Sternal pleural reflection

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.