The thoracic diaphragm, or simply the diaphragm (Ancient Greek: διάφραγμα, translit. diáphragma, lit. 'partition'), is a sheet of internal skeletal muscle in humans and other mammals that extends across the bottom of the thoracic cavity. The diaphragm separates the thoracic cavity, containing the heart and lungs, from the abdominal cavity and performs an important function in respiration: as the diaphragm contracts, the volume of the thoracic cavity increases, a negative vacuum is created which draws air into the lungs.
The term diaphragm in anatomy, created by Gerard of Cremona, can refer to other flat structures such as the urogenital diaphragm or pelvic diaphragm, but "the diaphragm" generally refers to the thoracic diaphragm. In humans, the diaphragm is slightly asymmetric—its right half is higher up (superior) to the left half, since the large liver rests beneath the right half of the diaphragm. There is also a theory that the diaphragm is lower on the other side due to the presence of the heart.
Other mammals have diaphragms, and other vertebrates such as amphibians and reptiles have diaphragm-like structures, but important details of the anatomy vary, such as the position of the lungs in the abdominal cavity.
|Origin||Septum transversum, pleuroperitoneal folds, body wall|
|Artery||Pericardiacophrenic artery, musculophrenic artery, inferior phrenic arteries|
|Vein||Superior phrenic vein, inferior phrenic vein|
|Nerve||Phrenic and lower intercostal nerves|
|Anatomical terms of muscle|
The diaphragm is a C-shaped structure of muscle and fibrous tissue that separates the thoracic cavity from the abdomen. The dome curves upwards. The superior surface of the dome forms the floor of the thoracic cavity, and the inferior surface the roof of the abdominal cavity.
As a dome, the diaphragm has peripheral attachments to structures that make up the abdominal and chest walls. The muscle fibres from these attachments converge in a central tendon, which forms the crest of the dome. Its peripheral part consists of muscular fibers that take origin from the circumference of the inferior thoracic aperture and converge to be inserted into a central tendon.
The muscle fibres of the diaphragm emerge from many surrounding structures. At the front, fibres insert into the xiphoid process and along the costal margin. Laterally, muscle fibers insert into ribs 6–12. In the back, muscle fibres insert into the vertebra at T12 and two appendages, the right and left crus, descend and insert into the lumbar vertebrae at L1 & L2.
The central tendon of the diaphragm is a thin but strong aponeurosis near the center of the vault formed by the muscle, closer to the front than to the back of the thorax, so that the posterior muscular fibers are the longer.
There are a number of openings in the diaphragm through which structures pass between the thorax and abdomen. There are three large openings—the aortic, the esophageal, and the caval opening—plus a series of smaller ones.
The inferior vena cava passes through the caval opening, a quadrilateral opening at the junction of the right and middle leaflets of the central tendon, so that its margins are tendinous. Surrounded by tendons, the opening is stretched open every time inspiration occurs. However, there has been argument that the caval opening actually constricts during inspiration. Since thoracic pressure decreases upon inspiration and draws the caval blood upwards toward the right atrium, increasing the size of the opening allows more blood to return to the heart, maximizing the efficacy of lowered thoracic pressure returning blood to the heart. The aorta does not pierce the diaphragm but rather passes behind it in between the left and right crus.
The thoracic spinal levels at which the three major structures pass through the diaphragm can be remembered by the number of letters contained in each structure:
|! Description||Vertebral level||Contents|
|caval opening||T8||The caval opening passes through the central tendon of the diaphragm. It contains the inferior vena cava, and some branches of the right phrenic nerve.|
|esophageal hiatus||T10||The esophageal hiatus is situated in the posterior part of the diaphragm, located slightly left of the central tendon through the muscular sling of the right crus of the diaphragm.|
It contains the esophagus, and anterior and posterior vagal trunks.
|aortic hiatus||T12||The aortic hiatus is in the posterior part of the diaphragm, between the left and right crus.|
It contains the aorta, the azygos vein, and the thoracic duct.
|two lesser apertures of right crus||greater and lesser right splanchnic nerves|
|two lesser apertures of left crus||greater and lesser left splanchnic nerves and the hemiazygos vein|
|behind the diaphragm, under the medial lumbocostal arch||sympathetic trunk|
|areolar tissue between the sternal and costal parts (see also foramina of Morgagni)||the superior epigastric branch of the internal thoracic artery and some lymphatics from the abdominal wall and convex surface of the liver|
|areolar tissue between the fibers springing from the medial and lateral lumbocostal arches||This interval is less constant; when this interval exists, the upper and back part of the kidney is separated from the pleura by areolar tissue only.|
The diaphragm is primarily innervated by the phrenic nerve which is formed from the cervical nerves C3, C4 and C5. While the central portion of the diaphragm sends sensory afferents via the phrenic nerve, the peripheral portions of the diaphragm send sensory afferents via the intercostal (T5–T11) and subcostal nerves (T12).
Arteries and veins above and below the diaphragm supply and drain blood.
From above, the diaphragm receives blood from branches of the internal thoracic arteries, namely the pericardiophrenic artery and musculophrenic artery; from the superior phrenic arteries, which arise directly from the thoracic aorta; and from the lower internal intercostal arteries. From below, the inferior phrenic arteries supply the diaphragm.
The sternal portion of the muscle is sometimes wanting and more rarely defects occur in the lateral part of the central tendon or adjoining muscle fibers.
The thoracic diaphragm develops during embryogenesis, beginning in the third week after fertilization with two processes known as transverse folding and longitudinal folding. The septum transversum, the primitive central tendon of the diaphragm, originates at the rostral pole of the embryo and is relocated during longitudinal folding to the ventral thoracic region. Transverse folding brings the body wall anteriorly to enclose the gut and body cavities. The pleuroperitoneal membrane and body wall myoblasts, from somatic lateral plate mesoderm, meet the septum transversum to close off the pericardio-peritoneal canals on either side of the presumptive esophagus, forming a barrier that separates the peritoneal and pleuropericardial cavities. Furthermore, dorsal mesenchyme surrounding the presumptive esophagus form the muscular crura of the diaphragm.
Because the earliest element of the embryological diaphragm, the septum transversum, forms in the cervical region, the phrenic nerve that innervates the diaphragm originates from the cervical spinal cord (C3,4, and 5). As the septum transversum descends inferiorly, the phrenic nerve follows, accounting for its circuitous route from the upper cervical vertebrae, around the pericardium, finally to innervate the diaphragm.
The diaphragm is the main muscle of respiration and functions in breathing. During inhalation, the diaphragm contracts and moves in the inferior direction, enlarging the volume of the thoracic cavity and reducing intra-thoracic pressure (the external intercostal muscles also participate in this enlargement), forcing the lungs to expand. In other words, the diaphragm's movement downwards creates a partial vacuum in the thoracic cavity, which forces the lungs to expand to fill the void, drawing air in the process.
Cavity expansion happens in two extremes, along with intermediary forms. When the lower ribs are stabilized and the central tendon of the diaphragm is mobile, a contraction brings the insertion (central tendon) towards the origins and pushes the lower cavity towards the pelvis, allowing the thoracic cavity to expand downward. This is often called belly breathing. When the central tendon is stabilized and the lower ribs are mobile, a contraction lifts the origins (ribs) up towards the insertion (central tendon) which works in conjunction with other muscles to allow the ribs to slide and the thoracic cavity to expand laterally and upwards.
When the diaphragm relaxes, air is exhaled by elastic recoil process of the lung and the tissues lining the thoracic cavity. Assisting this function with muscular effort (called forced exhalation) involves the internal intercostal muscles used in conjunction with the abdominal muscles, which act as an antagonist paired with the diaphragm's contraction.
The diaphragm is also involved in non-respiratory functions. It helps to expel vomit, feces, and urine from the body by increasing intra-abdominal pressure, aids in childbirth, and prevents acid reflux by exerting pressure on the esophagus as it passes through the esophageal hiatus.
In some non-human animals, the diaphragm is not crucial for breathing; a cow, for instance, can survive fairly asymptomatically with diaphragmatic paralysis as long as no massive aerobic metabolic demands are made of it.
If either the phrenic nerve, cervical spine or brainstem is damaged, this will sever the nervous supply to the diaphragm. The most common damage to the phrenic nerve is by bronchial cancer, which usually only affects one side of the diaphragm. Other causes include Guillain–Barré syndrome and systemic lupus erythematosus.
A hiatus hernia is a hernia common in adults in which parts of the lower esophagus or stomach that are normally in the abdomen pass/bulge abnormally through the diaphragm and are present in the thorax. Hernias are described as rolling, in which the hernia is beside the oesophagus, or sliding, in which the hernia directly involves the esophagus. These hernias are implicated in the development of reflux, as the different pressures between the thorax and abdomen normally act to keep pressure on the esophageal hiatus. With herniation, this pressure is no longer present, and the angle between the cardia of the stomach and the oesophagus disappear. Not all hiatus hernias cause symptoms however, although almost all people with Barrett's oesophagus or oesophagitis have a hiatus hernia.
Hernias may also occur as a result of congenital malformation, a congenital diaphragmatic hernia. When the pleuroperitoneal membranes fail to fuse, the diaphragm does not act as an effective barrier between the abdomen and thorax. Herniation is usually of the left, and commonly through the posterior lumbocostal triangle, although rarely through the anterior foramen of Morgagni. The contents of the abdomen, including the intestines, may be present in the thorax, which may impact development of the growing lungs and lead to hypoplasia. This condition is present in 1 out of 2,000 births. A large herniation has a mortality rate of three out of four, and requires immediate surgical repair.
Due to its position separating the thorax and abdomen, fluid abnormally present in the thorax, or air abnormally present in the abdomen, may collect on one side of the diaphragm. An X-ray may reveal this. Pleural effusion, in which there is fluid abnormally present between the two pleurae of the lungs, is detected by an X-ray of the chest, showing fluid collecting in the angle between the ribs and diaphragm. An X-ray may also be used to reveal a pneumoperitoneum, in which there is gas in the abdomen.
An X-ray may also be used to check for herniation.
The adoption of a deeper breathing pattern typically occurs during physical exercise in order to facilitate greater oxygen absorption. During this process the diaphragm more consistently adopts a lower position within the body’s core. In addition to its primary role in breathing, the diaphragm also plays a secondary role in strengthening the posture of the core. This is especially evident during deep breathing where its generally lower position increases intra-abdominal pressure, which serves to strengthen the lumbar spine.
The key to real core stabilization is to maintain the increased IAP while going through normal breathing cycles. […] The diaphragm then performs its breathing function at a lower position to facilitate a higher IAP.
Therefore, if a person's diaphragm position is lower in general, through deep breathing, then this assists the strengthening of their core during that period. This can be an aid in strength training and other forms of athletic endeavour. For this reason, taking a deep breath or adopting a deeper breathing pattern is typically recommended when lifting heavy weights.
The existence of a membrane separating the pharynx from the stomach can be traced widely among the chordates. Thus the model organism, the marine chordate lancelet, possesses an atriopore by which water exits the pharynx, which has been claimed (and disputed) to be homologous to structures in ascidians and hagfishes. The tunicate epicardium separates digestive organs from the pharynx and heart, but the anus returns to the upper compartment to discharge wastes through an outgoing siphon.
Thus the diaphragm emerges in the context of a body plan that separated an upper feeding compartment from a lower digestive tract, but the point at which it originates is a matter of definition. Structures in fish, amphibians, reptiles, and birds have been called diaphragms, but it has been argued that these structures are not homologous. For instance, the alligator diaphragmaticus muscle does not insert on the esophagus and does not affect pressure of the lower esophageal sphincter. The lungs are located in the abdominal compartment of amphibians and reptiles, so that contraction of the diaphragm expels air from the lungs rather than drawing it into them. In birds and mammals, lungs are located above the diaphragm. The presence of an exceptionally well-preserved fossil of Sinosauropteryx, with lungs located beneath the diaphragm as in crocodiles, has been used to argue that dinosaurs could not have sustained an active warm-blooded physiology, or that birds could not have evolved from dinosaurs. An explanation for this (put forward in 1905), is that lungs originated beneath the diaphragm, but as the demands for respiration increased in warm-blooded birds and mammals, natural selection came to favor the parallel evolution of the herniation of the lungs from the abdominal cavity in both lineages. However, birds do not have diaphragms. They do not breathe in the same way as mammals, and do not rely on creating a negative pressure in the thoracic cavity, at least not to the same extent. They rely on a rocking motion of the keel of the sternum to create local areas of reduced pressure to supply thin, membranous airsacs cranially and caudally to the fixed-volume, non-expansive lungs. A complicated system of valves and air sacs cycles air constantly over the absorption surfaces of the lungs so allowing maximal efficiency of gaseous exchange. Thus, birds do not have the reciprocal tidal breathing flow of mammals. On careful dissection, around eight air sacs can be clearly seen. They extend quite far caudally into the abdomen.
This article incorporates text from a publication now in the public domain: Chambers, Ephraim, ed. (1728). "article name needed". Cyclopædia, or an Universal Dictionary of Arts and Sciences (first ed.). James and John Knapton, et al.Abdomen
The abdomen (less formally called the belly, stomach, tummy or midriff) constitutes the part of the body between the thorax (chest) and pelvis, in humans and in other vertebrates. The abdomen is the frontal part of the abdominal segment of the trunk, the dorsal part of this segment being the back of the abdomen. The region occupied by the abdomen is termed the abdominal cavity. In arthropods it is the posterior tagma of the body; it follows the thorax or cephalothorax. The abdomen stretches from the thorax at the thoracic diaphragm to the pelvis at the pelvic brim. The pelvic brim stretches from the lumbosacral joint (the intervertebral disc between L5 and S1) to the pubic symphysis and is the edge of the pelvic inlet. The space above this inlet and under the thoracic diaphragm is termed the abdominal cavity. The boundary of the abdominal cavity is the abdominal wall in the front and the peritoneal surface at the rear.Abdominal cavity
The abdominal cavity is a large body cavity in humans and many other animals that contains many organs. It is a part of the abdominopelvic cavity. It is located below the thoracic cavity, and above the pelvic cavity. Its dome-shaped roof is the thoracic diaphragm, a thin sheet of muscle under the lungs, and its floor is the pelvic inlet, opening into the pelvis.Aortic hiatus
The aortic hiatus is a hole in the diaphragm. It is the lowest and most posterior of the large apertures.
It is located approximately at the level of the twelfth thoracic vertebra (T12).Central tendon of diaphragm
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 and right phrenic nerve.Crus of diaphragm
The crus of diaphragm (pl. crura), refers to one of two tendinous structures that extends below the diaphragm to the vertebral column. There is a right crus and a left crus, which together form a tether for muscular contraction. They take their name from their leg-shaped appearance – crus meaning leg in Latin.Diaphragm
Diaphragm may refer to:
Thoracic diaphragm, a thin sheet of muscle between the thorax and the abdomen
Diaphragm (optics), a stop in the light path of a lens, having an aperture that regulates the amount of light that passes
Diaphragm (acoustics), a thin, semi-rigid membrane that vibrates to produce or transmit sound waves
Diaphragm (contraceptive), a small rubber dome placed in the vagina to wall off the cervix, thus preventing sperm from entering
Diaphragm (mechanical device), a sheet of a semi-flexible material anchored at its periphery
Diaphragm (structural system), a structural engineering system used to resist lateral loadsDiaphragmatic excursion
Diaphragmatic excursion is the movement of the thoracic diaphragm during breathing.
Normal diaphragmatic excursion should be 3–5 cm, but can be increased in well-conditioned persons to 7–8 cm. This measures the contraction of the diaphragm.
It is performed by asking the patient to exhale and hold it. The provider then percusses down their back in the intercostal margins (bone will be dull), starting below the scapula, until sounds change from resonant to dull (lungs are resonant, solid organs should be dull). That is where the provider marks the spot. Then the patient takes a deep breath in and holds it as the provider percusses down again, marking the spot where the sound changes from resonant to dull again. Then the provider will measure the distance between the two spots. Repeat on the other side, is usually higher up on the right side. If it is less than 3–5 cm the patient may have a pneumonia or a pneumothorax in which a chest x-ray is diagnostic for either.Esophageal hiatus
In human anatomy, the esophageal hiatus is an opening in the diaphragm through which the esophagus and the vagus nerve pass. It is located in the right crus, one of the two tendinous structures that connect the diaphragm to the spine. Fibers of the right crus cross one another below the hiatus.It is located approximately at level of the tenth thoracic vertebra (T10).
The 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 superior, anterior, and slightly left of the aortic hiatus, and transmits the esophagus, the vagus nerve, the left inferior phrenic vessels, and some small esophageal arteries from left gastric vessels. The right crus of the diaphragm loops around forming a sling around the esophagus. Upon inspiration, this sling would constrict the esophagus, forming a functional (not anatomical) sphincter that prevents stomach contents from refluxing up the esophagus when intra-abdominal pressure rises during inspiration.Exhalation
Exhalation (or expiration) is the flow of the breath out of an organism. In humans it is the movement of air from the lungs out of the airways, to the external environment during breathing.
This happens due to elastic properties of the lungs, as well as the internal intercostal muscles which lower the rib cage and decrease thoracic volume. As the thoracic diaphragm relaxes during exhalation it causes the tissue it has depressed to rise superiorly and put pressure on the lungs to expel the air. During forced exhalation, as when blowing out a candle, expiratory muscles including the abdominal muscles and internal intercostal muscles generate abdominal and thoracic pressure, which forces air out of the lungs.
Exhaled air is rich in carbon dioxide, a waste product of cellular respiration during the production of energy, which is stored as ATP. Exhalation has a complementary relationship to inhalation which together make up the respiratory cycle of a breath.Kappo
Kappo (活法, kappō, "resuscitation techniques") are healing techniques that often involve stimulation of specific acupuncture points. Kappo is commonly used in martial arts such as Danzan Ryu and Judo. Kappo contains two kanji: katsu (活 “resuscitation, life”) and ho (法 “method”).
More specifically, kappo refers to resuscitation techniques used to revive someone who has been choked to the point of unconsciousness, to lessen the pain of a strike to the groin, to help unlock a seized thoracic diaphragm, to stop a bleeding nose, and other common training injuries. These techniques, as practiced by the martial arts of Judo and Danzan Ryu, can involve striking specific points on the body, manual manipulation of the carotid triangle to open closed arteries, or manually opening and closing the lungs to allow air to flow in and out. The manual manipulation of breathing, which has some similarities with rescue breathing and CPR, is called katsu.
A tradition in some Judo schools involves teaching kappo to all new shodan (black belts). This instruction is followed by a session where each of the shodan choke someone, are choked themselves, and resuscitate someone using kappo.Lateral arcuate ligament
The lateral arcuate ligament (also lateral lumbocostal arch and external arcuate ligament) is a ligament under the diaphragm that arches across the upper part of the quadratus lumborum muscle. It is traversed by the subcostal nerve, artery and vein.Lumbocostal triangle
The Lumbocostal triangle or Bochdalek's foramen is a space between the costal and lumbar parts of the diaphragm. The base of this triangular space is formed by muscle attachments originating from the XII rib and muscle fibers attaching to the lateral arcuate ligament. The apex of the triangle is oriented towards the tendinous centre of the diaphragm. Parietal pleura and renal capsule are in contact in this space, so possible infection can be transmitted through this space.Medial arcuate ligament
The medial arcuate ligament (also medial lumbocostal arch and internal arcuate ligament) is a tendinous fascia that arches over the psoas major muscle as it passes through the diaphragm.Median arcuate ligament
The median arcuate ligament is a ligament under the diaphragm that connects the right and left crura of diaphragm.Peritoneum
The peritoneum is the serous membrane forming the lining of the abdominal cavity or coelom in amniotes and some invertebrates, such as annelids. It covers most of the intra-abdominal (or coelomic) organs, and is composed of a layer of mesothelium supported by a thin layer of connective tissue. This peritoneal lining of the cavity supports many of the abdominal organs and serves as a conduit for their blood vessels, lymphatic vessels, and nerves.
The abdominal cavity (the space bounded by the vertebrae, abdominal muscles, diaphragm, and pelvic floor) is different from the intraperitoneal space (located within the abdominal cavity but wrapped in peritoneum). The structures within the intraperitoneal space are called "intraperitoneal" (e.g., the stomach and intestines), the structures in the abdominal cavity that are located behind the intraperitoneal space are called "retroperitoneal" (e.g., the kidneys), and those structures below the intraperitoneal space are called "subperitoneal" or "infraperitoneal" (e.g., the bladder).Phrenicocolic ligament
A fold of peritoneum, the phrenicocolic ligament is continued from the left colic flexure to the thoracic diaphragm opposite the tenth and eleventh ribs; it passes below and serves to support the spleen, and therefore has received the name of sustentaculum lienis.
The phrenicocolic ligament is also called Hensing's ligament after Friedrich Wilhelm Hensing (1719–1745), a German professor for medicine in Gießen.Septum transversum
The septum transversum is a thick mass of cranial mesenchyme, formed in the embryo, that gives rise to parts of the thoracic diaphragm and the ventral mesentery of the foregut in the developed human being.Sternocostal triangle
The sternocostal triangle or foramina of Morgagni are small zones lying between the costal and sternal attachments of the thoracic diaphragm. Important vessels that pass through these bilateral foramina include the superior epigastric arteries as terminations of the internal thoracic arteries, with accompanying veins and lymphatics.
Also known as sternocostal hiatus or (Larrey's) triangle.Superior phrenic vein
The superior phrenic vein, i.e., the vein accompanying the pericardiacophrenic artery, usually opens into the azygos vein.