A central venous catheter inserted via the right subclavian vein inadvertently pierces the pleural dome. Which structure forms the highest point of the pleural dome, and how far above the medial 1/3 of the clavicle does it extend?
- A The cervical pleura extends 2.5 cm (1 inch) above the medial 1/3 of the clavicle, supported by Sibson's fascia (suprapleural membrane) ✓
- B The pleural dome reaches the level of the clavicle only, not above it
- C The pleural dome extends 5 cm above the clavicle, just below the thyroid cartilage
- D The right pleural dome is higher than the left due to the liver displacing it upward
Correct answer: A. The cervical pleura extends 2.5 cm (1 inch) above the medial 1/3 of the clavicle, supported by Sibson's fascia (suprapleural membrane)
Explanation
The cervical pleura (pleural dome) projects above the medial third of the clavicle into the root of the neck, reaching approximately 2.5 cm (1 inch) above the medial end of the clavicle. It is reinforced by Sibson's fascia (suprapleural membrane — a thickening of endothoracic fascia), which is attached to the inner border of the 1st rib and the transverse process of C7. This anatomical fact is crucial for subclavian vein cannulation, scalene muscle surgeries, and cervical rib procedures where pneumothorax risk is highest.
Reference: BD Chaurasia's Human Anatomy, 8th ed.
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Written and medically reviewed by the StethoPrep medical team.