Figure 4 - uploaded by Carlos S Restrepo
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Axial T2-weighted MR image shows the normal appearance of the diaphragmatic crura at the level of the aortic hiatus. Normal retrocrural fat typically has high signal intensity on T1-and T2-weighted MR images.
Source publication
The retrocrural space (RCS) is a small triangular region within the most inferior posterior mediastinum bordered by the two diaphragmatic crura. Multiplanar imaging modalities such as computed tomography and magnetic resonance imaging allow evaluation of the RCS as part of routine examinations of the chest, abdomen, and spine. Normal structures wit...
Context in source publication
Context 1
... medial fibers of the right crus continue to sur- round the distal esophagus, forming the esopha- geal hiatus, with some superficial fibers extending around the left margin of the distal esophagus and the deeper fibers running along the right margin. A fasciculus of the medial aspect of the left crus crosses the aorta ventrally and runs along the lateral deeper fibers of the right crus toward the vena cava hiatus (Figs 4, 5). ...
Citations
... were also compared based on the anatomical characteristics of the CG. 13,16,17 This is mainly based on the following considerations: (1) the structure and position of the AG and CD are relatively fixed and can be properly compared at the same CT level; (2) the AG is an important effector organ of the SNS, which has a nerve fiber connection with the CG; and (3) the CD is a commonly used control tissue in radiography. ...
The celiac ganglion (CG) is associated with the sympathetic nervous system (SNS) and plays an important role in the pathogenesis of hypertension. The characteristics of the CG in patients with hypertension remain unknown. The aim of our study was to explore the differences in celiac ganglia (CGs) characteristics between hypertensive and non-hypertensive populations using computed tomography (CT). CGs manifestations on multidetector row CT in 1003 patients with and without hypertension were retrospectively analyzed. The morphological characteristics and CT values of the left CGs were recorded. The CT values of the ipsilateral adrenal gland (AG) and crus of the diaphragm (CD) were also measured. The left CG was located between the left AG and CD, and most CGs were long strips. The frequency of visualization of the left CGs was higher in the hypertension group than in the non-hypertension group (p < .05). There were no significant differences in the maximum diameter, size, and shape ratio of the left CGs between the two groups (p > .05). Except for the left CG in the arterial phase, the CT values of the left CG and AG in the non-hypertensive group were higher than those in the hypertension group (p < .05). The venous phase enhancement of the left CG in the non-hypertension group was significantly higher than that in the hypertension group (p < .05). Our findings reveal that CGs have characteristic manifestations in the hypertensive population. As important targets of the SNS, CGs have the potential to regulate blood pressure.
... These include retrocrural lymphadenopathy in the setting of malignancy or infection [4,8]. The imaging differential diagnosis for cystic mediastinal and retrocrural masses is broad and includes esophageal duplication cysts, benign congenital cysts, meningocele, cystic schwannoma, mature cystic teratoma, lymphangioma, abscess, pancreatic pseudocysts, cystic degeneration of malignant tumors, as well as normal anatomic variants [18][19][20]. Detailed anatomic location on cross-sectional imaging, tissue characteristics, as well as enhancement pattern are all critical in distinguishing these entities. For this reason, the imaging workup generally includes contrast-enhanced CT and often subsequent contrast-enhanced MRI. ...
Enlarged cisterna chyli is an infrequently encountered entity and is most often an asymptomatic, incidental finding on imaging for other reasons. The pathogenesis of cisterna chyli enlargement is not well elucidated and includes infectious, inflammatory, and idiopathic causes. In this report, we present the rare case of an asymptomatic, markedly dilated "mega" cisterna chyli in a 60-year-old female.
... It is bounded by the diaphragmatic crura anterolaterally and by the distal thoracic and proximal lumbar vertebral body posteriorly. Retrocrural neurolysis (RN) targets the thoracic splanchnic nerves that carry pain signals from the celiac plexus to the spinal cord in the space posterior to the diaphragmatic crura [5]. The advantage of RN over celiac plexus neurolysis (CPN) is that the retrocrural space is more superficial and less number of structures is traversed (Fig. 8). ...
Background
To study the qualitative efficacy and safety of percutaneous pain management under CT guidance. The success rate of medical management for chronic pain in long term is very less. This study aids in evaluating the clinical success rate in each CT-guided pain management procedure we have done.
Results
Among the 60 patients, 39 (65%) were male patients and 21 (35%) were female patients. We did 40 celiac plexus neurolysis (66.7%), 13 radiofrequency ablations (21.6%), 4 stellate ganglion neurolysis (6.7%), and 3 trigeminal nerve neurolysis (5%). The average pre-procedural pain score in all the procedures was 7 which was significantly reduced to 1 in 24 h and 1 and 3 months.
Conclusion
Percutaneous pain management under CT guidance by virtue of its precise needle placement offers effective pain relief. It has a lower rate of complications, reduces the need for repeat procedures, and ultimately increases the quality of life.
... The esophageal hiatus and the aortic hiatus pierce the muscle tissue, while the caval hole pierces the purely connective tissue. Other diaphragmatic spaces are found in the paravertebral areas for the passage of muscular structures, such as the psoas and the quadratus lumborum, and for the passage of the sympathetic nerve branches through the contractile tissue, the phrenic nerve, venous structures such as the azygos and hemiazygos veins and the ascending lumbar venous plexus [38,39]. ...
... The dorsal-lumbar portion is described by the medial pillars, extending superiorly from T 11 to L 4 , inferiorly [6,40]. The medial pillars form the diaphragmatic crura (or cross), a formation of muscle tissue that creates a kind of "eight", for the esophageal hiatus (above) and the aortic hiatus (below and posteriorly, also called median arched pillar); the right pillar with terminal contractile and connective tissue, involves the anterior vertebral bodies of T 11 to L 4 , passing over the intervertebral disks [39,40]. The left pillar is less thick and shorter, reaching inferiorly to the vertebral body of L 3 [40]. ...
... The rib fibers form the medial arcuate ligament extending over the psoas muscle, and the lateral arcuate ligament extending over the quadratus lumborum muscle. The first attaches laterally to the vertebral body of L 1 or L 2 and anterior to the transverse process of L 1 , while the second attaches laterally to the apex of the last rib and medially to the transverse process of the first lumbar vertebra [39] (Fig. 2). ...
The eupneic act in healthy subjects involves a coordinated combination of functional anatomy and neurological activation. Neurologically, a central pattern generator, the components of which are distributed between the brainstem and the spinal cord, are hypothesized to drive the process and are modeled mathematically. A functionally anatomical approach is easier to understand although just as complex. Osteopathic manipulative treatment (OMT) is part of osteopathic medicine, which has many manual techniques to approach the human body, trying to improve the patient’s homeostatic response. The principle on which OMT is based is the stimulation of self-healing processes, researching the intrinsic physiological mechanisms of the person, taking into consideration not only the physical aspect, but also the emotional one and the context in which the patient lives. This article reviews how the diaphragm muscle moves, with a brief discussion on anatomy and the respiratory neural network. The goal is to highlight the critical issues of OMT on the correct positioning of the hands on the posterolateral area of the diaphragm around the diaphragm, trying to respect the existing scientific anatomical-physiological data, and laying a solid foundation for improving the data obtainable from future research. The correctness of the position of the operator’s hands in this area allows a more effective palpatory perception and, consequently, a probably more incisive result on the respiratory function.
... The degree of contrast enhancement is weak to avid, and varies depending on disease activity. Iron deposition and calcification or fatty replacement can occur in long-standing, burnout lesions [5,6,38,39,41,42] compared with muscle, while on both T1WI and T2WI older inactive lesions can display low SI and high SI due to iron deposition and significant fatty replacement, respectively [6,41,42]. Extramedullary hematopoiesis at other sites can also coexist with splenomegaly or cardiomegaly due to chronic anemia [39,40]. ...
... The degree of contrast enhancement is weak to avid, and varies depending on disease activity. Iron deposition and calcification or fatty replacement can occur in long-standing, burnout lesions [5,6,38,39,41,42] compared with muscle, while on both T1WI and T2WI older inactive lesions can display low SI and high SI due to iron deposition and significant fatty replacement, respectively [6,41,42]. Extramedullary hematopoiesis at other sites can also coexist with splenomegaly or cardiomegaly due to chronic anemia [39,40]. 99m Tc-sulfur colloid and 111 In-chloride bone marrow scintigraphy have been reported to be useful for confirming the presence of functioning hematopoietic tissue [5,43]. ...
... They can exhibit high attenuation on CT, which is caused by hemorrhaging. Separate intra-abdominal pseudocysts may or may not be present [5,42,49]. ...
Lesions in the middle and posterior mediastinum are relatively rare, but there are some useful radiological clues that can be used to diagnose them precisely. It is useful to determine the affected mediastinal compartment and the locations of the main thoracic nerves on medical images for diagnosing such mediastinal lesions. Neurogenic tumors can occur in the middle mediastinum, although they generally arise as posterior mediastinal tumors. Based on the above considerations, we review various characteristic imaging findings of middle and posterior mediastinal lesions, and their differential diagnoses.
... The retrocrural space also contains lymph nodes, fat, and sympathetic nerve fibers. The retrocrural space directly communicates with the posterior mediastinum and retroperitoneum and serves as a pathway for spread of pathologic conditions across the diaphragm (21). ...
... cephalic to the retrocrural space and retrocrural lymph nodes and may invade the crura ( Fig 16) (5,8,21). Invasion of the crura by metastasis or lymphoma may provide a route for transdiaphragmatic spread (Fig 16) (5,8). ...
... Invasion of the crura by metastasis or lymphoma may provide a route for transdiaphragmatic spread (Fig 16) (5,8). An enlarged retrocrural lymph node (>6 mm) is considered suspicious (21). ...
The diaphragm serves as an anatomic border between the abdominal and thoracic cavities. Pathologic conditions traversing the diaphragm are often incompletely described and may be overlooked, resulting in diagnostic delays. Several routes allow abdominal contents or pathologic processes to spread into the thorax, including along normal transphrenic structures, through congenital defects in the diaphragm, through inherent areas of weakness between muscle groups, or by pathways created by tissue destruction, trauma, or iatrogenic injuries. A thorough knowledge of the anatomy of the diaphragm can inform an accurate differential diagnosis. Often, intraperitoneal pathologic conditions crossing the diaphragm may be overlooked if axial imaging is the only approach to this complex region because of the horizontal orientation of much of the diaphragm. Multiplanar capabilities of volumetric CT and MRI provide insight into the pathways where pathologic conditions may traverse this border. Knowledge of these characteristic routes and use of multiplanar imaging are critical for depiction of specific transdiaphragmatic pathologic conditions.©RSNA, 2020.
... La citerne du chyle ou citerne de Pecquet, principal point de destination de la lymphe est directement en lien avec le DT. La citerne du chyle est sous-diaphragmatique et entourée par les piliers du diaphragme (Restrepo et al., 2008). ...
... Les nerfs grand splanchnique, petit splanchnique et splanchnique inférieur traversent le DT dans sa partie crurale (Restrepo et al., 2008) par un hiatus commun, mais cette traversée est variable selon les individus (Gest et Hildebrandt, 2009;Loukas et al., 2010;Mirjalili et al., 2012;Restrepo et al., 2008). ...
... Les nerfs grand splanchnique, petit splanchnique et splanchnique inférieur traversent le DT dans sa partie crurale (Restrepo et al., 2008) par un hiatus commun, mais cette traversée est variable selon les individus (Gest et Hildebrandt, 2009;Loukas et al., 2010;Mirjalili et al., 2012;Restrepo et al., 2008). ...
... The lateral arcuate ligament extends from the transverse process of L1 to the last rib. 11 The lateral arcuate ligament, sometimes thick and nodular in appearance, may be mistaken for a retroperitoneal nodular metastasis on imaging. Continuity with the diaphragm is a good clue to differentiate this normal finding from metastasis. ...
The diaphragm is not only a sheet of muscle separating the abdominal and thoracic cavities: it plays an essential role in ventilation and can act as a gateway for the spread of different disease processes between the abdominal and the thoracic cavity. Careful attention to the appearance of the diaphragm on various imaging modalities is essential to ensure the accurate diagnosis of diaphragmatic disorders, which may be secondary to functional or anatomical derangements.
... As a consequence of disproportionate growth of the posterior aspect of the fetus, descent of the diaphragm ensues while preserving its nerve supply from cervical somites 3 to 5 (ie, phrenic nerve, C3-C5). 1,22 From a pathophysiologic perspective, the posteromedial extension and subsequent fusion of the pleuroperitoneal membranes with the dorsal mesentery of the esophagus and the septum transversum reduces diaphragmatic strength at the boundaries between membranes with the left copula weaker than the right. 1,22 Other areas of diaphragmatic weakness include zones of fusion to adjacent structures such as the right and left sternocostal triangles. ...
... 1,22 From a pathophysiologic perspective, the posteromedial extension and subsequent fusion of the pleuroperitoneal membranes with the dorsal mesentery of the esophagus and the septum transversum reduces diaphragmatic strength at the boundaries between membranes with the left copula weaker than the right. 1,22 Other areas of diaphragmatic weakness include zones of fusion to adjacent structures such as the right and left sternocostal triangles. 10,22 Separating the thoracic and abdominal cavities, the diaphragm is an upward dome-shaped muscle with a central fibrous tendon. ...
... 1,22 Other areas of diaphragmatic weakness include zones of fusion to adjacent structures such as the right and left sternocostal triangles. 10,22 Separating the thoracic and abdominal cavities, the diaphragm is an upward dome-shaped muscle with a central fibrous tendon. 17 The diaphragm consists of a thin central aponeurosis surrounded by radially extending peripheral striated muscle and is covered by parietal pleura and peritoneum with the exception of the liver bare area on the right hemidiaphragm. ...
Traumatic diaphragmatic injury (TDI) is an underdiagnosed condition that has recently increased in prevalence due to its association with automobile collisions. The initial injury is often obscured by concurrent thoracic and abdominal injuries. Traumatic diaphragmatic injury itself is rarely lethal at initial presentation, however associated injuries and complications of untreated TDI such as herniation and strangulation of abdominal viscera have serious clinical consequences. There are 2 primary mechanisms of TDIs: penetrating TDI which tend to be smaller, more difficult to detect, and result in fewer complications; and blunt TDIs which are larger and have higher overall mortality due to associated injuries or delayed complications. The anatomy of thoracic and abdominal cavities distinguishes the epidemiology, pathophysiology, symptoms, treatment, and prognosis of right versus left TDI. Although there is no definitive radiologic sign for diagnosing TDI, many signs have been introduced in the literature and the concurrent presence of multiple signs increases the sensitivity of TDI detection. Conservative versus surgical management depends on mechanism of TDI, side, and most importantly the associated injuries.
... RPH was diagnosed when high-attenuation (> 40 Hounsfield units) lesions in the retroperitoneal tissue were identified on two or more consecutive axial CT images [4]. Intramuscular hematoma or retrocrural hematoma [24] was not considered as an RPH (ESM_2). If RPH was present, it was classified into one of five types according to our classification for traumatic RPH [4,5] (ESM_3), with which the starting area of the RPH can be traced back based on the concept of interfascial planes: Type 0, having no RPH; Type I, spreading from the anterior pararenal space or the retromesenteric plane; Type II, spreading from the perirenal or posterior pararenal space, the lateroconal plane, or the lateral part of the retrorenal plane; Type III, spreading from the pelvic retroperitoneum; and Type IV, spreading from the combined interfascial plane or the medial or median part of the retrorenal plane. ...
... As shown in Table 2 [24] around the fracture (ESM_2). Thirty-eight (19.7%) patients had RPH not derived from the lumbar fracture. ...
Purpose:
Lumbar vertebral fracture (LVF) infrequently produces massive retroperitoneal hematoma (RPH). This study aimed to systematically review the clinical and radiographic characteristics of RPH resulting from LVF.
Methods:
For 193 consecutive patients having LVF who underwent computed tomography (CT), demographic data, physiological conditions, and outcomes were reviewed from their medical records. Presence or absence of RPH, other bone fractures, or organ/vessel injury was evaluated in their CT images, and LVF or RPH, if present, was classified according to either the Orthopaedic Trauma Association classification or the concept of interfascial planes.
Results:
RPH resulting only or dominantly from LVF was found in 66 (34.2%) patients, whereas among the others, 64 (33.2%) had no RPH, 38 (19.7%) had RPH from other injuries, and 25 (13.0%) had RPH partly attributable to LVF. The 66 RPHs resulting only or dominantly from LVF were radiologically classified into mild subtype of minor median (n = 35), moderate subtype of lateral (n = 11), and severe subtypes of central pushing-up (n = 13) and combined (n = 7). Of the 20 patients with severe subtypes, 18 (90.0%) were in hemorrhagic shock on admission, and 6 (30.0%) were clinically diagnosed as dying due to uncontrollable RPH resulting from vertebral body fractures despite no anticoagulant medication.
Conclusions:
LVF can directly produce massive RPH leading to hemorrhagic death. A major survey of such pathology should be conducted to establish appropriate diagnosis and treatment.
