1) Regarding the intercostals space [a] Pus from vertebra may accumulate in mid axillary line [b] Oesophageal opening in diaphragm transmits the vagal trunk. [c] Transverse septum forms the central tendon of the diaphragm. [d] In sliding type hernia cardio oesophageal junction is intact. [e] Pulmonary ligament does not help in distention of pulmonary vein.
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I now have enough information from the textbooks combined with my anatomical knowledge to give a thorough answer. Here is the complete analysis of each statement:
Intercostal Space & Diaphragm - MCQ Analysis
[a] Pus from vertebra may accumulate in mid axillary line
✅ TRUE
Pus from a vertebral (tuberculous) abscess - called a "cold abscess" or "psoas abscess" - tracks along tissue planes. From the thoracic vertebrae, pus can travel along the intercostal neurovascular bundle and point/bulge at the posterior triangle or mid-axillary line of the chest wall. This is because the abscess follows the path of least resistance along the fascial planes of the intercostal space. Specifically, pus from the lower thoracic vertebrae may track along the psoas muscle, but pus from upper/mid thoracic vertebrae can emerge at the mid-axillary line by following the lateral intercostal space.
[b] Oesophageal opening in diaphragm transmits the vagal trunk
✅ TRUE
The oesophageal hiatus (at the level of T10) transmits:
- The oesophagus
- The anterior and posterior vagal trunks (formed from the left and right vagus nerves as they spiral around the oesophagus)
- Oesophageal branches of the left gastric vessels
This is a well-established anatomical fact. The vagal trunks enter the abdomen through the oesophageal hiatus along with the oesophagus.
[c] Transverse septum forms the central tendon of the diaphragm
✅ TRUE
Confirmed by the textbooks in the library. From The Developing Human (Clinically Oriented Embryology):
"The septum transversum is the primordium of the central tendon of the diaphragm."
From Langman's Medical Embryology:
"The pleuroperitoneal membranes have fused and formed the central tendon of the diaphragm."
The diaphragm develops from four sources:
- Septum transversum → central tendon (the main contribution)
- Pleuroperitoneal membranes → posterolateral portions
- Dorsal mesentery of oesophagus → crura
- Body wall mesoderm → peripheral muscular rim
[d] In sliding type hernia, cardio-oesophageal junction is intact
❌ FALSE
Confirmed by the textbook (Grainger & Allison's Diagnostic Radiology):
"Sliding hiatal hernias are the most common type (type 1). In this type of hernia the gastro-oesophageal junction slides proximally through the diaphragmatic hiatus to assume an intrathoracic location."
The cardio-oesophageal (gastro-oesophageal) junction is NOT intact/in its normal position - it is displaced upward into the thorax. The junction moves above the diaphragm in a sliding hernia. This is in contrast to a para-oesophageal (rolling) hernia (type 2), where the gastro-oesophageal junction remains below the diaphragm while the fundus herniates alongside the oesophagus.
[e] Pulmonary ligament does not help in distension of pulmonary vein
❌ FALSE (i.e., the statement is incorrect - the ligament DOES help)
The pulmonary ligament is a double fold of pleura that extends inferiorly from the hilum of the lung to the diaphragm. It serves several functions, one of which is to allow distension (engorgement) of the inferior pulmonary vein - it acts as a reservoir space or allows the inferior pulmonary vein to expand when blood volume increases (e.g., during increased venous return). The ligament essentially provides slack so the vein can accommodate volume changes without kinking. Therefore, the statement that it "does NOT help" is false.
Summary Table
| Statement | Verdict | Key Point |
|---|---|---|
| [a] Pus from vertebra may accumulate at mid-axillary line | TRUE | Cold abscess tracks along intercostal space to mid-axillary line |
| [b] Oesophageal hiatus transmits vagal trunk | TRUE | T10 hiatus: oesophagus + anterior & posterior vagal trunks + L. gastric vessels |
| [c] Septum transversum forms central tendon of diaphragm | TRUE | Classic embryological fact - septum transversum = primordium of central tendon |
| [d] Cardio-oesophageal junction is intact in sliding hernia | FALSE | The GOJ itself slides above the diaphragm - it is displaced, not intact |
| [e] Pulmonary ligament does not help in distension of pulmonary vein | FALSE | Pulmonary ligament DOES allow inferior pulmonary vein to distend |
Correct (True) statements: [a], [b], [c]
False statements: [d], [e]
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