Crossing the Barrier: When the Diaphragm Is Not A Limit

Lidid, Leonardo; Valenzuela, J. L.; Villarroel, Carlos Giugliano; Alegria, J. R. Ruiz De

doi:10.2214/ajr.11.8264

Cited by 16 publications

(23 citation statements)

References 9 publications

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“…These defects create channels between abdominal and thoracic cavity known as pleura-peritoneal channels. This pathology is termed as porous diaphragm syndrome [3,4]. This may lead to transfer of gases or fluids into the thoracic cavity from abdomen [5].…”

Section: Discussionmentioning

confidence: 99%

Breaking the Diaphragmatic Barrier: Unilateral Pneumothorax and Hemothorax after Laparoscopic Myomectomy

Meshram¹,

Jain²,

Khanna³

2017

J Anesth Clin Res

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Laparoscopic surgeries can be associated with thoracic complications like pneumothorax and hemothorax. During laparoscopy, opening of pleura-peritoneal channels and defects in the diaphragm can occur termed as porous diaphragm syndrome and can result in pneumothorax. A 30 yr old woman undergoing laparoscopic myomectomy for uterine fibroid developed hemopneumothorax secondary to porous diaphragm syndrome in the post-operative period. ICD insertion and fluid resuscitation effectively treated this condition. The anesthetist and surgeon should be vigilant about these serious thoracic complications of laparoscopy and have knowledge on management of these conditions.

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Section: Discussionmentioning

confidence: 99%

Breaking the Diaphragmatic Barrier: Unilateral Pneumothorax and Hemothorax after Laparoscopic Myomectomy

Meshram¹,

Jain²,

Khanna³

2017

J Anesth Clin Res

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“…En la pelvis, el músculo ilíaco surge del aspecto profundo de la cresta ilíaca para unirse al músculo psoas bajo el ligamento inguinal, alcanzando después de este punto el muslo proximal, donde se observa su inserción a nivel del trocánter menor del fémur (Figura 2 5a 5b 5c una estrecha relación anatómica con el retroperitoneo, especialmente con los espacios perirrenal y pararrenal posterior, ya que la fascia renal posterior se fusiona con la fascia del músculo iliopsoas (y del cuadrado lumbar) en múltiples puntos, determinando así potenciales vías de comunicación entre ambas estructuras. Considerando que las fascias renales anterior y posterior no siempre están fusionadas en su parte superior o inferior, estas aberturas potenciales también ofrecen una ruta de diseminación tanto hacia el mediastino (dada su conexión con los hiatos diafragmáticos a través del área desnuda del hígado); como hacia los espacios extraperitoneales pélvianos, respectivamente 7,11 . Hacia ventral, el músculo iliopsoas está estrechamente relacionado con el páncreas, la aorta, la vena cava inferior y los ganglios linfáticos retroperitoneales.…”

Section: Anatomía: Compartimento Del Iliopsoas Y Vías De Diseminaciónunclassified

Absceso del iliopsoas: Claves para el diagnóstico imagenológico

2017

Rev. chil. radiol.

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IntroducciónEl absceso del iliopsoas, aunque infrecuente, es una entidad potencialmente letal, insidiosa y de difícil diagnóstico, estando su caracterización dada principalmente por reportes y series de casos 1,2 . El cuadro clínico es inespecífico, por lo que la sospecha inicial es a menudo escasa. La triada clásica de presentación (fiebre, dolor lumbar y cojera) se observa tan solo en un 30% de los casos, dificultándose aún más en la actualidad su diagnóstico, por el enmascaramiento de la sintomatología generado por el indiscriminado uso de antibióticos 3,4,5,6 . Ante tal escenario, los estudios de imagen se han convertido en un pilar diagnóstico fundamental, tanto por la precocidad de su detección como por la especificidad alcanzada por algunas técnicas. El objetivo de este artículo es describir las principales características imagenológicas del absceso del iliopsoas tanto en tomografía computada (TC) como en resonancia magnética (RM), haciendo especial énfasis en sus causas, rutas de diseminación y diagnósticos diferenciales. Anatomía: Compartimento del iliopsoas y vías de diseminación retroperitoneal.Si bien los abscesos pueden presentar fistulización a estructuras y órganos adyacentes (Figura 1), tanto las colecciones como las alteraciones inflamatorias

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“…During the early embryonic life, the coelomic cavity is formed, lined by a serous membrane, and deep to it lies the subserosal space; the integrity of this space is maintained during the division of the coelomic cavity, forming a thoracoabdominal continuum, which crosses the diaphragmatic hiatuses connecting the subperitoneal and subpleural portions of the subserous space [19, 21] (Fig. 7).…”

Section: Mediastinal Spacementioning

confidence: 99%

“…Besides these fully accepted congenital communications, there are also areas of structural weakness of embryologic origin, as tiny focal defects on the tendinous part of the diaphragm or the rare septum transversum lacunar aplasia, which allows transphrenic migration of air/gas [19]. …”

Section: Mediastinal Spacementioning

confidence: 99%

“…The posterolateral portion of PPS has anatomic continuity with the properitoneal flank “stripe” (a layer of areolar tissue and variable amount of fat in between the transversalis fascia and parietal peritoneum) Therefore, air arising within or entering this space may spread to the anterior abdominal wall. PPS also continues superiorly as a thin subdiaphragmatic layer of extraperitoneal fat [18, 19, 25, 26]. …”

Section: Retroperitoneal Spacementioning

confidence: 99%

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The anatomical compartments and their connections as demonstrated by ectopic air

2013

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Air/gas outside the aero-digestive tract is abnormal; depending on its location, it is usually called emphysema, referring to trapped air/gas in tissues, or ectopic air/gas. It can be associated to a wide range of disorders, and although it usually is an innocuous condition, it should prompt a search for the underlying aetiology, since some of its causes impose an urgent treatment. In rare instances, it may itself represent a life-threatening condition, depending on the site involved and how quickly it evolves. Abnormal air/gas beyond viscera and serosal spaces, reaches its location following some anatomic boundaries, such as fascia, which may help search the source; however if the air pressure exceeds the strength of the tissues, or the time between the aggression and the imaging is too long, the air/gas is almost everywhere, which may hinder its cause. Good knowledge of the anatomic spaces and how they connect between them facilitates the quick detection of the cause.Teaching points• Ectopic air can be depicted on conventional radiographs; but CT is more sensitive and accurate• Visceral and retropharyngeal spaces directly communicate with mediastinum• Renal fascia is a single multilaminated structure, which contains potential space

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Crossing the Barrier: When the Diaphragm Is Not A Limit

Abstract: The abdomen and thorax form a continuum on which the diaphragm is an important but incomplete barrier to disease migration.

Cited by 16 publications

References 9 publications

Breaking the Diaphragmatic Barrier: Unilateral Pneumothorax and Hemothorax after Laparoscopic Myomectomy

Breaking the Diaphragmatic Barrier: Unilateral Pneumothorax and Hemothorax after Laparoscopic Myomectomy

Absceso del iliopsoas: Claves para el diagnóstico imagenológico

The anatomical compartments and their connections as demonstrated by ectopic air

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