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ANATOMY OF THE PLEURA

PLEURAL DISEASES SERIES 08 BY WIDIRAHARDJO

1. ANATOMY OF THE PLEURA

The pleura is the serous membrane that covers the lung parenchyma, the mediastinum the diaphragm and the rib cage. This structure is divided into the visceral pleura and the parietal pleura. Parietal pleura divided into costal, mediastinal and diaphragmatic parietal pleura. Posterior to the lung root, the pleura is carried downward as a thin double fold as the pulmonary ligament. Pleural fluid as a film of fluid is normally present between the two pleuras.

1. ANATOMY OF THE PLEURA

The (potential) space between the two

pleuras called pleural space.

1. ANATOMY OF THE PLEURA

EMBRYOLOGY OF THE PLEURA

= In the embryo, pericardium communicate with pleural canals bilaterally, which in turn communicate with the peritoneal canals. = Three sets of partitions: septum transversum, pleuropericardial membranes and pleuroperitoneal membranes. = The newly formed pleural cavity is fully lined by mesothelial membrane: the pleura. = No communication between two pleural cavities.

1. ANATOMY OF THE PLEURA

1. ANATOMY OF THE PLEURA

BODY CAVITIES: many vital organs are suspended in either the dorsal or the ventral body cavity, where the diaphragm separate the body cavity into superior thoracic cavity, enclosed by the Chest wall, and an inferior abdominopelvic cavity.

1. ANATOMY OF THE PLEURA

1. ANATOMY OF THE PLEURA

HISTOLOGY OF THE PLEURA = Parietal pleura: loose, irregular connective tissue (composed mainly of collagen and elastic fiber) covered by single layer of mesothelial cells. Within the pleura are blood vessels, mainly capillaries, and lymphatic lacunas. The lacunas are initial lymphatic shaped, located over the intercostals spaces.

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= Visceral pleura: differs markedly from

parietal pleura (there are no lymphatic lacuna), and varies among species, primarily on its thickness, whereas human have a thick visceral pleural, that predominant source of blood supply come from systemic circulation. Thick visceral pleura composed by two layer: mesothelial cells and connective tissue.

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Two important function of the connective tissue in the visceral pleura that contain collagen and elastic fibers: 1. Contributes to the elastic recoil of the lung 2. To restricts the volume to which the lung can be hyperinflated

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= Microvilli are present diffusely overall the pleural surface, most numerous in the inferior parts of the visceral pleura, and the anterior and inferior mediastinum on the parietal pleura. More microvilli are present in the parietal pleura. The function of microvilli may be enmesh glycoproteins that are rich in hyaluronic acid, to lessen the friction between the lung and the chest wall.

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MESOTHELIAL CELLS These are active cells, sensitive and responsive to various stimuli, the cytoplasm always contains a moderate to abundant amount of organelles, suggestive an active metabolically cells. Any important functions are: = Regeneration: come from migration mesothelial cells = Converts to myofibroblast by TGF (transforming growth factor)

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= Produced type I, II and IV collagens elastin, fibronectine and laminin. = Also produced nitric oxide and TGF-1 (transforming growth factor). PLEURAL FLUID = Volume Normally: small amount; 8,4 4,3 ml = Cells WBC 1.716 cells/mm3, 75% macrophage RBC 700 cells/mm3

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= Physicochemical factors Protein electrophoresis pattern similar to serum. Ionic concentration differ significantly from serum: bicarbonate increased by 20-25% from serum, but K, Na & Cl slight lowered.

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BLOOD SUPPLY TO THE PLEURA The parietal and visceral pleura receives from systemic capillaries. PLEURAL LYMPHATIC The lymphatic plexuses in the costal pleura are mainly in the intercostal spaces and are absent or minimal over the ribs. The lymphatic vessels in the parietal pleura are in communication with pleural space by stoma. The stomas are found mostly on the mediastinal and on the intercostal surface, especially in the depressed areas just inferior to the ribs in the lower thorax.

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The lymphatic vessels in the parietal pleura have many branches, some of it submesothelialy have dilated, called lacunas. The visceral pleura dont have stoma. The lymphatic vessels form a plexus that run over the surface of the lung toward the hilum and also penetrate the lung to joint the bronchial lymph vessels.

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INNERVATION OF THE PLEURA Sensory nerve endings are present in the costal and diaphragmatic (peripheral portion) parietal pleura. The central portion of the diaphragm is innervated by the phrenic nerve. The visceral pleura contains no pain fibers.