Differential Diagnosis for an Elevated Right Hemi Diaphragm

The differential diagnosis for an elevated right hemi diaphragm can be categorized into several groups based on likelihood and potential impact on patient care.

• Single Most Likely Diagnosis

  • Pleural Effusion: This is often the most common cause of an elevated hemi diaphragm. Fluid accumulation in the pleural space can push the diaphragm upwards, leading to its elevation. The presence of symptoms such as shortness of breath and the findings on imaging (e.g., chest X-ray or ultrasound) can support this diagnosis.

• Other Likely Diagnoses

  • Atelectasis: Collapse of the lung tissue, which can be due to various reasons such as obstruction of the airways, can cause the diaphragm to appear elevated on imaging.
  • Pneumonia: Inflammation of the lung tissue, especially if it involves the lower lobe, can lead to elevation of the hemi diaphragm due to volume loss or pleural involvement.
  • Diaphragmatic Paralysis: Weakness or paralysis of the diaphragm, which can be due to neurological conditions affecting the phrenic nerve, leads to an inability of the diaphragm to contract properly, resulting in its elevation.

• Do Not Miss Diagnoses

  • Pulmonary Embolism: Although less common as a direct cause of diaphragmatic elevation, a large pulmonary embolism can lead to acute right ventricular strain and indirectly affect diaphragmatic positioning. Missing this diagnosis can be fatal.
  • Hemothorax: Accumulation of blood in the pleural space, often due to trauma, can cause an elevated hemi diaphragm. This condition requires prompt recognition and treatment.
  • Chylothorax: Leakage of lymphatic fluid into the pleural space, which can be due to trauma, surgery, or malignancy, is another critical condition that should not be missed.

• Rare Diagnoses

  • Diaphragmatic Hernia: A congenital or acquired defect in the diaphragm allowing abdominal contents to herniate into the thoracic cavity, which can cause elevation of the hemi diaphragm.
  • Tumors: Both benign and malignant tumors affecting the diaphragm or the adjacent structures can lead to its elevation. These include diaphragmatic tumors, lung tumors, or metastatic disease.
  • Subphrenic Abscess: An abscess located below the diaphragm, often as a complication of abdominal surgery or infection, can push the diaphragm upwards.