Surface Landmark And Recesses Flashcards
What is the significance of understanding the reflection of parietal pleura on the chest wall?
It is important for carrying out various medical and surgical procedures.
Knowledge of pleural reflection helps in procedures like thoracentesis and chest tube placement.
Describe the cervical pleura’s surface marking.
A curved line drawn from the sternoclavicular joint to the junction of the medial third and middle third of the clavicle, with the summit of the dome lying 1 inch above the medial one-third of the clavicle.
The cervical pleura is also known as the cupola of the pleura.
What is the anterior (costomediastinal) line of pleural reflection on the right side?
It extends downwards and medially from the right sternoclavicular joint to the midpoint of the sternal angle, then descends vertically to the midpoint of the xiphisternal joint.
This line is crucial for understanding the anatomy of the right lung and its relationship with surrounding structures.
What is the difference in the anterior line of pleural reflection between the right and left sides?
On the left, it extends to the 4th costal cartilage and arches outwards to reach the sternal margin, running downwards lateral to this margin to the 6th costal cartilage, leaving part of the pericardium in contact with the anterior chest wall.
This difference is significant for cardiac procedures and understanding heart anatomy.
Describe the inferior (costodiaphragmatic) line of pleural reflection on the right side.
Starts from the xiphisternal joint, crossing the 8th rib in the midclavicular line, 10th rib in the midaxillary line, and 12th rib at the lateral border of the erector spinae muscle, 2 cm lateral to T12 vertebra.
This line indicates the lower boundary of the pleural cavity.
How does the inferior line of pleural reflection differ on the left side?
It starts at the level of the 6th costal cartilage, about 2 cm lateral to the midline, and follows the same course as on the right side.
This is important for understanding the diaphragm’s position relative to the pleura.
What is the posterior (costovertebral) line of pleural reflection?
It ascends from the end of the inferior line, 2 cm lateral to the T12 spine along the vertebral column.
This line helps in identifying the posterior boundary of the pleural cavity.
What is the relationship between the costal pleura and the mediastinal pleura?
The costal pleura becomes mediastinal pleura along the line 2 cm lateral to the spine of C7 vertebra.
At which ribs does the inferior margin of the lung cross in the midclavicular line?
6th rib
At which ribs does the inferior margin of the pleura cross in the midaxillary line?
10th rib
What is the function of pleural recesses?
Pleural recesses serve as reserve spaces of pleural cavity for the lungs to expand during deep inspiration.
Name two types of pleural recesses.
- Costodiaphragmatic recesses (right and left)
- Costomediastinal recesses (right and left)
What are the retroesophageal recesses?
They are formed by the reflection of mediastinal pleura behind the esophagus.
What is the infracardiac recess?
It is a small recess of the right pleural sac which sometimes extends beneath the inferior vena cava.
Where is the costodiaphragmatic recess located?
It is located inferiorly between the costal and diaphragmatic pleurae.
How does the costodiaphragmatic recess measure vertically?
About 5 cm
What ribs does the costodiaphragmatic recess lie opposite?
8th-10th ribs
What is the clinical significance of the costodiaphragmatic recess?
It is the most dependent part of the pleural cavities where fluid of pleural effusion first collects.
What is the location of the costomediastinal recess?
It is located anteriorly between the costal and mediastinal pleurae.
What is the change in tone called during percussion of the left costomediastinal recess?
Area of superficial cardiac dullness
What happens to the costodiaphragmatic angle in the presence of pleural effusion?
The costodiaphragmatic angle is obliterated.
How can the costodiaphragmatic recess be accessed?
Through the 9th and 10th intercostal spaces without penetrating the lung.
Where does the pleura extend beyond the thoracic cage?
- Root of the neck (as domes of pleura)
- Right xiphisternal angle
- Costovertebral angle
What is the nerve supply of the parietal pleura?
- Intercostal nerves (costal and peripheral part of diaphragmatic pleura)
- Phrenic nerve (mediastinal and central part of diaphragmatic pleura)
Which nerves supply the visceral pleura?
Autonomic (sympathetic) nerves (T2-T5)
True or False: The visceral pleura is sensitive to pain.
False
What is referred pain of pleura?
Pain from central diaphragmatic pleura and mediastinal pleura referred to the neck or shoulder through phrenic nerves.
What is the procedure called for aspiration of fluid from the pleural cavity?
Paracentesis thoracis
Usually performed in the eighth intercostal space in the midaxillary line.
In which intercostal space is paracentesis thoracis typically performed?
Eighth intercostal space
Done in the midaxillary line.
What are the components of the principal neurovascular bundle in the pleural space?
Vein, artery, and nerve (VAN)
Important to avoid injury during procedures.
What is pleurisy?
Inflammation of the pleura
May be dry or accompanied by pleural effusion.
What is pleural effusion?
Collection of fluid in the pleural cavity
Often occurs with pleurisy.
Why is dry pleurisy more painful?
Friction occurs between pleural layers during inspiration
Both layers come in contact.
What is pneumothorax?
Presence of air in the pleural cavity
A condition affecting the pleura.
What is haemothorax?
Presence of blood in the pleural cavity
Another condition affecting the pleura.
What is hydropneumothorax?
Presence of both fluid and air in the pleural cavity
A combination of conditions.
What is empyema?
Presence of pus in the pleural cavity
Indicates infection in the pleural space.
Which nerves innervate the costal and peripheral parts of the diaphragmatic pleurae?
Intercostal nerves
Irritation causes referred pain to thoracic or abdominal wall.
Which nerve innervates the mediastinal and central part of the diaphragmatic pleurae?
Phrenic nerve (C4)
Irritation causes referred pain to the tip of shoulders.
What does pain in the right shoulder indicate?
Inflammation of gallbladder
Referred pain from the right upper quadrant.
What does pain in the left shoulder indicate?
Splenic rupture
Referred pain from the left upper quadrant.
What is the result of pleural effusion on costodiaphragmatic recess?
Obliteration of costodiaphragmatic recess
Affects lung expansion.
Where does the pleura extend beyond the thoracic cage?
Right xiphicostal angle, right and left costovertebral angles, right and left sides of root of neck
Known as the cervical dome of pleura.
What is a risk during surgical procedures related to pleura?
Injury at sites where pleura extends beyond the thoracic cage
Important to remember these sites.
