Pleura

The pleura is the serous membrane lining the inner surface of the chest wall and the outer surface of the lungs, forming two insulated bag (Fig).

pleura The boundaries of the pleura and light front (1) and rear (2): the dashed line is the border of the pleura, the solid line - the boundary of the lungs.

The pleura, the lining the wall of the chest cavity, called the parietal, or parietal. There are costal the pleura (covering ribs and intercostal spaces, diaphragmatic the pleura, the lining of the upper surface of the diaphragm, and the mediastinal pleura, limiting the mediastinum. Pulmonary, or visceral, pleura covers the outside and Magdalene surface of the lungs. She tightly joined with the parenchyma of the lung, and its deeper layers form a wall separating lung slices. Between the visceral and parietal pleura is closed isolated space slit pleural cavity.
Closed injuries of the pleura arise when struck by a blunt object. There are bruises and tears pleura in the result of the concussion, contusion or sdavljenia chest, rib was broken.
Wounds of the pleura are observed at all penetrating wounds of the chest. This raises a traumatic pneumothorax (see) and hemothorax (see) with possible infectious complications in subsequent pleurisy and pyopneumothorax (see Pleurisy purulent).
Inflammatory diseases of the pleura - see Pleurisy.
Among benign tumors of the pleura are observed fibroids, lipoma, angiomas, and other Specific symptoms in these tumors are not. Primary malignant tumours of the pleura often are multiple and are accompanied by a sharp thickening of the pleura with the development of secondary cataract. When them relatively early pain with deep breathing and coughing with irradiation in the shoulderand, later, dyspnea and fever. Serous effusion pleural cavity then goes into hemorrhagic. The prognosis is bad. In the pleura meet metastases of malignant tumors of other organs.
Rarely observed separatornyi cysts of the pleura. They are located mainly in the field of pleural sinuses. If Echinococcus cyst occur most often as a result of breakthrough podplavlennoj if Echinococcus cyst lung (see the Light). Operative treatment.

Pleura (from the Greek. pleura - side, side) - the serous membrane that covers the lungs and the internal surface of the chest, forms two symmetric isolated bag, located in both halves of the chest. Develops P. from internal (splanchnology) and external (somatoline) leaves splanchnotomy mesoderm.
Anatomy, histology. Visceral pleura (pleura visceralis, s. pleura pulmonalis) covers the entire surface of the lungs, is immersed in their grooves and leaves uncovered only a small area in the field of the gate of the lung. Parietal P. (pleura parietalis) is divided into the rib (pleura costalis), diaphragmatic (pleura diaphragmatica) and mediastinal (pleura inediastinalis). Pulmonary ligament (ligg. pulmonalia) present duplicatura serous membranes, located in the frontal plane and connecting the visceral and mediastinal the pleura. Between visceral and parietal P. has a slit-like microscopic cavity, reaching at losing light of the big sizes. Departments P., where one wall of the worksheet moves to the other, forming cracks, blank lung tissue, called sinuses P. (recessus pleuralis). There are a rib-diaphragmatic, rib-mediastinal and abdominal-mediastinal sinuses.
Like other serous membranes, pleura has a layered structure. Visceral P. includes 6 layers: 1) mesotheli; 2) border membrane; 3) surface of fibrous collagen layer; 4) surface elastic network; 5) a deep elastic network; 6) deep lattice collagen-elastic layer (Fig. 1). All fibrous layers P. permeated plexus reticular fibers. Places deep in lattice collagen-elastic layer, there are strands of smooth muscle fibers. Parietal pleura much thicker visceral and different characteristics of the structure of a fibrous structure. Among cellular forms of P. meet fibroblasts, histiocytes, fat and fat cells, lymphocytes.

Fig. 1. The scheme of the fibrous structure of the pleura (Wittels): 1 - mesotheli; 2 - border membrane; 3 - the surface of fibrous collagen layer; 4 - elastic surface network; 5 - deep elastic network; 6 - deep lattice collagen-elastic layer.

Throughout the visceral pleura and on prevailing square parietal P. blood and lymphatic vessels are deposited only in the deepest layer. They are separated from the pleural cavity fibrous sero-haemolymph barrier, including the majority of the Petrograd In certain places parietal P. (intercostal spaces, the area transverse muscle of the chest and side part of the tendon centre diaphragm) sero-lymph barrier "reduced" type. Thanks to this lymphatic vessels as close here to the pleural cavity. In these places are specifically differentiated devices resorption abdominal fluid - namasivaya hatches (see the Peritoneum). In visceral pleura adults predominate blood capillaries located superficially (closer to the pleural cavity). In the parietal., in areas of concentration namasivaya hatches predominate lymphatic capillaries that go into these places to the surface.
In the pleural cavity there is a continuous change of abdominal fluid: its formation and absorption. During the day through the pleural cavity passes fluid volume is approximately equal to 27% of the volume of blood plasma. Under physiological conditions the formation of abdominal fluid is mainly visceral P., sucks as this liquid is mainly rib pleura. The remaining parts of the parietal P. normally do not feature prominently in these processes. Due to the morphological and functional characteristics of different parts P., among which the most important value is different permeability of its vessels, the fluid moves from visceral to rib P., i.e. in the pleural cavity is directed liquid circulation. In conditions of a pathology these relations is radically changing, as any area of visceral or parietal P. becomes able to education and to the absorption of abdominal fluid.
The blood vessels of the pleura originate mainly from intercostal and internal thoracic arteries. Visceral P. supplied also by vessels from the system diaphragmatic artery.
Lymph outflow of parietal P. is parallel intercostal vessels in lymph nodes located in the heads of the ribs. From mediastinal and diaphragmatic P. lymph should sternal and the anterior mediastinal way in the dark corner or the thoracic duct, and on the back mediastinal way - in colourfully lymph nodes.
Innerviruetsya pleura wandering and phrenic nerves, fiber bundles, departing from the V-VII cervical and I - II thoracic spinal nodes. In the largest number receptor endings and small brain ganglia are concentrated in mediastinal P.: in the area of the root of the lung, lung ligaments and heart depressing.