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Dept of Anatomy
ANATOMY
• Dome-shaped musculo-tendinous
septum which separates the thoracic
from the abdominal cavity
• Composed of 2 portions:
a. Peripheral part - muscular part
• STERNAL PART
- attached to posterior xiphisternal
process
• COSTAL PART
- arise from inferior 6 ribs and costal
cartilages
- interdigitate with transversus
abdominis m.
- forms the right & left hemidiaphragm;
moves with respiration
- visible in CXR
DIAPHRAGM: MUSCULAR PART
• LUMBAR PART
- arise fr. Lumbar vertebra
- musculotendinous crura (R & L)
- R crus broader & longer
- R & L crura joined by median arcuate
ligament
DIAPHRAGM: MUSCULAR PART
• LUMBAR PART
- thickening of thoracolumbar fascia
a) Medial arcuate ligament
b) Lateral arcuate ligament
Vertebrocostal triangle- thin
muscular membrane that separates left
kidney from parietal pleura
DIAPHRAGM: Abdominal Surface
LUMBOCOSTAL
TRIANGLE
DIAPHRAGM: CENTRAL TENDON
STERNAL ORIGIN
COSTAL ORIGIN
LUMBAR ORIGIN
DIAPHRAGM: Thoracic Surface
T8-9
INTERVERTEBRAL
DISC
MIDDLE LEAF-
PERICARDIUM
STERNUM
CLINICAL CORRELATION
• DIAPHRAGMATIC HERNIA
- due to rupture of diaphragm
- congenital or traumatic
- herniation of abdominal viscera into
thoracic cavity
- respiratory distress
DIAPHRAGMATIC HERNIA
Normal CXR
INTESTINAL GAS
(LUSCENCY)
DIAPHRAGMATIC
SHADOW
DIAPHRAGMATIC HERNIA
LATERAL CXR
Intestinal gas
DIAPHRAGMATIC APERTURES
• AORTIC HIATUS
- Aorta does not pierce the diaphragm
because this hiatus is posterior to it
• STERNOCOSTAL HIATUS
- transmits Superior epigastric vessels
- also lymph vessels into anterior phrenic
lymph nodes
VENA CAVAL
FORAMEN
ESOPHAGEAL
HIATUS
AORTIC HIATUS W/
ABDOMINAL AORTA
DIAPHRAGM: Abdominal Surface
ESOPHAGEAL
HIATUS
PHRENIC NERVE
CAVAL OPENING
LATERAL ARCUATE
LIGAMENT
L1-L4 VERTERBRA
VESSELS & NERVES
• ARTERIAL SUPPLY
Superior surface
Superior phrenic arteries fr. Thoracic aorta
Musculophrenic & Pericardiophrenic
arteries fr. Internal thoracic artery
Inferior surface
Inferior phrenic artery fr. Abdominal aorta
VESSELS & NERVES
• VENOUS DRAINAGE
Superior surface
Musculophrenic & Pericardiophrenic
veins to Internal thoracic veins
Inferior surface
R inferior phrenic vein to IVC
L inferior phrenic vein to L suprarenal vein
PHRENIC NERVE
ACTIONS of the DIAPHRAGM
INSPIRATION EXPIRATION
• Contraction • Relaxation
• Dome • Dome rises
descent • vertical
• vertical diameter
diameter • intra-
• intra- thoracic
thoracic volume
volume • intra-
• intra- thoracic
thoracic pressure
pressure • Air is
• Air goes in expelled
CHIEF MUSCLE OF INSPIRATION
DIAPHRAGM & RESPIRATION
DIAPHRAGM & BLOOD CIRCULATION
CONTRACTION OF
DIAPHRAGM
COMPRESSION OF
ABDOMINAL VISCERA