From the Guidelines
Diaphragm elevation is primarily caused by conditions that push the diaphragm upward from its normal position, with the most common causes including phrenic nerve paralysis, abdominal distention, subphrenic abscess, atelectasis, pulmonary fibrosis, and thoracic surgery, as well as diaphragmatic eventration, abdominal tumors, and liver enlargement. The treatment of diaphragm elevation depends entirely on addressing the underlying cause rather than the elevation itself. For instance, phrenic nerve injury may be treated with watchful waiting or diaphragmatic plication surgery 1, while infections require appropriate antibiotics. Abdominal distention may need paracentesis to remove fluid, and pulmonary conditions like atelectasis benefit from breathing exercises, incentive spirometry, and chest physiotherapy 1.
Some key points to consider in the management of diaphragm elevation include:
- Identifying and treating the underlying cause
- Using diaphragm pacing as an optimal form of ventilatory support during wakefulness in carefully identified patients with congenital central hypoventilation syndrome 1
- Implementing inspiratory muscle training to enhance diaphragm function, particularly in patients with COPD and inspiratory muscle weakness 1
- Considering surgical intervention for tumors or severe eventration causing respiratory compromise
- Providing patients with guidance on managing symptoms, such as sleeping with the head elevated to alleviate shortness of breath
It is essential to prioritize the treatment of the underlying condition to improve diaphragm function and overall patient outcomes. By addressing the root cause of diaphragm elevation, healthcare providers can help patients experience significant improvements in their quality of life and reduce the risk of complications associated with diaphragm dysfunction.
From the Research
Causes of Diaphragm Elevation
- Diaphragmatic palsy can be caused by various factors, including injury to the phrenic nerve during thoracic surgeries 2
- Idiopathic phrenic nerve palsy is a rare cause of exertional dyspnea 3
- Phrenic nerve palsy can occur during surgery for pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries (PA-VSD and MAPCAs) 4
- Phrenic nerve injury during pneumonectomy can lead to diaphragm elevation 5
- Postoperative phrenic nerve palsy can occur after cardiothoracic surgery, resulting in diaphragmatic palsy 6
Treatments of Diaphragm Elevation
- Treatment of diaphragmatic palsy depends on the cause, and may include surgical repair of the diaphragm or noninvasive ventilation 2
- Diaphragm plication can be an effective treatment for diaphragmatic palsy, especially in cases of respiratory impairment 4, 6
- Noninvasive ventilation, such as bi-level positive pressure ventilation, can be used to manage diaphragmatic palsy 3
- Early spontaneous recovery of the phrenic nerve is rare, and early transthoracic diaphragmatic plication may be necessary in some cases 6
Diagnostic Approaches
- Pulmonary function tests, such as spirometry, can be used to diagnose diaphragmatic palsy 2, 5
- Fluoroscopic examination or bedside thoracic ultrasound can be used to visualize diaphragmatic movement and diagnose diaphragmatic palsy 2, 3
- Nerve conduction studies can be used to confirm phrenic nerve palsy 3