Diaphragm elevation, which is a rare condition in adults, can cause shortness of breath and tachycardia complaints during walking and exertion over time. Experts point out that the diagnosis is mostly made by chance and emphasize that diaphragm elevation is a disease that should definitely be treated.
Thoracic Surgery Specialist Assoc. Dr. Özkan Demirhan said, “The diaphragm is one of our most valuable respiratory muscles and is the name given to the flat wide muscle structure that separates the abdominal cavity from the chest cavity. Diaphragm height (Evantration) is the permanent elevation of all or part of the diaphragm muscle, provided that the parts attached to the ribs and organ contacts are not disrupted. This is a rare condition in adults. Diaphragm elevation may occur after primary or acquired phrenic border injury. Although this anomaly is mostly seen in the left diaphragm, it is characterized by a clear decrease in muscle fiber density in the diaphragm. Despite this, in the case of a median stroke in the diaphragm, even if the muscle’s mission is somewhat weakened, the muscle density remains close to the usual limits. Diaphragmatic paralysis usually occurs due to damage to the phrenic border (the nerve that stimulates the diaphragm). However, diaphragmatic elevation often occurs as a pure degenerative muscle disease without any neural damage. Although the causes of diaphragmatic height and diaphragm paralysis are different, they usually cause one-to-one radiological appearance and one-to-one clinical situations. Diaphragm height is more common in the male population.
The main symptom of shortness of breath
Referring to the symptoms caused by the height of the diaphragm, Demirhan said, “Dyspnea is the main symptom in patients with diaphragmatic elevation or diaphragmatic paralysis. In patients with diaphragmatic elevation or paralysis, the function of the diaphragm is reduced or lost due to immobility. Therefore, due to the imbalance of the lung and thoracic wall, there are important changes in breathing or breathing is disturbed. This is in the middle of the factors that increase the feeling of shortness of breath. In some patients, a decrease in oxygen in the blood, called hypoxemia, can be observed. Reflex hyperventilation that develops to correct hypoxemia, that is, if the normal air entry and exit required to maintain the normal gas level of the blood, occurs above the normal level, causes respiratory alkalosis. In contrast to normal individuals, some patients may experience severe respiratory distress, as the true displacement of abdominal organs to the thorax in the supine position will lead to a further reduction in lung volumes. Especially in patients with left hemidiaphragm elevation, symptoms such as abdominal pain, bloating, heartburn, vomiting, belching, nausea, constipation and weight loss may develop. These complaints are characteristically exacerbated by changes in status. In the examination of patients with moderate and advanced eventration, collapse in the lower part of the rib cage on the affected side and fullness in the abdomen can be detected. Severe and progressive dyspnea on bending or lying down is the most valuable reason for diagnosing diaphragmatic elevation. In the end, patients always have to work in an upright position and sleep in a sitting position.”
Diaphragm height does not show any symptoms in many patients
Referring to the need to be considered during the diagnosis of diaphragmatic height and the ways of treatment, Assoc. Dr. Özkan Demirhan, “Many adult patients with diaphragmatic elevation or paralysis do not have any complaints. Diaphragmatic height is often detected incidentally on chest X-ray. If there is any other pathological condition with tomography, it is excluded. Diaphragmatic movement can be observed with ultrasonography. It is valuable to prove that dyspnea or orthopnea is due to diaphragmatic elevation or paralysis. Therefore, a meticulous history and physical examination should be performed to reduce the time and progression of dyspnea and orthopnea, and to exclude other potential causes of dyspnea (morbid obesity, lung disease, congestive heart failure, etc.). Other causes should be excluded. While treatments were previously performed with open systems, diaphragm plication techniques have been developed with minimally invasive, transthoracic and transabdominal methods today. After the diaphragm is brought to its normal state, the pressure in the lung is removed and the effort capacity increases. Diaphragm pacing (DPS) is used in quadriplegic patients with bilateral diaphragmatic paralysis, but it is out of our scope.
