Surface Landmark And Recesses

Question 1

What is the significance of understanding the reflection of parietal pleura on the chest wall?

Answer 1

It is important for carrying out various medical and surgical procedures.

Knowledge of pleural reflection helps in procedures like thoracentesis and chest tube placement.

Question 2

Describe the cervical pleura’s surface marking.

Answer 2

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.

Question 3

What is the anterior (costomediastinal) line of pleural reflection on the right side?

Answer 3

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.

Question 4

What is the difference in the anterior line of pleural reflection between the right and left sides?

Answer 4

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.

Question 5

Describe the inferior (costodiaphragmatic) line of pleural reflection on the right side.

Answer 5

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.

Question 6

How does the inferior line of pleural reflection differ on the left side?

Answer 6

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.

Question 7

What is the posterior (costovertebral) line of pleural reflection?

Answer 7

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.

Question 8

What is the relationship between the costal pleura and the mediastinal pleura?

Answer 8

The costal pleura becomes mediastinal pleura along the line 2 cm lateral to the spine of C7 vertebra.

Question 9

At which ribs does the inferior margin of the lung cross in the midclavicular line?

Answer 9

6th rib

Question 10

At which ribs does the inferior margin of the pleura cross in the midaxillary line?

Answer 10

10th rib

Question 11

What is the function of pleural recesses?

Answer 11

Pleural recesses serve as reserve spaces of pleural cavity for the lungs to expand during deep inspiration.

Question 12

Name two types of pleural recesses.

Answer 12

• Costodiaphragmatic recesses (right and left)
• Costomediastinal recesses (right and left)

Question 13

What are the retroesophageal recesses?

Answer 13

They are formed by the reflection of mediastinal pleura behind the esophagus.

Question 14

What is the infracardiac recess?

Answer 14

It is a small recess of the right pleural sac which sometimes extends beneath the inferior vena cava.

Question 15

Where is the costodiaphragmatic recess located?

Answer 15

It is located inferiorly between the costal and diaphragmatic pleurae.

Question 16

How does the costodiaphragmatic recess measure vertically?

Answer 16

About 5 cm

Question 17

What ribs does the costodiaphragmatic recess lie opposite?

Answer 17

8th-10th ribs

Question 18

What is the clinical significance of the costodiaphragmatic recess?

Answer 18

It is the most dependent part of the pleural cavities where fluid of pleural effusion first collects.

Question 19

What is the location of the costomediastinal recess?

Answer 19

It is located anteriorly between the costal and mediastinal pleurae.

Question 20

What is the change in tone called during percussion of the left costomediastinal recess?

Answer 20

Area of superficial cardiac dullness

Question 21

What happens to the costodiaphragmatic angle in the presence of pleural effusion?

Answer 21

The costodiaphragmatic angle is obliterated.

Question 22

How can the costodiaphragmatic recess be accessed?

Answer 22

Through the 9th and 10th intercostal spaces without penetrating the lung.

Question 23

Where does the pleura extend beyond the thoracic cage?

Answer 23

• Root of the neck (as domes of pleura)
• Right xiphisternal angle
• Costovertebral angle

Question 24

What is the nerve supply of the parietal pleura?

Answer 24

• Intercostal nerves (costal and peripheral part of diaphragmatic pleura)
• Phrenic nerve (mediastinal and central part of diaphragmatic pleura)

Question 25

Which nerves supply the visceral pleura?

Answer 25

Autonomic (sympathetic) nerves (T2-T5)

Question 26

True or False: The visceral pleura is sensitive to pain.

Answer 26

False

Question 27

What is referred pain of pleura?

Answer 27

Pain from central diaphragmatic pleura and mediastinal pleura referred to the neck or shoulder through phrenic nerves.

Question 28

What is the procedure called for aspiration of fluid from the pleural cavity?

Answer 28

Paracentesis thoracis ## Footnote Usually performed in the eighth intercostal space in the midaxillary line.

Question 29

In which intercostal space is paracentesis thoracis typically performed?

Answer 29

Eighth intercostal space ## Footnote Done in the midaxillary line.

Question 30

What are the components of the principal neurovascular bundle in the pleural space?

Answer 30

Vein, artery, and nerve (VAN) ## Footnote Important to avoid injury during procedures.

Question 31

What is pleurisy?

Answer 31

Inflammation of the pleura ## Footnote May be dry or accompanied by pleural effusion.

Question 32

What is pleural effusion?

Answer 32

Collection of fluid in the pleural cavity ## Footnote Often occurs with pleurisy.

Question 33

Why is dry pleurisy more painful?

Answer 33

Friction occurs between pleural layers during inspiration ## Footnote Both layers come in contact.

Question 34

What is pneumothorax?

Answer 34

Presence of air in the pleural cavity ## Footnote A condition affecting the pleura.

Question 35

What is haemothorax?

Answer 35

Presence of blood in the pleural cavity ## Footnote Another condition affecting the pleura.

Question 36

What is hydropneumothorax?

Answer 36

Presence of both fluid and air in the pleural cavity ## Footnote A combination of conditions.

Question 37

What is empyema?

Answer 37

Presence of pus in the pleural cavity ## Footnote Indicates infection in the pleural space.

Question 38

Which nerves innervate the costal and peripheral parts of the diaphragmatic pleurae?

Answer 38

Intercostal nerves ## Footnote Irritation causes referred pain to thoracic or abdominal wall.

Question 39

Which nerve innervates the mediastinal and central part of the diaphragmatic pleurae?

Answer 39

Phrenic nerve (C4) ## Footnote Irritation causes referred pain to the tip of shoulders.

Question 40

What does pain in the right shoulder indicate?

Answer 40

Inflammation of gallbladder ## Footnote Referred pain from the right upper quadrant.

Question 41

What does pain in the left shoulder indicate?

Answer 41

Splenic rupture ## Footnote Referred pain from the left upper quadrant.

Question 42

What is the result of pleural effusion on costodiaphragmatic recess?

Answer 42

Obliteration of costodiaphragmatic recess ## Footnote Affects lung expansion.

Question 43

Where does the pleura extend beyond the thoracic cage?

Answer 43

Right xiphicostal angle, right and left costovertebral angles, right and left sides of root of neck ## Footnote Known as the cervical dome of pleura.

Question 44

What is a risk during surgical procedures related to pleura?

Answer 44

Injury at sites where pleura extends beyond the thoracic cage ## Footnote Important to remember these sites.