Pleura

In Imaging Anatomy: Chest, Abdomen, Pelvis (Second Edition), 2017

Coronal Section, Anatomy of Pleural Reflections

Parietal pleura

Visceral pleura

Incomplete minor fissure

Right major fissure

Caudal extent of lung

Costodiaphragmatic recess

Pleural reflection

Diaphragmatic pleura

Mediastinal pleura

Parietal pleura

Visceral pleura

Costal pleura

Left major fissure

Caudal extent of lung

Costodiaphragmatic recess

Pleural reflection

Diaphragmatic pleura

Mediastinal pleura

Graphic shows the extent and distribution of the pleura as visualized in the coronal plane. Visceral pleura covers the surfaces of both lungs and forms interlobar fissures that may be complete or incomplete in their extension to the hila. Parietal pleura lines both thoracic cavities and may be designated by its location as costal, diaphragmatic, or mediastinal pleurae. Inferiorly, the parietal pleura extends deeply into the costodiaphragmatic recesses where costal and diaphragmatic pleura are in apposition.

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Pleura

In Imaging Anatomy: Ultrasound (Second Edition), 2018

GROSS ANATOMY

Overview

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Pleura: Continuous surface epithelium and underlying connective tissue

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Visceral pleura adheres to pulmonary surfaces

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Parietal pleura is continuation of visceral pleura

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Lines corresponding 1/2 of thoracic wall

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Covers ipsilateral diaphragm and ipsilateral mediastinal surface

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Visceral and parietal pleurae form right and left pleural cavities

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Potential spaces containing small amount of serous pleural fluid

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Combined thickness of visceral and parietal pleurae and fluid-containing pleural space is < 0.5 mm

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Visceral pleura directly apposes and slides freely over parietal pleura during respiration

Pleural Space

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Potential space; normally contains 2-10 mL of fluid

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Fluid production capacity: 100 mL/h; fluid absorption capacity: 300 mL/h

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Fluid flux normally from parietal pleura capillaries to pleural space; absorbed by microscopic stomata in parietal pleura

Costodiaphragmatic Recesses

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Pleura extends caudally beyond inferior lung border

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Costal and diaphragmatic pleura separated by narrow slit, costodiaphragmatic recess

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Extends ~ 5 cm below inferior border of lung during quiet inspiration

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Caudal extent at 12th rib posterolaterally

Visceral Pleura

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Covers lung parenchyma surfaces

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Blood supply and drainage

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Supply by systemic bronchial vessels, drainage by pulmonary and bronchial veins

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Lymphatic drainage to deep pulmonary plexus within interlobar and peribronchial spaces toward hilum

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Histology

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Mesothelial layer, thin connective tissue layer, chief layer of connective tissue, vascular layer, limiting lung membrane (connected to chief layer by collagen and elastic fibers)

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Single layer of flat mesothelial cells separated by basal lamina from underlying lamina propria of loose connective tissue

Parietal Pleura

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Covers nonparenchymal surfaces

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Forms lining of thoracic cavities

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Blood supply and drainage

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Supply from adjacent chest wall (intercostal, internal mammary, diaphragmatic arteries)

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Drainage to bronchial veins (diaphragmatic pleural drainage to inferior vena cava and brachiocephalic trunk)

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Histology

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Single layer of parietal mesothelial cells over loose, fat-containing areolar connective tissue; bounded externally by endothoracic fascia

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PLEURAL SPACE

Y.C.G. Lee , ... N.M. Rahman , in Encyclopedia of Respiratory Medicine, 2006

Macroscopic Anatomy

The pleura consists of a double-layered serous membrane overlying the inner surface of the thoracic cage and the outer surface of the lung. Between these two delicate membranes lies the pleural cavity, a sealed space maintained ∼10–20   μm across.

In humans, the left and right pleural cavities are separated from each other and from the pericardial space. The pleural cavities contain the visceral pleura, overlying the entire lung surface, and the parietal pleura, overlying the inner surface of the entire thoracic cage, including the mediastinum and diaphragm. The area of the entire pleura is estimated to be 2000  cm2 in an average adult male. The two pleural membranes coalesce at the lung hilae, where they are penetrated by the major airways and pulmonary vessels.

The visceral pleura tightly adheres to the lung surface throughout the thorax and extends deep within the interlobar fissures. The parietal pleura is anatomically divided into four parts:

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costal pleura – overlying ribs, intercostal muscles, costal cartilage, and sternum;

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mediastinal pleura;

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cervical pleura – extending above the 1st rib by 2–3   cm over the medial end of the clavicle; and

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diaphragmatic pleura.

The inferior boundary of the parietal pleura mirrors the lower border of the thoracic cage, but may extend beyond the costal surface, specifically at the right lower sternal region and at the posterior junction of ribs and vertebra bilaterally.

Several structures (e.g., the hilae and sometimes the great veins) within the thoracic cavity acquire a double layer of parietal pleura during embryological development. Such a double layer is pulled into the thorax by the developing lung, and extends from the lung hilum vertically downward to the diaphragm on both sides – these form the pulmonary ligaments. They are of importance surgically as they may contain lymphatics, tumor, or vessels. Their presence may prevent torsion of the lower lobes.

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Pleura and chest wall

Bryan Corrin MD FRCPath , Andrew G. Nicholson DM FRCPath , in Pathology of the Lungs (Third Edition), 2011

Nerve sheath tumours

The visceral pleura is innervated by branches of the vagus nerve and the parietal pleura by the intercostal nerves, yet primary nerve sheath tumours of the pleura are distinctly rare. Reports are limited to one of a malignant nerve sheath tumour that mimicked a mesothelioma 563 and another describing two localised neurofibromas that mimicked solitary fibrous tumours. 493 The latter showed patchy positivity for CD34 but were distinguished from solitary fibrous tumour by expressing S-100. In contrast to their rarity in the pleura, nerve sheath tumours are common in the posterior mediastinum and these may impinge upon the pleura. They may also arise in the chest wall (see below).

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Pleura and Pericardium

Matthew R. Lindberg MD , Laura W. Lamps MD , in Diagnostic Pathology: Normal Histology (Second Edition), 2018

Macroscopic Anatomy

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Pleura

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Thin, continuous membranous lining within thoracic cavity

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Visceral pleura invests lungs

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Also extends along lobar fissures

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Parietal pleura lines outer surface of thoracic cavity

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Extends along inner chest wall (including ribs and sternum) and mediastinal structures

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Superior extent (cervical pleura)

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Inferior extent (diaphragmatic pleura)

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Parietal pleura reflects over parietal pericardium anteriorly

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Pericardium

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Thin, continuous layers surrounding heart and great vessels

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Visceral pericardium

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a.k.a. serous pericardium or epicardium

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Contacts myocardium

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Parietal pericardium

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a.k.a. fibrous pericardium

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Potential space exists between visceral and parietal pericardial layers

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Contains minimal amounts of clear fluid

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Visceral and parietal layers only make contact at site of pericardial reflections

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Pulmonary System

Robert G. Carroll PhD , in Elsevier's Integrated Physiology, 2007

Pleura

Pleurae are serous membranes that separate the lungs and the wall of the thoracic cavity. The visceral pleura covers the surface of the lungs, and the parietal pleura covers the inside of the thorax, mediastinum, and diaphragm. A thin film of serous fluid fills the space between the two pleurae. This pleural fluid couples the movement of the lungs and chest wall, so that changes in chest wall shape cause a corresponding change in lung shape. Normally the pressure in the interpleural space is negative and keeps the lungs inflated so that they fill the thoracic space.

Entry of air into the interpleural space (pneumothorax) allows the lung to collapse and the chest wall to expand. Lungs can be "reinflated" by removing pleural air. The mediastinum usually limits lung collapse to one side.

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Gross and Subgross Anatomy of Lungs, Pleura, Connective Tissue Septa, Distal Airways, and Structural Units

Janice L. Peake , Kent E. Pinkerton , in Comparative Biology of the Normal Lung (Second Edition), 2015

2.1 Pulmonary Pleura

The pleura is recognized as more than just a mechanical envelope, and its significance to both normal function and reactions to pulmonary and systemic diseases has been reviewed ( The Pleura in Health and Disease, 1985; Sahn, 1988). The basic structure of the mesothelium (Wang, 1985) and the connective tissue components (Rennard et al., 1985) have been well described. The pulmonary (visceral) pleura of human and large animal lungs tends to be thick, whereas the pulmonary pleura of lungs from smaller animals, including common laboratory species, tends to be thin (Table 1). Although thick and thin are relative terms that do not precisely describe the thickness of the pleura, species differences are obvious (Figure 1). The variable thickness of the pulmonary pleura is due to the submesothelial layer containing the connective tissue components, blood vessels, and lymphatics. In mammals, pulmonary pleural thickness varies from 20 to 80   μm (Albertine et al., 1982; Mariassy and Wheeldon, 1983; Negrini and Moriondo, 2013). The pulmonary pleura consists predominantly of a monolayer of squamous mesothelial cells with microvilli resting on a thin basement membrane firmly attached to a dense connective tissue consisting of elastic and collagenous fibers (Figure 2). It is also important to note that the thickness of the pulmonary pleura in an individual lung varies with the anatomical location examined (Mariassy and Wheeldon, 1983). To date, there are no precise data available on the thickness of the pleura in specific regions of the lungs from most species.

Table 1. Comparative Lung Biology: Morphologic Features of Pleura, Interlobular and Segmental Septa, and Distal Airways

Human Macaque Monkey Dog, Cat Ferret Mouse, Rat, Gerbil, Hamster, Guinea Pig, Rabbit Horse, Sheep Ox, Pig
Pleura Thick Thin Thin Thin Thin Thick Thick
Interlobular and segmental connective tissue Extensive, interlobular partially surrounds many lobules Little Little, if any Little Little, if any Extensive, a interlobular partially surrounds many lobules Extensive a interlobular surrounds many lobules completely
Nonrespiratory bronchiole commonly only one (nonalveolarized) Several generations
TB ends in respiratory bronchioles		 Fewer generations, commonly only one
TB ends in respiratory bronchioles		 Fewer generations
TB ends in respiratory bronchioles		 Several generations
TB ends in respiratory bronchioles		 Several generations
TB ends in alveolar ducts or very short respiratory bronchioles		 Several generations
TB ends in alveolar ducts or very short respiratory bronchioles		 Several generations
TB ends in alveolar ducts or very short respiratory bronchioles
Respiratory bronchiole (alveolarized) 1–3 generations Several generations Several generations Several generations Absent or a single short generation Absent or a single short generation Absent or a single short generation

TB, terminal nonrespiratory bronchiole.

a
The interlobular connective tissue of the sheep appears extensive and lobules appear completely separated in gross preparations, but not in light microscopy, scanning electron microscopy, or high-resolution computed tomography.

Figure 1. Pulmonary pleura and interlobular connective tissue from several species.

Arrowheads designate the thick or thin pleura. Light micrographs of inflation-fixed, hematoxylin- and eosin-stained paraffin sections of lung from (A) horse, (B) rat, (C) pig, and (D) monkey. The horse and rat have terminal bronchioles (TB) and the monkey has respiratory bronchioles (RB) ending in alveolar ducts. A trichrome-stained, immersion-fixed paraffin section of a (C) pig lung shows extensive interlobular connective tissue (∗). An airway (AW) and blood vessel (bv) are labeled.

Figure 2. Pulmonary pleura, interlobular septa (IS), and underlying alveoli.

The pleural surface is covered by a simple squamous epithelium with microvilli projecting from the surface as seen in the scanning electron micrograph (SEM) from a Sprague-Dawley rat in panel (A). Panel (B) is an elastin-stained paraffin section showing the thick, black elastic layer (white asterisk) in the pig pleura extending into the IS. Panel (C) is a Picro Sirius Red-stained paraffin section from a fetal lamb lung showing collagenous fibers (black asterisk) found in the pleura and IS.

The complexity of the blood supply to the pulmonary or visceral pleura of the human lungs has been reviewed by Staub et al. (1985), Bemaudin and Fleury (1985), and Sahn (1988). They concluded that the pulmonary pleura of human lungs is supplied by the bronchial artery, as described by Miller (1950), McLaughlin et al. (1961), and Naigaishi (1972), and not by the pulmonary artery, as described by von Hayek (1960). Because the pulmonary pleura of human lungs is thick, this conclusion supports the generalizations of McLaughlin et al. (1961, 1966) that thick pleura is supplied by branches of the bronchial artery and thin pleura is supplied by the pulmonary artery. Differences in the pressure of these two systems of vessels are likely to influence the rates of pleural fluid formation.

Although the lymphatic drainage of the human lung has been well described and reviewed (Bernaudin and Fleury, 1985), there have been only a few studies of other species (Leak and Jamuar, 1983). Animals with thick pulmonary pleura tend to have the most extensive network of lymphatics (Leak and Jamuar, 1983; Bernaudin and Fleury, 1985; Negrini and Moriondo, 2013). Of the animals with thin pulmonary pleura, the dog appears to have the most extensive pleural lymphatics (Naigaishi, 1972; Leak and Jamuar, 1983; Bernaudin and Fleury, 1985). Other animals with thin pulmonary pleura, such as the mouse, rat, and rabbit, have few pleural lymphatic vessels (Leak and Jamuar, 1983).

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The deeper fasciae of the neck and ventral torso

Rainer Breul , in Fascia: The Tensional Network of the Human Body, 2012

Parietal pleura

As the costal pleura, the parietal pleura lines the chest wall, as the mediastinal pleura it lines the lateral surface of the mediastinum, and as the diaphragmatic pleura it lines the diaphragm. The parietal pleura is significantly more firmly fixed to its surroundings than the visceral pleura because of the demands made on it by mechanical traction. The costal pleura is firmly attached to the endothoracic fascia and the diaphragmatic pleura to the phrenicopleural fascia.

Bulges in the pleural cavity serve as reserve space – pleural recess – into which parts of the lungs can slide during deep inspiration.

The costodiaphragmatic recess is a deep channel between the costal pleura and the diaphragmatic pleura at the lower margin of the chest wall. During deep inspiration, this reserve space unfolds and the lungs enter up to two intercostal spaces deep into the recess.

The costomediastinal recess also unfolds during inspiration, when the heart sinks down and the ribs lift and make available another, smaller, reserve space for breathing.

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The Pleura

Theresa C. McLoud , Phillip M. Boiselle , in Thoracic Radiology (Second Edition), 2010

ANATOMY AND PHYSIOLOGY OF THE PLEURAL SPACE

The pleura consists of a visceral and parietal layer that is composed of a continuous surface epithelium of mesothelial cells and underlying connective tissue. The visceral pleura covers the lungs and interlobar fissures, whereas the parietal pleura lines the ribs, diaphragm, and mediastinum. A double fold of pleura extends from the hilum to the diaphragm to form the inferior pulmonary ligament. There is no communication between the two pleural cavities. The pleural space is a potential space that contains 2 to 10  mL of pleural fluid in the normal individual. The pleura can produce up to 100   mL of fluid in an hour, and the absorption capacity of the pleural surface is approximately 300   mL per hour.

The parietal pleura is supplied by systemic capillary vessels and drains into the right atrium by way of the azygos, hemiazygos, and internal mammary veins. The visceral pleura is supplied by pulmonary arterioles and capillaries and drains mainly into the pulmonary veins. Fluid is usually produced at the level of the parietal pleura and is drained by the visceral pleura. Lymphatics also play a role in the clearance of pleural fluid in health and disease. Lymphatic drainage occurs through the parietal pleural lymphatics and ultimately reaches the thoracic duct. The lymphatic drainage of the pleural space begins within lymphatic stomas located mainly in the mediastinal, intercostal, and diaphragmatic portions of the parietal pleura. They eventually drain into larger lymphatic channels. The visceral subpleural space is in continuity with the interlobular septa of the pulmonary interstitium. Unlike the parietal pleura, there is no communication between lymphatic channels of the visceral pleura and the pleural space. Lymph from the visceral pleura flows centripetally toward the hila.

The main manifestations of disease in the pleura include pleural effusion, pleural thickening (which may or may not be calcified), pleural air (i.e., pneumothorax), and pleural neoplasms. Primary disease of the pleura is rare. Most pleural abnormalities result from disease processes in other organs.

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Approach to Neoplasms of Pleura and Chest Wall

In Specialty Imaging: Thoracic Neoplasms, 2016

Introduction

The pleura is a thin mesothelial layer that lines the thoracic cavity. The visceral pleura lines the lungs, and the parietal pleura lines the nonpulmonary surfaces. The apposition of these structures forms the pleural space. Pleural disease may affect the pleural space (pneumothorax, pleural effusion) &/or the pleura itself (thickening, calcification, neoplasia).

The chest wall contains a variety of tissues including skin, subcutaneous fat, muscles, vascular structures, nerves, and osseous structures (vertebrae, ribs, costal cartilages, sternum, clavicles, and scapulae). Chest wall disease may involve all of these structures.

Neoplastic processes affect both the pleura and chest wall, typically in the form of metastatic disease. Most pleural metastases are secondary to adenocarcinomas of the lung, breast, and gastrointestinal tract. Most chest wall metastases are from primary malignancies of the lung, breast, and prostate. However, a variety of primary benign and malignant neoplasms affect the pleura and chest wall.

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