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Pleura
Pleura
Each lung is enclosed in a serous pleural sac
Serous membrane lined by flattened epithelium
(mesothelium)
Outer layer- Parietal pleura
Inner layer- Visceral pleura (Pulmonary pleura)
Pleural cavity: potential space in between two
layers
consists of serous pleural fluid, which lubricate
pleural surfaces
visceral pleura
• Pulmonary pleura
• Adherent to all surfaces including those in fissures
• Except the root or hilum of the lung
• Visceral pleura is continuous with parietal pleura at
the hilum of the lung
Parietal pleura
• Outer layer of the pleura
• Lines the corresponding half of the thoracic wall,
mediastinum and diaphragm
• It is divided into four parts
• Cervical pleura: lies over the apex of the lungs
• Costal pleura: covers the internal surface of
the thoracic wall
• Mediastinal pleura: covers the lateral aspect
of the mediastinum
• Diaphragmatic pleura: lies on the thoracic
surface of the diaphragm
Cervical pleura
• Dome of pleura,
• Covers the apex of the lungs
• Ascends from inner border of first rib to the
apex of the lung
• And then passes downwards on to the
mediastinal surface to become continuous
with mediastinal pleura
• Extends 3 -4 cm above the first costal cartilage
• 2.5 cm above the sternal end of the clavicle
• Cervical pleura is covered externally by supra pleural
membrane [ sibson fascia]
• Attaches to the internal border of first rib below and
transverse process of 7th cervical vertebra above
• Relation
• Relation
Anterior
Subclavian artery and scalenus anterior muscle.
Posterior
Neck of 1st rib and structures passing in front of it.
Lateral
Sclenus medius muscle
Medially
Great vessels of the neck
Costal pleura
• Lines the inner surface of the thoracic wall
(consisting of ribs, costal cartilage and
intercostal muscles )
• Separated from the above structures by
endothoracic fascia
Mediastinal pleura
• Covers the mediastinal surface of the lung.
• At the root of the lung it continous with viseral
pleura.
• Pulmonary ligament is downward continuation
of the parietal pleura and has two layer.
Diaphragmatic pleura
• Covers the superior surface of the diaphragm
• A thin elastic layer of endothoracic fascia
connects diaphragmatic pleura with muscular
part of diaphragm
Pleural receses
• Lungs do not occupy the pulmonary cavities
completely during expiration
• These gaps are the pleural recesses
Costodiaphragmatic recess
• Cleft like potential space between lower limit
of pleural sac and lower border of the
corresponding lung
• It makes a provision to allow the expansion of
the lung in full inspiration
• Most dependent part of pleural sac
Costomediastinal recess
• Between anterior border of the lung and
costomediastinal reflection of the pleura
• Left recess is larger because of cardiac notch
Nerve supply
• Costal and peripheral part of diaphragmatic
pleurae- intercostal nerves
• Mediastinal and central part of the
diaphragmatic pleurae- phrenic nerve
• Visceral pleura by autonomic nerve fibres
(through anterior and posterior pulmonary
plexuses)
Blood supply
• Arterial supply
• Parietal pleura- intercostal, internal thoracic
and musculophrenic arteries
• Visceral pleura- bronchial arteries
• Venous drainage
• Parietal pleura- azygous and internal thoracic
veins
• Visceral pleura- bronchial veins
Lymphatic drainage
Parietal pleura
• Intercostal lymph nodes
• Internal thoracic lymph node
• Posterior mediastinal lymph node
• Diaphragmatic lymph node.
• Visceral pleura
• Bronchomediastinal lymph node.
Pleurisy / pleuritis
• Commonly caused by tuberculosis.
• Inflammation of pleura- dry and wet
• Makes lung surfaces rough
• Pleural rub/ friction
Pneumothorax
• Accumulation of air in the pleural cavity
• Penetrating wounds Eg: bullet wound
• Tear of pleura by fractured rib
• Haemothorax
– Blood in the pleural cavity
• Hydropneumothorax
– Fluid with air in the pleural cavity
• Pleural effusion
–Escape of fluid into pleural cavity
Pleura

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Pleura

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  • 3. Pleura Each lung is enclosed in a serous pleural sac Serous membrane lined by flattened epithelium (mesothelium) Outer layer- Parietal pleura Inner layer- Visceral pleura (Pulmonary pleura) Pleural cavity: potential space in between two layers consists of serous pleural fluid, which lubricate pleural surfaces
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  • 6. visceral pleura • Pulmonary pleura • Adherent to all surfaces including those in fissures • Except the root or hilum of the lung • Visceral pleura is continuous with parietal pleura at the hilum of the lung
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  • 10. Parietal pleura • Outer layer of the pleura • Lines the corresponding half of the thoracic wall, mediastinum and diaphragm • It is divided into four parts
  • 11. • Cervical pleura: lies over the apex of the lungs • Costal pleura: covers the internal surface of the thoracic wall • Mediastinal pleura: covers the lateral aspect of the mediastinum • Diaphragmatic pleura: lies on the thoracic surface of the diaphragm
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  • 13. Cervical pleura • Dome of pleura, • Covers the apex of the lungs • Ascends from inner border of first rib to the apex of the lung • And then passes downwards on to the mediastinal surface to become continuous with mediastinal pleura
  • 14. • Extends 3 -4 cm above the first costal cartilage • 2.5 cm above the sternal end of the clavicle • Cervical pleura is covered externally by supra pleural membrane [ sibson fascia] • Attaches to the internal border of first rib below and transverse process of 7th cervical vertebra above • Relation
  • 15. • Relation Anterior Subclavian artery and scalenus anterior muscle. Posterior Neck of 1st rib and structures passing in front of it. Lateral Sclenus medius muscle Medially Great vessels of the neck
  • 16. Costal pleura • Lines the inner surface of the thoracic wall (consisting of ribs, costal cartilage and intercostal muscles ) • Separated from the above structures by endothoracic fascia
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  • 18. Mediastinal pleura • Covers the mediastinal surface of the lung. • At the root of the lung it continous with viseral pleura. • Pulmonary ligament is downward continuation of the parietal pleura and has two layer.
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  • 21. Diaphragmatic pleura • Covers the superior surface of the diaphragm • A thin elastic layer of endothoracic fascia connects diaphragmatic pleura with muscular part of diaphragm
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  • 24. Pleural receses • Lungs do not occupy the pulmonary cavities completely during expiration • These gaps are the pleural recesses
  • 25. Costodiaphragmatic recess • Cleft like potential space between lower limit of pleural sac and lower border of the corresponding lung • It makes a provision to allow the expansion of the lung in full inspiration • Most dependent part of pleural sac
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  • 29. Costomediastinal recess • Between anterior border of the lung and costomediastinal reflection of the pleura • Left recess is larger because of cardiac notch
  • 30. Nerve supply • Costal and peripheral part of diaphragmatic pleurae- intercostal nerves • Mediastinal and central part of the diaphragmatic pleurae- phrenic nerve • Visceral pleura by autonomic nerve fibres (through anterior and posterior pulmonary plexuses)
  • 31. Blood supply • Arterial supply • Parietal pleura- intercostal, internal thoracic and musculophrenic arteries • Visceral pleura- bronchial arteries • Venous drainage • Parietal pleura- azygous and internal thoracic veins • Visceral pleura- bronchial veins
  • 32. Lymphatic drainage Parietal pleura • Intercostal lymph nodes • Internal thoracic lymph node • Posterior mediastinal lymph node • Diaphragmatic lymph node. • Visceral pleura • Bronchomediastinal lymph node.
  • 33. Pleurisy / pleuritis • Commonly caused by tuberculosis. • Inflammation of pleura- dry and wet • Makes lung surfaces rough • Pleural rub/ friction
  • 34. Pneumothorax • Accumulation of air in the pleural cavity • Penetrating wounds Eg: bullet wound • Tear of pleura by fractured rib
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  • 36.
  • 37. • Haemothorax – Blood in the pleural cavity • Hydropneumothorax – Fluid with air in the pleural cavity • Pleural effusion –Escape of fluid into pleural cavity