The apex is the rounded top of each lung, which rises above the first rib into the root of the neck, about 2-3 cm above the medial third of the clavicle. It is covered by the cervical pleura and the suprapleural membrane.
| Location | Root of the neck, above the first rib and behind the medial third of the clavicle |
|---|---|
| Parts |
|
| Nerve Supply | Pulmonary plexus (vagal and sympathetic fibres) |
| Blood Supply | Bronchial arteries; Pulmonary arteries (for gas exchange) |
| Venous drainage |
|
| Lymphatic drainage |
|
Forms the uppermost part of the lung, contributing to ventilation of the upper lobe.
Because the apex lies in the neck, it can be punctured during subclavian or internal jugular lines and supraclavicular nerve blocks, causing pneumothorax. A tumour here (Pancoast tumour) can invade the lower brachial plexus and sympathetic chain, causing arm pain and Horner syndrome. Tuberculosis classically favours the apices.
Lung cancer at the apex that invades nearby nerves, causing shoulder and arm pain, hand weakness and Horner syndrome.
Collapse of the lung after a needle passes through the apical pleura during neck procedures.
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