Differential Diagnosis for Moderate Elevation of the Left Hemidiaphragm with a Large Hiatus Hernia

• Single most likely diagnosis:
  • Hiatus hernia causing diaphragmatic elevation: The presence of a large hiatus hernia is a strong indicator that this is the cause of the diaphragmatic elevation, as the hernia can push the diaphragm upwards.
• Other Likely diagnoses:
  • Diaphragmatic eventration or paresis: These conditions involve abnormal movement or paralysis of the diaphragm, which could lead to its elevation. However, they are less directly linked to the presence of a hiatus hernia.
  • Subdiaphragmatic pathology (e.g., splenomegaly, subphrenic abscess): Conditions affecting organs below the diaphragm can push it upwards, but the clear lung fields and specific mention of a hiatus hernia make these less likely.
• Do Not Miss diagnoses:
  • Malignancy (e.g., gastric carcinoma invading the diaphragm or lung): Although less common, malignancies can cause diaphragmatic elevation and must be considered to avoid missing a potentially fatal diagnosis.
  • Pulmonary embolism with infarction: While the lung fields are described as clear, a pulmonary embolism could lead to diaphragmatic elevation due to pain or secondary effects, and it's crucial not to miss this potentially life-threatening condition.
• Rare diagnoses:
  • Diaphragmatic dysplasia or congenital defects: These are rare conditions that could result in abnormal diaphragm positioning or function.
  • Intra-abdominal shunt or other rare surgical complications: Complications from surgical procedures could potentially lead to diaphragmatic elevation, though these would be uncommon and typically have a clear clinical context.