Elevation of hemidiaphragm
Presenting for a routine check-up. Asymptomatic.
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Elevation of the left hemi-diaphragmatic is noted with bowel and stomach in place.
No parenchyma lesion is noted.
2 case question available
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.
- O'Brien FW. Elevation of the diaphragm. (1928) Radiology. 10(3):226-33.