A high diaphragm, which is a rare condition in adults, can cause complaints of shortness of breath and tachycardia during walking and exertion over time. Experts state that the diagnosis is often detected by chance and emphasize that high diaphragm is a disease that must be treated. Giving information on the subject, Thoracic Surgery Specialist Prof. Dr. Özkan Demirhan said, “Diaphragm is one of our most important respiratory muscles and is the name given to the flat, wide muscle structure that separates the abdominal cavity from the chest cavity. Diaphragm elevation (eventration) is the permanent elevation of all or part of the diaphragm muscle, provided that its attachment to the ribs and organ connections are not disrupted. This is a rare condition in adults. Diaphragmatic elevation may occur after primary or acquired phrenic nerve damage. Although this anomaly is usually seen in the left diaphragm, it is characterized by a significant decrease in the density of muscle fibers in the diaphragm. Heightened diaphragm sometimes occurs due to damage to the phrenic nerve (the nerve that stimulates the diaphragm). However, diaphragmatic hyperplasia often occurs as a pure degenerative muscle disease without any neural damage. Although the causes of diaphragmatic elevation and diaphragmatic paralysis are different, they generally cause the same radiological appearance and the same clinical conditions. Heightened diaphragm is more common in the male population.” he said.
Patients eventually have to sit in an upright position all the time and sleep in a sitting position.
Referring to the symptoms caused by the height of the diaphragm, Prof. Dr. Özkan Demirhan said, “Shortness of breath is the main symptom in patients with an elevated diaphragm or diaphragmatic paralysis. In patients with diaphragm elevation or paralysis, the function of the diaphragm has decreased or disappeared due to immobility. Therefore, due to the maladaptation of the lung and thorax wall, significant changes occur in breathing or breathing is impaired. This is among the factors that increase the feeling of shortness of breath. In some patients, a decrease in oxygen in the blood, called hypoxemia, may occur. The reflex hyperventilation that develops to correct hypoxemia, that is, if the normal air inlet and outlet required to maintain the normal gas level of the blood occurs above the normal level, causes respiratory alkalosis. Unlike normal people, the displacement of the abdominal organs towards the thorax in the supine position will lead to a further decrease in lung volumes, and some patients may experience severe respiratory distress. Especially in patients with an elevated left diaphragm, symptoms such as reflux, abdominal pain, bloating, heartburn, vomiting, belching, nausea, constipation and weight loss may develop. These complaints are characteristically exacerbated by position changes. In the examination of patients with moderate and severe diaphragmatic elevation, there may be a collapse in the lower part of the rib cage on the affected side, and a collapse in the abdomen due to the insertion of the abdominal organs into the rib cage. Severe and progressive shortness of breath when bending over or lying down is the most important reason for the diagnosis of an elevated diaphragm. Patients end up having to constantly work in an upright position and sleep in a sitting position.” he said.
It is usually detected incidentally on a chest radiograph.
Prof. Dr. Özkan Demirhan said, “Most adult patients with diaphragmatic elevation or paralysis do not have any complaints. Diaphragmatic height is usually detected incidentally on a chest radiograph. Any other pathological condition is excluded by tomography. Whether there is diaphragmatic movement or not can be observed with ultrasonography. It is important to prove that shortness of breath or orthopnea is due to diaphragmatic elevation or paralysis. Therefore, a meticulous history and physical examination should be performed to evaluate the duration and progression of shortness of breath and orthopnea and to exclude other potential causes of shortness of breath (morbid obesity, lung disease, congestive heart failure, etc.). Other causes should be excluded.” He spoke as follows.
Treatments are carried out using minimally invasive methods.
Prof. Dr. Özkan Demirhan also touched upon Diaphragm Height treatments and said, "While treatments used to be performed with open methods, today diaphragm plication techniques have been developed with minimally invasive transthoracic and transabdominal methods. Diaphragmatic plication is a surgical treatment method used for diaphragmatic elevation. The procedure involves creating folds in the weakened hemidiaphragm with U stitches and then pinning them down. Diaphragm plication
Nowadays, it can be performed through video-assisted thoracoscopic surgery (VATS), open surgery (Thoracotomy), robot-assisted surgery (RATS) or laparoscopic-laparotomy. "After the diaphragm is brought to its normal position, the pressure on the lungs is eliminated and the effort capacity increases." He gave information as follows.
He underlined the post-operative process.
Touching on the things that need to be taken into consideration in the post-operative period, Demirhan continued his words as follows.
“Diaphragm surgery should be performed in full-fledged hospitals as intensive care support treatment may be required as it will cause changes in rib cage and intra-abdominal pressure. Since there is a change in rib cage and abdominal alignment as the abdominal organs are lowered into the abdominal cavity, it is very important to perform postoperative extubation in a planned manner in intubated patients. Since problems with bowel movements may occur due to increased intra-abdominal pressure, patients are gradually transitioned to oral feeding in a controlled manner in the early period. Pain control, postoperative breathing exercises and early mobilization are very important.”
