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Phrenoesophageal ligament

The phrenoesophageal ligament is a double-layered fascial structure derived from the inferior diaphragm fascia, connecting the abdominal esophagus to the esophageal hiatus of the diaphragm. It surrounds the lower esophagus and merges with the adventitia of the esophageal wall.

This ligament is composed of two limbs:

  • Superior limb: Extends from the diaphragm to the esophagus just above the gastroesophageal junction.

  • Inferior limb: Extends from the diaphragm to the cardia of the stomach, just below the gastroesophageal junction.

By anchoring the esophagus to the diaphragm while still allowing some mobility during swallowing and respiration, the phrenoesophageal ligament plays a key role in maintaining the integrity of the gastroesophageal junction (GEJ). Weakness or laxity of this ligament is a major factor in the development of hiatal hernia and gastroesophageal reflux disease (GERD).

Synonyms

  • Phrenicoesophageal membrane

  • Diaphragmatic esophageal ligament

  • Ligament of gastroesophageal junction

Function

  • Anchors the abdominal esophagus to the diaphragm at the esophageal hiatus

  • Maintains alignment of gastroesophageal junction with diaphragmatic crura

  • Provides dynamic mobility during swallowing and respiration

  • Prevents upward migration of stomach into the thorax (anti-reflux mechanism)

  • Weakness predisposes to hiatal hernia and GERD

MRI Appearance

T1-weighted images:

  • Appears as a thin hypointense linear structure at the gastroesophageal junction

  • Surrounded by hyperintense periesophageal fat, which helps delineation

T2-weighted images:

  • Appears as a thin hypointense line bordering the lower esophagus

  • In cases of hernia, ligament displacement or discontinuity may be identified

STIR:

  • Suppresses fat signal, highlighting peri-ligamentous edema or inflammatory change

  • Useful for detecting associated esophagitis or paraesophageal pathology

T1 Fat-Saturated Post-Contrast (Gadolinium):

  • Normally, the ligament does not enhance

  • Pathology such as esophagitis, neoplastic infiltration, or inflammation may cause focal enhancement near the ligament

MRI Non-Contrast 3D Imaging:

  • Provides volumetric views of the GEJ, diaphragm, and ligamentous attachments

  • Useful for evaluating hiatal hernias and pre-surgical planning

CT Appearance

CT Pre-Contrast:

  • Seen as a thin soft-tissue density band attaching esophagus to diaphragm

  • Sometimes difficult to separate from diaphragmatic crura

CT Post-Contrast:

  • Ligament itself does not enhance significantly

  • Enhances visualization of adjacent esophagus, stomach, and crural diaphragm

  • Hiatal hernia is evident when stomach herniates through the esophageal hiatus, reflecting ligament laxity or disruption

MRI image

Phrenoesophageal ligament MRI axial image anatomy image -img-00000-00000

CT images

Phrenoesophageal ligament ct coronal image

CT images

Phrenoesophageal ligament ct axial image