Panda Ananya, Bhalla Ashu Seith, Sharma Raju, Arora Arundeep, Gupta Arun Kumar
Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India.
Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India.
Curr Probl Diagn Radiol. 2015 Mar-Apr;44(2):122-43. doi: 10.1067/j.cpradiol.2014.11.005. Epub 2014 Nov 20.
The thoracoabdominal region consists of the inferior thorax and superior abdomen and is separated by the diaphragm. Although the diaphragm appears to act as a barrier in this region, various lesions can straddle across the diaphragm and lie contiguously in both the thorax and the abdomen. Thoracoabdominal lesions can extend across the diaphragm either through its various natural openings or through abnormal defects. The natural openings lie in the midline and include the hiatuses for the inferior vena cava, the esophagus, and the retrocrural space, which includes the aortic hiatus and the prevertebral and paravertebral spaces. Abnormal defects include congenital defects in fusion, that is, foramina of Morgagni and Bochdalek and acquired diaphragmatic rupture. Very large lesions can also displace the diaphragm, either inferiorly or superiorly, and thus appear to pseudoextend across this region. Using a pattern approach based on the location and route of extension, thoracoabdominal lesions can be classified as central and lateral lesions. Central lesions form a large group, and based on their location, they can be further classified as central anterior, central tendon, inferior vena cava, esophageal, and retrocrural pathologies. Both central and lateral thoracoabdominal lesions form a diverse spectrum and can be congenital, neoplastic, inflammatory, iatrogenic, or traumatic in etiology. Morphologically, these can consist of solid masses, cystic lesions, and ill-defined collections extending across the diaphragm. This article depicts the imaging appearance of the wide spectrum of lesions straddling across the diaphragm. Familiarity with these pathologies can help in better understanding the continuum formed by the thoracoabdominal region and the various routes of transdiaphragmatic extension.
胸腹区域由下胸部和上腹部组成，由膈肌分隔。尽管膈肌在此区域似乎起到屏障作用，但各种病变可跨越膈肌并同时累及胸部和腹部。胸腹病变可通过膈肌的各种自然开口或异常缺损延伸至膈肌两侧。自然开口位于中线，包括下腔静脉裂孔、食管裂孔以及膈后间隙，膈后间隙包括主动脉裂孔以及椎前和椎旁间隙。异常缺损包括融合的先天性缺陷，即莫尔加尼孔和博赫达勒克孔，以及后天性膈肌破裂。非常大的病变也可使膈肌向上或向下移位，从而看似假性延伸至该区域。根据病变的位置和延伸途径采用模式化方法，胸腹病变可分为中央型和外侧型病变。中央型病变占很大一部分，根据其位置，可进一步分为中央前部、中央腱部（此处原文central tendon可能表述有误，推测可能是central tendonous，暂按中央腱部翻译）、下腔静脉、食管和膈后病变。中央型和外侧型胸腹病变病因多样，可为先天性、肿瘤性、炎症性、医源性或创伤性。形态学上，这些病变可表现为实性肿块、囊性病变以及跨越膈肌的边界不清的肿物。本文描述了跨越膈肌的各种病变的影像学表现。熟悉这些病变有助于更好地理解胸腹区域形成的连续结构以及膈肌跨膈延伸的各种途径。
