The fibrous pericardium is firmly attached to the central tendon of the diaphragm. Which structure passes through the central tendon at the T8 level, and what clinical significance does pericardial effusion at the left pleuropericardial angle have?

• A Esophagus passes through the central tendon at T8; pericardial effusion causes esophageal compression
• B Aorta passes through the central tendon at T8; large effusion causes aortic compression
• C IVC passes through the central tendon at T8; pericardial effusion at left angle obliterates the left costophrenic angle on CXR and can compress the left phrenic nerve ✓
• D Thoracic duct passes through the central tendon at T8; effusion causes chylothorax

Explanation

The IVC pierces the central tendon of the diaphragm at the T8 vertebral level (caval hiatus). The esophagus traverses the muscular part of the diaphragm at T10, and the aorta passes posterior to the diaphragm at T12 through the aortic hiatus. The fibrous pericardium is fused to the central tendon, so pericardial effusions can dissect into the left pleuropericardial recess, obliterating the left costophrenic angle on CXR and potentially compressing the left phrenic nerve (causing left hiccups or paradoxical diaphragm movement). The thoracic duct ascends through the aortic hiatus at T12.

Reference: BD Chaurasia's Human Anatomy, 8th ed.

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Written and medically reviewed by the StethoPrep medical team.