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Central tendon of diaphragm | |
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Details | |
Precursor | Septum transversum |
Identifiers | |
Latin | centrum tendineum diaphragmatis |
TA98 | A04.4.02.013 |
TA2 | 2340 |
FMA | 58279 |
Anatomical terminology |
The central tendon of the diaphragm is a thin but strong aponeurosis situated slightly anterior to the vault formed by the muscle, resulting in longer posterior muscle fibers.
It is inferior to the fibrous pericardium, which fuses with the central tendon of the diaphragm via the pericardiacophrenic ligament.
The caval opening (at the level of the T8 vertebra) passes through the central tendon. This transmits the inferior vena cava [1] and right phrenic nerve.
The central tendon 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.
The central 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.
During inspiration, the diaphragm contracts, causing the central tendon to be drawn inferiorly which partially flattens the domes bilaterally. The result is an increase in the thoracic volume and a reduction in intra-thoracic pressure. This reduction allows air to enter the lungs, enhancing venous return. During inspiration, the central tendon retains its shape due to its tendinous nature, and prevents constriction of the inferior vena cava.
Rarely, a central tendon defect may be involved in a central congenital diaphragmatic hernia. [2] This may be repaired with thoracoscopic surgery. [2]
The superior vena cava (SVC) is the superior of the two venae cavae, the great venous trunks that return deoxygenated blood from the systemic circulation to the right atrium of the heart. It is a large-diameter (24 mm) short length vein that receives venous return from the upper half of the body, above the diaphragm. Venous return from the lower half, below the diaphragm, flows through the inferior vena cava. The SVC is located in the anterior right superior mediastinum. It is the typical site of central venous access via a central venous catheter or a peripherally inserted central catheter. Mentions of "the cava" without further specification usually refer to the SVC.
The inferior vena cava is a large vein that carries the deoxygenated blood from the lower and middle body into the right atrium of the heart. It is formed by the joining of the right and the left common iliac veins, usually at the level of the fifth lumbar vertebra.
The phrenic nerve is a mixed motor/sensory nerve that originates from the C3-C5 spinal nerves in the neck. The nerve is important for breathing because it provides exclusive motor control of the diaphragm, the primary muscle of respiration. In humans, the right and left phrenic nerves are primarily supplied by the C4 spinal nerve, but there is also a contribution from the C3 and C5 spinal nerves. From its origin in the neck, the nerve travels downward into the chest to pass between the heart and lungs towards the diaphragm.
The thoracic diaphragm, or simply the diaphragm, is a sheet of internal skeletal muscle in humans and other mammals that extends across the bottom of the thoracic cavity. The diaphragm is the most important muscle of respiration, and separates the thoracic cavity, containing the heart and lungs, from the abdominal cavity: as the diaphragm contracts, the volume of the thoracic cavity increases, creating a negative pressure there, which draws air into the lungs. Its high oxygen consumption is noted by the many mitochondria and capillaries present; more than in any other skeletal muscle.
The azygos vein is a vein running up the right side of the thoracic vertebral column draining itself towards the superior vena cava. It connects the systems of superior vena cava and inferior vena cava and can provide an alternative path for blood to the right atrium when either of the venae cavae is blocked.
The mediastinum is the central compartment of the thoracic cavity. Surrounded by loose connective tissue, it is an undelineated region that contains a group of structures within the thorax, namely the heart and its vessels, the esophagus, the trachea, the phrenic and cardiac nerves, the thoracic duct, the thymus and the lymph nodes of the central chest.
The chordae tendineae or tendinous cords, colloquially known as the heart strings, are inelastic cords of fibrous connective tissue that connect the papillary muscles to the tricuspid valve and the mitral valve in the heart.
Congenital diaphragmatic hernia (CDH) is a birth defect of the diaphragm. The most common type of CDH is a Bochdalek hernia; other types include Morgagni hernia, diaphragm eventration and central tendon defects of the diaphragm. Malformation of the diaphragm allows the abdominal organs to push into the chest cavity, hindering proper lung formation.
The abdomen is the part of the body between the thorax (chest) and pelvis, in humans and in other vertebrates. The abdomen is the front part of the abdominal segment of the torso. The area occupied by the abdomen is called the abdominal cavity. In arthropods, it is the posterior tagma of the body; it follows the thorax or cephalothorax.
In human anatomy, the superior epigastric artery is a terminal branch of the internal thoracic artery that provides arterial supply to the abdominal wall, and upper rectus abdominis muscle. It enters the rectus sheath to descend upon the inner surface of the rectus abdominis muscle. It ends by anastomosing with the inferior epigastric artery.
Diaphragmatic hernia is a defect or hole in the diaphragm that allows the abdominal contents to move into the chest cavity. Treatment is usually surgical.
The hemiazygos vein is a vein running superiorly in the lower thoracic region, just to the left side of the vertebral column.
The inferior phrenic artery is a bilaterally paired artery of the abdominal cavity which represents the main source of arterial supply to the diaphragm. Each artery usually arises either from the coeliac trunk or the abdominal aorta, however, their origin is highly variable and the different sites of origin are different for the left artery and right artery. The superior suprarenal artery is a branch of the inferior phrenic artery.
In human anatomy, the esophageal hiatus is an opening in the diaphragm through which the esophagus and the vagus nerve pass.
The caval opening of diaphragm is an opening in the central tendon of diaphragm giving passage to the inferior vena cava as well as to some terminal branches of the right phrenic nerve, and some lymphatic vessels en route to middle phrenic and mediastinal lymph nodes. The foramen occurs between the middle leaf and the right leaf of the central tendon of diaphragm, with the fibres of the central tendon uniting vigorously with the adventitia of the inferior vena cava.
The lumbar veins are four pairs of veins running along the inside of the posterior abdominal wall, and drain venous blood from parts of the abdominal wall. Each lumbar vein accompanies a single lumbar artery. The lower two pairs of lumbar veins all drain directly into the inferior vena cava, whereas the fate of the upper two pairs is more variable.
The bare area of the liver is a large triangular area on the diaphragmatic surface of the liver. It is the only part of the liver with no peritoneal covering, although it is still covered by Glisson’s capsule. It is attached directly to the diaphragm by loose connective tissue. The bare area of the liver is relevant to the portacaval anastomosis, encloses the right extraperitoneal subphrenic space, and can be a site of spread of infection from the abdominal cavity to the thoracic cavity
Diaphragmatic rupture is a tear of the diaphragm, the muscle across the bottom of the ribcage that plays a crucial role in breathing. Most commonly, acquired diaphragmatic tears result from physical trauma. Diaphragmatic rupture can result from blunt or penetrating trauma and occurs in about 0.5% of all people with trauma.
Congenital stenosis of vena cava is a congenital anomaly in which the superior vena cava or inferior vena cava has an aberrant interruption or coarctation.
The heart is a muscular organ situated in the mediastinum. It consists of four chambers, four valves, two main arteries, and the conduction system. The left and right sides of the heart have different functions: the right side receives de-oxygenated blood through the superior and inferior venae cavae and pumps blood to the lungs through the pulmonary artery, and the left side receives saturated blood from the lungs.
This article incorporates text in the public domain from page 406 of the 20th edition of Gray's Anatomy (1918)