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Submitted: 20 January 2017 Modified: 26 January 2017
HERDIN Record #: NCR-PHC-17012010583649

A case of a symptomatic diaphragmatic eventration in a COPD patient.

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Background. Diaphragmatic eventration is a common disease entity among infants and children, it is infrequently seen in adults, and it is very rare in the elderly. In this condition, the muscle is permanently elevated but retains its continuity and attachments to the costal margin. It is seldom symptomatic and often requires no treatment. For the symptomatic patient, plication of the diaphragm may offer relief.1


Case. This is a case of a 69-year old male, hypertensive, with COPD who presented at the emergency department due to difficulty of breathing. He was initially managed as a case of community-acquired pneumonia - moderate risk and exacerbation of eOPD. He was previously diagnosed with an elevated hemidiaphragm but remained asymptomatic until the last six months. On chest radiograph, there was elevation of the left hemidiaphragm and a chest C'T scan revealed a globally elevated left hemidiaphragm. Upon control of the patient's pneumonia and eOPD exacerbation, definitive management of the diaphragmatic eventration was offered and was subsequently done. A thoracotomy, left with plication of diaphragm was successfully performed.


Conclusion. During the postoperative period there was continued improvement of his symptoms throughout discharge. He underwent pulmonary rehabilitation with continued improvement. When encountered with an elevated left hemidiaphragm, a focused clinical history and physical examination are warranted to ascertain the possible causes of the condition. Work up generally includes chest radiography, fluoroscopic sniff test, chest CI tomography, spirometry. Surgical management by diaphragm plication is indicated in symptomatic patients for symptom relief.

Publication Type
Journal
Publication Sub Type
Journal Article, Original
Title
Philippine Heart Center Journal
Frequency
Semi-Annual
Publication Date
July-December 2015
Volume
20
Page(s)
76-81
LocationLocation CodeAvailable FormatAvailability
Philippine Heart Center Medical Library Fulltext Print Format

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