Pleura

Question 1

Parietal vs. Visceral

Answer 1

• Parietal: “glued” to the body wall or some outside structure
• Visceral: intimately attached to organ in such a way that it becomes part of the organ

Question 2

Exceptions to Pleural Cavity Definition

Answer 2

1. Right and Left Costo-Diaphragmatic Recesses: Between Costal and Diaphragmatic Parietal Pleura
2. Left Costo-Mediastinal Recess: Between Mediastinal and Costal Parietal Pleura
3. Oblique Fissure of Right Lung (Visceral to visceral)
4. Oblique Fissure of Left Lung (Visceral to visceral)
5. Horizontal Fissure of Right Lung (Visceral to visceral)

Question 3

Parts of Parietal Pleura

Answer 3

1. Costal Parietal Pleura
2. Mediastinal Parietal Pleura
3. Cervical/Cupula Parietal Pleura
4. Diaphragmatic Parietal Pleura

Question 4

Pain Referral in Pleurisy

Answer 4

1. Sensory branches of intercostal nerves receive pain signals from costal and Cervical/Cupula Parietal Pleura so pain NOT referred
2. Pain Referred to Neck when in Mediastinal or Diaphragmatic parietal pleura because Phrenic Nerve comes from Cervical Plexus (C3-C4)

Question 5

Pleurisy

Answer 5

Inflammation of Pleura from external insult or internal pathology

Question 6

Chronic, Fibrous Cords

Answer 6

Pleural adhesions between parietal and visceral pleura

Question 7

Pneumothorax

Answer 7

Air in the pleural cavity from puncture of visceral or parietal pleura

Question 8

Pleural Effusion

Answer 8

Fluid in the pleural cavity

Question 9

Hemothorax

Answer 9

Blood in the pleural Cavity

Question 10

Mediastinal Shift

Answer 10

• During inspiration, the pleural cavity is filled with air, pushing the organs in the mediastinum to the opposite side, possibly kinking the IVC
• Expiration shifts mediastinal organs back

Question 11

Trace Inferior Border of Lung, Visceral Pleura, and Parietal Pleura at Expiration

Answer 11

1. 1 inch lateral from Xiphisternal Junction at level of T6
2. Crosses Midaxillary line at T8
3. Continues around to level of T10 at Thoracic Spinous Process
4. Visceral Follows path of lung
5. Parietal pleura is always 2 ribs inferior to lung

Question 12

Thoracocentesis

Answer 12

Needle into pleural cavity, specifically into costo-diaphragmatic recess to drain fluid from pleural cavity

Question 13

Where would you stick a needle for Thoracocentesis?

Answer 13

Ask patient to expire and then stick needle between 9th and 10th rib, near the superior aspect of the 10th rib (to avoid nerves and vessels) and aiming superiorly to miss the liver and Diaphragm