Presentation
Benign prostatic hyperplasia patient come for elective surgery work up, otherwise asymptomatic. No history of trauma or surgery.
Patient Data
Elevated left diaphragmatic copula with high position intra abdominal contents including distended large bowel loops with haustral markings and stomach.
Elevated left diaphragmatic cupola with slightly thinner left diaphragmatic crus measuring 5 mm in comparison to the right sided one averaging 7 mm. The left anterior costophrenic recess is relatively effaced compared with the posterior. No suspicious parenchymal lesions were identified. The left hemi diaphragm is 3.5 cm higher than the right hemidiaphragm with associated intra-abdominal content stomach, spleen and distended splenic flexure of the colon higher in position under elevated hemidiaphragm.
No intrathoracic mass.
Additionally, The liver has a small size with no anatomic segments to the left of the gall bladder. Only the atrophic segment 4 remnant is seen on coronal images. The stomach is central in position. No history of surgery or trauma. Findings are suggestive of left hepatic lobe hypoplasia.
Case Discussion
Uniform elevation of an entire hemidiaphragm is caused by an imbalance between intra-abdominal pressure and diaphragmatic strength. In this case the left crural and costal muscular portions of the left hemidiaphragm are not atrophied, ruling out paralysis.
Gaseous distension of stomach and splenic flexure are often associated with an elevated left hemidiaphragm, presumably due to increased abdominal pressure.
Diaphragmatic eventration typically affects only a segment of the hemidiaphragm, usually anteromedial, and the posterior costophrenic recess is normal.
Diaphragmatic motion is assessed by fluoroscopy or ultrasound but neither were performed in this case.
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