Thoracic Cavity and Pleurae
Read And Learn More: Anatomy Important Question And Answers
Table of Contents
Enumerate Recesses of Pleura
- Costomediastinal Situation: Anteriorly
- Costomediastinal Position: Between the costal and mediastinal pleurae.
- Costodiaphragmatic Recess Situation: Inferiorly
- Costodiaphragmatic Recess Extent: 8th to 10th ribs along the mid-axillary line.
Nerve Supply of Pleura
- Intercostal and
- Phrenic nerves–C3, C4 and C5
- Sympathetic nerves: 2nd to 5th ganglia, and
- Parasympathetic nerves: Vagus nerve.
- This part of the pleura is not sensitive to pain.
Costodiaphragmatic Recess
- Superiorly: Costal and diaphragmatic pleurae
- Relations of right recess
- Liver, and
- Posterior surface of right kidney
- Relations of left recess
- Fundus of the stomach,
- Spleen,
- Posterior surface of the left, and
- Left kidney.
- When the patient is in the upright position, intrapleural fluid accumulates in the costodiaphragmatic recess.
- Thoracocentesis is done for the fluid drainage. The direction of the tube is inferiorly (toward the costodiaphragmatic recess).
- Paracentesis (Gr. pierce). It is a surgical puncture of a cavity with a needle. It is also called pleurocentesis or thoracocentesis.
- Widening of costadiaphragmatic recess is the first indication of fluid in the pleural cavity.
- Inferior margin of pleura is in close relation to the12th rib. While approaching kidney from back, care should be taken to remove a section of the 12th rib.
- The presence of 300 ml of fluid in the costodiaphragmatic recess in an adult is sufficient to diagnose pleural effusion.
- Costal,
- Diaphragmatic,
- Cervical, and
- Mediastinal.
Costal Pleura: It lines the inner surface of the sternum, costal cartilage, ribs, intercostal spaces and sides of vertebral bodies but the costal layer is separated by end thoracic fascia. Tracing
- It can be traced from back of the sternum-mediastinal pleura sternoclavicular joint> middle of the sternal angle >vertically up to the 4th costal cartilage.
- On the right side: It reflects vertically behind the xiphisternal joint-right costoxiphoid angle-7th costal cartilage – costodiaphragmatic line of pleura.
- On the left side: It descends close to sternum-and deviates laterally from the sternum to 4th costal cartilage costodiaphragmatic line.
- Behind: It continues with mediastinal pleura by the side of vertebral column along a line known as the costovertebral reflection.
- Above: It continues as cervical pleura along the inner border of 1st rib. d. Below: It continues as the diaphragmatic pleura.
Diaphragmatic pleura: It covers the thoracic surface of the corresponding part of diaphragm. Laterally, it continues as the costal pleura. Medially, it continues as mediastinal pleura.
Cervical Pleura: It extends from the inner border of 1st rib to the apex of the lung. It continues medially with mediastinal pleura. The summit of the cervical pleura is 3 to 4 cm above 1st costal cartilage. It does not extend above upper border of neck of 1st rib.
- Above the root of the lung: It extends from the sternum to vertebral column.
- At the root of the lung: The mediastinal pleura passes laterally in the form of a tube enclosing the structures of the root of lung. It continues with pulmonary pleura.
- Below the root of the lung: The mediastinal pleura forms a bilaminar fold known as pulmonary ligament which extends from
- Oesophagus to corresponding lung below its hilum. At the hilum, the two layers are continuous with pulmonary pleura.
- Contents of pulmonary ligament: No important structures pass except
- Loose areolar tissue,
- Lymphatics, and
- Sometimes accessory bronchial artery.
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