Where do the inferior phrenic veins drain?
The Inferior Phrenic Veins drain the diaphragm and follow the course of the inferior phrenic arteries; the right ends in the inferior vena cava;
Where do the phrenic nerves supply blood?
Both phrenic nerves are supplied by the pericardiophrenic artery , which is a branch of the internal thoracic artery, and the superior phrenic vein. 2 The phrenic nerves begin in the neck (cervical spine) and travel to the right and left diaphragm to control contraction and inspiration.
What is the origin of the inferior phrenic artery?
The two inferior phrenic arteries may originate at the aorta, (although both will not generally begin here), the celiac artery, or from a trunk that sprouts from the celiac artery or aorta. One of the inferior phrenic arteries may also arise from the renal arteries.
What is the path of the right phrenic nerve?
The right phrenic nerve descends along the inner aspect of the lung and passes just lateral to the right atrium and right ventricle of the heart. It then passes through the vena cava hiatus on its way to the diaphragm.
What is the phrenic vein?
Medical Definition of phrenic vein : any of the veins that drain the diaphragm and accompany the phrenic arteries: a : one that accompanies the pericardiophrenic artery and usually empties into the internal mammary vein. — called also superior phrenic vein.
Where does the phrenic vein go?
The inferior phrenic veins drain into the posterolateral aspect of the inferior vena cava at the level of T10. The left inferior phrenic vein drains higher than its right counterpart and is found superior to the oesophageal opening in the diaphragm.
Where do phrenic veins drain?
The Inferior Phrenic Veins drain the diaphragm and follow the course of the inferior phrenic arteries. The right ends in the inferior vena cava.
Where is phrenic artery located?
The inferior phrenic artery is a paired vessel that arises from the abdominal aorta. The left and right inferior phrenic arteries emerge immediately below the diaphragm, being the first set of paired branches of the abdominal aorta.
What does phrenic nerve pain feel like?
It causes your diaphragm to contract and expand, giving your lungs ability to inhale and exhale air. Nerve damage can cause a paralyzed diaphragm. You may feel short of breath and have problems sleeping. An irritated phrenic nerve can cause persistent hiccups.
What causes phrenic nerve pain?
Causes of phrenic nerve injury can be from mechanical trauma, as in severe injuries such as spinal cord injury, birth injury, surgical injury, or effects of the disease. Compression can pinch the phrenic nerve from surrounding injury, internal bleeding, and tumor.
What vein drains the diaphragm?
The venous drainage of the diaphragm includes the brachiocephalic veins, azygos veins, and the smaller tributaries of both the inferior vena cava and the left suprarenal vein.
What vein drains blood from the liver?
inferior vena cavaThe three main hepatic veins link up at the top of your liver at the inferior vena cava, a large vein that drains the liver to your right heart chamber. On the bottom end of the liver are the organ's unusual double blood supplies. One is the hepatic artery, which brings in oxygen-rich blood from the heart.
Which veins drain directly into IVC?
The right hepatic vein drains directly into the inferior vena cava (IVC), while the left and middle hepatic veins usually merge before draining into the IVC via a common trunk.
What does the phrenic artery do?
Function. The inferior phrenic arteries supply the diaphragm. Each of the smaller vessels give off superior suprarenal branches to the suprarenal gland of its own side. The spleen and the liver also receive a few twigs from the left and right vessels respectively.
What does phrenic artery mean?
Medical Definition of phrenic artery : any of the several arteries supplying the diaphragm: a : either of two arising from the thoracic aorta and distributed over the upper surface of the diaphragm.
What does the superior phrenic artery do?
The superior phrenic artery is a small paired artery that arises from the anterior aspect of the lower part of the thoracic aorta, just before it passes through the aortic hiatus of the diaphragm. The superior phrenic artery supplies the posterior part of the superior surface of the diaphragm.
What is the tissues supplied or drained by phrenic vein?
Each inferior phrenic artery is a counterpart of a superior phrenic artery and supplies blood to the inferior surface of the diaphragm. The adrenal artery supplies blood to the adrenal (suprarenal) glands and arises near the superior mesenteric artery.
What vein drains the diaphragm?
The venous drainage of the diaphragm includes the brachiocephalic veins, azygos veins, and the smaller tributaries of both the inferior vena cava and the left suprarenal vein.
Where does right suprarenal vein drain into?
inferior vena cavaThe right suprarenal vein drains into the inferior vena cava and the left suprarenal vein drains into the left renal vein or the left inferior phrenic vein.
Where does internal thoracic vein drain?
Where does the internal thoracic vein drain? Blood travels through the internal thoracic vein until it drains into the larger brachiocephalic veins, a pair of large veins in your upper chest. The right and left sides of the brachiocephalic vein come together to form the superior vena cava.
Where does the phrenic nerve originate?
The phrenic nerve originates from the anterior rami of C3 through C5 and traverses the neck, heart, and lungs to reach the diaphragm. From its origin, the phrenic nerve descends vertically caudad and adjacent to the internal jugular vein. In the neck and upper thorax, the left phrenic nerve tracts proximal to the subclavian artery. The right phrenic nerve runs superficial to the anterior scalene muscle and the second part of the right subclavian artery. In the thorax, the right and left phrenic nerve will continue to descend anteriorly to the root of the lung and between the mediastinal surface of the parietal pleura and fibrous pericardium. The right phrenic nerve passes lateral to the right atrium and right ventricle and will continue to descend through the vena cava hiatus in the diaphragmatic opening at the level of T8. The left phrenic nerve descends anterior to the pericardial sac of the left ventricle and terminates at the central tendon of the diaphragm.[1][2][3]
Where is the accessory phrenic nerve located?
In a small number of people, there may be an accessory branch of the phrenic nerve. An accessory phrenic nerve will follow the true phrenic nerve down its course to the diaphragm but often terminates at the pericardium. This variation will be located laterally and posteriorly to the main phrenic nerve and anteriorly to the subclavian vein. This variant is mostly C5 contribution and will branch off proximally at the root of the neck to provide motor innervation to the subclavius muscle.
What nerve is responsible for the hiccup reflex?
The phrenic nerve supplies sensory innervation to the diaphragm. Pain arising from the diaphragm is often referred to the tip of the shoulder, also known as the Kehr sign. For example, a patient with a subphrenic abscess or a ruptured spleen may complain of pain in the left shoulder. The hiccup reflex is due to irritation of the phrenic nerve. It results from sudden spasms of the diaphragm which pull air against the closed fold of the larynx. The phrenic nerve must be identified during thoracic and open-heart surgery. It may be injured during the taking down of the internal mammary artery, which is used for coronary artery bypass. The phrenic nerve often is injured in infants undergoing congenital heart procedures. Once the phrenic nerve is injured, the diaphragm will become paralyzed. On a chest X-ray, the diaphragm will appear elevated. Ultrasound or fluoroscopy can be used to make the diagnosis of a paralyzed diaphragm. If only one side of the diaphragm is paralyzed, most patients can overcome the deficit and lead normal lives. If both sides are paralyzed, phrenic nerve stimulation, intercostal nerve transfer, or a permanent tracheostomy with ventilation dependence is required. Diaphragmatic plication is sometimes done in symptomatic patients when only one diaphragm is paralyzed. Patients who have spinal cord trauma may be able to breathe despite being paralyzed because the phrenic nerve has a higher origin at C3 through C5. [7][8]
What nerve causes elevation of the ipsilateral dome of the diaphragm?
Lesions to either the left or right phrenic nerve will cause relative elevation of the ipsilateral dome of the diaphragm, ultimately paralyzing it from contraction and depression during inspiration. The right phrenic nerve is at risk of being severed with vena cava clamping as the phrenic nerve enters the caval diaphragmatic opening with the inferior vena cava at T8. [4][5][6]
What nerves are involved in the diaphragm?
The phrenic nerve originates from the anterior rami of the C3 through C5 nerve roots and consists of motor, sensory, and sympathetic nerve fibers. It provides complete motor innervation to the diaphragm and sensation to the central tendon aspect of the diaphragm. The left phrenic nerve innervates the left diaphragmatic dome, and the right phrenic nerve innervates the right diaphragmatic dome, with the majority of nerve branching occurring on the inferior aspect of the diaphragm. The motor innervation activation will cause the diaphragm to contract with inspiration, resulting in a flattened diaphragm and increased intrapleural space. During exhalation, the diaphragm relaxes and returns to the dual dome shape. The phrenic nerve also provides touch and pain sensory innervation to the mediastinal pleura and the pericardium in addition to the intercostal nerves.
Which nerves provide motor innervation to the diaphragm?
The phrenic nerves provide motor innervation to the diaphragm and work in conjunction with secondary respiratory muscles (trapezius, pectoralis major, pectoralis minor, sternocleidomastoid, and intercostals) to allow respiration.
What is the purpose of the inferior phrenic arteries?
The inferior phrenic arteries are small vessels that may have various sites of origin. The purpose of these two arteries is to deliver blood to the diaphragm.
Which arteries run along the lumbar spine?
The inferior phrenic arteries separate across the crura of the diaphragm, the muscular bundles that attach the diaphragm to the lumbar spine. The arteries run upward and laterally on the underside of the crura. The left artery passes behind the esophagus, while the right artery passes behind the inferior vena cava.
Which arteries divide into medial and lateral branches?
In the back of the central tendon (which forms the top of the diaphragm), the left and right inferior phrenic arteries divide again into medial and the lateral branches. These arteries also branch into the superior suprarenal braches and the suprarenal gland. Small branches from these arteries may reach the spleen and liver.
Where do the left and right inferior phrenic arteries originate?
The left and right inferior phrenic arteries usually arise as the first branches from the abdominal aorta. They take a superior course, passing anterolaterally to the corresponding crus of the diaphragm. At this level, both arteries give off 1-3 collateral superior suprarenal branches.
What is inferior phrenic artery?
Inferior phrenic artery (Arteria phrenica inferior) The inferior phrenic artery is a paired vessel that arises from the abdominal aorta. The left and right inferior phrenic arteries emerge immediately below the diaphragm, being the first set of paired branches of the abdominal aorta.
Which artery supplies the distal esophagus and tendinous diaphragm?
One of these branches anastomoses with its counterpart branch of the right inferior phrenic artery with which it supplies the distal esophagus and tendinous diaphragm. While the other branch anastomoses with the musculophrenic and pericardiacophrenic arteries, joining the supply system of the trunk wall and pericardium.
Where do the superior suprarenal arteries originate?
The superior suprarenal arteries arise from the inferior aspect of the trunk of each inferior phrenic artery at the level of diaphragmatic crura. They take a short inferior course to reach the ipsilateral adrenal gland and supply its superior portion. Small collateral branches for the upper pole of the spleen and the capsule ...
Which arteries terminate with the lower posterior intercostal and musculophrenic arteries?
They supply the muscular portion of the diaphragm and terminate by anastomosing with the lower posterior intercostal and musculophrenic arteries.
Which artery passes behind the esophagus and then along the left margin of the esoph?
The right inferior phrenic artery curves around the posterior aspect of the inferior vena cava and continues along the right margin of the vena caval foramen. The left inferior phrenic artery passes behind the esophagus and then along the left margin of the esophageal hiatus. Both arteries reach the posterior margin of the central tendon ...
Which branch of the diaphragm bifurcates?
The right ascending branch bifurcates after curving around the inferior vena cava. One of its branches anastomoses with its left-sided counterpart, while the other one diminishes along its course over the lateral part of the abdominal surface of the diaphragm.
Anatomy
Associated Conditions
- Conditions associated with phrenic nerve function or dysfunction can range from benign hiccups to paralysis of both sides of the diaphragm and severe respiratory distress.
Causes
- There are a number of possible causes of phrenic nerve injury leading to paralysis of the diaphragm. These can be broken down by mechanism.
Symptoms
- The symptoms of phrenic nerve injury depend on whether one or both nerves are damaged as well as the age of the person and other health conditions. When only one nerve is damaged in an adult, there may be no symptoms, or there may be shortness of breath that is more apparent with exercise and problems with sleep-disordered breathing.3 When both nerves are damaged sym…
Diagnosis
- The diagnosis is sometimes challenging as symptoms can mimic those of a number of heart and lung conditions. Since a paralyzed diaphragm results in a paradoxical motion of he diaphragm (the diaphragm moves up in the chest during inspiration and down during expiration), a person's abdomen may be noted to move inward rather than outward with inspiration. Elevation of the dia…
Treatment
- The treatment of a phrenic nerve injury and paresis or paralysis of the diaphragm will depend on whether one or both nerves are involved, as well as whether the nerve is severed (as when it is disrupted during surgery) or remains functional (such as with ALS or a spinal cord injury). With some injuries causing only partial paralysis, function may return in time. When both sides are inv…
Prognosis
- The prognosis of a phrenic nerve injury leading to paresis or paralysis of the diaphragm depends on the cause.3 With some infectious or autoimmune conditions, or when the nerve is only injured and not destroyed such as with radiofrequency ablation, function may be restored in several months. Since nerves such as the phrenic nerve do not regenerate, complete disruption …