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Pericardium
Published in Mary N. Sheppard, Practical Cardiovascular Pathology, 2022
This is continuous with the central tendon of the diaphragm. It is made of tough connective tissue and is relatively non-distensible. Its rigid structure prevents rapid overfilling of the heart, but can contribute to serious clinical consequences of cardiac tamponade. There can be extensive fat on the surface especially in obese subjects (Fig. 12.1).
Trunk Muscles
Published in Eve K. Boyle, Vondel S. E. Mahon, Rui Diogo, Handbook of Muscle Variations and Anomalies in Humans, 2022
Eve K. Boyle, Vondel S. E. Mahon, Rui Diogo, Rowan Sherwood
The diaphragm is a continuous musculofibrous sheet that has three portions (Standring 2016). The sternal portion originates from the xiphoid process (Standring 2016). The costal portion originates from the lower six costal cartilages and their corresponding ribs on each side of the thorax (Bergman et al. 1988; Standring 2016). The lumbar portion originates from the medial and lateral arcuate ligaments and from the first three lumbar vertebrae via left and right crura (Standring 2016). The muscle fibers converge into a central tendon near the center of the muscle (Standring 2016).
Diaphragmatic Thickness and Thickening
Published in Massimo Zambon, Ultrasound of the Diaphragm and the Respiratory Muscles, 2022
Thickness and thickening of the diaphragm can be assessed with ultrasound at the zone of apposition (ZOA). The ZOA extends from the diaphragm's caudal insertion near the costal margin, to the costophrenic angle, where the fibres break away from the rib cage to form the free diaphragmatic dome. While the dome of the diaphragm corresponds to the central tendon, the majority of the muscular portion of the diaphragm lies directly in the ZOA (see Chapter 2).
Physiotherapeutic assessment and management of overactive bladder syndrome: a case report
Published in Physiotherapy Theory and Practice, 2023
Bartlomiej Burzynski, Tomasz Jurys, Karolina Kwiatkowska, Katarzyna Cempa, Andrzej Paradysz
The physiotherapist next carried out per vaginum examination of the patient in the same position. The examination began with an observation of perineal area, during which the physiotherapist observed skin color and the appearance of the vaginal orifice and checked for the existence of scar tissue. There were no visible pathological changes in the perineal area or vaginal orifice. Thereafter, the bulbocavernosus reflex was tested by squeezing the clitoral glans (Previnaire, 2018), and a correct reflex response was observed suggesting proper innervation from the S2-S4 level. The physiotherapist also assessed the flexibility of and prevalence of pain in the central tendon of the perineum by means of palpation. The patient did not report any painful symptoms, and the central tendon of her perineum was flexible. In addition, the dynamic function of the central tendon of the perineum was evaluated during coughing. The patient was asked to cough and the physiotherapist observed a correct reflex response and correct timing, which is to say that the central tendon first moved upward and then downward. The perineal behavior was visually assessed, excluding possible external pathologies.
Diaphragmatic endometriosis minimally invasive treatment: a feasible and effective approach
Published in Journal of Obstetrics and Gynaecology, 2021
Andres Vigueras Smith, Ramiro Cabrera, William Kondo, Helder Ferreira
Innervation came from intercostal (T5–T11), subcostal (T12), but mainly by the phrenic nerve (C3–C5), which is in charge of all motor and most of sensitive functions. This phrenic nerve descends following the lateral edge of the scalene muscle (between the subclavian artery and vein) and divides giving two main branches: the pericardial and the phrenic-abdominal branch. At the right side, it reaches the diaphragm in the medial part of the central tendon, just lateral and anterior to vena cava foramen, and is usually not encountered until the non-peritoneal area is exposed. Meanwhile, the left nerve penetrates the diaphragm above the central tendon. This knowledge is crucial when performing a diaphragmatic surgery close the midline because their path is deep and not seen during laparoscopy.
Clinical presentation and treatment of catameinal pneumothorax and endometriosis-related pneumothorax
Published in Expert Review of Respiratory Medicine, 2018
Ludovic Fournel, Antonio Bobbio, Edouard Robin, Emelyne Canny-Hamelin, Marco Alifano, Jean-François Regnard
Obviously, absence of the abovedescribed typical presentation must not exclude diagnosis of CP- or non-CP-TER but, on the contrary, requires careful intraoperative exploration and histopathological assessment in operated women of child-bearing age. As evidence of this disease mostly relies on surgical exploration, minimally invasive approaches in particular (VATS), thus diagnostic and therapeutic procedures, are often combined. Complete intrathoracic exploration should be performed including visualization of the parietal and visceral pleura, the lung, and above all the diaphragm. Indeed, diaphragmatic lesions are frequently observed in series of patients treated mini-invasively with thoracoscopy allowing magnification of lesions presenting as small brown, red, purple, or violet nodules and/or subsequent perforations, usually surrounding the central tendon of diaphragm [6,7,30–34]. An appropriate parenchymal inspection is also recommended for diagnosis and treatment effectiveness, to rule out potential endometrial implants or to assess the presence of other lung defect which could have caused non-TER pneumothorax.