Development of The Diaphragm-1

DEVELOPMENT OF THE DIAPHRAGM
FORMATION OF THE INTRAEMBRYONIC COELOM/CAVITY
At the end of the 3rd week, intraembryonic mesoderm on each side of the midline
differentiates into a paraxial portion, an intermediate portion, and a lateral plate. When
intercellular clefts appear in the lateral mesoderm, the plates are divided into two
layers: the somatic mesoderm layer and the splanchnic mesoderm layer. The space
between these layers forms the intraembryonic cavity (body cavity). This
intraembryonic cavity extends from the thoracic to the pelvic region.
In other words, when the body of the embryo folds cephalocaudally and laterally, a
large intraembryonic cavity extending from the thoracic to the pelvic region forms.
PARTITIONING OF THE INTRAEMBRYONIC COELOM. The intraembryonic cavity/coelom
is initially one continuous space from the thoracic to the pelvic region. In order to form
the definitive adult pericardial, pleural, and peritoneal cavities, 2 partitions must
develop: the paired pleuropericardial membranes and the diaphragm.
The paired pleuropericardial membranes are sheets of somatic mesoderm that separate
the pericardial cavity from the pleural cavities. They develop into the definitive fibrous
pericardium that surrounds the adult heart.
The Diaphragm
The diaphragm separates the pleural cavities from the peritoneal cavity. It is formed
through the fusion of tissue from four different sources:
1. The septum transversum is a thick mass of mesoderm between the primitive heart
tube and the developing liver. This septum does not separate the thoracic and abdominal
cavities
completely but leaves large openings, the pleuroperitoneal canals, on each side of the
foregut. Septum transversum is the primordium of the central tendon of the diaphragm in
the adult.
2. The paired pleuroperitoneal membranes are sheets of somatic mesoderm that
develop from the dorsal and dorsolateral body wall. Gradually they extend medially and
ventrally so that by the 7th week they fuse with the mesentery of the esophagus and
with the septum transversum. Hence the connection between the pleural and
peritoneal portions of the body cavity (left by posterior defective covering by septum
transversum) is closed by the pleuroperitoneal membranes.
3. The dorsal mesentery of the esophagus is invaded by myoblasts and forms the crura
of the diaphragm in the adult.
4. The body wall contributes muscle to the peripheral portions of the definitive
diaphragm
Positional Changes of the Diaphragm
Initially the septum transversum lies opposite cervical somites, and nerve components
of the third, fourth, and fifth cervical segments (C3, C4, C5) of the spinal cord (known as
phrenic nerves) grow into the septum and pass through the pleuropericardial
membranes. (This explains the definitive location of the phrenic nerves associated with
the fibrous pericardium).
Although the septum transversum lies opposite cervical segments during the fourth
week, by the sixth week the developing diaphragm is at the level of thoracic somites.
The repositioning of the diaphragm is caused by rapid growth of the dorsal part of the
embryo (vertebral column), compared with that of the ventral part. By the beginning of
the third month some of the dorsal bands of the diaphragm originate at the level of the
first lumbar vertebra.
The phrenic nerves supply the diaphragm with its motor and sensory innervation.
Since the most peripheral part of the diaphragm is derived from mesenchyme of the
thoracic wall, it is generally accepted that some of the lower intercostal (thoracic)
nerves contribute sensory fibers to the peripheral part of the diaphragm.
CLINICAL CORRELATIONS
A. Esophageal hiatal hernia is a herniation of the stomach through the esophageal

hiatus into the pleural cavity, caused by an abnormally large esophageal hiatus.
Esophageal hiatal hernia renders the esophago-gastric sphincter incompetent so that
stomach contents reflux into the esophagus. The clinical sign in the newborn is vomiting
(frequently projectile) when the infant is laid on its back after feeding.
B. Congenital diaphragmatic hernia is a herniation of abdominal contents into the

pleural cavity, caused by a failure of the pleuroperitoneal membrane to develop or fuse
with the other components of the diaphragm. It is found most commonly on the left
posterolateral side. The hernia is usually life threatening, because abdominal contents
compress the lung buds and cause pulmonary hypoplasia. Clinical signs in the newborn
consist of an unusually flat abdomen, breathlessness, and cyanosis.
Figure. (A) A congenital diaphragmatic hernia. Note the defect in the diaphragm, which
allows loops of intestine and a portion of the liver to enter the pleural cavity. There is
attendant pulmonary hypoplasia. (B) Radiograph of a congenital diaphragmatic hernia.
Note the loops of intestine within the pleural cavity as indicated by the bowel gas above
and below the diaphragm and the mediastinal shift to the right.

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Development of The Diaphragm-1

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DEVELOPMENT OF THE DIAPHRAGM

FORMATION OF THE INTRAEMBRYONIC COELOM/CAVITY

Positional Changes of the Diaphragm

A. Esophageal hiatal hernia is a herniation of the stomach through the esophageal

B. Congenital diaphragmatic hernia is a herniation of abdominal contents into the

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