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The Chest
Published in Kenneth D Boffard, Manual of Definitive Surgical Trauma Care: Incorporating Definitive Anaesthetic Trauma Care, 2019
This is formed by the diaphragm with its various openings. This broad sheet of muscle with its large, trefoil-shaped central tendon has hiatuses through which pass the aorta, the oesophagus and the inferior vena cava, and is it innervated by the phrenic nerves. The oesophageal hiatus also contains both vagus nerves. The aortic hiatus contains the azygos vein and the thoracic duct.
Respiratory system
Published in Aida Lai, Essential Concepts in Anatomy and Pathology for Undergraduate Revision, 2018
Borders of thoracic outlet (closed by diaphragm)– T12, ribs 11 and 12, costal cartilages of ribs 7–10 (costal margin), xiphoid cartilage (level of T9/T10)– Structures passing through: IVCOesophagusAortic hiatus
Anatomy of veins and lymphatics
Published in Ken Myers, Paul Hannah, Marcus Cremonese, Lourens Bester, Phil Bekhor, Attilio Cavezzi, Marianne de Maeseneer, Greg Goodman, David Jenkins, Herman Lee, Adrian Lim, David Mitchell, Nick Morrison, Andrew Nicolaides, Hugo Partsch, Tony Penington, Neil Piller, Stefania Roberts, Greg Seeley, Paul Thibault, Steve Yelland, Manual of Venous and Lymphatic Diseases, 2017
Ken Myers, Paul Hannah, Marcus Cremonese, Lourens Bester, Phil Bekhor, Attilio Cavezzi, Marianne de Maeseneer, Greg Goodman, David Jenkins, Herman Lee, Adrian Lim, David Mitchell, Nick Morrison, Andrew Nicolaides, Hugo Partsch, Tony Penington, Neil Piller, Stefania Roberts, Greg Seeley, Paul Thibault, Steve Yelland
The thoracic duct is 38–45 cm long in an adult and extends from the second lumbar vertebra to the base of neck (Figure 2.20). It passes through the aortic hiatus of the diaphragm and ascends through the posterior mediastinum between the aorta and azygos vein, lying on the vertebral column and behind the oesophagus.
Recognizing and Managing Pancreaticopleural Fistulas in Children
Published in Journal of Investigative Surgery, 2022
Konstantina Dimopoulou, Anastasia Dimopoulou, Nikolaos Koliakos, Andrianos Tzortzis, Dimitra Dimopoulou, Nikolaos Zavras
Pleural effusions related to the presence of PPF are typically large, recurrent, rich in amylase, frequently left-sided, but alsoright-sided, or even bilateral [1–4]. It has been illustrated that PPF arises from either a posterior disruption of the main pancreatic duct or a leaking pseudocyst [1,2,5,6]. Remarkably, PPF was associated with pseudocysts in 26 out of 47 published pediatric cases (Table 1). It is reported that more than 60% of pseudocysts in childhood are attributed to blunt abdominal trauma [7]. Specifically, the main pancreatic duct obstructs and ruptures posteriorly, leading to the formation of a pseudocyst secondary to trauma, surgery, ERCP, or pancreatitis [8–10]. Subsequently, retroperitoneal pancreatic fluid leaks to the mediastinum, usually through a diaphragmatic or aortic hiatus that is the path of least resistance, creating a fistulous tract between the pancreas and mediastinum [11]. A pseudocyst is then formed in the posterior mediastinum that may either become localized or erode into one or both pleural cavities, giving rise to massive unilateral or bilateral pleural effusions [11,12]. Alternatively, the fistula can develop by direct passage of a pseudocyst via a natural diaphragmatic hiatus or though the dome of the diaphragm [2,5,13]. Conversely, anterior pancreatic duct disruption results in pancreatic ascites [8,14].
EUS-guided trans-esophageal drainage of a mediastinal necrotic fluid collection using the axios electrocautery enhanced delivery system™
Published in Scandinavian Journal of Gastroenterology, 2019
Margherita Pizzicannella, Monica Pandolfi, Gianluca Andrisani, Marianna Signoretti, Margareth Martino, Roberta Rea, Francesco Maria Di Matteo
Despite minimally invasive techniques have been developed for the treatment of post-acute pancreatitis abdominal collections, no consensus exists about mediastinal collections. The extension of pancreatic collection in the mediastinum is a consequence of the posterior rupture of pancreatic duct into the retroperitoneal space with penetration of the pancreatic fluid through the diaphragmatic orifices (usually the esophageal or aortic hiatus). To our knowledge, there have been about 50 case reports in literature describing mediastinal extension of pancreatic pseudocyst (PP). Due to the rarity of this clinical scenario, only few case reports about successful EUS-transesophageal drainage have been described [4,7–10]. The first case of endoscopic transesophageal drainage of a mediastinal pseudocyst was reported by Baron et al [8], with placement of a double pigtail drainage stent. Gornals et al [9], first described the successful use of the first generation AXIOS stent for this indication, which caused rapid collapse of the PP and development of immediate pneumothorax requiring T-tube placement. Nevertheless according to Ajmera and Judge [4], all unstable patients or all complicated pseudocysts should be treated with open surgery, recommending as a second step radiological drainage and limiting endoscopic drainage only to expert centers with significant experience.
Image in transplantation surgery: median arcuate ligament in liver transplantation
Published in Acta Chirurgica Belgica, 2020
Morgan Vandermeulen, Martin Moïse, Nicolas Meurisse, Pierre Honoré, Michel Meurisse, Paul Meunier, Olivier Detry
Median arcuate ligament is a fibro-tendinous vault at the base of the diaphragm connecting left and right diaphragmatic crura and forming the anterior margin of the aortic hiatus [2]. Its localization is variable and in case of low insertion at or below the origin of the celiac trunk, extrinsic vascular compression can occur (Figure 2). This anatomical entity can be detected in 2–50% of patients and is most of the time asymptomatic [1,3–5]. Nonetheless, low MAL insertion is controversially believed to cause MAL syndrome (association of post-prandial epigastric pain, weight loss and nausea or vomiting), first described by Dunbar et al. [6]. In their series, Jurim et al. found celiac compression syndrome in 10% of 193 patients undergoing LT [3].