Presentation
Child presented with a respiratory tract infection. A chest radiograph was done.
Patient Data
Age: 7 months old
Gender: Male
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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.
From the case:
Elevated hemidiaphragm
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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.