The pleura and pleural space have the following key points: 1) The pleura is a thin membrane that surrounds the lungs and lines the chest cavity. It allows the lungs to move smoothly in the chest during breathing. 2) The pleural space between the lungs and chest wall normally contains a small amount of fluid that is constantly produced and reabsorbed, reducing friction. 3) Several common pathologies can affect the pleural space, including pneumothorax, pleural effusion, and empyema, requiring treatments like chest tube insertion, pleurodesis, or surgery to address the condition.

1. PLEURA AND PLEURAL SPACE
Dr Winston Makanga, M.B.Ch.B., M.Med. (Surg)
Consultant General and Laparoscopic Surgeon

2. Outline
• Introduction and definition
• Anatomy
• Physiology
• Pathology
• General approach to treatment

3. Introduction & definition
• Pleura
• Pleural cavity

4. Surgical anatomy
• Parietal pleura
• Costal (thickest)
• Cervical
• Mediastinal
• Diaphragmatic
• Visceral pleura
• Arterial, venous and lymphatics
• One layered mesothelium with underlying elastic stromal tissue
(endothoracic fascia)

5. • Histological architecture of the
pleural surfaces
• Note the thickness of the
endothoracic fascia

6. Physiology
• 0.01mL/kg/hr fluid produced by the pleura (mainly parietal)
• Reabsorbed by lymphatics (90% visceral pleura)
• Reduces friction between the lungs and chest wall
• Cavity is in basal negative pressure due to elastic pull of the lung and
chest wall -2 to -5 cmH2O (-4 mmHg)
• Differential pressure in the apex vs base in the upright position
• Increase in volume of the cavity during inhalation results in further
drop in pressure (-25 to -30 cmH2O) causing entry of air via the
tracheobronchial system

8. Pathology
• Pneumothorax
• Traumatic (blunt vs penetrating)
• Spontaneous (primary vs secondary)
• Pleural effusion
• Hemothorax
• Empyema thoracis
• Emphysema
• Mesothelioma

9. Management
• Chest tube insertion
• Pleuridesis
• Decortication
• VATS
6th rib
Mid-axillary
line
Pec major

10. Video assisted Thoracic Surgery

11. Review
• Definitions
• Anatomy
• Physiology
• Pathology
• Treatment

12. Thank you