The diaphragm is a muscular structure, though covered in respiration the notes on musculoskeletal development should also be read. (More? Musculoskeletal System)
Adult Diaphragm
Page Links: Introduction | Diaphragm Components | Adult Diaphragm | Abnormalities | Congenital Diaphragmatic Hernia | Glossary
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Five elements contribute to the diaphragm. septum transversum - central tendon 3rd to 5th somite - musculature of diaphragm (More? Somites) ventral pleural sac - connective tissue mesentry of oesophagus - connective tissue around oesophasus and IVC (More? Gastrointestinal Tract) pleuroperitoneal membranes - connective tissue around central tendon |
Congenital Diaphragmatic Hernia (International Classification of Diseases code 756.6)
Failure of the pleuroperitoneal foramen (foramen of Bochdalek) to close allows viscera into thorax. Intestine, stomach or spleen can enter the pleural cavity, compressing the lung.
Australian national rate (1982-1992) 2.1 - 3.8 /10,000 births. (Congenital Malformations Australia 1981-1992 P. Lancaster and E. Pedisich ISSN 1321-8352)
References:
Gallot D, Boda C, Ughetto S, Perthus I, Robert-Gnansia E, Francannet C, Laurichesse-Delmas H, Jani J, Coste K, Deprest J, Labbe A, Sapin V, Lemery D. Prenatal detection and outcome of congenital diaphragmatic hernia: a French registry-based study. Ultrasound Obstet Gynecol. 2007 Mar;29(3):276-83.
"501 cases of CDH were identified from a total of 1,835,022 live births (2.7/10 000 live births). The overall prenatal detection rate was 54%."
Colvin J, Bower C, Dickinson JE, Sokol J. Outcomes of congenital diaphragmatic hernia: a population-based study in Western Australia. Pediatrics. 2005 Sep;116(3):e356-63.
"Ninety-two percent of postoperative infants survived beyond 1 year of age, as did 80% of infants who reached the surgical referral center. However, only 52% of live-born infants, 32% of all cases, and 16% of all prenatally diagnosed cases survived. Therefore, the overall mortality rate for this condition remains high, despite increased prenatal detection, transfer to tertiary institutions for delivery, and advances in neonatal care, and is influenced significantly by the rate of prenatal termination. In our study, 33% of all cases of CDH and 49% of prenatally diagnosed fetuses underwent elective termination of pregnancy. This large number of fetal terminations confounds the accurate assessment of the true outcomes of this condition."
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Notes Under Development (notice removed when complete).
The respiratory system does not carry out its physiological function (gas exchange) prenatally and postnatally the lungs continue to grow for another 8+ years.
Many other tissues/systems are involved in respiratory function: musculoskeletal (ribs and diaphragm) cardiovascular (pulmonary circulation). The musculoskeletal begins functioning prenatally, the cardiovasular pulmonary circulation is activated and altered postnatally.
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