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Related Experiment Videos

The right inferior lung margin: anatomy and clinical implication

B M Morrissey1, R A Bisset

  • 1Department of Diagnostic Radiology, North Manchester General Hospital, Crumpsall, UK.

The British Journal of Radiology
|June 1, 1993
PubMed
Summary

Classical anatomy teaching about the diaphragm sulcus is inaccurate. In living patients, lung tissue extends deeper into this space than previously believed, requiring clinical caution during posterior abdominal procedures.

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Area of Science:

  • Anatomical studies
  • Radiological imaging
  • Clinical anatomy

Background:

  • Traditional anatomical knowledge relies on formalin-fixed cadavers.
  • Assumptions about anatomical structure preservation in the deceased are common.
  • The inferior extent of the lung and pleura in the posterior diaphragmatic sulcus is a key area of anatomical inquiry.

Purpose of the Study:

  • To investigate the actual inferior extent of the lung and pleura in the posterior diaphragmatic sulcus in living adult patients.
  • To compare radiological findings with established classical anatomical descriptions.
  • To highlight potential clinical implications of anatomical discrepancies.

Main Methods:

  • Analysis of plain abdominal radiographs from 100 adult patients.

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  • Radiographic assessment of the inferior borders of the lung and pleura.
  • Comparison of observed anatomical relationships with textbook descriptions.

    • Main Results:

    • In 80% of patients, lung tissue was observed at or below the 12th rib level.
    • In 18% of patients, lung tissue extended to the level of the first lumbar vertebra (L1).
    • A significant difference was found between classical anatomical teaching and radiological findings regarding lung extension into the diaphragmatic sulcus.

    Conclusions:

    • Classical anatomical descriptions of the posterior diaphragmatic sulcus are inaccurate for living patients.
    • Lung tissue, not just pleura, occupies the deep posterior diaphragmatic sulcus in a majority of living individuals.
    • Clinicians performing posterior abdominal procedures near the liver, adrenal gland, or kidney must exercise caution to avoid inadvertent lung or pleural injury.