Diseases & Conditions
Diseases of the Diaphragm
The Division of Thoracic Surgery at Boston Medical Center treats a wide variety of conditions with the skill and compassion for which we are known, including diseases of the diaphragm. Our team of dedicated surgeons and nurses is here for you and your family. We’ll work diligently to treat you in the most effective way possible, help minimize your pain and start you on the path to recovery.
What are Diseases of the Diaphragm?
The diaphragm, the main muscle involved in breathing, separates the thoracic and abdominal cavities. When you inhale, it decreases pressure in the lungs and helps expand the rib cage. As with any organ or muscle, the diaphragm is subject to disorders and abnormalities, which come in many different forms and can stem from injury or illness. The overall number of disorders of the diaphragm isn’t known, but there are estimates for disorders that are due to specific problems; for example, about 11 percent of people have a disorder related to the diaphragm after heart surgery.
Symptoms vary based on the disorder, but may include:
- Discomfort or difficulty breathing
- Pain in the chest, shoulder or abdominal area
- Hypoxemia (a lack of oxygen in the blood)
- Fewer breath sounds
- Paralysis, in rare cases
Causes of diseases of the diaphragm vary, but they are usually a result of problems with the anatomy or the neurologic system, such as:
- Congenital defects, which happen at birth and have no known cause
- Acquired defects, which occur as the result of an injury, accident or surgery
- Muscular disorders, such as muscular dystrophy
- Multiple sclerosis
- Thyroid disorders
- Radiation therapy
- Trauma to the muscle or nerve going through the chest to the muscle
Your physician first will take your history and do a physical examination. Listening to your heart and breathing can often provide a great deal of information. Sometimes blood oxygen is measured through testing arterial blood gas.
Other tests may include:
- Chest radiography, or chest X-ray, provides an image of the heart, lungs, airways, blood vessels and bones in the spine and chest area.
- Fluoroscopy is a moving X-ray. As the X-ray beam passes through the chest area, a moving image is displayed on a monitor so your physician can assess function.
- Pulmonary function tests are a series of tests designed to measure how well your lungs work. With each breath you take in and breathe out, information is captured about how much air your lungs take in, how the air moves through your lungs and how well your lungs deliver oxygen to your bloodstream.
- Measurement of transdiaphragmatic pressure measures the difference between the pressure in the stomach and the pressure in the area surrounding the lungs.
- Nerve conduction studies involve the nerve to the diaphragm.
We will work with you and your family to make the most appropriate treatment decision, which may include one or more of the following therapies:
- Medication. If the diaphragm disease is neurologic in origin, medication may be prescribed.
- Supportive management. This includes diaphragmatic pacing, which is similar to a heart pacemaker but the electrodes are implanted on the diaphragm to guide respiration.
- Surgery. Your physician may recommend a surgical procedure. This may involve removing part of the diaphragm or abnormal tissue, folding the diaphragm or repairing the muscle. Repair may involve the phrenic nerve, the only receiver of neurologic impulse in the diaphragm. Whenever possible, we will minimize incision size and invasiveness so that your hospital stay and recovery time are no longer than absolutely necessary.