Functional Disorders of the Diaphragm: Eventration and Acquired Paralysis

  • Willem Nicolaas WelvaartEmail author
  • Marinus A. Paul


A paralyzed, elevated diaphragm is thought to be the result of either eventration or an acquired paralysis. Although these conditions are considered to be two separate entities, they will be discussed together because symptoms and treatment are similar. We will also give some arguments why they might even be different stages in the same process.


Pulmonary Function Test Phrenic Nerve Diaphragmatic Paralysis Cardiac Compression Diaphragmatic Muscle 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Laxdal OE, Mc Doughall H, Mellin GW (1954) Congenital eventration of the diaphragm. N Engl J Med 250:401–408PubMedCrossRefGoogle Scholar
  2. 2.
    Thomas TV (1968) Non-paralytic eventration of the diaphragm. J Thorac Cardiovasc Surg 55:586–593PubMedGoogle Scholar
  3. 3.
    Schumpelick V, Steinau G, Schluper I et al (1968) Surgical embryology and anatomy of the diaphragm with surgical applications. Surg Clin North Am 55:586–593Google Scholar
  4. 4.
    Wright CD, Williams JG, Ogilvie CM et al (1985) Results of diaphragmatic plication for unilateral diaphragmatic paralysis. J Thorac Cardiovasc Surg 90:195–198PubMedGoogle Scholar
  5. 5.
    Shah-Mirany J, Schmitz GL, Watson RR (1968) Eventration of the diaphragm. Physiologic and surgical significance. Arch Surg 96(5):844–850PubMedCrossRefGoogle Scholar
  6. 6.
    Chin EF, Lynn RB (1959) Surgery of the eventration of the diaphragm. Thorax 14:311–319CrossRefGoogle Scholar
  7. 7.
    McNamara JJ, Paulson DL, Urschel HC et al (1968) Eventration of the diaphragm. Surgery 64:1013–1021PubMedGoogle Scholar
  8. 8.
    Christensen P (1979) Eventration of the diaphragm. Thorax 14:311–319CrossRefGoogle Scholar
  9. 9.
    Deslaurier J (1998) Eventration of the diaphragm. Chest Surg Clin N Am 8(2):315–330, ReviewGoogle Scholar
  10. 10.
    Fell SC (1998) Surgical anatomy of the diaphragm and the phrenic nerve. Chest Surg Clin N Am 8(2):281–294, ReviewPubMedGoogle Scholar
  11. 11.
    Ko MA, Gail ED (2009) Acquired paralysis of the diaphragm. Thorac Surg Clin 19(4):501–510PubMedCrossRefGoogle Scholar
  12. 12.
    Gierada DS, Slone RM, Fleischman MJ (1998) Imaging evaluation of the diaphragm. Chest Surg Clin N Am 8(2):237–280PubMedGoogle Scholar
  13. 13.
    Michelson E (1961) Eventration of the diaphragm. Surgery 49:410–422PubMedGoogle Scholar
  14. 14.
    Balci AE, Özyurtkan MO (2010) Clinical and surgical specifications of adult unilateral diaphragmatic eventration according to their aetiology in 28 patients. Importance of using diaphragmatic patch and minimal thoracotomy incision. Eur J Cardiothorac Surg 37:606–612PubMedCrossRefGoogle Scholar
  15. 15.
    Revillon Y, Fekete CN (1982) Eventration diaphragmatique chez l’enfant. Etude de trente-six cas de 1951 à 1980. Ann Chir Thorac Cardiovasc 36:71–74Google Scholar
  16. 16.
    Levine S, Nguyen T, Taylor N et al (2008) Rapid disuse atrophy of diaphragm fibers in mechanically ventilated humans. N Engl J Med 358(13):1327–1335PubMedCrossRefGoogle Scholar
  17. 17.
    Merendino KA, Johnson RS, Skinner HH et al (1956) The intradiaphragmatic distribution of the phrenic nerve with particular reference to the placement of diaphragmatic incisions and control, ed segmental paralysis. Surgery 39:189–198PubMedGoogle Scholar
  18. 18.
    Piehler JM, Pairolero PC, Gracey DR (1982) et al Unexplained diaphragmatic paralysis; a harbinger of malignant disease? J Thorac Cardiovasc Surg 84:861–864PubMedGoogle Scholar
  19. 19.
    Ribet M, Linder JL (1992) Plication of the diaphragm for unilateral eventration or paralysis. Eur J Cardiothorac Surg 6(7):357–360PubMedCrossRefGoogle Scholar
  20. 20.
    Hountis P, Ikonomidis P, Stamatelopoulos A, Douzinas M (2008) Compression of the right atrium due to coexistence of diaphragmatic eventration and Chilaiditi’s syndrome. Thorac Cardiovasc Surg 56(6):365–367PubMedCrossRefGoogle Scholar
  21. 21.
    Aigner C, Lang G, Taghavi S et al (2008) Haemodynamic complications after pneumonectomy: atrial inflow obstruction and reopening of the foramen ovale. Eur J Cardiothorac Surg 33(2):268–271PubMedCrossRefGoogle Scholar
  22. 22.
    Welvaart WN, Becker A, Marcus JT et al (2010) Unusual treatment of patent foramen ovale after pneumonectomy. Eur Resp J 35:929–931CrossRefGoogle Scholar
  23. 23.
    Kalra PR, Frymann R, Allen DR (2000) An unusual cause of cardiac compression resulting in electromechanical dissociation. Heart 83:250CrossRefGoogle Scholar
  24. 24.
    Schoen SC, Altmann O, Strasser RH (2008) Elevation of left sided diaphragm leading to myocardial infarction by compression of the left circumflex artery. J Invasive Cardiol 20(8):E250–E252PubMedGoogle Scholar
  25. 25.
    Tayyareci Y, Bayazit P, Tastan CP et al (2008) Right atrial compression due to idiopathic right diaphragm paralysis detected incidentally by transthoracic echocardiography. Turk Kardiyol Dern Ars 36(6):412–414 (Engl abstr)PubMedGoogle Scholar
  26. 26.
    Mc Credie JM, Lovejoy FW, Kaltreider NL (1962) Pulmonary function in hemidiaphragmatic paralysis. Thorax 17:213–217CrossRefGoogle Scholar
  27. 27.
    Clague HW, Hall DR (1979) Effect of posture on lung volume; airway closure and gas exchange in hemidiaphragmatic paralysis. Thorax 34:523–526PubMedCrossRefGoogle Scholar
  28. 28.
    Groth SS, Andrade RS (2010) Diaphragm plication for eventration or paralysis; a review of the literature. Ann Thorac Surg 89:S2146–S2150PubMedCrossRefGoogle Scholar
  29. 29.
    Alexander C (1966) Diaphragm movements and the diagnosis of diaphragmatic paralysis. Clin Radiol 17:79–83PubMedCrossRefGoogle Scholar
  30. 30.
    Gottesman E, McCool FD (1997) Ultrasound evaluation of the paralysed diaphragm. Am J Respir Crit Care Med 155:1570–1574PubMedGoogle Scholar
  31. 31.
    Houston JG, Fleet M, Cowan MD et al (1997) Comparison of ultrasound with fluoroscopy in the assessment of suspected hemidiaphragmatic movement abnormalities. Clin Radiol 50:95–98CrossRefGoogle Scholar
  32. 32.
    Roberts HC (2009) Imaging the diaphragm. Thorac Surg Clin 19(4):431–450, ReviewPubMedCrossRefGoogle Scholar
  33. 33.
    Di Giorgio A, Cardini CL, Sammartino P et al (2006) Dual-layer sandwich mesh repair in the treatment of major diaphragmatic eventration in an adult. J Thorac Cardiovasc Surg 132:187–189PubMedCrossRefGoogle Scholar
  34. 34.
    Morrison JM (1923) Eventration of diaphragm due to unilateral phrenic nerve paralysis. Arch Radiol Electrotherapy 28:72–75Google Scholar
  35. 35.
    Wood HG (1916) Eventration of the diaphragm. Surg Gynecol Obstet 23:244–248Google Scholar
  36. 36.
    Glenn WW, Holcomb WG, Hogan J et al (1973) Diaphragm pacing by radiofrequency transmission in the treatment of chronic ventilator insufficiency: present status. J Thorac Cardiovasc Surg 66:505–520PubMedGoogle Scholar
  37. 37.
    Stolk J, Versteegh MI (2000) Long-term effect of bilateral plication of the diaphragm. Chest 117(3):786–789PubMedCrossRefGoogle Scholar
  38. 38.
    Ohta M, Ikeda N, Tanaka H et al (2007) Satisfactory results of diaphragmatic plication for bilateral phrenic nerve paralysis. Ann Thorac Surg 84(3):1029–1031PubMedCrossRefGoogle Scholar
  39. 39.
    Graham DR, Kaplan D, Evans CC et al (1990) Diaphragmatic plication for unilateral diaphragmatic paralysis: a 10-year experience. Ann Thorac Surg 49(2):248–251PubMedCrossRefGoogle Scholar
  40. 40.
    Kuniyoshi Y, Yamashiro S, Miyagi K et al (2004) Diaphragmatic plication in adult patients with diaphragm paralysis after cardiac surgery. Ann Thorac Cardiovasc Surg 10:160–166PubMedGoogle Scholar
  41. 41.
    Simansky DA, Palye M, Refaely Y et al (2002) Diaphragm plication following phrenic nerve injury; a comparison of paediatric and adult patients. Thorax 57:613–616PubMedCrossRefGoogle Scholar
  42. 42.
    Higgs SM, Hussain A, Jackson M et al (2002) Long term results of diaphragmatic plication for unilateral diaphragm paralysis. Eur J Cardiothorac Surg 21:294–297PubMedCrossRefGoogle Scholar
  43. 43.
    Calvinho P, Bastos C, Bernardo JE et al (2009) Diaphragmatic eventration: long-term follow-up and results of open-chest plicature. Eur J Cardiothorac Surg 36(5):883–887PubMedCrossRefGoogle Scholar
  44. 44.
    Versteegh MI, Braun J, Voigt PG et al (2007) Diaphragm plication in adult patients with diaphragm paralysis leads to long-term improvement of pulmonary function and level of dyspnea. Eur J Cardiothorac Surg 32(3):449–456PubMedCrossRefGoogle Scholar
  45. 45.
    Lai DT, Paterson HS (1999) Mini-thoracotomy for diaphragmatic plication with thoracoscopic assistance. Ann Thorac Surg 68:2364–2365PubMedCrossRefGoogle Scholar
  46. 46.
    Mouroux J, Venisssac N, Leo F et al (2005) Surgical treatment of diaphragmatic eventration using video-assisted thoracic surgery: a prospective study. Ann Thorac Surg 79:308–312PubMedCrossRefGoogle Scholar
  47. 47.
    Hüttl TP, Wichmann MW, Reichart B et al (2004) Laparoscopic diaphragmatic plication: long-term results of a novel surgical technique for postoperative phrenic nerve palsy. Surg Endosc 18(3):547–551PubMedCrossRefGoogle Scholar
  48. 48.
    Freeman RK, Wozniak TC, Fitzgerald EB (2006) Functional and physiologic results of video-assisted thoracoscopic diaphragm plication in adult patients with unilateral diaphragm paralysis. Ann Thorac Surg 81(5):1853–1857PubMedCrossRefGoogle Scholar
  49. 49.
    Kim DH, Hwang JJ, Kim KD (2007) Thoracoscopic diaphragmatic plication using three 5-mm ports. Interact Cardiovasc Thorac Surg 6:280–282PubMedCrossRefGoogle Scholar
  50. 50.
    Sato M, Hamada Y, Takada K et al (2005) Thoracoscopic diaphragmatic procedures under artificial pneumothorax. Pediatr Surg Int 21(1):34–38PubMedCrossRefGoogle Scholar
  51. 51.
    Hwang Z, Shin JS, Cho YH et al (2003) A simple technique for the thoracoscopic plication of the diaphragm. Chest 124(1):376–378PubMedCrossRefGoogle Scholar
  52. 52.
    Langer JC, Filler RM, Coles J et al (1988) Plication of the diaphragm for infants and young children with phrenic nerve palsy. J Pediatr Surg 23(8):749–751PubMedCrossRefGoogle Scholar
  53. 53.
    Groth SS, Rueth NM, Kast T et al (2010) Laparoscopic diaphragm plication for diaphragmatic paralysis and eventration: an objective evaluation of short- and mid-term results. J Thorac Cardiovasc Surg 139:1452–1456PubMedCrossRefGoogle Scholar
  54. 54.
    Maxson T, Robertson R, Wagner CW (1993) An improved method of diaphragmatic plication. Surg Gynecol Obstet 177:620–621PubMedGoogle Scholar
  55. 55.
    Moon SW, Wang YP, Kim YW et al (2000) Thoracoscopic plication of diaphragmatic eventration using endostaplers. Ann Thorac Surg 70(1):299–300PubMedCrossRefGoogle Scholar
  56. 56.
    Freeman RK, Van Woerkom J, Vyverberg A et al (2009) Long-term follow-up of the functional and physiologic results of diaphragm plication in adults with unilateral diaphragm paralysis. Ann Thorac Surg 88(4):1112–1117PubMedCrossRefGoogle Scholar
  57. 57.
    Smulders SA, Marcus JT, Gan CT, Sutedja TG, Smeenk FW, Vonk-Noordegraaf A. Left ventricular encasement after pneumonectomy: case report. J Thorac Cardiovasc Surg. 2006 Oct;132(4):e23–4PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.Department of SurgeryRivierland Ziekenhuis TielTielThe Netherlands
  2. 2.Department of SurgeryVU University HospitalAmsterdamThe Netherlands

Personalised recommendations