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Diseases of the Diaphragm

The diaphragm, the main muscle involved in breathing, separates the thoracic and abdominal cavities. When a person inhales, 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.

Symptoms

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

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
  • Stroke
  • Muscular disorders, such as muscular dystrophy
  • Multiple sclerosis
  • Thyroid disorders
  • Lupus
  • Radiation therapy
  • Infection
  • Malnutrition
  • Trauma to the muscle or nerve going through the chest to the muscle

Diagnosis

The physician first will take the patient’s history and do a physical examination. Listening to a patient’s 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 X-ray

    Chest x-rays provide an image of the heart, lungs, airways, blood vessels and bones in the spine and chest area. They can be used to look for broken bones, diseases like pneumonia, abnormalities, or cancer.

  • Fluoroscopy

    A 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 the physician can assess function.

  • Pulmonary Function Test (PFT)

    To understand how well your lungs are working, your physician may order a series of pulmonary function tests. With each breath you take in and breathe out, information is recorded 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 

    The measurement of transdiaphragmatic pressure measures the difference between the pressure in the stomach and the pressure in the area surrounding the lungs.

  • Nerve conduction study

     A nerve conduction study measures how well and how fast the nerves can send electrical signals.

Treatment

We will work with the patient and family to make the most appropriate treatment decision, which may include one or more of the following therapies:

  • Medication
  • Supportive Management for Diaphragm

    This includes diaphragmatic pacing, which is similar to a heart pacemaker but the electrodes are implanted on the diaphragm to guide respiration.

  • Surgery. 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, the surgeons will minimize incision size and invasiveness so that the patient’s hospital stay and recovery time are no longer than absolutely necessary.
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