Eventration of the diaphragm

Eventration of the diaphragm is a condition where part or all of the diaphragm is abnormally elevated due to weakness or thinning of the muscle, but the diaphragm remains intact—unlike in hernias, where there is a hole.

🧬 What Is Diaphragmatic Eventration?

• A portion of the diaphragm is abnormally thin or lacks muscle fibers, leading to reduced movement and elevation.
• The diaphragm balloons upward like a parachute, but no organs herniate through.
• It can be congenital (present from birth) or acquired (usually from nerve injury).

🔍 Types

1. Congenital Eventration

• Due to incomplete muscular development of the diaphragm.
• Often affects one side, most commonly the left hemidiaphragm.
• May be associated with other congenital anomalies.

2. Acquired Eventration

• Caused by phrenic nerve injury or neuromuscular disease.
• Common causes include:
  • Trauma or surgery (e.g., cardiac or neck surgery)
  • Infection (e.g., viral neuropathy)
  • Tumor compression of the phrenic nerve

⚠️ Symptoms

🧒 In Infants/Children:

• Respiratory distress
• Recurrent pneumonia
• Feeding difficulties
• Failure to thrive (if severe)

🧑 In Adults:

• Often asymptomatic if mild
• Shortness of breath (especially when lying down)
• Chest discomfort
• Fatigue
• Recurrent respiratory infections (due to poor lung expansion)

🧪 Diagnosis

🖼️ Imaging:

• Chest X-ray: elevated hemidiaphragm (often incidental finding)
• Fluoroscopy (“sniff test”): reveals paradoxical motion (the diaphragm moves up during inspiration)
• Ultrasound: assesses diaphragm thickness and movement
• CT or MRI: helps rule out hernia or mass

🧫 Additional tests:

• Pulmonary function tests: may show restrictive pattern
• Phrenic nerve studies (if nerve injury suspected)

💊 Treatment

🛡️ Prognosis

• Good in mild or managed cases
• Surgical correction can significantly improve lung function and symptoms
• Important to distinguish from diaphragmatic hernia to avoid misdiagnosis

🔄 Eventration vs. Hernia