Physiology of the pleural space

Charalampos Charalampidis, Andrianna Youroukou, George Lazaridis, Sofia Baka, Ioannis Mpoukovinas, Vasilis Karavasilis, Ioannis Kioumis, Georgia Pitsiou, Antonis Papaiwannou, Anastasia Karavergou, Kosmas Tsakiridis, Nikolaos Katsikogiannis, Eirini Sarika, Konstantinos Kapanidis, Leonidas Sakkas, Ipokratis Korantzis, Sofia Lampaki, Konstantinos Zarogoulidis, Paul Zarogoulidis


The pleural cavity is created between the 4th and 7th week of embryologic development. These embryonic components of visceral and parietal pleurae develop different anatomic characteristics with regard to vascular, lymphatic, and nervous supply. There are two layers: a superficial mesothelial cell layer facing the pleural space and an underlying connective tissue layer. The pleura might present inflammatory response and maintenance of the pleural fluid is observed. The latter function is especially important in the mechanical coupling of the lung and chest wall. Fluid is filtered into the pleural space according to the net hydrostatic oncotic pressure gradient. It flows downward along a vertical pressure gradient, presumably determined by hydrostatic pressure and resistance to viscous flow. There also may be a net movement of fluid from the costal pleura to the mediastinal and interlobar regions. In these areas, pleural fluid is resorbed primarily through lymphatic stomata on the parietal pleural surface. In the current review we will present the physiology of the pleural space in a step by step manner.