Pleurae Anatomy and Function

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Questions and Answers

What is the primary management approach for diaphragmatic paralysis?

Identification and treatment of the underlying cause (correct)

Chest X-Ray to monitor progression

Immediate intubation and invasive ventilation

Symptomatic relief with oxygen therapy

In a bilateral diaphragmatic paralysis, which of the following may be required?

Non-invasive positive ventilation (correct)

Non-invasive negative ventilation

Chest physiotherapy

Pneumonia vaccination

What is the characterization of lung function tests in diaphragmatic paralysis?

Obstructive deficit

Mixed deficit

Normal lung function

Restrictive deficit (correct)

What is the term for the condition where both sides of the diaphragm are paralyzed?

Bilateral diaphragmatic paralysis Signup and view all the answers

What is the main symptom experienced by patients with bilateral diaphragmatic paralysis?

Orthopnoea Signup and view all the answers

What is the anatomical structure located between the two lungs?

Mediastinum Signup and view all the answers

What happens to the margins of the base of the lung during deep inspiration?

They decline and the costal and diaphragmatic pleurae split Signup and view all the answers

What is the name of the dome of parietal pleura that extends into the root of the neck?

Cupola Signup and view all the answers

Which structure does the scalenus anterior muscle envelop?

The anterolateral part of the dome of the pleura Signup and view all the answers

What is the direction of the vertebral artery in relation to the subclavian artery?

It rises above the subclavian artery Signup and view all the answers

What is the direction of the internal mammary artery from the subclavian artery?

It goes downwards from the subclavian artery Signup and view all the answers

What is the relationship between the costocervical trunk and the dome of the pleura?

It arcs towards the back from the subclavian artery and goes across the summit of the dome Signup and view all the answers

What is the location of the superior intercostal branch in relation to the dome of the pleura?

It goes downwards behind the dome Signup and view all the answers

What is the lateral boundary of the mediastinum?

The mediastinal pleura Signup and view all the answers

What is the main function of the pleurae?

To facilitate smooth and effortless respiration Signup and view all the answers

What is the term for the layer of simple squamous cells that lines the pleura?

Mesothelium Signup and view all the answers

What is the primary source of arterial supply to the lungs?

Bronchial arteries Signup and view all the answers

What is the term for the condition where air or gas is present in the pleural space?

Pneumothorax Signup and view all the answers

What is the characteristic of the affected side in a pneumothorax upon percussion?

Hyper-resonance Signup and view all the answers

What is the term for a pneumothorax that occurs without a specific cause?

Spontaneous pneumothorax Signup and view all the answers

What is the procedure used to remove excess air/gas in a pneumothorax?

Chest drain insertion Signup and view all the answers

What is the name of the nerve network that provides autonomic innervation to the lungs?

Pulmonary plexus Signup and view all the answers

What is the diameter of the ascending aorta?

2.5 cm Signup and view all the answers

Where does the ascending aorta begin?

At the aortic orifice Signup and view all the answers

At what level of the costal cartilage does the lung display the cardiac notch and lies 2.5 cm from the edge of the pleura and sternum?

Fifth costal cartilage Signup and view all the answers

What is the only branch of the ascending aorta?

Coronary arteries Signup and view all the answers

What is the position of the arch of the aorta relative to the trachea and esophagus?

Anterior to the trachea and esophagus Signup and view all the answers

What is the level of the vertebral column where the posterior borders of the lungs begin?

Spine of the seventh cervical vertebra Signup and view all the answers

What is the location of the arch of the aorta relative to the root of the left lung?

Posterior to the root of the left lung Signup and view all the answers

What is the recess formed behind the dome of the diaphragm due to the separation of visceral and parietal pleura?

Costodiaphragmatic recess Signup and view all the answers

Which lung lobe is produced by the additional transverse or minor fissure?

Middle lobe Signup and view all the answers

What is the usual branch of the arch of the aorta associated with the right side of the body?

Right subclavian artery Signup and view all the answers

What is the ligamentum arteriosum attached to?

The inferior surface of the arch of the aorta Signup and view all the answers

What is the level where the right oblique fissure starts?

Opposite the fourth thoracic spinous process Signup and view all the answers

Where does the brachiocephalic trunk arise from?

Posterior to the manubrium Signup and view all the answers

What is the line followed by the right oblique fissure to end near the right sixth costochondral junction?

A line just below the fifth rib Signup and view all the answers

What is the level where the separation of visceral and parietal pleura occurs to give rise to the slit-like costodiaphragmatic recess?

At the level of the base of the lung Signup and view all the answers

What is the feature of the left lung that gives rise to the costomediastinal recess behind the left lower costal cartilages?

Cardiac notch Signup and view all the answers

Study Notes

Pleurae

The pleurae are serous membranes that line the lungs and thoracic cavity, allowing for efficient and effortless respiration.
There are two pleurae in the body, one associated with each lung.
Each pleura consists of a serous membrane, a layer of simple squamous cells supported by connective tissue, also known as the mesothelium.
The pleura can be divided into two parts: visceral pleura (covers the lungs) and parietal pleura (covers the internal surface of the thoracic cavity).
The two parts are continuous with each other at the hilum of each lung.

Costodiaphragmatic Recess

The margins of the base of the lung decline, and the costal and diaphragmatic pleurae split up in deep inspiration.
The lower zone of the pleural cavity into which the lung enlarges is called the costodiaphragmatic recess.

Mediastinal Pleura

The mediastinal pleura lines the corresponding outermost layer of the mediastinum and creates its lateral boundary.
It is represented as a cuff over the root of the lung and becomes continuous with the visceral pleura.

Cervical Pleura

The cervical pleura is the dome of parietal pleura, which extends into the root of the neck about 1 inch (2.5 cm) above the medial end of the clavicle and 2 inches (5 cm) above the 1st costal cartilage.
It is termed the cupola and covers the apex of the lung.
It is covered by the suprapleural membrane.

Relations of the Cervical Pleura

Anteriorly: subclavian artery and scalenus anterior muscle
Posteriorly: neck of 1st rib and structures passing in front of it
Laterally: scalenus medius muscle
Medially: great vessels of the neck

Clinical Application: Pneumothorax

A pneumothorax occurs when air or gas is present within the pleural space, removing the surface tension of the serous fluid and reducing lung extension.
Clinical features: chest pain, shortness of breath, and asymmetrical chest expansion.
Upon percussion, the affected side may be hyper-resonant due to excess air within the chest.
Treatment: decompression to remove extra air/gas via the insertion of a chest drain.

Mediastinum

The mediastinum is the median septum of the thorax between the two lungs.
The ascending aorta begins at the aortic orifice and is approximately 2.5 cm in diameter.
The arch of the aorta (aortic arch) is the curved continuation of the ascending aorta, beginning posterior to the 2nd right sternocostal joint at the level of the sternal angle.

Great Vessels

The arch of the aorta ascends anterior to the right pulmonary artery and the bifurcation of the trachea, reaching its apex at the left side of the trachea and esophagus.
The arch of the aorta ends by becoming the thoracic aorta posterior to the 2nd left sternocostal joint.
The usual branches of the arch of the aorta are the brachiocephalic trunk, left common carotid artery, and left subclavian artery.

Pulmonary Fissures

The left lung is separated into upper lobe and lower lobe by the oblique or major fissure.
An additional transverse or minor fissure produces the middle lobe of the right lung.
The right oblique fissure starts opposite the fourth thoracic spinous process and follows the line of the fifth rib, or a line just below, to end near the right sixth costochondral junction or just above in the fifth intercostal space.

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Description

Learn about the structure and function of the pleurae, serous membranes that facilitate respiration. Understand the visceral and parietal pleura and their roles in the thoracic cavity.