From the Guidelines
Right hemidiaphragm elevation is most commonly caused by conditions such as diaphragmatic injuries or hernias, which can be diagnosed using imaging methods like chest X-ray or CT scan, with CT scan being the gold standard for diagnosis 1. When considering the potential causes of right hemidiaphragm elevation, it's essential to prioritize conditions that can significantly impact morbidity, mortality, and quality of life.
- Diaphragmatic injuries or hernias are critical conditions that require prompt diagnosis and treatment to prevent complications such as bowel strangulation or respiratory failure.
- The chest X-ray, although having a low sensitivity of 17-33% for right-sided hernia, can still be useful in initial assessments due to its ease, low cost, and wide availability 1.
- However, a CT scan is necessary for confirming the diagnosis, with a sensitivity and specificity of 14-82% and 87%, respectively, and can provide detailed information about the diaphragmatic defect and potential complications 1.
- Other potential causes of right hemidiaphragm elevation, such as phrenic nerve paralysis, subphrenic abscess, liver enlargement, and lung collapse, should also be considered and addressed accordingly.
- Treatment of the underlying cause is crucial to improve patient outcomes and quality of life, and may involve surgical intervention, supportive care, or management of underlying conditions.
From the Research
Causes of Right Hemidiaphragm Elevation
- The right hemidiaphragm elevation can be caused by eventration or paralysis of the diaphragm, as stated in the study 2.
- Eventration of the diaphragm is an abnormal elevation of the dome of the diaphragm, where all or part of the diaphragm is largely composed of fibrous tissue with only a few or no interspersed muscle fibers 3.
- Diaphragmatic paralysis is a condition where the diaphragm is unable to contract and relax properly, leading to an elevation of the hemidiaphragm 4.
Diagnosis of Right Hemidiaphragm Elevation
- Conventional chest radiography can be used to assess the functional status of an elevated diaphragm, and the shape of the diaphragm on lateral chest radiograph is an important factor for detection of the presence or absence of diaphragmatic paralysis 4.
- Fluoroscopic testing, such as the sniff test, can also be used to differentiate eventration from paralysis, as it can show paradoxic motion of the diaphragm in cases of paralysis 2.
Treatment of Right Hemidiaphragm Elevation
- Diaphragm plication is a surgical procedure that can be used to treat symptomatic patients with an elevated diaphragm, regardless of the underlying cause 2, 5, 6.
- The goal of plication is to improve lung volumes and decrease paradoxic elevation of the hemidiaphragm, and it can be approached either from a thoracic or abdominal approach 2, 5.