Medical answers: Signs of an elevated hemidiaphragm

What are the physical signs of an elevated hemidiaphragm? — Sam, Lewiston, N.Y.

The diaphragm separates the chest cavity and abdomen, rising and falling as we breathe. Each side is called a hemidiaphragm and when one is found to be significantly higher than another, it's called an elevated or raised hemidiaphragm.

If the diaphragm is working properly, the muscle membrane is curved when relaxed, flat and straight when we breathe.

"When it's weakened, it's not getting as flat and straight," says Dr. Thomas Warfel, a cardiothoracic radiologist at highly rated Providence Portland Medical Center in Portland, Ore.

In itself, it's not a condition to be diagnosed or a disease to be treated, but it can be a clue that a serious medical problem exists.

Usually it's an incidental finding on a chest X-ray, with no outwardly visible physical signs, Warfel says. He finds an elevated hemidiaphragm in about one in 15 of his patients. If it's "old" — unchanged for two or more years — and the patient doesn't have respiratory issues, he says, there's nothing to be concerned about.

But a newly elevated hemidiaphragm can indicate damage to the phrenic nerve that controls the diaphragm, which can make breathing more difficult. "It can also be a sign of problems such as esophageal cancer, lung cancer, or lymphoma," Warfel says.

Temporary elevation of a hemidiaphragm also frequently occurs after abdominal surgery or in patients with pancreatitis.

If it is a new finding, Warfel recommends an aggressive evaluation, including a CT scan.

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