Diaphragma

Abstract: One hundred sphenoid bones that were removed at autopsy from patients without apparent pituitary disease and with histologically normal pituitary glands were examined. In 46 specimens the diaphragma sellae was complete. The majority showed convex downward bowing below the diaphragmatic line in both the lateral and frontal planes while the remainder were straight, corresponding to the diaphragmatic line. In only one specimen was the diaphragma sellae convex upward in both planes. These findings suggest that upward displacement of the diaphragma sella as seen of coronal and sagittal computed tomography (CT) may provide early evidence of an expanding pituitary lesion. Twenty of 54 defective specimens had a defect that was larger than 80% of the length of the diaphragma sellae. There was a correlation between the size of the defect and the depth of the intrasellar cistern that resulted from the downward extension of the suprasellar cistern. Such variations may lead to confusion in CT interpretation. The pituitary infundibulum was at or behind the level of the midpoint of the diaphragma sellae in all specimens. In the presence of a defect, the infundibulum usually retained its relationship to the posterior rim of the defect, and therefore when the defect was large the infundibulum was found adjacent to the dorsum sellae.

Abstract: The objective of the present work was to use equine pericardiun preserved in glycerin as an implant to correct diaphragmatic lesions in adult mongrel dogs. After laparotomy, a 4 x 4 cm fragment of the muscular coat of the diaphragma was resected; afterwards the lesion was occluded by an implant of pericardium through a festoned suture using chromic catgut 3-0. The dogs did well during the post-operative period, with no signs of respiratory restriction. The animals (5/group) were sacrificed 7, 15, 30, 45 and 60 days post-surgery. At the autopsy, the findings of the diaphragma and surrounding tissues were noted and fragments were taken for histopathology. Grossly the implant occluded completely the induced lesion, was adhered to the liver and pericardium and decreased in size without interfering with the diaphragma elasticity. At the histology, there was an initial phase (day 7 and 15) characterized by an acute inflammatory response followed by a reparative process ending up with the appearance of newly formed fibrous membrane which totally replaced the former muscular coat. The present procedure seems to be an adequate technique to repair diaphragmatic lesions in small animals. In addition, it employs a material which is non-expensive and easy to obtain, to keep and to apply.

Abstract: We report a case of hydatid cyst of diaphragma in a 70 year-old male, who was admitted to hospital in emergency for right basithoracic pain, aggravated by cough and deep breathing. Laboratory tests were normal. Standard roentgenographs showed a right-sided subpulmonic opacity. Pleural aspiration fluid revealed hemorrhagic pleural effusion. Lung scintigraphy showed and hypoperfused area at the base. Abdominal echography evidenced an hepatic cyst referred to the diaphragma. Thoracoabdominal CT-scans indicated a calcium-loaded mass on the postero-lateral aspect of the right lobe of liver. Surgical exploration revealed an independent hepatic cyst localized in the latero-costal bundles of the diaphragma which was removed en masse.