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Lung diseases

Eventration of right hemidiaphragm

12/15/2008

Question:

My 87 yr old mother`s abdomen has enlarged significantly over the past year. She is stooped forward significantly. Her bones are diffusely osteopenic. She has developed severe shortness of breath. Recent chest Xray notes an eventration of the right hemidiaphragm which her doctor feels is insignificant. I believe it is a major contributing factor to her breathlessness and causes her to feel full with only a few bites of food. How should I approach this regarding further investigation. My aim is to get her more comfortable. Thank you.

Answer:

Eventration of the diaphragm most frequently involves the anterior (front) portion of the right hemidiaphragm where the muscular portion of the diaphragm becomes replaced with a membranous sheath. This can be congential but there also appears to be an acquired form since it seems to become more common with age. Usually this is asymptomatic. However, in your mother's case, I would wonder if she has an elevated hemidiaphragm for another reason. By the history you provide, I would worry about the possibility of progressive kyphoscoliosis leading to an anatomic change in her chest which results in her hemidiaphragm being elevated. I would also worry about something going wrong in her stomach or small intestine causing her to feel full quickly. Such abdominal distention could lead to feelings of breathlessness. In general, there is little to do for an eventrated hemi-diaphragm or a paralyzed hemi-diaphragm (which can present as an elevated hemi-diaphragm). Occasionally, non-invasive ventilation at night is tried. Her early satiety (feeling full early) could be evaluated by a scope test or esophagram with an upper GI series. I think the primary question should be "what could be done to make her feel more comfortable" since that is your goal. In this instance, invasive testing may not be appropriate.

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Response by:

James M O'Brien, Jr, MD James M O'Brien, Jr, MD
Former Associate Professor
Pulmonary and Critical Care Medicine
College of Medicine
The Ohio State University