Partial Eventration Research Articles

An unusual cause of right lower lobe rounded opacity in an adult

Abstract In adults, congenital partial eventration of the diaphragm is usually asymptomatic and detected as an incidental chest radiographic finding during health check-up for other reasons. Any rise in intra-abdominal pressure due to underlying pulmonary diseases such as asthma or chronic obstructive pulmonary disease or abdominal conditions such as obesity and ascites may further distend the eventrated portion of the hemidiaphragm by pushing the abdominal contents upwards to fill the space and resulting in spurious radiologic appearance of a tumour. Computed tomography of the chest helps both in diagnostic confirmation of hemidiaphragmatic eventration and evaluation of lung parenchyma, mediastinal and subdiaphragmatic pathology.

RIGHT SIDED DIAPHRAGMATIC EVENTRATION: A RARE CASE REPORT

Introduction: Eventration of hemidiaphragm is dened as the permanent elevation of all or part of the diaphragm, without defects of continuity in which the involved muscles of the diaphragm are being replaced partly or in full by a bro membranous sheet. Incidence of congenital eventration is 1 in 10,000. Complete and partial eventration both can occur. Complete eventration of the right hemidiaphragm with asthma in an adult female, as presented in this patient, is rarely seen. Case Presentation: A middle aged female presented with complaints of dyspnea and dry cough. Chest examination revealed decreased movements and breath sounds on right side in inframammary, infraaxillary, and infrascapular areas along with bilateral wheeze. Plain Chest radiograph followed by CT thorax was done which revealed an elevated right hemidiaphragm. Possibility of diaphragmatic eventration and paralysis was made. Later on, uoroscopic sniff test was performed. Discussion: Patients are generally asymptomatic however obese patients are usually symptomatic. Conventional chest radiography has been found to be a useful modality for assessment of the functional status of an elevated diaphragm as the evaluation of the shape of an elevated diaphragm may preclude the need for uoroscopic sniff test. However, uoroscopy is necessary to conrm between diaphragmatic paralysis and eventration. Conclusion: It is difcult to distinguish diaphragmatic eventration from paralysis clinically. In our case, diagnosis was made based on radiological ndings and conrmed by nerve conduction study. Patients are managed conservatively but symptomatic patients require surgery.

Azygos lobe and partial eventration of diaphragm

An azygos lobe is an accessory lobe of the lung that may occasionally be confused with a pathological process such as a bulla, lung abscess, or neoplasm. Eventration of the diaphragm is generally regarded as a condition in which the left or the right leaf of the diaphragm has ascended abnormally high into the chest. In this case, both eventration of diaphragm and azygos lobe presented in the same patient on the same side.

A Rare Case of Partial Diaphragmatic Eventration with Hepatic Herniation

A 43 year old Female with past history of hypertension, diabetes mellitus presented to the Emergency room with a chief complaint of left flank pain. Her physical examination was notable for left sided flank tenderness with no abdominal rigidity or guarding. Routine blood work showed normal complete blood count, with normal comprehensive metabolic profile. A chest xray showed a soft tissue mass at the right lung base. Further contrast Computed Tomography(CT) of the chest and abdomen showed an incidental soft tissue mass at right lung base that measured 4.4 cm in diameter representing a focal eventration of the right hemi-diaphragm with liver tissue extending through the eventration.(Fig 1,2).2343_A Figure 1. Arrow depicting hepatic herniation2343_B Figure 2. Coronal CT showing hepatic mass extending through diaphragamDiaphragmatic eventration was first recognized by Jean Louis Petit in 1774 and the term was coined by Beclard in 1916. It is defined anatomically by thinning of the diaphragmatic tissue, characterized by the cephalic displacement of all or a part of an intact diaphragm. While complete eventration in more common on left, partial eventration is seen majorly on the right side. Congenital diaphragmatic eventration has been frequently cited as common in infancy, requiring urgent care and observation but it is rarely seen in adults. Typically this entity is frequently asymptomatic but can rarely manifest as progressive dyspnea, chest pain, abdominal discomfort, nausea, vomiting, heartburn and recurrent pneumonia. Partial eventration are usually detected incidentally on chest x-ray as a smooth homogeneous mass in continuation with the diaphragm.Ultrasound may reveal more anatomical detail about the diaphragmatic integrity, specifically eventration content or other diaphragmatic pathologies.If a contrast CT scan is performed, hepatic or omental vascular enhancements are seen as hyper-dense areas. Other modalities such as fluoroscopy with sniff testing and Magnetic resonance imaging are done if the diagnosis is still in doubt. Once diagnosed asymptomatic patients are usually managed conservatively and diaphragmatic plication is done in symptomatic patient. Our patient's left sided pain was musculoskeletal and not related to the diaphragmatic eventration. Her pain resolved with analgesics and she has remained asymptomatic on follow up visits. In summary we present a rare case of partial diaphragmatic eventration with hepatic herniation. Our case highlights conservative management in asymptomatic patients with diaphragmatic eventration.

Neonatal arrhythmia with diaphragmatic eventration

Supraventricular tachycardia is the most common symptomatic arrhythmia in young patients, frequently associated with Wolff-Parkinson-White (WPW) syndrome. We report a case of supraventricular tachycardia with Wolff-Parkinson-White (WPW) syndrome associated with partial eventration of a diaphragm in a neonate.

Congenital diaphragmatic eventration as a cause of anterior mediastinal mass in the children: imaging modalities and literature review

Congenital eventration of the diaphragm, as a cause of mediastinal mass, is an unusual condition and it may be unilateral or bilateral. Although this entity is frequently asymptomatic and firstly detected on the chest radiography, it may be difficult to distinguish a partial eventration from the other diaphragmatic lesions or mediastinal pathologies on the chest radiographs. US may present valuable information about diaphragm integrity with eventration content or the other diaphragmatic pathologies. Although the other imaging modalities such as fluoroscopy, computed tomography, and MR imaging may be performed as adjunct techniques in cases of the diagnosis still in doubt, they are frequently unnecessary after US. Our goal is to present imaging features and management of this entity together with a literature review.

Anatomic variations and abnormalities in the diaphragm seen with US.

The authors report their experience with diaphragmatic structures that simulate intrahepatic masses at abdominal ultrasonography (US). In a series of 74 patients, diaphragmatic slips were the most common finding (34 patients). The slips could be differentiated from masses by scanning along their long axis to demonstrate elongated structures with multiple linear echoes. Scalloping of the diaphragm, associated with multiple slips, was seen in 10 patients. Partial eventration was found in 23. Inversion of a hemidiaphragm, caused by a large pleural effusion or intrathoracic mass, was seen in 13 patients. Pleural masses affecting the diaphragm were seen in 13 patients; focal hypertrophy of a diaphragmatic crus simulated a mass in three. Real-time US allowed the differentiation of diaphragmatic abnormalities from lesions.

CT findings in partial eventration of the right diaphragm.

Elevation of the anterior part of the right diaphragm results in the spurious radiological appearance of a mass at the right lung base. Standard chest views are usually sufficient to show the true nature of the "mass." Occasionally, however, a true mass lesion cannot be entirely excluded, and further studies are then required. Two such cases are described and in both the computed tomographic findings clearly showed the anterior part of the liver to be situated under the elevated diaphragm. This elevation of the anterior part of the liver results in tilting of the organ with the posterior part remaining in its normal position below the nonelevated part of the diaphragm. The anterior and posterior parts of the liver are therefore not shown on the same tomographic planes but are found to lie at different levels.

Age related gross changes of the liver and right diaphragm, with special reference to partial eventration

A total of 38937 6 X 6 cm chest films, made in three series of check-up programmes for local residents above the age for nursery school, were examined for partial eventration of the right dome of the diaphragm in relation to age. It was found that after nursery school age, eventration and irregularity of the right dome increased with age, particularly among women over the age of 60. In a series observed in a rural region, marked eventration was found in more than 1% of the women above 60 years. In another study on 1 332 liver scans in patients without intrinsic liver disease, a prominent, dome-like elevation of the right lobe of the liver was also very frequent among older women. It is concluded that the majority of right-sided eventrations are acquired and may be attributable to dietary and dressing habits.

Partial Eventration of the Diaphragm: Differential Diagnosis and the Use of Pneumoperitoneum

Partial Eventration of the Diaphragm: Differential Diagnosis and the Use of Pneumoperitoneum

Partial eventration of the right diaphragm

Summary A case of partial eventration of the right diaphragm in a child has been presented. The dangers of blind diagnostic aspiration have been reviewed. It is suggested that exploratory thoracotomy be done in preference to aspiration, pneumothorax, or pneumoperitoneum.