DDX of diaphragm elevation

Approach to the DDX 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