case study: diaphragm eventration with differtials
Post on 11-Apr-2017
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CASE STUDYDr Saleem Muhammad ManshaPGR Alnoor Diagnostic Centre
Mr. Saber 50Y/M came for CT Chest with contrast at Alnoor Diagnostic centre on 03-08-2016 with h/oFever 15 daysCough 4,5 days Intermittent SOB ( more on walking)No h/o Trauma , Anorexia , Weight loss
CT SCAN (Coronal view)
USG
From Imaging we can ConcludeElevated Left hemi diaphragmNo shift of mediastinum or hilar displacementNo mass in lung No volume loss in lung No collapse of lungNo evidence of consolidationDiaphragm surface is smooth No mass seen in or below the diaphragm No visceromegaly No ascites
The most probable diagnosis in our case is Diaphragmatic eventration .
Diaphragmatic EventrationNormal Diaphragm is replaced by a thin layer of connective tissue and a few scattered muscle fibers Mostly congenital but can be acquired as many cases of surgically proven eventration had normal CXR previouslyTotal or PartialTotal eventration mostly on Left side & partial mostly on Right side
Causes and differential for elevated hemidiaphragm
Causes above DiaphragmPhrenic Nerve PalsyPulmonary collapseSubpulmonic effusionInflammatory infiltrate in lungsPulmonary Infarction Pleural disease (Haemothorax , empyema )Hemiplegia
Diaphragmatic CausesEventrationDiaphragmatic herniasDiaphragmatic tumors Diaphragmatic trauma
Causes Below DiaphragmGaseous distension of stomach and colon Subphrenic abscessSubphrenic mass Massive ascites
Causes Above Diaphragm
Phrenic Nerve PalsyMass in Left upper zone compressing Left Phrenic NerveRaised Left Hemi DiaphragmNo movement of diaphragm possible
Left Lower Lobe Collapse (PA View)
Raised Left hemi diaphragmLoss of volume on left sideIpsilateral shift of heartDouble opacity behind heartSilhouette sign
Subpulmonic Effusion
Raised hemidiaphragmLateralization of diaphragm apex
Acute Pneumonia
Raised Right hemi diaphragm due to lower lobe infiltrate
HaemothoraxH/O Trauma
Diaphragmatic Causes
Bochdalak HerniaMostly on leftPosterior aspect of diaphragmMay contain Retroperitoneal fat , kidney and spleen
Morgagni HerniaCXRCT
Primary Malignant Tumor of Diaphragm
Trauma
Causes Below Diaphragm
Distended Stomach
Liver Mass
Post surgical Subphrenic AbscessCXR
CT(Axial view)
Massive AscitesRight hemidiaphragm is elevated
Take Home MessageAll cases of raised hemi diaphragm should be dealt with seriously to rule out causes above diaphragm , diaphragmatic causes and causes below the diaphragm. All modalities should be utilized for proper guidance and help of the patient .
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