Patología del diafragma / Diseases of the diaphragm

El diafragma es el principal músculo involucrado en la ventilación y está inervado exclusivamente por los nervios frénicos. Los defectos congénitos de la musculación del diafragma o la lesión de los nervios frénicos causan la patología denominada parálisis-eventración diafragmática. El pronóstico y el tratamiento dependen de si la afectación es uni o bilateral y de la situación clínica previa del paciente. Además, el diafragma sirve de separación anatómica entre la cavidad torácica y abdominal, y está atravesado por el esófago e importantes estructuras vasculares y nerviosas. La dilatación anómala de los orificios naturales del diafragma o la pérdida de continuidad del mismo pueden provocar el paso de estructuras abdominales a la cavidad torácica, lo que conocemos como hernias diafragmáticas. Según su etiología, las hernias se dividen en: congénitas, adquiridas y traumáticas. Las manifestaciones clínicas, el pronóstico y el tratamiento dependen en gran medida del tamaño de la hernia y de la edad de aparición. Como en cualquier músculo, en el diafragma se pueden desarrollar tumores primarios benignos o malignos. Sin embargo, es mucho más frecuente la afectación tumoral del diafragma por tumores que asientan en órganos vecinos. El pronóstico es bueno en los tumores primarios benignos y pésimo en los tumores malignos, tanto primarios como secundarios. En este artículo se revisan las principales características anatómicas y fisiológicas del diafragma, sus vías de abordaje quirúrgico y sus patologías más frecuentes (AU)

The diaphragm is the main muscle involved in ventilation and is supplied exclusively by the phrenic nerves. Congenital defects of the diaphragm muscle or phrenic nerve injury cause diaphragmatic paralysis eventration. Prognosis and treatment depend on whether involvement is unilateral or bilateral and on the patient’s previous clinical status. In addition, the diaphragm is an anatomical barrier between the thoracic and abdominal cavities and is traversed by the esophagus and important vascular and nerve structures. Abnormal dilation of the natural orifices of the diaphragm or loss of its continuity can cause abdominal structures to pass into the chest cavity, an occurrence known as diaphragmatic hernias. According to their etiology, hernias are divided into congenital, acquired and traumatic. Clinical manifestations, prognosis and treatment depend mainly on hernia size and age at diagnosis. Like any muscle, the diaphragm can develop benign or malignant primary tumors. However, diaphragm involvement due to tumors arising in adjacent organs is much more common. The prognosis is good in benign primary tumors and poor in both primary and secondary malignant tumors. This article reviews the main anatomical and physiological characteristics of the diaphragm, routes of surgical access and the most frequent diseases affecting this structure (AU)

[Diseases of the diaphragm]. / Patología del diafragma.

The diaphragm is the main muscle involved in ventilation and is supplied exclusively by the phrenic nerves. Congenital defects of the diaphragm muscle or phrenic nerve injury cause diaphragmatic paralysis-eventration. Prognosis and treatment depend on whether involvement is unilateral or bilateral and on the patient's previous clinical status. In addition, the diaphragm is an anatomical barrier between the thoracic and abdominal cavities and is traversed by the esophagus and important vascular and nerve structures. Abnormal dilation of the natural orifices of the diaphragm or loss of its continuity can cause abdominal structures to pass into the chest cavity, an occurrence known as diaphragmatic hernias. According to their etiology, hernias are divided into congenital, acquired and traumatic. Clinical manifestations, prognosis and treatment depend mainly on hernia size and age at diagnosis. Like any muscle, the diaphragm can develop benign or malignant primary tumors. However, diaphragm involvement due to tumors arising in adjacent organs is much more common. The prognosis is good in benign primary tumors and poor in both primary and secondary malignant tumors. This article reviews the main anatomical and physiological characteristics of the diaphragm, routes of surgical access and the most frequent diseases affecting this structure.