Pleurae and Pericardium PDF

Pleurae and Pericardium Calin Lucaciu MD, PhD Learning objectives 1. Divisions of the thoracic cavity: pulmonary cavities (right, left) + mediastinum 2. Pleurae: parietal pleura (costal, mediastinal, cervical, diaphragmatic parts), visceral pleura, pleural cavity, blood supply, innervatio...

Pleurae and Pericardium Calin Lucaciu MD, PhD Learning objectives 1. Divisions of the thoracic cavity: pulmonary cavities (right, left) + mediastinum 2. Pleurae: parietal pleura (costal, mediastinal, cervical, diaphragmatic parts), visceral pleura, pleural cavity, blood supply, innervation 3. Pericardium: fibrous pericardium, serous pericardium (parietal layer, visceral layer, pericardial cavity and pericardial sinuses), blood supply, innervation 4. Clinical applications Thoracic Cavity. Divisions Thoracic Cavity. Divisions Thoracic Cavity. Divisions R & L pulmonary Mediastinum cavities – Divisions (see lectures – Separated by #5 and 6) mediastinum – Middle mediastinum w – Each space occupied pericardial sac (and its by the R & L lung content) Part 1: Pleurae and Pleural Cavity Calin Lucaciu Md, PhD Pulmonary Cavities. Pleurae Pleural Cavity (aka Sac) Parietal Pleura Costal part: Musculo-phrenic, Inf – IC neurovascular phrenic, pericardiaco- bundle(s) phrenic, lower IC – Clinic: Sharp vessesls; phrenic n dermatomal pain (mostly) & lower IC nn Mediastinal part: – Clinic: Referred shoulder and lower – Pericardiacophrenic chest pain vessels & Phrenic n. – Clinic: Referred Cervical part shoulder pain – Phrenic n (medial ½) & 1st IC n (lateral ½) Diaphragmatic part: – Clinic: Referred should – Sup phrenic, pain Parietal Pleurae/Pleural Cavity Recesses Lines of pleural – Ant costomediastinal reflection Cardiac notch (left side) – Sternal line Ant border of lung – Costal line – Post costomediastinal – Vertebral line Post border of lung – Costodiaphragmatic Applications: Inferior border of lung – auscultation of the (~ 4-5 cm above during lung(s) quiet inspiration) – Pleural dome Apex of lung Parietal Pleurae/Visceral Pleura Other structures Visceral pleura – Pleural sleeve around – Covers the lung the root of the lung Same blood supply, – Pleural ligament, an lymphatic drainage and innervation as the lung inferior extension of the pleural sleeve Pneumothorax vs Hemothorax Pancoast-Tobias Syndrome A 65-year-old man with 50 pack-year smoking history presented to the emergency department for evaluation of upper back and right shoulder pain secondary to a fall. Physical examination was notable for anisocoria with a constricted left pupil (miosis), mild ptosis of the left eyelid, and bilateral shoulder pain, right more than left, with both passive and active movements. Chest computed tomography identified a soft tissue mass at the left lung apex with extension into the pleural surface, associated with destructive osseous changes of the right scapula, adjacent ribs, and thoracic vertebral bodies. Pancoast-Tobias Syndrome: A Unique Presentation of Lung Cancer M. Munir, S.b. Jamil, S. Rehmani, Cborx-Baba Cureus. 2021 Feb; 13(2): e13112. Part 2: Pericardium and Pericardial Cavity Calin Lucaciu Md, PhD Pericardium Pericardium – Fibrous vs Serous Pericardial Sac and Sinuses (1) Transverse pericardial sinus (pic above (2) Oblique pericardial sac (left pic, asterisks) Pericardial Sac. Blood Supply and Innervation Pericardium. Notes Fibrous pericardium: – Parietal layer (covers – Attached to the the inside of fibrous diaphragm (phrenico- pericardium) pericardial lig), – Visceral layer or sternum (sterno- epicardium (covers the pericardial lig), heart) mediastinum (bands Pericardial sac of CT), and – W pericardial fluid continuous w adventitia of great – Transverse pericardial vessels sinus (or arterial) – Obliques pericardial Serous pericardium sinus (or venous) Pericardium. Notes Blood supply Epicardium – Pericardiacophrenic – From coronary vessels arteries (same as the – Musculophrenic heart) vessels Innervation – R & L phrenic nerves (C3 – C5) – Clinic: referred supraclavicular & shoulders pain! Pericarditis A 66-year-old farmer was admitted with 1-day history of acute-onset severe pleuritic chest pain (???) , with four episodes lasting 10–15 min. The pain was worse when lying flat and relieved by leaning forward. He had no sweating nor fever. His history includes … His medications were … He had a 40 pack-year smoking history and a significant familial premature coronary disease (???). His vaccination schedule was up to date… Acute pericarditis as a primary presentation of COVID-19 R. Kumar, J. Kumar, C. Day, S.A. Edroos BMJ Case Rep. 2020; 13(8); e2376717