What is the diaphragm height? What are the symptoms and treatment modalities?

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Diaphragm elevation, which is a rare condition in adults, can cause shortness of breath and tachycardia complaints during walking and exertion over time. Experts point out that the diagnosis is mostly made by chance and emphasize that diaphragm elevation is a disease that must be treated.

Providing information on the subject, Thoracic Surgery Specialist Assoc. Dr. Özkan Demirhan said, “The diaphragm is one of our most important respiratory muscles and is the name given to the flat wide muscle structure that separates the abdominal cavity from the thoracic cavity. Diaphragm height (Evantration) is the permanent elevation of all or part of the diaphragm muscle, provided that the parts to which it is attached to the rib and organ connections are not impaired. This is a rare condition in adults. Diaphragmatic elevation may occur after primary or acquired phrenic nerve injury. Although this anomaly is usually seen in the left diaphragm, it is characterized by a significant decrease in muscle fiber density in the diaphragm. On the other hand, in the case of a median stroke in the diaphragm, the muscle density remains close to the normal limits, even if the muscle’s function is slightly weakened. Diaphragmatic paralysis usually occurs due to damage to the phrenic nerve (the nerve that stimulates the diaphragm). However, diaphragmatic elevation often occurs as a pure degenerative muscle disease without any neural damage. Although the causes of diaphragmatic elevation and diaphragmatic paralysis are different, they usually cause the same radiological appearance and the same clinical conditions. Diaphragm height is more common in the male population.

The main symptom of shortness of breath

Referring to the symptoms caused by the height of the diaphragm, Demirhan said, “Difficulty of breath is the main symptom in patients with high diaphragm or diaphragmatic paralysis. In patients with diaphragmatic elevation or paralysis, the function of the diaphragm is reduced or lost due to immobility. Therefore, due to the maladaptation of the lung and thoracic wall, there are significant changes in respiration or respiration is impaired. This is among the factors that increase the feeling of shortness of breath. In some patients, a decrease in oxygen in the blood, called hypoxemia, can be observed. If the reflex hyperventilation that develops to correct hypoxemia, that is, the normal air inlet and outlet required to maintain the normal gas level of the blood, occurs above the normal level, it causes respiratory alkalosis. Contrary to normal people, some patients may experience severe respiratory distress, as the displacement of the abdominal organs towards the thorax in the supine position will lead to a further decrease in lung volumes. Especially in patients with left hemidiaphragm elevation, symptoms such as abdominal pain, bloating, heartburn, vomiting, belching, nausea, constipation and weight loss may develop. These complaints are characteristically exacerbated by position changes. In the examination of patients with moderate and advanced eventration, collapse in the lower part of the rib cage on the affected side and fullness in the abdomen can be detected. Severe and progressive dyspnea on bending or lying down is the most important reason for diagnosing diaphragmatic elevation. Patients eventually have to work in an upright position and sleep in a sitting position.

Diaphragm height does not show any symptoms in most patients.

Touching on the requirements to be considered during the diagnosis of diaphragm height and the treatment methods, Assoc. Dr. Özkan Demirhan, “Most adult patients with diaphragmatic elevation or paralysis do not have any complaints. Diaphragmatic elevation is usually detected incidentally on chest X-ray. If there is any other pathological condition with tomography, it is excluded. Diaphragmatic movement can be observed with ultrasonography. It is important to prove that dyspnea or orthopnea is due to diaphragmatic elevation or paralysis. Therefore, a meticulous history and physical examination should be performed to evaluate the duration and progression of dyspnea and orthopnea, and to exclude other potential causes of dyspnea (morbid obesity, lung disease, congestive heart failure, etc.). Other causes should be excluded. While treatments were used with open methods in the past, diaphragm plication techniques have been developed with minimally invasive, transthoracic and transabdominal methods today. After the diaphragm is brought to its normal position, the pressure in the lung disappears and the effort capacity increases. Diaphragmatic pacing (DPS) is used in quadriplegic patients with bilateral diaphragmatic paralysis, but it is out of our scope.

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