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The DIAPHRAGM

Dept of Anatomy
ANATOMY

• Dome-shaped musculo-tendinous
septum which separates the thoracic
from the abdominal cavity

• Principal muscle of Respiration


ANATOMY

• Composed of 2 portions:
a. Peripheral part - muscular part

b. Central aponeurotic part


“CENTRAL TENDON”
DIAPHRAGM: MUSCULAR PART

• STERNAL PART
- attached to posterior xiphisternal
process

- anterolateral gap  Sternocostal


hiatus (Foramen of Morgagni)
ANATOMY: STERNAL ORIGIN
DIAPHRAGM: MUSCULAR PART

• 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

• Convergence of muscle fibers –


Aponeurosis
• Fused with fibrous pericardium-
cardiac silhouette
• C-shaped with 3 leaves
Right leaf- largest, lateral
Middle leaf- intermediate, anterior
Left leaf- smallest
The DIAPHRAGM: OVERVIEW

STERNAL ORIGIN

COSTAL ORIGIN

LUMBAR ORIGIN
DIAPHRAGM: Thoracic Surface
T8-9
INTERVERTEBRAL
DISC

RIGHT & LEFT LEAF


OF CENTRAL
TENDON

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

Abnormal A-P CXR

INTESTINAL GAS
(LUSCENCY)

DIAPHRAGMATIC
SHADOW
DIAPHRAGMATIC HERNIA

LATERAL CXR

Intestinal gas
DIAPHRAGMATIC APERTURES

• VENA CAVAL FORAMEN


- level of intervertebral disc bet. T8 & T9,
right of median plane
- Most superior in location
- IVC adherent to margins
Inspiration Diaphragm contracts 
widening of foramen  dilates IVC
- R phrenic nerve, R hepatic vein also pass
through
DIAPHRAGMATIC APERTURES
• ESOPHAGEAL HIATUS
- Where esophagus passes obliquely
- left of vena caval foramen, R crus, T10
- transmits anterior & posterior Vagal trunks
& esophageal br. of L gastric vessels
- R crus forms esophageal sphincter w/c
prevents gastro-esophageal reflux
DIAPHRAGMATIC APERTURES

• AORTIC HIATUS
- Aorta does not pierce the diaphragm
because this hiatus is posterior to it

- passes posterior to median arcuate


ligament, anterior to T12, left of median
plane

- also transmits Thoracic duct, Azygos veins


& 2 Intercostal lymph trunks to cisterna chyli
DIAPHRAGMATIC APERTURES

• STERNOCOSTAL HIATUS
- transmits Superior epigastric vessels
- also lymph vessels into anterior phrenic
lymph nodes

• Other structures that pass thru the Diaphragm


- Phrenic nerves, Intercostal nerves, Subcostal
nerves, Sympathetic trunks, splanchnic nerve,
Hemiazygos vein
DIAPHRAGM: Abdominal Surface

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

Posterior surface drains into Azygos &


Hemiazygos veins
VESSELS & NERVES
• LYMPHATIC DRAINAGE

Thoracic Lymph drainage  Phrenic lymph


nodes  Mediastinal lymph nodes

Abdominal lymph drainage  Superior


lumbar lymph nodes
VESSELS & NERVES
• INNERVATION

Phrenic nerves- entire motor supply; fr.


ventral rami of C3-C5 spinal cord

Inferior 6-7 Intercostal & subcostal nerves-


sensory innervation to peripheral
diaphragm
DIAPHRAGM: PHRENIC NERVE

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

BLOOD FORCED TO IVC


THRU DILATATION OF VC
FORAMEN

BLOOD RETURNS TO HEART


THANK
YOU

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