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Sternal pleural reflection

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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The sternal pleural reflection is the junction of costal pleura and anterior margin of mediastinal pleura:

  • on the right, sequentially from:
    • lung apex to
    • deep surface of sternoclavicular joint to
    • inner surface of sternum at level of sternal angle to
    • right posterolateral margin of xiphisternum
  • on the left, sequentially from:
    • lung apex to
    • deep surface of sternoclavicular joint to
    • inner surface of sternum at level of fourth costal cartilage, then passing laterally to
    • posterior surface of fourth intercostal space then inferiorly to
    • posterior margin of sixth costal cartilage

Hence, the left sternal reflection is displaced laterally by the cardiac margin; this length of the reflection is termed the cardiac notch.

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