Diaphragm

The sternal portion of the diaphragm may be absent, and its costal origins may extend from the sixth or even the fifth rib. The slip from the twelfth rib may be absent; if this is associated with an absence of the fibers from the lateral arched band, the lumbocostal trigone becomes an extensive gap. This condition, in exaggerated form, occurs in congenital diaphragmatic hernia. In such cases, it may be noted that the lumbar portion of the diaphragm extends anteroposteriorly on the medial side of the aperture.

The extension of muscle fibers onto the (surface) fascia of psoas or quadratus lumborum occurs occasionally. Connections with transversus abdominis have been reported. Various detached or aberrant bundles of muscle fibers have also been described. A ribbon-like muscle, associated with the vertebral bodies of the 6th and 7th ribs, varying in width between 0.5 and 2.5 cm., blended with the arcuate ligament and joined the left crus of the diaphragm. Compression of the renal artery may result.

From the right crus, a slip may extend in the suspensory ligament of Treitz to the back of the duodenum near the duodenojejunal junction, with an extension to the mesentery along blood vessels. From the medial borders of the crura that define the esophageal foramen, bands of fascia containing muscle fibers may be joined to the esophagus (Cruveilhier). Frequently, detached bundles of muscle fibers are found in the tendinous center, located on the surface or between the layers of the aponeurosis. Partial duplication of the diaphragm has been reported. Transverse muscle fiber bundles have been found running anteroposterioly to the aorta or central tendon.

A muscle, hepatodiaphragmaticus, has been reported arising from the lateral aspect of the central tendon, anterior to the esophagus and to the right of and beneath the liver, to form a tendon that blended with the obliterated ductus venosus and umbilical vein.

Syn.: Septum transversum, m. phrenicus, Zwerchmuskel.

Riferimenti dell’opera originale

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• Cutler, E.C. nad H.S.F. Cooper. (1924) Congenital deficiency of the diaphragm. Arch. Surg. 8:506-523.
• Dietlen, H. and G. Knierim. (1910) Hernia diaphragmatica dextra. Berlin Klin. Wochenschrift 47:1174-1177.
• Guerrier, Y. et A. Thevenet. (1955) La région diaphragmatique antérieure. L'Assoc. Anatomistes, Comptes Rendus. 42:620-633.
• Guinane, F.R. (1924) Two anomalies in the construction of the diaphragm. J. Anat. 59:83-86.
• Henle, J. (1871) Handbuch der Muskellehre des Menschen, in Handbuch der systematischen Anatomy des Menschen. Verlag von Friedrich Vieweg und Sohn, Braunschweig.
• Knott, J.F. (1877-83) Muscular anomalies including those of the diaphragm and subdiaphragmatic regions of the human body. Proc. Roy. Irish Acad. Sci. S.2, 3:627-641.
• Knox, R. (1843) On some varieties in human structure, with remarks on the doctrine of "Unity of the Organization." Lond. Med. Gaz. 32:529-532.
• Knox, R. (1843) IV.- Muscular system. Varieties in muscles; musculus-hepatico-diaphragmaticus. Lond. Med. Gaz. 32:531.
• Latta, J.S. (1922) Congenital Deficiency of the diaphragm. Am. J. Dis. Child. 24:297-305.
• Low, A. (1908) A note on the crura of the diaphragm and the muscle of Treitz. J. Anat. Physiol. 42:93-96.
• Macalister, A. (1875) Additional observations on muscular anomalies in human anatomy (third series), with a catalogue of the principal muscular variations hitherto published. Trans. Roy. Irish Acad. Sci. 25:1-134.
• Miyata, H. (1951) On the diaphragma. Kanazawa Daigaku Igakubu IKaibogakubu Kyoshitsu Gyosekishu. 39:1-15. In Japanese.
• Mori,-., and -. Mizeo (1952) The costal origin of the diaphragma. Kaibogaku Zasshi. 27 (57th Meeting):71. In Japanese.
• Schaefer, E.A., Symington, J. and T.H. Bryce. (1923) Quain's Elements of Human Anatomy, 11th ed., Longmans, Green and Co., London.
• Shimata, M. (1952) The diaphragma of the fetus and the new-born. Tokyo Ikadaigaku Zasshi 10:1-28. In Japanese.