Anatomy of the pleura

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Anatomy of the pleura

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Bones and joints of the thoracic wall
Muscles of the thoracic wall
Vessels and nerves of the thoracic wall
Anatomy of the breast
Anatomy of the pleura
Anatomy of the lungs and tracheobronchial tree
Anatomy of the heart
Anatomy of the coronary circulation
Anatomy of the superior mediastinum
Anatomy of the inferior mediastinum
Anatomy clinical correlates: Thoracic wall
Anatomy clinical correlates: Breast
Anatomy clinical correlates: Pleura and lungs
Anatomy clinical correlates: Heart
Anatomy clinical correlates: Mediastinum
Cranial nerve pathways
Anatomy of the abdominal viscera: Blood supply of the foregut, midgut and hindgut
Anatomy of the pelvic girdle
Anatomy of the pelvic cavity
Anatomy of the urinary organs of the pelvis
Anatomy of the gastrointestinal organs of the pelvis and perineum
Arteries and veins of the pelvis
Vessels and nerves of the vertebral column
Fascia, vessels, and nerves of the lower limb
Anatomy of the anterior and medial thigh
Vessels and nerves of the gluteal region and posterior thigh
Fascia, vessels and nerves of the upper limb
Anatomy of the brachial plexus
Anatomy of the pectoral and scapular regions
Anatomy of the arm
Muscles of the forearm
Vessels and nerves of the forearm
Anatomy clinical correlates: Arm, elbow and forearm
Anatomy clinical correlates: Wrist and hand
Superficial structures of the neck: Posterior triangle
Superficial structures of the neck: Cervical plexus
Superficial structures of the neck: Anterior triangle
Anatomy of the larynx and trachea
Anatomy of the pharynx and esophagus
Bones of the cranium
Anatomy of the orbit
Anatomy of the cerebral cortex
Introduction to the cranial nerves
Anatomy of the oculomotor (CN III), trochlear (CN IV) and abducens (CN VI) nerves
Anatomy of the trigeminal nerve (CN V)
Personality disorders: Pathology review
Eating disorders: Pathology review
Selective serotonin reuptake inhibitors
Serotonin and norepinephrine reuptake inhibitors
Tricyclic antidepressants
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Glycolysis
Citric acid cycle
Electron transport chain and oxidative phosphorylation
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Glycogen metabolism
Pentose phosphate pathway
Physiological changes during exercise
Amino acid metabolism
Nitrogen and urea cycle
Fatty acid synthesis
Fatty acid oxidation
Ketone body metabolism
Cholesterol metabolism
Type I and type II errors
Clinical trials
Cell signaling pathways
Peroxisomal disorders: Pathology review
Purine and pyrimidine synthesis and metabolism disorders: Pathology review
Human development days 1-4
Human development days 4-7
Human development week 2
Human development week 3
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Miscellaneous genetic disorders: Pathology review
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Pharmacokinetics: Drug absorption and distribution
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Sympathomimetics: Direct agonists
Muscarinic antagonists
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Sympatholytics: Alpha-2 agonists
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Adrenergic antagonists: Alpha blockers
Adrenergic antagonists: Beta blockers
Medication overdoses and toxicities: Pathology review
Development of the cardiovascular system
Fetal circulation
Pressures in the cardiovascular system
Measuring cardiac output (Fick principle)
Action potentials in myocytes
Action potentials in pacemaker cells
Excitability and refractory periods
Cardiac excitation-contraction coupling
ECG basics
ECG rate and rhythm
ECG intervals
ECG QRS transition
ECG axis
ECG normal sinus rhythm
Acyanotic congenital heart defects: Pathology review
Cyanotic congenital heart defects: Pathology review
Peripheral artery disease: Pathology review
Valvular heart disease: Pathology review
Cardiomyopathies: Pathology review
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Ventricular arrhythmias: Pathology review
Heart blocks: Pathology review
Endocarditis: Pathology review
Shock: Pathology review
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Class II antiarrhythmics: Beta blockers
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Pharyngeal arches, pouches, and clefts
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Phosphate, calcium and magnesium homeostasis
Parathyroid hormone
Vitamin D
Calcitonin
Development of the face and palate
Optic pathways and visual fields
Auditory transduction and pathways
Vestibular transduction
Vestibulo-ocular reflex and nystagmus
Taste and the tongue
Eye conditions: Retinal disorders: Pathology review
Platelet plug formation (primary hemostasis)
Coagulation (secondary hemostasis)
Role of Vitamin K in coagulation
Clot retraction and fibrinolysis
Heme synthesis disorders: Pathology review
Coagulation disorders: Pathology review
Platelet disorders: Pathology review
Mixed platelet and coagulation disorders: Pathology review
Thrombosis syndromes (hypercoagulability): Pathology review
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Thymus histology
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Introduction to the immune system
Cytokines
Innate immune system
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T-cell development
B-cell development
MHC class I and MHC class II molecules
T-cell activation
B-cell activation and differentiation
Cell-mediated immunity of CD4 cells
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Antibody classes
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VDJ rearrangement
Contracting the immune response and peripheral tolerance
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Vaccinations
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Immunodeficiencies: T-cell and B-cell disorders: Pathology review
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Immunodeficiencies: Phagocyte and complement dysfunction: Pathology review
Glucocorticoids
Acneiform skin disorders: Pathology review
Papulosquamous and inflammatory skin disorders: Pathology review
Vesiculobullous and desquamating skin disorders: Pathology review
Skin cancer: Pathology review
Cartilage structure and growth
Neuromuscular junction and motor unit
Sliding filament model of muscle contraction
Slow twitch and fast twitch muscle fibers
Muscle contraction
Back pain: Pathology review
Rheumatoid arthritis and osteoarthritis: Pathology review
Seronegative and septic arthritis: Pathology review
Gout and pseudogout: Pathology review
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Scleroderma: Pathology review
Sjogren syndrome: Pathology review
Bone disorders: Pathology review
Bone tumors: Pathology review
Myalgias and myositis: Pathology review
Neuromuscular junction disorders: Pathology review
Acetaminophen (Paracetamol)
Non-steroidal anti-inflammatory drugs
Opioid agonists, mixed agonist-antagonists and partial agonists
Antigout medications
Osteoporosis medications
Development of the nervous system
Central nervous system histology
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Neuron action potential
Cerebral circulation
Blood brain barrier
Cerebrospinal fluid
Ascending and descending spinal tracts
Motor cortex
Pyramidal and extrapyramidal tracts
Muscle spindles and golgi tendon organs
Spinal cord reflexes
Sensory receptor function
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Somatosensory pathways
Sympathetic nervous system
Adrenergic receptors
Parasympathetic nervous system
Cholinergic receptors
Enteric nervous system
Body temperature regulation (thermoregulation)
Hunger and satiety
Cerebellum
Basal ganglia: Direct and indirect pathway of movement
Memory
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Consciousness
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Stress
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Emotion
Attention
Congenital neurological disorders: Pathology review
Headaches: Pathology review
Seizures: Pathology review
Cerebral vascular disease: Pathology review
Traumatic brain injury: Pathology review
Spinal cord disorders: Pathology review
Dementia: Pathology review
Central nervous system infections: Pathology review
Movement disorders: Pathology review
Demyelinating disorders: Pathology review
Adult brain tumors: Pathology review
Pediatric brain tumors: Pathology review
Neurocutaneous disorders: Pathology review
Migraine medications
General anesthetics
Local anesthetics
Neuromuscular blockers
Anti-parkinson medications
Medications for neurodegenerative diseases
Opioid antagonists
Development of the renal system
Proximal convoluted tubule
Loop of Henle
Distal convoluted tubule
Sodium homeostasis
Potassium homeostasis
Osmoregulation
Antidiuretic hormone
Kidney countercurrent multiplication
Plasma anion gap
Congenital renal disorders: Pathology review
Renal tubular defects: Pathology review
Renal tubular acidosis: Pathology review
Acid-base disturbances: Pathology review
Electrolyte disturbances: Pathology review
Renal failure: Pathology review
Nephrotic syndromes: Pathology review
Nephritic syndromes: Pathology review
Urinary incontinence: Pathology review
Urinary tract infections: Pathology review
Kidney stones: Pathology review
Renal and urinary tract masses: Pathology review
Osmotic diuretics
Carbonic anhydrase inhibitors
Loop diuretics
Thiazide and thiazide-like diuretics
Potassium sparing diuretics
Development of the reproductive system
Menstrual cycle
Menopause
Disorders of sex chromosomes: Pathology review
Prostate disorders and cancer: Pathology review
Testicular tumors: Pathology review
Uterine disorders: Pathology review
Ovarian cysts and tumors: Pathology review
Cervical cancer: Pathology review
Vaginal and vulvar disorders: Pathology review
Benign breast conditions: Pathology review
Breast cancer: Pathology review
Complications during pregnancy: Pathology review
Congenital TORCH infections: Pathology review
Development of the respiratory system
Lung volumes and capacities
Anatomic and physiologic dead space
Alveolar surface tension and surfactant
Ventilation
Zones of pulmonary blood flow
Regulation of pulmonary blood flow
Pulmonary shunts
Ventilation-perfusion ratios and V/Q mismatch
Airflow, pressure, and resistance
Diffusion-limited and perfusion-limited gas exchange
Alveolar gas equation
Oxygen binding capacity and oxygen content
Oxygen-hemoglobin dissociation curve
Carbon dioxide transport in blood
Respiratory distress syndrome: Pathology review
Cystic fibrosis: Pathology review
Deep vein thrombosis and pulmonary embolism: Pathology review
Obstructive lung diseases: Pathology review
Restrictive lung diseases: Pathology review
Lung cancer and mesothelioma: Pathology review
Antihistamines for allergies
Bronchodilators: Beta 2-agonists and muscarinic antagonists
Bronchodilators: Leukotriene antagonists and methylxanthines

Notes

Anatomy of the Pleura

Figure 1. Layers of the thoracic wall. B Anterolateral view of the pleurae with the ribs partially removed and the parietal pleura removed on the right lung. C Anterolateral view of the surfaces of the parietal pleura, with the ribs partially removed and the left lung removed completely.
Figure 2. Anterior and posterior view of the lines of pleural reflection.
Figure 3. Anterolateral view of the lungs showing the pleural recesses.
UNLABELLED DIAGRAMS

Transcript

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The pleura is a thin membrane that covers each of our lungs and surrounding pulmonary cavity, and it can be subdivided into two layers, the visceral pleura which intimately adheres to the lungs, and the parietal pleura which lines the rest of the pulmonary cavity.

Between these two pleural layers there’s the pleural cavity, which is normally filled with a thin film of fluid in order to lubricate the pleural surfaces and allow them to slide smoothly over each other during each breath.

Now, on the medial part of each lung, there’s the pulmonary hilum, where the root of the lung passes through.

The root of the lungs is made of structures like the tracheobronchial tree, as well as arteries and veins.

At this level, the visceral and parietal pleura are continuous, making one continuous structure.

To make this easier, you can imagine an underinflated balloon through which you press your fist into, the fist representing the root of the lung and the balloon representing the visceral and parietal pleura.

As you can see, the parietal and visceral pleura are one continuous layer, however they are reflected on different surfaces.

Okay, the visceral pleura covers the entire lung and adheres intimately to all its surfaces, including the ones between the fissures of each lung.

The visceral pleura is continuous with the parietal pleura at the hilum of the lung.

The parietal pleura is thicker than the visceral one, lines the pulmonary cavities and adheres to the thoracic wall, mediastinum and diaphragm.

The parietal pleura actually has four parts: costal, mediastinal, diaphragmatic and cervical pleura.

The costal pleura covers the internal surface of the thoracic wall, from which it’s separated by the endothoracic fascia, a thin layer of loose connective tissue that comes in handy during surgical procedures, making it really easy to separate the lungs from the thoracic wall.

The mediastinal pleura covers the lateral aspects of the mediastinum, which is the space between the lungs and continues as cervical pleura superiorly in relation to the root of the neck.

It’s also continuous inferiorly with the diaphragmatic pleura and with the costal pleura anteriorly and posteriorly.

At the hilum, the mediastinal pleura changes direction laterally onto the root of the lung to become one with the visceral pleura.

Superior to the hilum it is a continuous sheet passing between the sternum and vertebral column.

The diaphragmatic pleura covers the superior surface of the diaphragm on each side of the mediastinum, minus where the diaphragm is fused with the pericardium and minus the diaphragm’s costal attachments to the xiphoid process anteriorly, to the 11th and 12th rib laterally.

Finally, the cervical pleura is basically a continuation of the costal and mediastinal pleura and covers the apex of the lungs, which is the part that extends through the superior thoracic aperture into the root of the neck.

Over the apex, the cervical pleura forms the pleural cupula, which domes over the apex that reaches its crest at about 2 to 3 centimeters superior to clavicle at the level of the neck’s first rib.

The cervical pleura is made stronger by a fibrous extension of the endothoracic fascia, called the suprapleural membrane.

This membrane attaches to the internal border of the first rib and the transverse process of C7 vertebra.

So you see, the parietal pleura covers many different thoracic surfaces, and in doing so creates different lines called lines of pleural reflection.

There are 3 lines of pleural reflection on each side of the pulmonary cavities: sternal, costal and vertebral.

Sources

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  2. "Gray's Anatomy for Students" Churchill Livingstone (2014)
  3. "Gray's Anatomy" Churchill Livingstone (2007)
  4. "The fissure: interlobar collateral ventilation and implications for endoscopic therapy in emphysema" International Journal of Chronic Obstructive Pulmonary Disease (2016)
  5. "Anatomy, Thorax, Lung Pleura And Mediastinum" StatPearls Publishing (2021)
  6. "The structure of the parietal pleura and its relationship to pleural liquid dynamics in sheep" The Anatomical Record (1984)
  7. "Ultrastructural study on the pleural stomata in human" Funct Dev Morphol (1993)
  8. "Anatomy, thorax, lungs" In: StatPearls. StatPearls Publishing (2021)