Saturday, February 21, 2009

Elevated right hemi-diaphragm

The right hemi-diaphragm is grossly elevated compared to the left hemi-diaphragm. Normally, the right hemi-diaphragm is higher than the left hemi-diaphragm but not more than 3.0-3.5cm. In this case, the difference is 5.5cm. This requires further investigation to determine the cause of the elevation. 
The possible causes can be divided into 3 groups: above the diaphragm, the diaphragm itself and below the diaphragm. 
Causes for above the diaphragm are pulmonary fibrosis or pleural fibrosis. Diaphragmatic causes include eventration and paralysis. Below the diaphragm includes liver pathology (eg liver abscess & HCC) and sub-diaphragmatic fluid collection. 
My next recommendation would be to do an ultrasound to assess for liver pathology and diaphragmatic excursion. If the diaphragm does not move well with respiration, then a diaphragmatic paralysis ought to be considered. 

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