Cervical Pleura Above the Clavicle

Expansion

• The apex of the lung and its covering cervical pleura reach 2 to 3 cm above the medial third of the clavicle
• They are protected by the suprapleural membrane (Sibson’s fascia), attached to the transverse process of C7 and the inner border of the first rib

Two clinical consequences follow directly. First, needles placed at the root of the neck, central lines, brachial plexus blocks, supraclavicular procedures, can enter the pleural cavity. Second, a tumour at the lung apex (Pancoast tumour) sits immediately adjacent to the sympathetic chain and the lower brachial plexus, producing Horner syndrome and T1 wasting of the small muscles of the hand.