Pleural liquid and its exchanges

After an account on morphological features of visceral and parietal pleura, mechanical coupling between lung and chest wall is outlined. Volume of pleural liquid is considered along with its thickness in various regions, and its composition. Pleural liquid pressure (P-liq) and pressure exerted by lung recoil in various species and postures are then compared, and the vertical gradient of Pliq considered. Implications of lower Pliq in the lung zone than in the costo-phrenic sinus at iso-height are pointed out. Mesothelial permeability to H2O, Cl-, Na+, mannitol, sucrose, inulin, albumin, and various size dextrans is provided, along with paracellular "pore" radius of mesothelium. Pleural liquid is produced by filtration from parietal pleura capillaries according to Starling forces. It is removed by absorption in visceral pleura capillaries according to Starling forces (at least in some species), lymphatic drainage through stomata of parietal mesothelium (essential to remove cells, particles, and large macromolecules), solute-coupled liquid absorption, and transcytosis through mesothelium. (C) 2007 Elsevier B.V. All rights reserved.