Analysis of diaphragmatic morphology and cause of death: An autopsy study at District General Hospital, Kegalle, Sri Lanka

The lack of detailed morphology of the diaphragm limits the understanding of its pathological manifestations. Objective: The objective of this study was to assess the diaphragmatic morphology of the height, sex, age, and the organ systems involved in the cause of death (COD). This prospective cross-sectional autopsy study was conducted at the District General Hospital, Kegalle, Sri Lanka. Diaphragms, dissected using Letulle’s technique at the autopsy, were measured for weight, anteroposterior (APD) and transverse (TD) diameters, costal and vertebral thicknesses, and the demographic features, body height and COD were recorded. The sample of 252 individuals consisted of 57.9% males, and the mean body height was 156.68 cm. Multiple comorbidities were recorded in 34.1% of the cases, and cardiovascular diseases contributed to 28.2% as COD, while the respiratory system and central nervous system contributed with 20.2% and 11.1% of cases, respectively. Means of weight, APD, TD, left and right costal thickness, and left and right vertebral thickness were 187.5 g, 19.4 cm, 33.1 cm, 1.6 cm, 1.6 cm, 2.7 cm, and 2.8 cm, respectively. All the diaphragmatic parameters showed positive linear correlations with body height. When the Kruskal-Wallis test was applied, males recorded higher mean rank values in diaphragmatic parameters, and the difference between the sexes was statistically significant. Diaphragmatic parameters showed statistically significant differences across age groups, with the youngest subjects recording higher values in diaphragmatic measurements. There were statistically significant differences across organ systems in all diaphragmatic parameters. Diaphragmatic measurements showed positive linear correlations with the subjects' heights, and males recorded higher values in diaphragmatic parameters than females. Values of the diaphragm measurements decreased with increasing age and showed significant differences across the organ systems involved in CODs.