Elevated hemidiaphragm

Case contributed by Dr Varun Babu

Presentation

Child presented with a respiratory tract infection. A chest radiograph was done.

Patient Data

Age: 7 months old
Gender: Male
X-ray

Chest radiograph

Frontal

  • elevated right hemidiaphragm with dome of the diaphragm at the level of intersection of the 4th anterior rib. 
  • smooth sharp right costophrenic angle. 
  • right lower heart border is obscured by the elevated hemidiaphragm and subdiaphragmatic liver. 
  • the right heart border is just crossing the midline suggestive of left sided cardiac shift. 
  • the visualized right lung zones and the left lung zones are clear.   

Lateral

  • the smooth margins of the elevated right hemidiaphragm are clearly delineated in the lateral radiograph. 
  • no focal eventration. 
  • the left hemidiaphragm is normal in position and contour. 
Fluoroscopy

Symmetric excursion of both diaphragms seen.

Case Discussion

In the crying infant, it is not possible to do the 'sniff test'. The diagnosis is made using the normal inspiratory efforts that are exaggerated when the child is crying. In this case, despite the elevation of the right hemidiaphragm, there appeared to be equal excursion on both sides, ruling out the possibility of a phrenic nerve palsy. Hence a congenital weakness of the right dome of diaphragm was considered. 

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Case information

rID: 44691
Case created: 2nd May 2016
Last edited: 10th May 2016
System: Chest
Inclusion in quiz mode: Included

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