Elevation of hemidiaphragm

Case contributed by Dr Huy Sruy

Presentation

Presenting for a routine check-up. Asymptomatic.

Patient Data

Age: 35 years
Gender: Male
X-ray

Elevation of the left hemi-diaphragmatic is noted with bowel and stomach in place.

No parenchyma lesion is noted.

Case Discussion

An elevated diaphragm is when either:

  • the left diaphragmatic dome is to the same level or higher than the right diaphragmatic dome
  • the right diaphragmatic dome is higher than the right 5th anterior bow in deep inspiration

Elevation of diaphragm should be temporary or permanently according to the pathology. Possibly etiologies include:

  • subpulmonic effusion
    • if on the right side, there is effacement of posterior pulmonary vascular
    • if on the left side, there is a distance of >1.5 cm from left diaphragmatic dome to gastric air bubble
  • collapsed lung, where there is deviation of diaphragm (looking at the trachea is helpful)
  • diaphragmatic eventration, where there is an elevated diaphragm without effacement of posterior pulmonary vascularity
  • diaphragmatic Hernia, where there is an elevated diaphragm, a retrocardiac opacity, but also a respect for the costophrenic angle
  • phrenic nerve palsy
  • sub-diaphragmatic pathology such as a liver mass

In this case, the study shows an left elevated diaphragm without effacement of posterior pulmonary vascularity, thus diphragmatic eventration is most likely. A lateral plain radiograph view or a CT scan would be helpful.

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