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Eventration of the diaphragm in infants

INTRODUCTION

Eventration of the diaphragm is a disorder in which all or part of the diaphragmatic muscle is replaced by fibroelastic tissue [1,2]. The diaphragm retains its continuity and attachments to the costal margin. However, the weakened hemidiaphragm is displaced into the thorax, which can compromise breathing. With diaphragmatic hernia, in contrast, this continuity between the diaphragm and the costal margin is disrupted.

EPIDEMIOLOGY

The incidence of eventration is uncertain, although in one report, the condition was detected in 1 per 1400 patients who had chest radiographs [3]. More males than females are affected. Congenital eventrations can be isolated, although they sometimes are associated with other developmental defects such as cleft palate, congenital heart disease, situs inversus, or undescended testicle [4].

PATHOGENESIS

Eventration of the diaphragm can be congenital or acquired [4-6]. Congenital eventration results from inadequate development of the muscle or absence of the phrenic nerves. The most common cause of acquired eventration is injury to the phrenic nerve, resulting from either a traumatic birth or thoracic surgery for congenital heart disease. The loss of contractility leads to muscle atrophy with elevation of the hemidiaphragm [5]. (See "Diaphragmatic paralysis in the newborn".)

The defect in congenital eventration can be partial or diffuse [3,7]. In the former, the defect is localized; whereas, in the latter, the diaphragm consists of a thin, diaphanous membrane that is attached peripherally to normal muscle. In one series, partial defects, mostly affecting the right hemidiaphragm, occurred in 65 percent of children [8]. Diffuse defects also tend to be unilateral but occur more commonly on the left side.

In the acquired form, the central tendon is normal and the diaphragm consists of normally developed muscle that is atrophic. The phrenic nerve typically is small. Both sides are affected equally.

    

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Literature review current through: Mar 2014. | This topic last updated: May 22, 2012.
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References
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  1. BISGARD JD. Congenital eventration of the diaphragm. J Thorac Surg 1947; 16:484.
  2. Shah-Mirany J, Schmitz GL, Watson RR. Eventration of the diaphragm. Physiologic and surgical significance. Arch Surg 1968; 96:844.
  3. CHIN EF, LYNN RB. Surgery of eventration of the diaphragm. J Thorac Surg 1956; 32:6.
  4. Smith CD, Sade RM, Crawford FA, Othersen HB. Diaphragmatic paralysis and eventration in infants. J Thorac Cardiovasc Surg 1986; 91:490.
  5. Deslauriers J. Eventration of the diaphragm. Chest Surg Clin N Am 1998; 8:315.
  6. Obara H, Hoshina H, Iwai S, et al. Eventration of the diaphragm in infants and children. Acta Paediatr Scand 1987; 76:654.
  7. Reed, JA, Borden, DL. Eventration of the diaphragm. Arch Surg 1935; 31:30.
  8. Wayne ER, Campbell JB, Burrington JD, Davis WS. Eventration of the diaphragm. J Pediatr Surg 1974; 9:643.
  9. Thomas TV. Congenital eventration of the diaphragm. Ann Thorac Surg 1970; 10:180.
  10. Goldstein JD, Reid LM. Pulmonary hypoplasia resulting from phrenic nerve agenesis and diaphragmatic amyoplasia. J Pediatr 1980; 97:282.
  11. París F, Blasco E, Cantó A, et al. Diaphragmatic eventration in infants. Thorax 1973; 28:66.
  12. Kizilcan F, Tanyel FC, Hiçsönmez A, Büyükpamukçu N. The long-term results of diaphragmatic plication. J Pediatr Surg 1993; 28:42.
  13. Haller JA Jr, Pickard LR, Tepas JJ, et al. Management of diaphragmatic paralysis in infants with special emphasis on selection of patients for operative plication. J Pediatr Surg 1979; 14:779.
  14. Mouroux J, Venissac N, Leo F, et al. Surgical treatment of diaphragmatic eventration using video-assisted thoracic surgery: a prospective study. Ann Thorac Surg 2005; 79:308.
  15. Shimizu M. Bilateral phrenic-nerve paralysis treated by thoracoscopic diaphragmatic plication in a neonate. Pediatr Surg Int 2003; 19:79.
  16. Shah SR, Wishnew J, Barsness K, et al. Minimally invasive congenital diaphragmatic hernia repair: a 7-year review of one institution's experience. Surg Endosc 2009; 23:1265.
  17. Schwartz MZ, Filler RM. Plication of the diaphragm for symptomatic phrenic nerve paralysis. J Pediatr Surg 1978; 13:259.