Pleural function and lymphatics

D Negrini, A Moriondo - Acta Physiologica, 2013 - Wiley Online Library
Acta Physiologica, 2013Wiley Online Library
The pleural space plays an important role in respiratory function as the negative intrapleural
pressure regimen ensures lung expansion and in the mean time maintains the tight
mechanical coupling between the lung and the chest wall. The efficiency of the lung–chest
wall coupling depends upon pleural liquid volume, which in turn reflects the balance
between the filtration of fluid into and its egress out of the cavity. While filtration occurs
through a single mechanism passively driving fluid from the interstitium of the parietal pleura …
Abstract
The pleural space plays an important role in respiratory function as the negative intrapleural pressure regimen ensures lung expansion and in the mean time maintains the tight mechanical coupling between the lung and the chest wall. The efficiency of the lung–chest wall coupling depends upon pleural liquid volume, which in turn reflects the balance between the filtration of fluid into and its egress out of the cavity. While filtration occurs through a single mechanism passively driving fluid from the interstitium of the parietal pleura into the cavity, several mechanisms may co‐operate to remove pleural fluid. Among these, the pleural lymphatic system emerges as the most important one in quantitative terms and the only one able to cope with variable pleural fluid volume and drainage requirements. In this review, we present a detailed account of the actual knowledge on: (a) the complex morphology of the pleural lymphatic system, (b) the mechanism supporting pleural lymph formation and propulsion, (c) the dependence of pleural lymphatic function upon local tissue mechanics and (d) the effect of lymphatic inefficiency in the development of clinically severe pleural and, more in general, respiratory pathologies.
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