Dr.

Ganesh Khemnar
 Parietal Pleura

 Visceral Pleura

 Pleural Space
 The pleurae and lungs lie on either side of the
mediastinum within the chest cavity
 Each pleura has two parts:

 Parietal layer
 Visceral layer
 It lines the thoracic wall

 Covers the thoracic surface of the diaphragm

and the lateral aspect of the mediastinum

 Extends into the root of the neck to line the

undersurface of the suprapleural membrane at
the thoracic outlet
 It completely covers the outer surfaces of the
lungs

 Extends into the depths of the interlobar

fissures
 The two layers continuous with one another by
means of a cuff of pleura

 This cuff surrounds the structures entering and

leaving the lung at the hilum of each lung

 Pleural cuff hangs down as a loose fold called

the pulmonary ligament
 The parietal and visceral layers are separated from
one another by a slitlike space called pleural cavity

 Clinicians use the term pleural space instead of the

anatomic term pleural cavity

 Pleural cavity contains thin film of tissue fluid

called pleural fluid

 Fluid permits the two layers to move on each other

with the minimum of friction
 Parietal pleura is divided into the region in which
it lies or the surface that it covers

 The cervical pleura extends up into the neck

 It lines the undersurface of the suprapleural

membrane

 It reaches a level 1 to 1.5 in. (2.5 to 4 cm) above

the medial third of the clavicle
 It lines the inner surfaces of:

 The ribs
 The costal cartilages
 The intercostal spaces
 The sides of the vertebral bodies
 The back of the sternum
 It covers the thoracic surface of the diaphragm

 In quiet respiration, the costal and

diaphragmatic pleurae are in apposition to
each other below the lower border of the lung

 Costal and diaphragmatic pleurae separate in

deep inspiration
 The lower area of the pleural cavity into which
the lung expands on inspiration is referred to
as the costodiaphragmatic recess
 It covers and forms the lateral boundary of the mediastinum

 It is reflected as a cuff around the vessels and bronchi at the

hilum of the lung

 Then continuous with the visceral pleura

 Each lung lies free except at the hilum

 it is attached to the blood vessels and bronchi that constitute

the lung root
 During full inspiration the lungs expand and
fill the pleural cavities

 During quiet inspiration the lungs do not fully

occupy the pleural cavities at four sites

 The right and left costodiaphragmatic recesses

 The right and left costomediastinal recesses

 Are slitlike spaces between the costal and
diaphragmatic parietal pleurae

 Separated only by a capillary layer of pleural fluid

 During inspiration, the lower margins of the lungs

descend into the recesses

 During expiration, the lower margins of the lungs

ascend so that the costal and diaphragmatic pleurae
come together again
 Are situated along the anterior margins of the pleura

 They are slitlike spaces between the costal and the

mediastinal parietal pleurae

 Separated by a capillary layer of pleural fluid

 During inspiration and expiration, the anterior borders

of the lungs slide in and out of the recesses
• Arterial supply :
– Parietal pleura :
• Costal pleura : small branches of intercostal arteries
• Mediastinal pleura : supplied by pericardio phrenic
artery
• Diaphragmatic pleura : supplied by superior phrenic and
musculophrenic artery.
– Visceral pleura :
• Bronchial artery : supplies visceral pleura facing the
mediastinum, pleura covering the interlobular surface
and part of the diaphragmatic surface.
• Pulmonary artery : supplies remaining portion.
 Venous drainage :
 Parietal pleura
 Through the intercostal veins which empty into inferior
venacava or brachio-cephalic trunk.
 Visceral pleura
 Through pulmonary veins.
 The visceral pleura covering the lungs is
sensitive to stretch

 It is insensitive to common sensations such as

pain and touch

 It receives an autonomic nerve supply from the

pulmonary plexus
 The parietal pleura is sensitive to pain, temperature,
touch and pressure, and is supplied as follows:

 The costal pleura is segmentally supplied by the

intercostal nerves

 The mediastinal pleura is supplied by the phrenic nerve

 The diaphragmatic pleura is supplied over the domes by

the phrenic nerve and around the periphery by the lower
six intercostal nerves
 The pleural space normally contains 5 to 10 ml of clear
fluid

 It lubricates the opposing surfaces of the visceral and

parietal pleurae during respiration

 The formation of the fluid results from hydrostatic and

osmotic pressures between the capillaries

 The pleural fluid is normally absorbed into the

capillaries of the visceral pleura
 Any condition that increases the production of the fluid
or impairs the drainage of the fluid results in the
abnormal accumulation of fluid, called pleural effusion

 The presence of 300 ml of fluid in the

costodiaphragmatic recess in an adult is sufficient to
enable its clinical detection

 The clinical signs include decreased lung expansion on

the side of the effusion, with decreased breath sounds
and dullness on percussion over the effusion
 It is an abnormal
accumulation of pleural
fluid about 300 ml, in the
Costodiaphragmatic
recess , (normally 5-10 ml
of clear fluid)
 Causes:
 Inflammation, TB,
malignancy, congestive
heart disease.
 The lung is compressed
& the bronchi are
narrowed.
 Auscultation would
reveal only faint &
decreased breath sounds
over the compressed or
collapsed lung.
 Dullness on percussion
over the effusion.
 Inflammation of the pleura secondary to
inflammation of the lung called pneumonia

 Pleural surfaces become coated with inflammatory

exudate, causing the surfaces to be roughened

 Produces friction, and a pleural rub

 It can be heard with the stethoscope on inspiration

and expiration
 Often the exudate becomes invaded by
fibroblasts

 That lay down collagen and bind the visceral

pleura to the parietal pleura

 Forms pleural adhesions

• Pleuritis or pleurisy : This is the inflammation of the pleura.
Acute pleuritis is marked by sharp, stabbing pain, especially
on exertion.
• Pneumothorax : Presence of air in the pleural cavity. Entry of
air into the pleural cavity, resulting from a penetrating wound
of the parietal pleura or rupture of a lung results in partial
collapse of the lung.
• Hemothorax : Presence of blood in the pleural cavity. It results
more often from injury to a major intercostal vessel than
laceration of lung.
• Hydropneumo thorax : prence of both fluid and air in the
pleural cavity.
• Empyema : presence of pus in pleural cavity.
 Applied anatomy : Aspiration of any fluid from the
pleural cavity is called parencentesis thoracis. It is
usually done in the 6th intercostal space in the
midaxillary line. The needle is passed through the
lower part of the space to avoid injury to the
neurovascular bundle.