From the Guidelines
Elevation of the right diaphragm is most commonly caused by traumatic diaphragmatic hernia, which can result from a sudden increase in intra-abdominal pressure or a penetrating injury, as reported in a 2023 study published in the World Journal of Emergency Surgery 1.
Causes of Right Diaphragmatic Elevation
The causes of right diaphragmatic elevation can be varied, but traumatic diaphragmatic hernia is a significant consideration, especially in patients with a history of trauma. According to the study, diaphragmatic rupture occurs in 2.1% of blunt trauma and 3.5% of penetrating trauma 1. Other potential causes include phrenic nerve paralysis, subphrenic abscess, liver enlargement, lung collapse or atelectasis, and pulmonary fibrosis.
Clinical Significance and Management
If right diaphragm elevation is discovered on imaging, further evaluation is recommended to determine if it's pathological. This typically includes comparing with previous imaging if available, assessing for symptoms like shortness of breath or abdominal pain, and potentially ordering additional tests such as ultrasound, CT scan, or sniff test (fluoroscopy during inhalation) to evaluate diaphragm movement 1. Treatment depends entirely on the underlying cause rather than the elevation itself. For instance, if caused by phrenic nerve injury, it may improve with time or require supportive care, while infectious causes would require appropriate antibiotics.
Morbidity and Mortality Considerations
It's essential to consider the potential morbidity and mortality associated with right diaphragmatic elevation, particularly in cases of traumatic diaphragmatic hernia. The study reports that postoperative pulmonary complications, including atelectasis, are common following surgery for TDH, with morbidity rates ranging from 11 to 62.9% 1. Therefore, prompt and appropriate management of the underlying cause is crucial to minimize morbidity and mortality.
From the Research
Causes of Right Diaphragmatic Elevation
The causes of right diaphragmatic elevation can be varied and include:
- Sarcoidosis involvement of the diaphragm, as seen in a case report where a 69-year-old male presented with dyspnea on exertion related to unilateral diaphragmatic dysfunction caused by sarcoidosis 2
- Diaphragmatic disease due to surgery, trauma, tumor, or infection, which can manifest as elevation at chest radiography 3
- Congenital diaphragmatic eventration, characterized by the elevation of the diaphragm, causing a protrusion of the intraabdominal viscera into the affected hemithorax and resulting in respiratory distress 4
- Partial eventration of the right diaphragm, which can result in the spurious radiological appearance of a mass at the right lung base 5
Associated Conditions
Right diaphragmatic elevation can be associated with other conditions, including:
- Respiratory distress, as seen in a case report of a 16-day-old male with congenital diaphragmatic eventration and an intrathoracic ectopic kidney 4
- Myocardial infarction, as seen in a case report of a 46-year-old male with elevation of the left-sided diaphragm leading to compression of the left circumflex artery 6
- Diaphragmatic paralysis or weakness, which can be indicated by absence of orthograde excursion on quiet and deep breathing, with paradoxical motion on sniffing 3
Diagnostic Methods
Diagnostic methods for right diaphragmatic elevation include:
- Chest radiography, which can show elevation of the diaphragm 3, 4, 5
- Functional imaging with fluoroscopy, ultrasonography, or magnetic resonance imaging, which can diagnose diaphragmatic dysfunction 3
- Computed tomography (CT) scanning, which can confirm the diagnosis and define the dome elevation and intrathoracic organ precisely 4, 5, 6