Elevated diaphragm: causes, symptoms, and thoracoscopic surgical treatment

Diaphragm Eventration

Diaphragm eventration is a condition in which there is weakness or thinning of the diaphragm muscle, resulting in part of the diaphragm rising into the chest cavity instead of its normal position.

The diaphragm is the primary muscle responsible for breathing, separating the thoracic and abdominal cavities. When the diaphragm is elevated, it can reduce lung volume on the affected side, potentially causing respiratory symptoms in some patients.

The elevation of the diaphragm may be partial or complete, and may affect either the right or left side of the chest.

The difference between diaphragmatic elevation and diaphragmatic paralysis

It is important to distinguish between two different cases:

Elevation of the diaphragm (Eventration)
This occurs due to a weakness in the diaphragm muscle itself, which leads to its thinning and elevation.

Diaphragmatic paralysis
It occurs due to injury or dysfunction of the phrenic nerve, which is responsible for the movement of the diaphragm.

The symptoms may be similar between the two conditions, so a doctor needs to conduct a thorough evaluation to determine the cause.

Causes of elevated diaphragm

Types of Diaphragm Elevation

First: Congenital Diaphragm Elevation

This condition is present from birth and occurs due to incomplete development of the diaphragm muscle during fetal growth. In such cases, the diaphragm is thin or weak.

It is often diagnosed during childhood, but in some cases, it may be discovered incidentally in adulthood.

Second: Acquired Diaphragm Elevation

This may develop later in life due to several causes, including:

Phrenic nerve injury
Previous chest surgery
Chest trauma or accidents
Nerve inflammation
Certain neuromuscular diseases

Symptoms

Some patients may have no symptoms, and the condition is discovered incidentally during chest imaging.

However, in other cases, symptoms may include:

Shortness of breath
Chest pain
Easy fatigue during exertion
Recurrent chest infections
A feeling of pressure in the chest
Difficulty breathing when lying down

In severe cases, diaphragm elevation can compress the lung and reduce its ability to expand properly during breathing.

Diagnosis of Diaphragm Elevation

Diagnosis is based on clinical evaluation and imaging studies.

Investigations include:

Chest X-ray
Shows an abnormally elevated diaphragm compared to the normal position.

CT scan of the chest
Helps assess:

Shape of the diaphragm
Degree of elevation
Effect on the lung and surrounding structures

Diaphragm motion studies
Used to evaluate diaphragm movement during breathing.

Ultrasound
May help assess diaphragm motion dynamically.

When is Treatment Needed?

Not all patients require treatment.

Surgical treatment may be recommended in the following situations:

Persistent shortness of breath
Recurrent lung infections
Reduced lung function
Significant compression of the lung
Impaired quality of life due to symptoms

Surgical Treatment: Diaphragm Plication

The surgical treatment is called:

Diaphragm Plication

This procedure involves tightening and repositioning the diaphragm to its normal level, allowing the lung to expand better and improving breathing function.

Surgical Approaches

1. Open Surgery

Performed through a traditional chest incision.

2. Thoracoscopic Surgery (VATS)

This is the most commonly used modern technique.

Advantages of Thoracoscopic Surgery (VATS)

VATS is performed through small incisions using a surgical camera.

Benefits include:

Less postoperative pain
Smaller incisions
Faster recovery
Shorter hospital stay
Earlier return to normal activities

Duration of Surgery and Hospital Stay

The procedure usually takes about 2 hours, depending on the case.

After surgery, patients typically stay in the hospital for 2 to 3 days, then return home.

Most patients can resume normal activities within a few weeks.

Our Experience in Diaphragm Surgery

At Dr. Mohammad Al-Tarshihi’s clinic, we perform advanced diaphragm repair procedures using thoracoscopic (VATS) techniques, as well as modern hybrid approaches when indicated.

The goals of treatment are: