The pleura is the thin, shiny serous membrane that lines each half of the chest and covers each lung. Its two layers, the visceral pleura on the lung and the parietal pleura on the chest wall, diaphragm and mediastinum, are continuous around the lung root. Between them is a thin film of fluid in the pleural cavity.
| Location | Lines each side of the thoracic cavity; the parietal pleura extends about 2-3 cm above the clavicle and reaches down to about the 8th rib at the midclavicular line, 10th at the midaxillary line and 12th at the back. |
|---|---|
| Parts |
|
| Nerve Supply | Intercostal and phrenic nerves (parietal, pain sensitive); Pulmonary plexus (visceral, not pain sensitive) |
| Blood Supply | Intercostal, internal thoracic and musculophrenic arteries (parietal); Bronchial arteries (visceral) |
| Lymphatic drainage |
|
Allows the lungs to glide smoothly against the chest wall, and the surface tension of the pleural fluid couples the lungs to the chest wall so they expand when the chest expands.
The pleural reflections extend about two ribs lower than the lung edges, which is why fluid collects at the bases and why needle and drain sites are carefully chosen. Pleuritic pain is sharp and worse on deep breathing or coughing, and arises from the parietal layer. Asbestos exposure causes pleural plaques and mesothelioma decades later.
Excess fluid in the pleural cavity from heart failure, infection, cancer or other causes. It compresses the lung and causes breathlessness.
Air in the pleural space causing lung collapse. It may be spontaneous, traumatic or a tension pneumothorax needing immediate decompression.
A malignant tumour of the pleural lining strongly linked to asbestos exposure. It causes chest pain, breathlessness and effusion.
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