Anatomy of the Diaphragm

OVERVIEW
 The Diaphragm
Is a musculotendinous,
dome-shaped, flat
structure
It separates thoracic
cavity from abdominal
cavity, hence sometimes
called thoraco-
abdominal diaphragm
 Attachments of the Diaphragm
It is the principal muscle of
respiration, and consists of
peripheral muscular part, and
central fibrous part called
central tendon of diaphragm

Peripherally it is attached to the:

- Xiphoid process of the
sternum
- Costal margin of the thoracic
wall
- Vertebrae of the lumbar region
From peripheral
Contd.
attachments,
muscle fibers
converge to form
central tendon of
diaphragm
• Origin is from three parts:
1. Sternal. Origin of Diaphragm
2. Costal.
3. Vertebral

Sternal part: Consists of two fleshy slips,

which arise from the posterior surface of
the xiphoid process

Costal part: Consists of six fleshy slips,

which arise from the inner surface of lower
six ribs near their costal cartilages

Vertebral part: Arises by means of

(a) Rt and Lt crura of diaphragm
(b) 5 arcuate ligaments
 Crura of Diaphragm

• Right crus: A vertical fleshy

bundle, that arises from the right side
of anterior aspects of the upper three
lumbar vertebrae and intervening
intervertebral discs
• Left crus: Vertical fleshy bundle,
that arises from the left side of
anterior aspects of upper two lumbar
vertebrae and the intervening
intervertebral discs
 Arcuate Ligaments
Medial arcuate ligament:
Medial arcuate ligament is the
thickened upper margin of the sheath of
Psoas muscle
Extends from the side of the body of
L2 vertebra to the tip of the transverse
process of L1 vertebra

Lateral arcuate ligament:

Thickened upper margin of fascia
covering the anterior surface of the
Quadratus lumborum Extends from
the tip of transverse process of L1
vertebra to the 12th rib
 Surfaces and Relations of the Diaphragm
• The superior surface of diaphragm projects • On the right side it is related to
on either side as dome or cupola into the
thoracic cavity (a) right lobe of the liver
• Depressed area between the two domes is (b) right kidney
called central tendon (c) right suprarenal gland
• The superior surface is covered by
endothoracic fascia and is related to the • On the left side it is related to
bases of right and left pleura on the sides
the fibrous pericardium in the middle (a) left lobe of the liver
• (b) fundus of stomach
The inferior surface of diaphragm is lined (c) spleen
by the diaphragmatic fascia and parietal
peritoneum. (d) left kidney
(e) left suprarenal gland
 Diaphragmatic Orifices/Openings
• The openings of diaphragm are
classified into two types:
(a) major openings
(b) minor openings.

Major Openings
There are three named major
openings, viz.
1. Vena caval opening (T8)
2. Esophageal opening (T10)
3. Aortic opening (T12)
 Contd.
• Minor Openings
These are unnamed •
• Structures passing through
these 5. Sympathetic chain
openings are as follows: 6. Greater, lesser, and
1. Superior epigastric vessels least splanchnic nerves
2. Musculophrenic artery 7. Hemiazygos vein
3. Lower five intercostal
nerves and vessels
4. Subcostal nerves and vessels
(a) Right and Left phrenic nerves Nerve Supply
(b) lower five intercostal and subcostal nerves

Phrenic nerves are motor and sensory

Right phrenic nerve: Motor supply to
the right half of the diaphragm up to the
right margin of esophageal opening
Left phrenic nerve: Motor supply to the
left half of the diaphragm up to the left
margin of the esophageal opening
Both phrenic nerves provide sensory
innervation to the central tendon of the
diaphragm, pleura and peritoneum
related to it
Intercostal nerves supply the peripheral
parts of the diaphragm
 Arterial Supply
Arterial Supply is by the following
arteries:
1. Superior 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
• Lymph from diaphragm
drains 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
Venous Drainage:
Branches of IVC
Functions of Diaphragm

• Useful as muscle of • Enlarges thoracic cavity

inspiration • Reduces intrathoracic
• Abdominal straining pressure
• Weight lifting • Increases vertical dimension
• Thoraco-muscular pump of the chest
• Sphincter of esophagus
 Clinical Correlates
1) Diaphragmatic paralysis (paralysis of
diaphragm):
• Unilateral damage of phrenic nerve leads
to unilateral diaphragmatic paralysis
• There is elevated hemidiaphragm on the
side of lesion
• The bilateral damage of phrenic nerves
leads to complete diaphragmatic
paralysis
• Could be fatal, may cause respiratory
failure
2) Hiccups:
• Occurs 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
3) Diaphragmatic hernias: Congenital,
traumatic, sliding
What happens during contraction of the diaphragm
To the IVC Opening?
To the Esophageal opening?
To the aortic opening?
Which is the commonest internal hernias?
What is the sensory and motor innervation to the diaphragm