THORAX

ANA 212

DIAPHRAGM

Auza, M I (BSc, MSc)

Department of Human Anatomy

Faculty of Basic Medical Sciences
Bingham University, Karu
 WISDOM QUOTE
“Without instructions,
you’re bound to suffer
destructions.”
 DIAPHRAGM OF INFERIOR
THORACIC APERTURE
• The thoracic outlet is closed by a large dome-shaped
flat muscle called diaphragm.
• Since it separates thoracic cavity from abdominal
cavity, it is also termed thoraco-abdominal
diaphragm.
• The diaphragm is the principal muscle of
respiration.
• It is dome shaped and consists of peripheral
muscular part, and central fibrous part called
central tendon.
 DIAPHRAGM: Origin
The origin of the diaphragm is divided into three parts, viz.
1. Sternal.
2. Costal.
3. Vertebral.
Sternal part:
• It consists of two fleshy slips, which arise from the posterior surface of the
xiphoid process.
Costal part:
• On each side, it consists of six fleshy slips, which arise from the inner
surface of lower six ribs near their costal cartilages.
Vertebral part:
• This part arises by means of (a) right and left crura of diaphragm and (b) five
arcuate ligaments.
DIAPHRAGM: Insertion
• From circumferential origin (vide supra), the muscle fibres converge
towards the central tendon and insert into its margins.
• The features of the central tendon are as follows:
1. It is trifoliate in shape, having
(a) an anterior (central) leaflet, and (b and c) two tongue-shaped
posterior leaflets. It resembles an equilateral triangle. The right
posterior leaflet is short and stout, whereas the left posterior leaflet is
thin and long.
2. It is inseparably fused with the fibrous pericardium.
3. It is located nearer to the sternum than to the vertebral column.
DIAPHRAGM: Surfaces and Relations
• The superior surface of diaphragm projects on
either side as dome or cupola into the thoracic
cavity.
• Depressed area between the two domes is called
central tendon.
• The superior surface is covered by endo-thoracic
fascia and is related to the bases of right and left
pleura on the sides and to the fibrous pericardium in
the middle.
 DIAPHRAGM: Surfaces and Relations
The inferior surface of diaphragm is lined by the diaphragmatic fascia and
parietal peritoneum.
On the right side it is related to
(a) right lobe of the liver,
(b) right kidney, and
(c) right suprarenal gland.
On the left side it is related to
(a) left lobe of the liver,
(b) fundus of stomach,
(c) spleen,
(d) left kidney, and
(e) left suprarenal gland.
 Openings of the Diaphragm
• The openings of diaphragm are Minor Openings
classified into two types: • These are unnamed opening.
(a) major openings However there are structures
(b) minor openings. passing through these
openings which we shall see
shortly.
Major Openings
There are three named major
openings, viz.
1. Vena caval opening.
2. Esophageal opening.
3. Aortic opening.
Location, shape, and vertebral level of
three major openings of the diaphragm
Opening Location Shape Vertebral level
Vena caval opening In the central tendon Quadrangular T8 (body)
slightly to the right of or square
median plane
between the central
and right posterior
leaflets
Esophageal Opening Slightly to the left of Oval or T10 (body)
median plane (The elliptical
fibres of right crus
split around the
opening and act like
pinch cock)
Aortic Opening In the midline behind Circular or T12 (lower
the median arcuate round border of
ligament the body)
 Major Openings: Structures passing
through
Opening Structures passing through
Vena caval opening • Inferior vena cava
• Right phrenic nerve
Esophageal opening • Esophagus
• Right and left vagal trunks
• Esophageal branches of left
gastric artery
Aortic opening From right to left these are:
– Azygos vein
– Thoracic duct
– Aorta
 Minor Openings
These are unnamed.
• Structures passing through these openings are as follows:
1. Superior epigastric vessels pass through the gap (space of Larry) between
the muscular slips arising from xiphoid process and 7th costal cartilage.
2. Musculophrenic artery passes through the gap between the slips of origin
from 7th to 8th ribs.
3. Lower five intercostal nerves and vessels (i.e., 7th–11th) pass through
gaps between the adjoining costal slips.
4. Subcostal nerves and vessels pass deep to the lateral arcuate ligament.
5. Sympathetic chain passes deep to the medial arcuate ligament.
6. Greater, lesser, and least splanchnic nerves pass by piercing the crus of
diaphragm on the corresponding side.
7. Hemiazygos vein pierces the left crus of the diaphragm.
 Diaphragm: Nerve Supply
• The diaphragm is supplied by:
(a) Right and left phrenic nerves, and
(b) Lower five intercostal and subcostal nerves.
 Diaphragm: Nerve Supply
• The phrenic nerves are both • The phrenic nerves provide
motor and sensory. sensory innervation to the
• The right phrenic nerve central tendon of the
provides motor innervation to diaphragm, and pleura and
the right half of the peritoneum related to it.
diaphragm up to the right
margin of esophageal opening, • The intercostal nerves supply
and the peripheral parts of the
• Left phrenic nerve provides diaphragm.
motor innervation to the left
half of the diaphragm up to
the left margin of the
esophageal opening.
Arterial Supply
• The diaphragm is supplied
by the following arteries:
1. Superior phrenic arteries
(also called phrenic arteries)
from thoracic aorta.
2. Inferior phrenic arteries,
from the abdominal aorta.
3. Pericardiophrenic arteries,
from the internal thoracic
arteries.
4. Musculophrenic arteries,
the terminal branches of the
internal thoracic arteries.
5. Superior epigastric
arteries, the terminal
branches of the internal
thoracic arteries.
6. Lower five intercostal and
subcostal arteries from the
aorta.
 Lymphatic Drainage
• The lymph from diaphragm
is drained into the following
• groups of lymph nodes:
• 1. Anterior diaphragmatic
lymph nodes, situated
behind the xiphoid process.
• 2. Posterior diaphragmatic
lymph nodes, situated near
the aortic orifice.
• 3. Right lateral
diaphragmatic nodes,
situated near the caval
opening.
• 4. Left lateral
diaphragmatic nodes,
situated near the
esophageal opening.
 Actions of Diaphragm
• The diaphragm acts to subserve the
following functions:
1. Muscle of inspiration: The diaphragm is the
main/ principal muscle of respiration. When it
contracts, it descends and increases the
vertical diameter of the thoracic cavity (for
details see page 223).
2. Muscle of abdominal staining: The
contraction of diaphragm along with
contraction of muscles of anterior abdominal
wall raises the intra-abdominal pressure to
evacuate the pelvic contents (voluntary
expulsive efforts, e.g., micturition, defecation,
vomiting, and parturition).
3. Muscle of weight lifting: By taking deep
breath and closing the glottis, if possible to
raise the intraabdominal pressure to such an
extent that it will help support the vertebral
column and prevent its flexion. This assists
the postvertebral muscles in lifting the heavy
weights.
4. Thoraco-muscular pump: The descent of
diaphragm decreases the intrathoracic
pressure and at the same time increases the
intra-abdominal pressure. This pressure
change compresses the inferior vena cava, and
consequently its blood is forced upward into
the right atrium.
5. Sphincter of esophagus: The fibres of the
right crus of diaphragm subserve a sphincteric
control over the esophageal opening.
 Clinical correlation
• Diaphragmatic paralysis
(paralysis of diaphragm):
• The unilateral damage of phrenic
nerve leads to unilateral
diaphragmatic paralysis. The
condition is diagnosed during
fluoroscopy when an elevated
hemidiaphragm is seen on the
side of lesion, and showing
paradoxical movements.
• The bilateral damage of phrenic
nerves leads to complete
diaphragmatic paralysis.
• It is a serious condition as it may
cause respiratory failure.
• Hiccups: They occur due to
involuntary spasmodic
contractions of the diaphragm
accompanied by the closure of
the glottis.
• Hiccups normally occur after
eating or drinking as a result of
gastric irritation.
• The pathological causes of
hiccups include diaphragmatic
irritation, phrenic nerve
irritation, hysteria, and uremia.