related figure

Since the lung and chest are elastic, we can represent them with springs. Under normal conditions, they are coupled together: the “lung” springs are stretched and the “chest” springs are compressed. During a pneumothorax, the lungs and chest are independent and the springs representing them go to their relaxed positions, causing the lung to collapse and the chest wall to enlarge.

This analogy is honestly completely flying over my head. How are the lung and chest wall “coupled”? Heck, earlier in this book it’s mentioned that one of the two forces keeping the lungs from collapsing is “the surface tension between the lungs and the chest wall” (the other being the intrapulmonary pressure).

This and the said analogy make it sound like there is a physical-contact adhesion force between the lungs and the chest wall, which, from what I’ve looked into (and several other analogical figures the book has provided), seems to not be the case.

I believe this analogy of “coupling” is probably related to pressure relations, but I don’t understand how those are exactly set up either, and why during a pneumothorax they just cease as the two become “uncoupled”.

For those interested, the book is Medical Physics by John R. Cameron.

  • $\begingroup$ Then add how the diaphragm functions : the chest (ribs etc) can stay stationary and xou can breathe via the diaphragm... $\endgroup$ – Solar Mike Dec 16 '18 at 6:47
  • $\begingroup$ @SolarMike this question isn't really about that (the dynamics of breathing). It's about the coupling of the chest wall and lungs. Of note: if the chest wall and lungs are decoupled (as in a pneumothorax or hemothorax, breathing via the diaphragm isn't effective. $\endgroup$ – De Novo Dec 16 '18 at 18:14

How are the lung and chest wall coupled?

You have your answer in the text:

the surface tension between the lungs and the chest wall

And as you say, it is very much

like there is a physical-contact adhesion force between the lungs and the chest wall

A good, medical school level anatomy textbook will walk you through this. Moore's Clinically Oriented Anatomy gives the appropriate level of detail. Lets refer to Fig 1.30 (pg 107 of the 6th edition):

Below, you can see that there is a bag of fluid (the pleura) around the lung itself, like an under inflated balloon wrapped around the lung (see the picture of the fist, representing the lung, wrapped in a balloon, representing the pleural sac). The space inside the bag of fluid is very small, very thin, in a normal lung. The size of that space is exaggerated in the figure below in order to show the layers more clearly. In fact, in medical images of a healthy chest, it doesn't even appear as a space. The thin layer of fluid provides surface tension, keeping the two pleural walls close together. Since the chest and lungs are physically attached to the pleural walls on either side, that surface tension pulls the elastic lung outward (expanding it), and the chest wall inward (collapsing it, slightly). If the pleura is punctured, blood or air can enter, surface tension can no longer keep the two pleural walls next to each other, the chest wall returns to its preferred state (slightly more expanded than it would otherwise be), and the lung returns to its preferred state (substantially more collapsed than it would otherwise be).

enter image description here


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