Causes and Diagnoses

Causes and Diagnoses of Disorders of the Diaphragm

Disorders of the diaphragm can have a variety of causes, depending on the type of disorder, ranging from being present at birth to major trauma. Causes may include:

  • Congenital diaphragmatic hernia (CDH):
    • An unknown defect occurs during fetal development
  • Acquired diaphragmatic hernia (ADH):
    • Blunt trauma from car accidents or falls
    • Stab wounds
    • Gunshot wounds
  • Hiatal hernia: 
    • Coughing
    • Vomiting
    • Straining to move your bowels
    • Sudden physical movement, such as lifting
    • Pregnancy
    • Obesity
  • Diaphragmatic tumor:
    • Benign (noncancerous) tumors
    • Cancerous tumors metastasizing (spreading) from the lungs or liver
  • Paralysis of the diaphragm:
    • Lung or lymph cancer that compresses the phrenic nerve
    • Surgical trauma
    • Birth trauma to phrenic nerve
    • Injury to the phrenic nerve or the spinal cord
    • Neuromuscular disorders, such as ALS and MS
    • Thyroid disease
    • Autoimmune disease

Diagnosing Disorders of the Diaphragm

Diagnosis of a diaphragm disorder will begin with a physical exam and discussion of your symptoms. Tests may include:

  • X-ray: A chest X-ray can identify the presence of blockages or fluids creating pressure.
  • Computed tomography (CT) scan: This test combines X-ray and computer technology to produce detailed cross-sectional images of your chest cavity.
  • Magnetic resonance imaging (MRI): Magnetic resonance imaging (MRI) creates detailed images of organs and other body structures using a large magnet, a computer and radiofrequencies. Unlike computed tomography (CT or CAT) scans or X-rays, MRI does not use radiation.
  • Ultrasound: This type of imaging captures movement to detect any irregularities in the diaphragmatic function.
  • Pulmonary function tests while upright and lying down, including:
    • Spirometry: This test measures the quantity and speed of air you exhale to estimate how much your bronchial tubes are inflamed and narrowed.
    • Peak flow meter: This device measures how hard you can exhale. Peak flow meters can be used at home to monitor your condition.
    • Exercise oximetry: This checks the oxygen level in your blood during moments of exertion with a sensor that’s clipped onto your finger.
  • Arterial blood gas: This blood test checks the amount of oxygen and carbon dioxide in your blood and measures your blood’s acidity.
  • Phrenic nerve stimulation test: This test uses electric or magnetic stimulation to the neck to measure the response of the phrenic nerve.
  • Electromyography (EMG): This test measures the electrical potential of muscle fibers stimulated by electrical impulses.