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Thrall > Chapter 29 - Diaphragm > Flashcards

Chapter 29 - Diaphragm Flashcards

1
Q

How is diaphragm formed embryologically?

A

Septum transversum ventrally and by mesentery of foregut and two pleuroperitoneal folds dorsally

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2
Q

What makes up the pars lumbalis?

Where does the pars lumbalis attach?

A

Right and left crura

L3-L4 vertebral body

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3
Q

What are 3 openings in the diaphragm?

A

1) aortic hiatus: aorta, azygos, hemiazygos veins, and thoracic duct
2) esophageal hiatus - esophagus and vagus nerve trunks
3) caudal vena cava

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4
Q

Which crura is displaced cranially on a lateral radiograph?

A

The dependent crura

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5
Q

What do the crura appear like on a right lateral radiograph?

A

Parallel to each other

CVC goes ‘right’ up to the cranial aspect of the diaphragm

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6
Q

What do the crura appear like on a left lateral radiograph?

A

V-shaped to each other

CVC ‘leaves’ (l for leaves) the cranial aspect of the diaphragm (the left crus) behind.

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7
Q

What is the differences in the diaphragm appearance between a highly inspiratory vs expiratory lateral radiograph?

A

Inspiration normally the diaphragm intersects with the spinebetween T11-T13 but may be further caudal.
Inspiration - flattened shape

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8
Q

What can cause cranial displacement of the diaphragm?

A

obesity, ascites, gastric/intestinal distention, abdominal masses , peritoneal fluid, diaphragmatic paralysis

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9
Q

What does the term ‘tenting of the diaphragm’ refer too?

A

Attachment sites at muscle attachments to the diaphragm that are seen on VD radiographs - little V shaped structures on cranial aspect of diaphragm.

Due to hyperinflation

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10
Q

Why can the cranial aspect of the duodenum be seen so well, and not the caudal?

A

Cranial - no border effacement. Air from lung and soft tissue from diaphragm interface

Caudal - border effacement with the liver. Soft tissue on top of soft tissue

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11
Q

What are things that cause superimposition with the cranial aspect of the diaphragm (stuff in the thorax?)

A

fluid, fat, hernias, mass, pleural inflammation

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12
Q

What will cause caudal displacement of the diaphragm

A

severe respiratory distress, tension pneumothorax

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13
Q

What types of diaphragmatic hernias are there?

A 
Trumatic
Peritoneopericardial
Haital
Peritoneopleural
other congenital diaphragmatic defects
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14
Q

What imaging tests could be done to confirm a diaphragmatic hernia?

A 
barium swallow
positive contrast peritoneography 
positive contrsat pleurography
angiocardiography
nonselective cardiography
CT
US
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15
Q

Most common organs to herniate in a traumatic hernia?

A

liver, small bowel, stomach, spleen, omentum

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16
Q

Radiographic signs seen with a traumatic diaphragmatic hernia?

A

Abnormal structures in the thorax (homogeneous soft tissue vs bowel loops)
Loss of definition of the diaphragmatic borders
Cranial displacement of abdominal organs
pleural fluid - can mask some of these other signs

17
Q

What are the congenitally predisposed diaphragmatic hernias?

A

peritoneopericardial diaphragmatic
hiatal hernias
peritoneopleural

18
Q

What is PPDH?

A

Peritoneopericardial diaphragmatic hernia
Abdominal viscera herniates into pericardial sac through a congenital hiatus formed between tendinous portion of diaphragm and pericardial sac

19
Q

What is presenting complaint of PPDH?

A

Usually none - incidental findings

20
Q

Radiographic signs associated with PPDH?

A

Abdominal organs in the pericardial sac: gas, ingesta, soft tissue opacity
Large, round cardiac silhouette
Communication/lack of distinction between caudal aspect of cardiac silhouette and cranial diaphragm
Dorsal peritoneopericardlal mesothelial remnant in between heart and diaphragm on lateral views

21
Q

What is a hiatal hernia?

A

portion of stomach enters the thorax through the esophageal hiatus

22
Q

What are the 2 types of hiatal hernias?

A

sliding and paraesophageal

23
Q

What is a sliding hiatal hernia?

A

Gastroesophageal sphincter and portion of the stomach herniate into the thorax through the esophageal hiatus

Supposedly associated with esophagitis and GE reflux (not always true - see article about congenital sliding hernias in shar-peis)

24
Q

What is a paraesophagela hiatal hernia?

A

Cardiac or cardia and fundus of stomach or other tissue herniates through or alongside the esophageal hiatus and becomes positioned adjacent to the esophagus.

These are usually static

25
Q

Which type of hernia (or both) are static or temporary?

A

Static - paraesophageal, PPDH

Temporary - sliding, traumatic

26
Q

What are hte types of hiatal hernias?

A 
Type I-IV
I - sliding
II - paraesophageal
III - combination of I and II
IV - herniation of organ other than stomach, OR gastroesophageal intussusception
27
Q

Radiographic signs associated with sliding hiatal hernias?

A 
Soft tissue mass adjacent to left diaphragmatic crus
Loss of thoracic surface outline
Craniald isplacement of gastric cardia
Dilated esophagus
pneumonia
28
Q

Esophagram findings of sliding hiatal hernias?

A

Dilated esophagus
Hypomotile esophagus
Gastroesophageal sphincter within thorax - circumferentially narrowed area of esophagus
GE reflux

29
Q

What is radiographic appearance of GE intussusception?

A

large soft tissue mass adjacent to diaphragms with a dilated esophagus.

30
Q

What nerve innervates the diaphragm

A

The phrenic nerve

31
Q

Where does the phrenic nerve originate?

A

C3,4-5 - keeps the diaphragm alive!

32
Q

What are causes of diaphragmatic paralysis?

A

pneumonia, trauma, myopathies, neuropathies, or unidentified

33
Q

What is best way to confirm diaphragmatic paralysis?

A

fluoroscopy

34
Q

what is seen on fluoroscopy with unilateral diaphragmatic paralysis?

A

unequal movement between the crura

35
Q

What is seen on fluoroscopy with bilateral diaphragmatic paralysis?

A

minimal or no diaphragmatic movement

or a paradoxic cranial displacement during inspiration

Thrall (4 decks)

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