Eventration of the diaphragm
Abnormal elevation of the diaphragm and
paradoxical motion of the affected diaphragm during inspiration and
Etiology: Congenital - Congenital
muscular deficiency (CMD); congenital defect in the development
of central tendon or diaphragmatic muscle. (non-paralytic type)
- Phrenic nerve paralysis - caused by injury of
phrenic nerve during birth or - less
common - during (cardiothoracic ) operation. Obstetric injury may be
combined with lesion of brachial plexus leading to a paralysis of the Erb-Duchenne type.
Wide spectrum of signs and symptoms: - ranging from asymptomatic to
dyspnea , tachypnea , recurrent pneumonia , chronic bronchitis,
exercise intolerance, life - threatening respiratory distress Obstetric
cause - low APGAR score Thoracotomy cause
- failure weaning from respirator (hypercapnea)
symptoms; functional disorder of
stomach, failure to thrive, nausea and vomiting, post
prandial pain, bloating
Chest - x rays; the affected hemidiaphragm should be at least two
intercostal spaces higher than the other side.
Fluoroscopy; paradoxical movement during breathing (elevate ipsilateral
diaphragm during inspir.)
Pulmonary function test ;
Indications for surgery:
nerve injury: Conservative treatment should not last longer than one
Thoracotomy, Thoracoscopic assisted, or Laparotomy
Post operative evaluation:
Respiratory function Motion of the plicated
diaphragm, by fluoroscopy.
Grading system by Kizilcan et al.
Postoperative motion according to the
contribution of various parts of the diaphragm to motion and
amplitude and direction of movement.
Grade 1 : Satisfactory Motion
of equal amplitude with synchronous contraction in the same direction of the
entire plicated hemidiaphragm compared with the contralateral normal
Grade 2 : Moderately satisfactory Varying
amplitudes of motion of the entire plicated hemidiaphragm or part of it in
the absence of paradoxical motion compared with the normal hemidiaphragm.
Grade 3 : Unsatisfactory Entire
operated hemidiaphragm was immobile or showed paradoxic motion ever at any
part of it.
Thickness of the plicated diaphragm , by
Operative complications: Intraabdominal