diaphragmatic eventration

Diaphragmatic eventration refers to an abnormal contour of the diaphragmatic dome with no disruption to the diaphragmatic continuity. It typically affects only a segment of the hemidiaphragm, compared to paralysis/weakness where the entire hemidiaphragm is typically affected.

Pathology

Diaphragmatic eventration is congenital in nature and due to incomplete muscularisation of the diaphragm with a thin membranous sheet replacing normal diaphragmatic muscle. Over time this region stretches and on inspiration does not contract normally.

Causes
Congenital
  • Phrenic nerve agenesis.

  • Failure of myotomes to migrate to a localized area in the diaphragm leading to an abnormal muscularisation.
Acquired
  • Trauma/Surgery/Birth trauma leading to phrenic neve paralysis (most common cause)

Unilateral eventration may be associated with Beckwith-Weidemann Syndrome, trisomy 13, 15 or 18.

Bilateral eventration may be associated with toxoplasmosis, CMV or arthrogryposis.

Location

Congenital eventration is frequently seen in the anteromedial portion of the right hemidiaphragm, while acquired eventration is frequently seen in the left hemidiaphragm.

Radiographic features

Plain radiograph

Elevation of the affected portion of the diaphragm is usually seen as a smooth hump, while the remainder of the hemidiaphragm contour is normal. The frontal X-ray may show a 'double' diaphragmatic contour, which is easily confirmed on the lateral projection.

CT
  • maybe a sharp border between the eventrated portion and the remainder of the hemidiaphragm

Differential diagnosis

Possible considerations on plain film include: