Human Anatomy Vol 1

Parietal pleura

Horizontal fissure

Oblique fissure

Lung/visceral pleura

Costodiaphragmatic

recess

Fig. 21.2': Parietal (black), visceral pleurae and lung (pink) from
the lateral aspect. Costodiaphragmatic recess is seen

border of the twelfth thoracic vertebra, 2 cm lateral to
the upper border of the twelfth thoracic spine (Fig. 21.3).
Thus the pleurae descend below the costal margin
at three places, at the right xiphicostal angle, and at
the right and left costovertebral angles below the
twelfth rib behind the upper poles of the kidneys. The
latter fact is of surgical importance in exposure of
the kidney. The pleura may be damaged at these sites
(Fig. 21.1).

The posterior margins of the pleura pass from a point

2 cm lateral to the twelfth thoracic spine to a point^2 cm

lateral to the seventh cervical spine. The costal pleura

becomes the mediastinal pleura along this line

(Fig.21.3).

Suiloce Morking of the lung/Visce]ol Pleuro

The apex of the lung coincides with the cervical pleura,

and is represented by a line convex upwards rising

2.5 cm above the medial one-third of the clavicle

(Fis.21..a).

The anterior border of the right lung cotesponds very

closely to the anterior margin or costomediastinal line

of the pleura and is obtained by joining:

. A point at the sternoclavicular joint,
. A point in the median plane at the sternal angle,
. A point in the median plane just above the
xiphisternal joint.
The anterior border of the left lung corresponds to the
anterior margin of the pleura up to the level of the
fourth costal cartilage.
In the lower part, 7t presents a cardiac notch of
variable size. From the level of the fourth costal cartilage
it passes laterally for 3.5 cm from the sternal margin,
and then curves downwards and medially to reach the
sixth costal cartilage^4 cm from the median plane. In
the region of the cardiac notch, the pericardium is
covered only by a double layer of pleura. The area of
the cardiac notch is dull on percussion and is called the
area of superficial cardiac dullness.

SURFACE MARKING AND RADIOLOGICAL ANATOMY OF THOHAX

Lumbar vertebra

Cervical vertebra

Oblique fissure

Lung/visceral pleura

Parietal pleura

Costovertebral angles

Fig.21.3: Parieta-l (black) and visceral pleurae (pink) on the back of thorax costovertebral angles are seen