Approach to the differential diagnosis of diaphragm elevation:
- When diaphragm elevation is encountered in the clinical setting of bacterial pneumonia, consider subpulmonic pleural effusion as the etiology and obtain a decubitus radiograph or chest ultrasound to confirm
- When diaphragm elevation is otherwise encountered, check the history for causes of diaphragm paralysis (birth trauma or thoracic surgery)
- Otherwise assume the diaphragm elevation is due to diaphragm eventration
- Ultrasound of the diaphragm and fluoroscopy of the diaphragm can be used to determine the amount of functional impairment of the diaphragm
- It can be difficult to distinguish radiologically between diaphragm eventration and diaphragm paralysis
Pediatric Imaging 