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Innovative and Contemporary Interventions of Diaphragmatic Disorders

Black, Matthew C. MD*; Joubert, Kyla MD*; Seese, Laura MD*; Ocak, Iclal MD; Frazier, Aletta A. MD; Sarkaria, Inderpal MD*; Strollo, Diane C. MD*; Sanchez, Manuel V. MD*

doi: 10.1097/RTI.0000000000000416
Symposium: Imaging of Innovative and Contemporary Thoracic Interventions: State-of-the-Art
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The diaphragm is an inconspicuous fibromuscular septum, and disorders may result in respiratory impairment and morbidity and mortality when untreated. Radiologists need to accurately diagnose diaphragmatic disorders, understand the surgical approaches to diaphragmatic incisions/repairs, and recognize postoperative changes and complications. Diaphragmatic defects violate the boundary between the chest and abdomen, with the risk of herniation and strangulation of abdominal contents. In our surgical practice, patients with diaphragmatic hernias present acutely with incarceration and/or strangulation. Bochdalek hernias are commonly diagnosed in asymptomatic older adults on computed tomography; however, when viscera or a large amount of fat herniates into the chest, surgical intervention is strongly advocated. Morgagni hernias are rare in adults and typically manifest acutely with bowel obstruction. Patients with traumatic diaphragm injury may have an acute, latent, or delayed presentation, and radiologists should be vigilant in inspecting the diaphragm on the initial and all subsequent thoracoabdominal imaging studies. Almost all traumatic diaphragm injury are surgically repaired. Finally, with porous diaphragm syndrome, fluid, air, and tissue from the abdomen may communicate with the pleural space through diaphragmatic fenestrations and result in a catamenial pneumothorax or large pleural effusion. When the underlying disorder cannot be effectively treated, the goal of surgical intervention is to establish the diagnosis, incite pleural adhesions, and close diaphragmatic defects. Diaphragmatic plication may be helpful in patients with eventration or acquired injuries of the phrenic nerve, as it can stabilize the affected diaphragm. Phrenic nerve pacing may improve respiratory function in select patients with high cervical cord injury or central hypoventilation syndrome.

Departments of * Cardiothoracic Surgery

Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA

Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD

The authors declare no conflicts of interest.

Correspondence to: Matthew C. Black, MD, University of Pittsburgh Medical Center, 200 Lothrop St, Suite C800, Pittsburgh, PA 15213 (e-mail: blackmc@upmc.edu).

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