Elevation of hemidiaphragm

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.