Abstrakt

The pleura is not a vitally important structure however contributes to optimum lung function. The parietal pleura basically reveals a three layer-structure comprising the endothoracic fascia, loose connective tissue and the surface mesothelial cell lining. Their microvilli surface, the release of specific metabolic products such as hyaluronan and the pleural fluid are responsible for the pleural gliding function. Visceral and parietal pleura show marked differences as to vascular und lymphatic vessel supply. Based on systemic arterial blood supply and characteristic lymphatic structures (stomata, interstitial lacunae) the parietal pleura is the dominant operator in pleural fluid transfer. The pleural space normally contains 2 – 15 ml of a low protein content transudate (0.9 – 1.5 ­g/dL). The pleural fluid balance is essentially governed by STARLINGs-law containing hydrostatic and colloidosmotic pressure gradients as key determinants. The pleural fluid production (influx) in man occurs virtually exclusively via systemic parietal vascular ultrafiltration at a flow rate of 0.01 ml/kg/h (ca. 20 ml/day). Drainage (efflux) of pleural fluid likewise depends on the parietal pleura through lymphatic pathways. Prior to creation of clinical effusion the pleural fluid transport system may compensate an excess influx up to factor 20 (700 ml/day). The pleural pressure is basically negative and modified by gravitation and structural changes of the lung. It is an important determinant of breathing mechanics as a reference for lung volume, air flow und lung compliance. The loss of the pleural cleft as occurring in pleurectomy or pleurodesis entails no clinically important lung function impairment. Pleurisy, pneumothorax (PTX), malignancy and fibrothorax are the leading pathologies occurring in the pleura.

Autoreninformation

Autoren

• W. Frank

Abteilungen

• Meoclinic Berlin

Adresse

Dr. med. Wolfgang Frank
Meoclinic Berlin
Friedrichstraße71
10117 Berlin
Email: [email protected]

Citation