Eventration of the Diaphragm

Abstract

Eventration of the diaphragm is an abnormal elevation of one or both hemidiaphragms into the thorax. This condition can be congenital or acquired and has a variety of presentations, ranging from an incidental finding on imaging studies to severe respiratory impairment with difficulty weaning from the ventilator. A chest radiograph in two views will show elevation of the affected diaphragm. Recently, ultrasound has replaced fluoroscopy as the imaging study of choice. Patients with small, asymptomatic congenital eventrations can be managed without an operation, while large or symptomatic eventrations should undergo surgical repair. Acquired eventrations are initially managed with supportive care and observed to assess for spontaneous return of phrenic nerve and diaphragmatic function. Repair of the eventration can be approached either through the abdomen or thoracic cavity and can be performed using open or minimally invasive techniques. Plication is achieved by either imbrication of the diaphragm or excision of the weakened central portion of the diaphragm. As loosening of the plication over time is expected, a taut repair without undue tension is essential at the time of operation to prevent recurrence.