CTICasesDiaphragmatic Eventration
Imaging findings
CT scout and chest fluoroscopy demonstrate an elevated left hemidiaphragm. Cross-sectional CT shows preserved thickness of the left diaphragmatic muscle anteriorly and at the level of the crus near the aorta, although some thinning of the central diaphragmatic dome is present. Fluoroscopy in both standing and supine positions demonstrates preserved, vigorous excursion of the left hemidiaphragm, particularly posteriorly along the crus, moving in the correct direction during deep inspiration.
Key takeaways
Diaphragmatic eventration can clinically and radiographically mimic diaphragmatic paralysis due to the marked elevation of the hemidiaphragm. Standard cross-sectional CT is useful to differentiate the two: paralysis typically causes diffuse atrophy and thinning of the entire diaphragmatic muscle and the crus, whereas eventration shows preserved muscular thickness anteriorly and at the crus with thinning limited to the elevated aponeurotic portion. Fluoroscopy in the supine position serves as a reliable stress test, confirming preserved active contraction in eventration and ruling out true paralysis.
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