Mnemonic

Other Structures Piercing the Diaphragm

A memory aid for the smaller structures crossing the diaphragm beyond the three main openings.

Expansion

Left phrenic nerve, superior epigastric vessels, splanchnic nerves, hemiazygos vein and lymphatics

Expansion

Beyond the three named apertures:

  • Left phrenic nerve - pierces the muscular dome to the left of the pericardium
  • Superior epigastric vessels - through the sternocostal triangle (foramen of Morgagni)
  • Greater, lesser and least splanchnic nerves - pierce the crura
  • Hemiazygos vein - pierces the left crus
  • Sympathetic trunks - behind the medial arcuate ligament
  • Subcostal vessels and nerve - behind the lateral arcuate ligament
  • Lymphatics - from the liver, through several sites

The sternocostal triangle is a genuine weak point in the muscle, and it is the route of a Morgagni hernia as well as of the superior epigastric vessels.