CTICasesRight Hemidiaphragm Eventration (distinguished from Paralysis)
Imaging findings
A patient presented with an elevated right hemidiaphragm, where a good portion of the central and anterior diaphragm was elevated and appeared thinned on sagittal CT, but the posterior quarter of the diaphragm and the ipsilateral crus maintained normal thickness and position. Initial fluoroscopy in the frontal projection showed paradoxical elevation, which was interpreted as paralysis. However, the non-atrophic diaphragmatic crus on CT, and the potential for retained independent motion of the intact posterior muscle (if assessed with lateral fluoroscopy), supported a diagnosis of eventration rather than complete diaphragmatic paralysis.
Key takeaways
Diaphragmatic eventration is characterized by congenital or acquired thinning and elevation of a portion of the diaphragm, often with preserved muscle in other segments. This differentiates it from complete diaphragmatic paralysis, which involves nerve injury and atrophy of the entire hemidiaphragm. Paradoxical motion on frontal fluoroscopy alone does not equate to paralysis; evaluation of diaphragmatic crus thickness on CT and consideration of lateral fluoroscopy can help distinguish eventration from true paralysis by assessing the integrity and function of different muscle segments.
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