part of pleura into mediastinal one. The right anterior edge

23 
supraclavicularis minor) downwards and to the middle of the 
right sternoclavicular joint, behind the hand and body of 
sternum and at the level of attachment of 2nd rib cartilage it 
passes behind the median line to the anterior edge of the left 
side at the level of 3rd – 4th costal cartilages (cartilago 
costalis). 
From here it goes down to the attachment point of the 6th 
rib to sternum, and deviates downwards out merging into 
inferior edge.
The anterior edge from the left begins from the left 
supraclavicular fossa, goes down and to the middle of left 
sternoclavicular joint, goes behind the left side of sternum to 
the 4th rib joint. It turns round the heart discharging 
downwards and outside then goes to the middle of cartilage of 
the 6th rib where merges into the inferior edge.
Between the anterior edges of the left and right pleuras the 
spaces of triangle are formed: in the suprasternal notch and 
behind the sternum above the 3rd rib there is superior 
interpleural area (area interpleurica superior) or thymus. The 
newborns and children have thymus, and the adults have 
cellular tissue and lymph nodes.
Downwards from the 4th rib with the help of incisura 
cardiaca the inferior interpleural area or Wojnicz – Sianożęcki 
triangle of safety is formed. From the side it is limited with 
parietal pleura and from below – with diaphragm. There is the 
frontal part of pericardium which is not adjacent to pleura and 
used by cardiac surgeon as access to the heart which is located 
beyond pleura and in pericardiocentesis in this space.
The inferior edge of pleura is the transition line of costal 
parietal pleura into diaphragmal pleura: 
● linea parasternalis – the 6th rib; 
● linea medioclavicularis – the 7th rib;
● linea axillaris anterior – the 8th rib; 

24 
● linea axillaris media – the 9th or the 10th rib;
● linea axillaris posterior – the 10th rib;
● linea scapularis – the 11th rib;
● linea paravertebralis – the 12th rib.
During the maximal deep breath lungs fill the whole pleural 
cavity. During moderate breath or expiration lungs do not reach 
the place of transition of pleura parts and they are called 
recessus pleurales. Angles are the part of pleural cavity in the 
area of transfering one part of parietal pleura into another.
There are pair recessus costomediastinalis. They are located 
between anterior parts of costal pleura which pass into 
pericardium making duplicate, and limiting area interpleurica 
superior et inferior. During surgery after median sternotomy in 
extrapleural access to pericardium, heart and great blood 
vessels these areas can be artificially widen for better access. 
In extrapleural access there still exists the integration of 
pleural sacs which helps to avoid the use of apparatus for 
artificial lung ventilation.
The biggest is costodiaphragmatic recess (recessus 
costodiaphragmaticus) which is limited by inferior edges of 
costal and diaphragm parts of parietal pleura. It has the depth 
to 9 cm along linea axillaris media from the 7th to the 10th 
ribs. Costodiaphragmatic recess is not filled with pulmonary 
tissue even deep deep breathing. It is the place of 
accumulation of exudate or blood and that's why is used for 
pleurocentesis.
There is the space before diaphragm filled with subpleural 
tissue which was described by O. V. Melnikov. It is located 
below costodiaphragmatic recess between diaphragm and 
thoracic wall. Subpleural tissue gives an opportunity to 
separate pleura from diaphragm and to have the direct and 
safe access to diaphragm what is used in extrapleural 
transthoracic access to subdiaphragmatic abscesses. 

25 
The third pair recessus is recessus phrenicomediastinalis.
Parietal pleura is supplied with blood due to posterior 
intercostal, interior thoracic, phrenic and musculophrenic 
arteries. Pulmonary pleura is supplied with blood due to 
vessels of lungs (pulmonary and bronchial arteries).
Venous blood is drained from parietal pleura into the 
system of precava and partially of postcava. 
The lymph outflows from the costal part of parietal pleura 
of anterior thoracic areas into parasternal lymph nodes; from 
the posterior thoracic areas – into nodi parasternales; from 
diaphragmal pleura – into superior diaphragmal nodes (nodi 
phrenici superiores) and prepericardial lymph nodes (nodi 
prepericardiaci); from the mediastinum – into the lateral 
pericardium and paraesophageal lymph nodes. 

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