Elevated Diaphragm: Causes, Symptoms, Diagnosis, Treatment

What is elevated diaphragm?

A common finding on imaging is elevation of the diaphragm which means that the diaphragm muscle is higher than is usually found on one or both sides.

How is an elevated diaphragm diagnosed?

Usually with imaging tests.  Often this is with chest X-ray or CT.

What is a sniff test used for?

This is a test done to evaluate the function of the diaphragm.  The  diaphragm is observed under fluoroscopy during breathing and a sniff maneuver through the nose.

The absence of contraction of the diaphragm (movement downward) confirms diaphragm paralysis.  This can also be seen in patients with neuromuscular disorders, stroke and trauma to the diaphragm.

Symptoms of elevated diaphragm

This can be an asymptomatic finding in the majority of cases.  More severe cases can lead to problems with breathing, pneumonia and respiratory failure.

What causes elevated diaphragm?

Generally causes can be above the diaphragm, involving the diaphragm or below the diaphragm.

Above the diaphragm

The diaphragm can be elevated when the lung above it is smaller than it should be. This then makes the diaphragm go higher than normal.  This can be caused by a lung that has been removed for some reason like cancer. There could be lung collapse which is called atelectasis. This can be from a portion of the lung that did not develop properly.

Diaphragm

The diaphragm itself can also be the cause of the elevation. The diaphragm is controlled by the phrenic nerve which travels from the neck through the chest and then to the diaphragm. You can imagine lesions or abnormalities could damage or press on the nerve. Cancers, traumas, pneumonia or other inflammatory processes can involve the nerve.

Another cause is called diaphgramic eventration in which a part of the diaphgram is elevated causing a bulge instead of a smooth contour. This is caused by parts of the diaphragm not having muscle fibers or nerve function.

Below the diaphragm

Abnormalities pushing up against the diaphragm from below can also cause it to look elevated on a chest X-ray. The liver is positioned just below the diaphragm.  Therefore a mass of the liver or an abnormality around it can cause the diaphragm to be elevated.

On the left side, a big stomach filled with food or gas can cause the diaphragm to appear elevated. Sometimes distended colon underneath the diaphragm can cause it to be elevated.

What can look like an elevated diaphragm?

Other diagnosis can mimic an elevated diaphragm. This can be a tumor or mass about the diaphragm

A subpulmonic effusion is when fluid collects underneath the lung and may look like an elevated hemidiaphragm.

A hernia of the diaphragm can also mimic an elevated diaphragm.

What does elevated diaphragm  look like on imaging?  How do you look for a cause?

Imaging like X-ray, CT, and MRI will show a diaphragm on one side which is higher than the other side.  Imaging may also provide a reason for the elevated diaphragm.  For example, there can be a mass involving the phrenic nerve or a collapsed lung seen on imaging.

Is elevated diaphragm dangerous?

It can be in severe cases.  There can be respiratory distress and pneumonia.  There can be a need for mechanical ventilation.  The cause of an elevated diaphragm can be a dangerous condition which may need prompt treatment.

What type of doctor treats elevated diaphragm?

Many specialists can be involved in the diagnosis and treatment of elevated diaphragm.  Radiologists are often involved in the diagnosis.  Pulmonary specialists, neurologists and thoracic surgeons may be involved in the treatment.

Elevated diaphragm: summary

Elevated diaphragm is a common finding on imaging tests.  This is often an asymptomatic finding but can lead to symptoms in some cases.  A sniff test is often used to look at the function of the diaphragm.   There are numerous causes as outlined above, some of which involve the lung above the diaphragm and structures below the diaphragm.