Adult Human Diaphragm
Historic Gray's anatomy figure of the adult diaphragm (viewed from below).
- Links: Diaphragm Development
The Diaphragm (Fig. 391) is a dome-shaped musculofibrous septum which separates the thoracic from the abdominal cavity, its convex upper surface forming the floor of the former, and its concave under surface the roof of the latter. Its peripheral part consists of muscular fibers which take origin from the circumference of the thoracic outlet and converge to be inserted into a central tendon.
The muscular fibers may be grouped according to their origins into three parts—sternal, costal, and lumbar. The sternal part arises by two fleshy slips from the back of the xiphoid process; the costal part from the inner surfaces of the cartilages and adjacent portions of the lower six ribs on either side, interdigitating with the Transversus abdominis; and the lumbar part from aponeurotic arches, named the lumbocostal arches, and from the lumbar vertebræ by two pillars or crura. There are two lumbocostal arches, a medial and a lateral, on either side.
At their origins the crura are tendinous in structure, and blend with the anterior longitudinal ligament of the vertebral column. The right crus, larger and longer than the left, arises from the anterior surfaces of the bodies and intervertebral fibrocartilages of the upper three lumbar vertebræ, while the left crus arises from the corresponding parts of the upper two only. The medial tendinous margins of the crura pass forward and medialward, and meet in the middle line to form an arch across the front of the aorta; this arch is often poorly defined.
From this series of origins the fibers of the diaphragm converge to be inserted into the central tendon. The fibers arising from the xiphoid process are very short, and occasionally aponeurotic; those from the medial and lateral lumbocostal arches, and more especially those from the ribs and their cartilages, are longer, and describe marked curves as they ascend and converge to their insertion. The fibers of the crura diverge as they ascend, the most lateral being directed upward and lateralward to the central tendon. The medial fibers of the right crus ascend on the left side of the esophageal hiatus, and occasionally a fasciculus of the left crus crosses the aorta and runs obliquely through the fibers of the right crus toward the vena cavil foramen.
The Central Tendon
The central tendon of the diaphragm is a thin but strong aponeurosis situated near the center of the vault formed by the muscle, but somewhat closer to the front than to the back of the thorax, so that the posterior muscular fibers are the longer. It is situated immediately below the pericardium, with which it is partially blended. It is shaped somewhat like a trefoil leaf, consisting of three divisions or leaflets separated from one another by slight indentations. The right leaflet is the largest, the middle, directed toward the xiphoid process, the next in size, and the left the smallest. In structure the tendon is composed of several planes of fibers, which intersect one another at various angles and unite into straight or curved bundles—an arrangement which gives it additional strength.
Openings in the Diaphragm
The diaphragm is pierced by a series of apertures to permit of the passage of structures between the thorax and abdomen. Three large openings—the aortic, the esophageal, and the vena caval—and a series of smaller ones are described.
- aortic hiatus is the lowest and most posterior of the large apertures; it lies at the level of the twelfth thoracic vertebra. Strictly speaking, it is not an aperture in the diaphragm but an osseoaponeurotic opening between it and the vertebral column, and therefore behind the diaphragm; occasionally some tendinous fibers prolonged across the bodies of the vertebræ from the medial parts of the lower ends of the crura pass behind the aorta, and thus convert the hiatus into a fibrous ring. The hiatus is situated slightly to the left of the middle line, and is bounded in front by the crura, and behind by the body of the first lumbar vertebra. Through it pass the aorta, the azygos vein, and the thoracic duct; occasionally the azygos vein is transmitted through the right crus.
- esophageal hiatus is situated in the muscular part of the diaphragm at the level of the tenth thoracic vertebra, and is elliptical in shape. It is placed above, in front, and a little to the left of the aortic hiatus, and transmits the esophagus, the vagus nerves, and some small esophageal arteries.
- vena caval foramen is the highest of the three, and is situated about the level of the fibrocartilage between the eighth and ninth thoracic vertebræ. It is quadrilateral in form, and is placed at the junction of the right and middle leaflets of the central tendon, so that its margins are tendinous. It transmits the inferior vena cava, the wall of which is adherent to the margins of the opening, and some branches of the right phrenic nerve.
- Of the lesser apertures, two in the right crus transmit the greater and lesser right splanchnic nerves; three in the left crus give passage to the greater and lesser left splanchnic nerves and the hemiazygos vein. The gangliated trunks of the sympathetic usually enter the abdominal cavity behind the diaphragm, under the medial lumbocostal arches.
- On either side two small intervals exist at which the muscular fibers of the diaphragm are deficient and are replaced by areolar tissue. One between the sternal and costal parts transmits the superior epigastric branch of the internal mammary artery and some lymphatics from the abdominal wall and convex surface of the liver. The other, between the fibers springing from the medial and lateral lumbocostal arches, is less constant; when this interval exists, the upper and back part of the kidney is separated from the pleura by areolar tissue only.
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Gray H. Anatomy of the human body. (1918) Philadelphia: Lea & Febiger.
Cite this page: Hill, M.A. (2019, August 21) Embryology Gray0391.jpg. Retrieved from https://embryology.med.unsw.edu.au/embryology/index.php/File:Gray0391.jpg
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