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<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p><p>StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. </p></div></div></div>
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<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><h1 id="_NBK519048_"><span class="title" itemprop="name">Anatomy, Thorax, Lung Pleura And Mediastinum</span></h1><p class="contrib-group"><h4>Authors</h4><span itemprop="author">Navid Mahabadi</span><sup>1</sup>; <span itemprop="author">Alberto A. Goizueta</span><sup>2</sup>; <span itemprop="author">Bruno Bordoni</span><sup>3</sup>.</p><h4>Affiliations</h4><div class="affiliation"><sup>1</sup> A.T. Still University</div><div class="affiliation"><sup>2</sup> Boston Un at Roger Williams Med Cen</div><div class="affiliation"><sup>3</sup> Foundation Don Carlo Gnocchi IRCCS</div><p class="small">Last Update: <span itemprop="dateModified">March 24, 2024</span>.</p></div><div class="body-content whole_rhythm" itemprop="text"><div id="article-24518.s1"><h2 id="_article-24518_s1_">Introduction</h2><p>A pleura is a serous membrane that folds back on itself to form a two-layered membranous pleural sac. The outer layer is called the parietal pleura and attaches to the chest wall. The inner layer is called the visceral pleura and covers the lungs, blood vessels, nerves, and bronchi. There is no anatomical connection between the right and left pleural cavities.<a class="bk_pop" href="#article-24518.r1">[1]</a> See <b>Image.</b> Lung Anatomy. With the addition of pleural fluid, the lung pleura allows for easy movement of the lungs and inflation during breathing. </p><p>The mediastinum is a central compartment in the thoracic cavity between the pleural sacs of the lungs (see <b>Image.</b> The Mediastinum, Transverse Section of the Thorax). It is divided into two major parts, the superior and inferior portions. The inferior portion is then further divided into the anterior, middle, and posterior portions. Each region of the mediastinum contains specific groups of structures.<a class="bk_pop" href="#article-24518.r2">[2]</a> See <b>Image.</b> Mediastinal Divisions. </p><ul><li class="half_rhythm"><div>Superior mediastinum: Organs: thymus, trachea, esophagus; Arteries: aortic arch, brachiocephalic trunk, left common carotid artery, left subclavian artery; Veins and lymphatics: superior vena cava, brachiocephalic vein, thoracic duct; Nerves: vagus nerve, left recurrent laryngeal nerve, cardiac nerve, phrenic nerve.</div></li><li class="half_rhythm"><div>Anterior mediastinum: Organs: thymus; Arteries: small arterial branches; Veins and lymphatics: small branches; Nerves: none.</div></li><li class="half_rhythm"><div>Middle mediastinum: Organs: heart, pericardium; Arteries: ascending aorta, pulmonary trunk, pericardiacophrenic arteries; Veins and lymphatics: superior vena cava, azygos vein, pulmonary vein, pericardiacophrenic vein; Nerve: phrenic</div></li><li class="half_rhythm"><div>Posterior mediastinum: Organs: esophagus; Arteries: thoracic aorta; Veins and lymphatics: Azygos vein, hemiazygos vein, thoracic duct; Nerve: the vagus nerve. </div></li></ul></div><div id="article-24518.s2"><h2 id="_article-24518_s2_">Structure and Function</h2><p>The pleural cavity is a space between the visceral and parietal pleura. The space contains a tiny amount of serous fluid, which has two key functions.</p><p>The serous fluid continuously lubricates the pleural surface and makes it easy for them to slide over each other during lung inflation and deflation. The serous fluid also generates surface tension, which pulls the visceral and parietal pleura adjacent to each other. This function will allow the thoracic cavity to expand during inspiration. </p><p>NB; when air enters the pleural space, the surface tension will disappear, and the resulting condition is known as a pneumothorax.</p><p>
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<b>Pleural Recesses</b>
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</p><p>Located posteriorly and anteriorly are spaces where the pleural cavity is not totally filled by the lung parenchyma. This space is known as the recess - an area where the adjacent surfaces of the parietal pleura come into contact. The two recesses in the pleural cavity include the following:</p><ul><li class="half_rhythm"><div>The costomediastinal recess is one of these two spaces, which is found between the mediastinal and costal pleura. The space is located just posterior to the sternum.</div></li><li class="half_rhythm"><div>The costodiaphragmatic recess is the other, which is between the diaphragmatic and costal pleura.</div></li></ul><p>The reason these recesses are important is that they provide a space for fluid to accumulate. Pleural effusions usually collect in the costodiaphragmatic recess.</p></div><div id="article-24518.s3"><h2 id="_article-24518_s3_">Blood Supply and Lymphatics</h2><p>The visceral pleura receives its blood supply from the bronchial circulation, while the parietal pleura receives its blood supply from the intercostal arteries.<a class="bk_pop" href="#article-24518.r3">[3]</a><a class="bk_pop" href="#article-24518.r4">[4]</a></p></div><div id="article-24518.s4"><h2 id="_article-24518_s4_">Nerves</h2><p>The costal and cervical portions of the parietal pleura are innervated by the intercostal nerve, and the diaphragmatic portion is supplied by the phrenic nerve. The parietal pleura is the only portion of the pleura that can sense pain. The visceral pleura receives its nerve supply via the autonomic nervous system (ANS) and lacks sensory innervation.<a class="bk_pop" href="#article-24518.r5">[5]</a></p></div><div id="article-24518.s5"><h2 id="_article-24518_s5_">Surgical Considerations</h2><p>Pneumothorax is a common clinical event, and it occurs when the pleural space is violated.<a class="bk_pop" href="#article-24518.r6">[6]</a><a class="bk_pop" href="#article-24518.r7">[7]</a> The patient can present with a variety of symptoms depending on the size of the pneumothorax. With a small pneumothorax, the patient may be asymptomatic. But if the pneumothorax is large, the following symptoms will be present:</p><ul><li class="half_rhythm"><div>Chest pain</div></li><li class="half_rhythm"><div>Dyspnea</div></li><li class="half_rhythm"><div>Asymmetrical chest expansion</div></li></ul><p>Percussion and auscultation will reveal a hyper-resonant chest with no breath sounds.</p><p>The two types of pneumothorax include:</p><p>
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<b>Spontaneous</b>: These pneumothoraces occur without any traumatic event. They are most common in young males who smoke. The most common cause of a spontaneous pneumothorax is the presence of small blebs on the superior surface of the upper lobes.<a class="bk_pop" href="#article-24518.r6">[6]</a></p><p>
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<b>Traumatic</b>: Traumatic pneumothorax is very common and may occur as a result of a central line insertion, penetrating chest trauma, or rib fracture.<a class="bk_pop" href="#article-24518.r7">[7]</a></p><p>The treatment of a pneumothorax again depends on the size and presence of symptoms. Most asymptomatic cases can be observed if the patient is reliable and agrees to follow up. Repeat chest X-rays are required to ensure that the pneumothorax is resolving. For patients with large and symptomatic pneumothorax, insertion of a chest tube is the most straightforward treatment. Unlike the past when large-sized chest tubes were inserted, today, several kits are available with small size 8-12 French tubes which can be inserted without causing too much pain.<a class="bk_pop" href="#article-24518.r8">[8]</a></p></div><div id="article-24518.s6"><h2 id="_article-24518_s6_">Clinical Significance</h2><p>Normally, there is a small amount of pleural fluid found in the pleural cavity. When there is a pathological collection of pleural fluid, it is called a pleural effusion. Pleural effusion is classified as either exudative or transudative and can be caused by multiple mechanisms, including lymphatic obstruction, increased capillary permeability, decreased plasma colloid pressure, increased capillary, venous pressure, and increased negative intrapleural pressure.</p><p>The mediastinum is commonly a site for tumors, and specific regions of the mediastinum are prone to certain tumors. Pneumomediastinum can also develop when air is introduced into the mediastinum, most commonly seen in ruptures of the esophagus. A widened mediastinum is a worrisome clinical sign for possible aortic aneurysm or rupture.<a class="bk_pop" href="#article-24518.r9">[9]</a></p><p>The mediastinum is also very important with respect to lung cancer—all lung cancers when in advanced stages, involve the mediastinal lymph nodes. The treatment for a patient with lung cancer without mediastinal lymph node involvement is surgery, and it has a high cure rate. However, surgery alone is not curative once the mediastinal nodes are involved, and patients will need chemotherapy. To determine if the mediastinal lymph nodes are involved, a CT scan of the chest is necessary. If the nodes are greater than 1 cm, then a biopsy is required. The lymph nodes are biopsied using mediastinoscopy. If they turn out to be negative, then lobectomy alone is sufficient.<a class="bk_pop" href="#article-24518.r10">[10]</a></p><p>The status of the mediastinal lymph nodes is also important when dealing with patients with sarcoidosis, lymphoma, and tuberculosis. In each of these cases, a mediastinoscopy is necessary to assess the histology before treatment can be provided.</p></div><div id="article-24518.s7"><h2 id="_article-24518_s7_">Review Questions</h2><ul><li class="half_rhythm"><div>
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</div></li></ul></div><div class="floats-group" id="article-24518.s8"></div><div class="floats-group" id="article-24518.s9"></div><div class="floats-group" id="article-24518.s10"></div><div id="article-24518.s11"><h2 id="_article-24518_s11_">References</h2><dl class="temp-labeled-list"><dt>1.</dt><dd><div class="bk_ref" id="article-24518.r1">Adeyinka A, Pierre L. <span class="ref-journal">StatPearls [Internet].</span> StatPearls Publishing; Treasure Island (FL): Jul 4, 2023. Air Leak. [<a href="https://pubmed.ncbi.nlm.nih.gov/30020594" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30020594</span></a>]</div></dd><dt>2.</dt><dd><div class="bk_ref" id="article-24518.r2">Volpe JK, Makaryus AN. <span class="ref-journal">StatPearls [Internet].</span> StatPearls Publishing; Treasure Island (FL): Jul 25, 2023. Anatomy, Thorax, Heart and Pericardial Cavity. [<a href="https://pubmed.ncbi.nlm.nih.gov/29494059" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29494059</span></a>]</div></dd><dt>3.</dt><dd><div class="bk_ref" id="article-24518.r3">Stauffer CM, Meshida K, Bernor RL, Granite GE, Boaz NT. <span class="ref-journal">StatPearls [Internet].</span> StatPearls Publishing; Treasure Island (FL): Jul 17, 2023. Anatomy, Thorax, Pericardiacophrenic Vessels. [<a href="/pmc/articles/PMC559242/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC559242</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/32644668" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32644668</span></a>]</div></dd><dt>4.</dt><dd><div class="bk_ref" id="article-24518.r4">Isaka T, Mitsuboshi S, Maeda H, Kikkawa T, Oyama K, Murasugi M, Kanzaki M, Onuki T. Anatomical analysis of the left upper lobe of lung on three-dimensional images with focusing the branching pattern of the subsegmental veins. <span><span class="ref-journal">J Cardiothorac Surg. </span>2020 Sep 29;<span class="ref-vol">15</span>(1):273.</span> [<a href="/pmc/articles/PMC7526204/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7526204</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/32993708" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32993708</span></a>]</div></dd><dt>5.</dt><dd><div class="bk_ref" id="article-24518.r5">Cho TH, Kim SH, O J, Kwon HJ, Kim KW, Yang HM. Anatomy of the thoracic paravertebral space: 3D micro-CT findings and their clinical implications for nerve blockade. <span><span class="ref-journal">Reg Anesth Pain Med. </span>2021 Aug;<span class="ref-vol">46</span>(8):699-703.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/33990438" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33990438</span></a>]</div></dd><dt>6.</dt><dd><div class="bk_ref" id="article-24518.r6">Gilday C, Odunayo A, Hespel AM. Spontaneous Pneumothorax: Pathophysiology, Clinical Presentation and Diagnosis. <span><span class="ref-journal">Top Companion Anim Med. </span>2021 Nov;<span class="ref-vol">45</span>:100563.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/34303864" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 34303864</span></a>]</div></dd><dt>7.</dt><dd><div class="bk_ref" id="article-24518.r7">Tran J, Haussner W, Shah K. Traumatic Pneumothorax: A Review of Current Diagnostic Practices And Evolving Management. <span><span class="ref-journal">J Emerg Med. </span>2021 Nov;<span class="ref-vol">61</span>(5):517-528.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/34470716" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 34470716</span></a>]</div></dd><dt>8.</dt><dd><div class="bk_ref" id="article-24518.r8">Hu K, Chopra A, Kurman J, Huggins JT. Management of complex pleural disease in the critically ill patient. <span><span class="ref-journal">J Thorac Dis. </span>2021 Aug;<span class="ref-vol">13</span>(8):5205-5222.</span> [<a href="/pmc/articles/PMC8411157/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC8411157</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/34527360" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 34527360</span></a>]</div></dd><dt>9.</dt><dd><div class="bk_ref" id="article-24518.r9">Ferreiro L, Toubes ME, San José ME, Suárez-Antelo J, Golpe A, Valdés L. Advances in pleural effusion diagnostics. <span><span class="ref-journal">Expert Rev Respir Med. </span>2020 Jan;<span class="ref-vol">14</span>(1):51-66.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/31640432" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31640432</span></a>]</div></dd><dt>10.</dt><dd><div class="bk_ref" id="article-24518.r10">Ghigna MR, Thomas de Montpreville V. Mediastinal tumours and pseudo-tumours: a comprehensive review with emphasis on multidisciplinary approach. <span><span class="ref-journal">Eur Respir Rev. </span>2021 Dec 31;<span class="ref-vol">30</span>(162)</span> [<a href="/pmc/articles/PMC9488622/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC9488622</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/34615701" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 34615701</span></a>]</div></dd></dl></div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_top_margin">
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<b>Disclosure: </b>Navid Mahabadi declares no relevant financial relationships with ineligible companies.</p></div></dd><dt></dt><dd><div><p class="no_top_margin">
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<b>Disclosure: </b>Alberto Goizueta declares no relevant financial relationships with ineligible companies.</p></div></dd><dt></dt><dd><div><p class="no_top_margin">
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<b>Disclosure: </b>Bruno Bordoni declares no relevant financial relationships with ineligible companies.</p></div></dd></dl></div><div class="bk_prnt_sctn"><h2>Figures</h2><div class="whole_rhythm bk_prnt_obj bk_first_prnt_obj"><div id="article-24518.image.f1" class="figure bk_fig"><div class="graphic"><img src="/books/NBK519048/bin/pleura.jpg" alt="Lung Anatomy" /></div><div class="caption"><p>Lung Anatomy. This illustration includes the visceral and parietal pleurae, the right and left lungs, the right and left pleural cavities, and the mediastinum. The anatomic relationships of these structures to the ribs, trachea, and main bronchi are also shown. Contributed by B Palmer</p></div></div></div><div class="whole_rhythm bk_prnt_obj"><div id="article-24518.image.f2" class="figure bk_fig"><div class="graphic"><img src="/books/NBK519048/bin/Mediastinum__Compartments.jpg" alt="Mediastinal Divisions" /></div><div class="caption"><p>Mediastinal Divisions. The mediastinum can be divided into the following areas: superior mediastinum, anterior mediastinum, middle mediastinum, posterior mediastinum, superior compartment, and inferior compartment. Contributed by B Parker</p></div></div></div><div class="whole_rhythm bk_prnt_obj"><div id="article-24518.image.f3" class="figure bk_fig"><div class="graphic"><img src="/books/NBK519048/bin/Gray968.jpg" alt="The Mediastinum, Transverse Section of the Thorax" /></div><div class="caption"><p>The Mediastinum, Transverse Section of the Thorax. The Mediastinum, a transverse section of the thorax, showing the contents of the middle and the posterior mediastinum, left phrenic nerve, heart, lungs, pulmonary pleura, and costal pleura. Henry Vandyke Carter,<a href="https://commons.wikimedia.org/wiki/File:Gray968-ar.png" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri"> Public Domain</a>, via Wikimedia Commons</p></div></div></div></div></div></div>
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<div class="post-content"><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © 2025, StatPearls Publishing LLC.<p class="small">
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This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0)
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(<a href="https://creativecommons.org/licenses/by-nc-nd/4.0/" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=uri">
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http://creativecommons.org/licenses/by-nc-nd/4.0/
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</a>), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.
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</p></div><div class="small"><span class="label">Bookshelf ID: NBK519048</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/30085590" title="PubMed record of this page" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">30085590</a></span></div></div></div>
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