root also descend into it during inspiration

Figure shows the line of reflections of parietal to visceral pleura as a

white line around the hilum ,prolonged below as two layered pulmonary
ligaments

Pleural cavity
Between the parietal and visceral pleura is the intra pleural space
=pleural cavity
Two pleural cavities on either sides of the
mediastinum??
Contains small amount of serous fluid which forms a thin film of liquid
between two pleural layers
It lubricates the surfaces so that lung can easily move within the
thoracic cavity
It also provides surface tension which helps to keep the lung suitably
close to the wall of the thorax.Thus allowing the the volume of lung to
change with volume of the thoracic cavity during respiration

Pleural Reflections

The lines along which the parietal pleura

changes direction =reflects as it passes from one wall of the pleural
cavity to another is called line of pleural reflections
Sternal line of reflections =anterior border of pleura
Here costal parietal pleura becomes continuous with mediastinal pleura
anteriorly
On the right side extends downward from
lung apex/ cupola,passing posterior to
deep surface of stereo clavicular joint
then to
Inner surface of middle of sternum at the level of sternal angle
and next to
Xiphisternal joint
On the left side like the right side extends downward from lung apex /
cupola,passing posterior to
deep surface of stereo clavicular joint
then to
Inner surface of middle of sternum at the level of fourth costal
cartilage then passing laterally to
Posterior surface of fourth intercostal space
Then it turns sharply down ward to
The xiphisternal joint , creating a notch
which is shallower than the cardiac notch of lung
[The left sternal reflection is displaced laterally by cardiac margin. This
lateral deflection is marked on the anterior border as cardiac notch
It is produced to accomodate the space taken up by the heart
It leaves a small anterior area of pericardium in the direct contact of
sternum=bare area of pericardium .This area is dull to percussion =the
area of superficial cardiac dullness
and is unlike the surrounding regions where overlying lung makes the
percussions note relatively resonant]

Then it turns sharply down ward to

The xiphisternal joint

Costal line of pleural reflections = Inferior border of the pleura

Here the costal pleura becomes diaphragmatic pleura inferiorly
The inferior margins of parietal pleura
takes an oblique path
Extends laterally from xiphisternal joint (=
the inferior edge of the sternal pleural reflections )on each side to
Cross rib 8 in the mid clavicular line
Rib 10 in the mid axillary line and then
Proceed towards the spine of the 12th thoracic vertebra
Vertebral line of reflections
Posterior border of pleura
Lies posteriorly
Run in Para vertebral plane from first to twelve thoracic vertebrae

*The peripheral reflections of parietal pleura mark the extent of the

pleural cavities

Pleural recesses

The pleural membrane is larger than lungs which they encase thus
there are areas where the facing surfaces of parietal pleura touch each
other which are also separated by a thin layer of pleural fluid. These
are known as pleural recess (=pleura lined gutter)
The lungs do not completely fill the anterior posterior inferior region of
the pleural cavity
There are two pleural recesses
These are part of pleural cavity not occupied by lung tissue during
quite respiration
Pleural recess are only occupied by lung tissue during full inspirations
The recesses also provide potential spaces in which fluid can collect
Costodiaphragmatic recess
Space between the costal and diaphragmatic pleura along the inferior
border of lung
Radiologically it is known as costophrenic
angle
Larger of the recesses
Costo mediastinal recesses
Space between the costal and mediastinal pleura behind the sternum
Innervation Of Pleura

Visceral pleura
Is supplied by autonomic nerve from pulmonary plexus
It doesn’t feel pain but it is sensitive to stretch
Parietal pleura
Is supplied by somatic nerves
This somatic sensory /afferent innervation comes from
– Intercostal nerves

– Phrenic nerves

The costal pleura and peripheral parts of diaphragmatic pleura get

nerve supply from intercostal nerves
[The costal pleura is segmentally supplied by intercostal nerves
The diaphragmatic pleura around the periphery gets nerve supply from
lower six intercostal nerves ]
The mediastinal pleura and central part of
diaphragmatic pleura get nerve supply from phrenic nerves
The parietal pleura is sensitive to touch pressure ,pain and
temperature .
Pleural Effusion
Is the abnormal accumulation of fluid in the pleural cavity
[The pleural space normally contains 5 to 10 ml of clear fluid ]
Excess fluid is likely to collect in costodiaphragmatic recesses/ costo
phrenic angle due to gravity
On a CXR ,pleural effusion can be diagnosed as costophrenic angle
blunting
= costophrenic angle will be more obtuse and blurred. Under normal
circumstances it is distinct and sharp
The presence of 300 ml of fluid in the costophrenic/
costodiaphragmatic space in an adult is sufficient to enable its clinical
diagnosis
Haemo thorax =blood accumulates in pleura cavity
Pyothorax/ empyema = pus accumulates in pleura cavity
Pneumothorax = air accumulates in pleura cavity