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Eventration of the diaphragm is an abnormal elevation of the dome of diaphragm. It is a condition in which all or part of the diaphragm is largely composed of fibrous tissue with only a few or no interspersed muscle fibers. It can be complete or partial. Complete eventration of the right diaphragm, as seen in this adult patient, is relatively rare.
Citations
... Diaphragmatic eventration can be defined as an abnormal elevation of a portion or the entire hemidiaphragm due to lack of muscle or nerve dysfunction while maintaining its continuity. 1,2 The eventration can be congenital or acquired. A portion of the diaphragm is weakened, resulting in cephalic displacement in the affected side that leads to diminished lung expansion that results in symptoms like dyspnea on exertion, orthopnea, tachypnea, shallow breathing, and respiratory distress. ...
Diaphragmatic plication is the recommended surgical procedure for the treatment of diaphragmatic eventration in those who have failed conservative care. The present case report describes a 63-year-old male patient who presented with breathlessness on exertional activities. Chest X-ray and Computed Tomography (CT) of the thorax revealed diaphragmatic eventration on the right side. After failed conservative management, the patient underwent diaphragmatic plication surgery and was followed up with postoperative physical therapy management. Physical therapy intervention was started from 3 days postsurgery and was continued for 1 week. The treatment goals focused on reducing breathlessness, reducing pain on the incision site, preventing postoperative complications, and improving functional capacity. The present study highlights the benefits of early physical therapy interventions including incentive spirometer, dyspnea relieving techniques, Transcutaneous Electrical Nerve Stimulation (TENS), and light- to moderate-intensity aerobic exercises in the patient after plication surgery.
... Surgical intervention is necessary in cases of severe respiratory distress, recurring infections, and a poor response to conservative treatment. More often reported in men, it affects the left hemi-diaphragm [7]. ...
Tuberculosis is rampant in endemic countries. Extrapulmonary tuberculosis, like pleural effusion, is infrequently reported in outpatient departments. However, diaphragmatic eventration is rare and is not reported in active tuberculosis. Herein, the first-of-its-type case of a diaphragmatic eventration with tuberculous right pleural effusion in an Indian male is presented. The diagnosis was challenging and achieved through radiometric investigations and diagnostic pleural tapping. He was put on an antituberculous treatment based on his weight.
... Thoracic extracardiac activity in MIBI perfusion imaging can be due to various reasons, like thoracic tumor, diaphragmatic hernia, or diaphragmatic eventration [2,3]. Diaphragmatic eventration is abnormally high positioning of the diaphragmatic leaflet, either due to congenital weakness in muscle fibers or due to acquired causes leading to atrophy or paralysis of the dome of the diaphragm [4]. It is usually an asymptomatic phenomenon and is incidentally detected. ...
... An elevated hemi-diaphragm could be secondary to neoplasms or surgical causes. [4] The index patient had undergone coronary artery bypass graft (CABG) surgery. The incidence of phrenic nerve injury post CABG has been well documented. ...
... Diaphragmatic eventration is an abnormal elevation of the dome of the diaphragm into the thoracic cavity [1]. It is an abnormal function and structure of the diaphragm resulting in the displacement of the anatomical position of the diaphragm into the thorax. ...
Background: Diaphragmatic eventration is an abnormal elevation of the dome of the diaphragm into the thoracic cavity. Neonatal respiratory distress is the most common clinical presentation of diaphragmatic eventration. Direct abdominal organ compression on the lung or lung hypoplasia is the cause of this symptom. Preoperative radiological imaging is important to diagnose diaphragmatic eventration. Chest radiographs, ultrasound, CT scans and MRI can be used to evaluate the anatomy of the diaphragm. In complicated condition, video-assisted thoracoscopy (VATS) play a role as a diagnostic and therapeutic tool to diagnose and manage diaphragmatic eventration. Case presentation: We presented a case of a full-term unfortunate baby delivered via emergency lower segment caesarean section due to bleeding of the placenta previa type III. Immediately post-delivery, the patient had respiratory distress with an episode of desaturation. CT scan showed a focal right hemi-diaphragmatic bulge with liver tissue within. Video-assisted thoracoscopy (VATS) was performed and the diagnosis of right diaphragmatic eventration had been established. Diaphragmatic plication was done via a VATS-assisted thoracotomy approach. Conclusion: Video-assisted thoracoscopy (VATS) plays a role as a diagnostic tool and even as a therapeutic tool to diagnose and manage diaphragmatic eventration. The capability of VATS to provide direct visualization intrathoracically has a great advantage in managing a such case.
... Ultrasonography may be used in diagnosing partial eventration and differentiating it from diaphragmatic nerve interruption. Fluoroscopy is considered for the investigation of diaphragmatic paralysis [6]. ...
... (10) An elevated diaphragm might be difficult for clinicians to identify due to their relative rareness. (11) As the elevated diaphragm is usually undiagnosed during clinical examination, it should not be neglected, since this can adversely affect the quality of life, and can also be a predictor of the seriousness of pathology. (12) A chest X-ray is the most frequent radiologic examination used to evaluate the diaphragm because it is very simple and accessible. ...
The aim of this study was to establish normal measurements of the hemidiaphragm widths and heights in the Saudi population by a posteroanterior (PA) chest X-ray in the Mecca Region.
Methods and Results: The data were collected prospectively at King Abdulaziz Hospital in Saudi Arabia, Jeddah, between March and April 2021, using a computed radiography imaging unit. A total of 45 patients (51.1% men and 48.9% women; the age range between 15 and 79 years) were included in the study. Measurements were obtained on an ideal PA chest radiograph by measuring the distance from the highest points of the right hemidiaphragm and left hemidiaphragm. The width from the right and left costophrenic angle was also measured as an ended point. The total diaphragm width (DW) was 278.32±24.83mm, the total right diaphragmatic dome height (RDDH) -51.30±10.58mm, and left diaphragmatic dome height (LDDH) - 38.40±9.21mm.
The DW was greater in men than in women: 291.74±20.4mm and 264.28±21.2mm, respectively. RDDH and LDDH were also greater in men than in women: 55.4±6.77mm and 47.005±12.19mm, and 43.29±6.65mm and 33.28±8.83, respectively
Conclusion: Computed radiography was useful in measuring the diaphragm because measurement points can be identified accurately and easily due to the availability of the processing system functions such as the ability to manipulate the image resolution, image contrast, and magnification.
... However, right DE seems to be the most common presentation. [4][5][6][7][8] DE is usually accompanied by poor lung expansion, reduced blood flow, reduced oxygen and carbon monoxide exchanges, and upward displacement of the abdominal contents. A few cases have been associated with other malformations such as intestinal malrotation, dextrocardia, renal agenesis, and ectopia. ...
Diaphragmatic eventration (DE) associated with intestinal malrotation and renal agenesis is a rare entity. The authors report a case of a 69-year-old man who had symptoms of heart failure. He had a previous imaging diagnosis of right diaphragmatic eventration and dilated cardiomyopathy. He died on the second day after the hospital admission and had a post mortem examination that confirmed complete right diaphragmatic eventration, intestinal malrotation, left renal agenesis, dilated cardiomyopathy, and anteriorly rotated right kidney and had findings suggestive of a thoracoabdominal compartment syndrome. Thoracoabdominal compartment syndrome is described as transmission of abdominal pressure through a defective diaphragm causing compression of the hemithorax viscera and mediastinal shift with a hemodynamic alteration. The association of these anomalies is rare, and the possibility of this finding in a patient with eventration should always be considered.
... Eventration of diaphragm is a condition in which fibrous tissue constitutes majority of the diaphragm with sparse muscle fibers. 3 Diagnosis of diaphragmatic eventration is typically made on a chest X-ray showing the rounded contour of the elevated diaphragm. This rare condition is mostly asymptomatic and detected incidentally. ...
Liver radiotracer activity interfering with the inferior myocardial wall in a patient undergoing myocardial perfusion imaging (MPI) with 99mTc-Sestamibi is a known pitfall. We report a patient with pituitary macroadenoma who was subjected to stress-MPI study for pre-anesthetic clearance. The post-stress raw image showed the liver radiotracer activity in close approximation to the anteroseptal wall of the left ventricular myocardium, secondary to right hemi-diaphragmatic eventration.
... The diaphragm can be seen as a continuous thin layer above the elevated abdominal viscera with reduced mobility. CT scan and magnetic resonance imaging may be performed as adjuvant techniques in cases where the diagnosis still remains in doubt (1,4,6). Associated findings include Horner's syndrome, contralateral ptosis, and chest wall deformities with and without missing ribs, gastric volvulus, coarctation of the aorta, cleft palate, hemivertebrae, congenital heart disease, renal ectopia, hypoplastic aorta, situs inversus, club foot…(4). ...
... The benefits of endoscopic surgery are evident in the literature and include smaller incision, quicker recovery, and decreased pain (7,8,9). If the patient experiences no or a few symptoms, they should still be strictly followed-up to promptly indicate the necessity for operation in the event of an even slight deterioration in respiratory function (5,6). ...
Prérequis : L'éventration diaphragmatique (ED) est une surélévation permanente du diaphragme sans solution de continuité. Les manifestations cliniques sont diverses, allant des formes asymptomatique à une détresse respiratoire mortelle. Le but de cette étude était d'évaluer notre expérience dans la prise en charge de 8 enfants hospitalisés pour éventration diaphragmatique au cours des 15 dernières années. Méthodes : Etude rétrospective colligeant huit cas d'ED au département de chirurgie pédiatrique de l'hôpital d'enfant de Tunis. Résultats : Cinq patients (2 garçons et 3 filles) dont l'âge a varié de 5 mois à 7 ans, ont bénéficié d'une plicature diaphragmatique (3 du côté droit et 2 du côté gauche) pour ED symptomatique avec une amélioration spectaculaire de leur état respiratoire. Un autre patient (garçon de 3 mois) a été admis pour une détresse respiratoire ayant nécessité une ventilation mécanique. Il est décédé avant l'opération dans un tableau de septicémie. Deux autres enfants, suivis pour ED de découverte fortuite, étaient asymptomatiques pour une durée moyenne de 5 ans. La radiographie thoracique a suggéré l'éventration dans tous les cas. L'échographie a permis le diagnostic dans 6 cas. Aucun cas de malformation associée n'a été noté. Conclusion : L'échographie est un examen radiologique important pour le diagnostic. La plicature diaphragmatique semble être sûre et efficace. La chirurgie n'est pas recommandée pour les enfants asymptomatiques. LA TUNISIE MEDICALE-2015 ; Vol 93 (n°02) s u m m a r y Background: Diaphragmatic eventration (ED) is a rare anomaly defined by a permanent elevation of a hemidiaphragm without defects. Clinical manifestations are diverse, ranging from asymptomatic to life-threatening respiratory distress. The aim of this study is to report our experience of management of eight children with ED over the past 15 years. Methods: A retrospective study was conducted involving 8 infants and children with ED managed at the department of pediatric surgery of Tunis Children's Hospital. Results: Five patients (2 males, 3 females) whose ages ranged from 5 month to 7 years (mean, 13 months) were operated on using diaphragmatic plication (3 right-sided and 2 left-sided plications) for symptomatic ED with a dramatic improvement in their respiratory status. Another infant (a 3-month-old boy) was admitted for respiratory distress that required mechanical ventilatory support. He died before operation because of sepsis. Two other asymptomatic patients with incidentally diagnosed ED were followed up for 5 years on average. Chest x-ray suggested eventration in all cases. Ultrasound was found to be a useful modality for diagnosis in 6 cases. There were no cases of associated malformation. Conclusion: Diaphragmatic eventration in children is usually congenital but may be acquired. Chest ultrasound is an important imaging modality for diagnosis. Diaphragmatic plication appears to be safe and effective. Surgical intervention is not recommended in asymptomatic patients.
