Diaphragm Diseases

Diseases of the diaphragm — the muscle that powers a person’s breathing and serves as the barrier between the chest and the abdominal cavity — can cause breathing problems. These conditions are often present at birth or form as a result of injury, accident or surgery.

WakeMed’s thoracic surgeons work in collaboration with other physicians, nurses and rehabilitation specialists to develop a personalized treatment plan for each patient dealing with a diaphragm disease.

Our team offers minimally invasive robotic and thoracoscopic (VATS) options for all our diaphragm surgical procedures, to shorten a patient’s hospital stay and recovery time.

Symptoms of Diaphragm Diseases

Symptoms of diaphragm diseases vary based on the disorder, but may include:

• Cyanosis, a bluish tinge to the skin, especially around the mouth, eyes and nails
• Discomfort or difficulty breathing
• Hypoxemia, a lack of oxygen in the blood
• Pain in the chest, shoulder or abdominal area
• Shortness of breath
• Tachycardia (rapid heart rate)
• Paralysis, in rare cases

People with hiatal hernia, a condition in which the stomach pushes up through the diaphragm, may experience symptoms such as:

• A bitter taste in the mouth
• Abdominal pain, bleeding or blood loss
• Burping
• Chest pain
• Dysphagia (trouble swallowing)
• Feeling full after a small amount of food
• Feeling nauseated
• Gastric torsion, a twisting of the stomach that cuts off the blood supply
• Heartburn
• Regurgitation

Types and Causes of Diaphragm Diseases

There are a number of disorders that can impact the diaphragm, including:

• Congenital diaphragmatic hernia: Before birth, a hole in the diaphragm allows the baby’s digestive organs to move into the chest cavity, reducing the space for the lungs and causing breathing problems.
• Acquired diaphragmatic hernia: Blunt trauma, stab wounds or gunshot wounds can cause a hole to develop in the diaphragm that allows the digestive organs to move into the chest cavity and interfere with breathing.
• Hiatal hernia: Part of the stomach pushes through the diaphragm and into the esophagus, leading to acid reflux.
• Diaphragmatic tumor: Tumors that begin in the diaphragm are rare and often benign. Tumors can also appear in the diaphragm after metastasizing (spreading) from the lungs or liver.
• Paralysis of the diaphragm: When the phrenic nerve is injured, one side or both sides of the diaphragm can become paralyzed, compromising lung function.

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:

• Acquired defects, which occur as the result of an injury, accident or surgery
• Cancer
• Congenital defects, which happen at birth and have no known cause
• Infection
• Lupus
• Malnutrition
• Muscular disorders, such as muscular dystrophy
• Multiple sclerosis
• Radiation therapy
• Stroke
• Thyroid disorders
• Trauma to the muscle or nerve going through the chest to the muscle

Hiatal hernias may be caused by:

• Coughing
• Obesity
• Pregnancy
• Straining to move your bowels
• Sudden physical movement, such as lifting
• Vomiting

Diagnosing Diaphragm Diseases

Diagnosing a diaphragm disease or disorder begins with a physical examination. Sometimes blood oxygen is measured through testing arterial blood gas. Other diagnostic tests may include:

• Electromyography (EMG): This test measures the electrical potential of muscle fibers stimulated by electrical impulses
• Imaging studies, such as chest X-ray, computed tomography (CT) scan, magnetic resonance imaging (MRI) and ultrasound to look for broken bones, pneumonia, cancer and other abnormalities, blockages or fluids
• Phrenic nerve stimulation test: This test uses electric or magnetic stimulation to the neck to measure the response of the phrenic nerve
• Pulmonary function tests

Treating Diaphragm Diseases

We work with each patient to make the most appropriate treatment decision, which may include one or more of these therapies:

• Medication
• Supplemental oxygen
• Surgically implanted diaphragmatic pacemaker
• Tracheostomy and mechanical ventilator
• Watchful waiting, if symptoms are not severe

Surgery is often necessary to treat diaphragm paralysis, abnormal elevation or shape, or hernia. WakeMed thoracic surgeons perform the following procedures:

• Diaphragm plication: The diaphragm is depressed into the abdomen, and two rows of sutures are sewn into either side of the edge of diaphragm where it meets the chest wall. The suture is tied in place, creating a crease in the diaphragm, tightening and lowering the diaphragm into the abdomen.
• Diaphragm hernia repair: The hernia is closed with sutures to restore the integrity of the diaphragm and prevent abdominal organs from entering the thoracic cavity. Whenever possible, our surgeons minimize incision size and invasiveness so the patient’s hospital stay and recovery time are no longer than necessary.

Make an Appointment

We welcome new patients. If you’d like to meet with one of WakeMed’s thoracic experts, please make an appointment by calling us at 919-231-6333.