THE PLEURAE AND PLEURAL CAVITIES

A pleural sac surrounds each lung.

A parietal layer of pleura forms its external wall and a visceral layer the internal wall that
invests the lungs.
The pleura cavity is a separate and closed potential space.
Normally it contains only a capillary layer of serous fluid with lubricates the two layers of
pleura and reduces friction.
THE VISCERAL PLEURA
The moist and shiny visceral (pulmonary) pleura closely covers the lung and is adherent to all
its surfaces.
It provides the lung with a smooth, slippery surface for free movement in the parietal pleura.
The visceral pleura dips into the fissures of the lungs so that the lobes are covered by it.
The visceral pleura is continuous with the parietal pleura at the root of the lung, where
structures enter and leave it.
THE PARIETAL PLEURA
This is the external wall of the pleura cavity and is adherent to the thoracic wall and diaphragm
by connective tissue.
The parietal pleura is also attached to the pericardium.
The parietal pleura is given different names according to the parts with which it is associated:
costal pleura (ribs and sternum); mediastinal pleura (mediastinum); diaphragmatic pleura
(diaphragm); and pleural cupula (apex of the lung).
THE COSTAL PLEURA
This part of the parietal pleura covers the internal surfaces of the sternum, costal cartilages,
ribs, intercostal muscles, and the sides of the thoracic vertebrae.
It is separated from these structures by a thin layer of connective tissue, called endothoracic
fascia.
THE MEDIASTINAL PLEURA
This part of the parietal pleura covers the mediastinum.
It is continuous with the costal pleura anteriorly and posteriorly; with the diaphragmatic pleura
inferiorly; and with the cupula or cervical superiorly.
Superior to the root of the lung, the mediastinal pleura is a continuous sheet between the
sternum and vertebral column.
At the root of the lung, the mediastinal pleura passes laterally, where it encloses the structures
in the root, and becomes continuous with the visceral pleura.
Inferior to the root of the lung, the mediastinal pleura passes laterally as a double layer from
the oesophagus to the lung, where it is continuous with the visceral pleura.
This double layer of pleura is called the pulmonary ligament.
It is continuous superiorly with the mediastinal pleura and ends inferiorly in a free border.
THE DIAPHRAGMATIC PLEURA
This part of the parietal pleura covers the superior surface of the diaphragm, lateral to the
mediastinum.
THE PLEURAL CUPULA OR CERVICAL PLEURA
The pleural cupula is the dome-shaped apex of the pleural sac that is formed by the cervical
pleura.
The pleural cupula is the continuation of the costal and mediastinal layers of pleura that covers
the apex of the lung.
It extends superiorly posterior to the clavicle and 1st rib and passes through the superior
thoracic aperture into the root of the neck.
Its summit is nearly 3 cm superior to the level of the medial third of the clavicle.
PLEURAL REFLECTIONS
These are the relatively abrupt lines along which the parietal pleura folds back or changes
direction from one wall of the pleura cavity or another.
They occur where the costal pleura becomes continuous with the mediastinal pleura anteriorly
and posteriorly, and with the diaphragmatic pleura inferiorly.
STERNAL LINE OF REFLECTION (ANTERIOR COSTOMEDIASTINAL REFLECTION)
This is where the costal pleura is continuous with the mediastinal pleura, posterior to the
sternum.
The right and left sternal reflections are indicated by lines that pass inferomedially from the
sternoclavicular joints to the anterior median line at the level of the sternal angle.
On the right side, the sternal line of reflection passes inferiorly in the medial plane to the
posterior aspect of the xiphoid process, where it turns laterally.
On the left side, the sternal line of pleura reflection passes inferiorly in the median plane to
the level of the 4th costal cartilage.
Here it passes to the left margin of the sternum and then continues inferiorly to the 6th costal
cartilage.
THE COSTAL LINE OF PLEURAL REFLECTION
This is where the costal pleura is continuous with the diaphragmatic pleura.
It passes obliquely across the 8th rib in the midclavicular line, the 10th rib in the midaxillary
line, and the 12th rib at its neck or inferior to it.
THE PLEURAL RECESSES
During deep inspiration, the lungs fill the pleural cavities, but during quiet respiration, the
lungs do not occupy parts of these cavities.
Here, portions of the parietal pleura and in contact.
These potential spaces are called pleura recesses.
 THE COSTODIAPHRAGMATIC RECESSES
These are slit-like intervals between the costal and diaphragmatic pleurae on each side.
They become alternatively smaller and larger as the lungs move in and out of them during
inspiration and expiration.
THE COSTOMEDIASTINAL RECESSES
These potential spaces lie along the anterior margin of the pleura.
Here, the costal and mediastinal parts of the parietal pleura come into contact.
The left recess is larger because of the presence of a semicircular deficiency, the cardiac notch,
in the left lung anterior to the pericardium.
The costomediastinal recesses lie at the anterior ends of the 4th and 5th intercostal spaces.
During inspiration and expiration, a thin tongue-like edge of the left lung, called the lingula (L.
dim. of lingua, tongue), slides in and out of the left costomediastinal recess.
ARTERIAL SUPPLY OF THE PLEURAE
The arterial supply of the parietal pleura is from the arteries that supply the thoracic wall
(intercostal, internal thoracic, and musculophrenic arteries).
The arterial supply of the visceral pleura is from the bronchial arteries, which are branches of
the thoracic aorta.
INNERVATION OF THE PLEURAE
Parietal pleura costal: intercostal nerves
mediastinal & diaphragmatic: phrenic nerve
Visceral pleura autonomic nerves from the pulmonary plexuses