The diaphragm is a powerful muscle below the lungs and heart. The diaphragm is important for breathing. When the diaphragm contracts, the lungs expand in the thoracic cavity. Expanding the thoracic cavity allows air to enter the lungs, known as inhaling. During relaxation, the lungs expand, reducing lung capacity and causing exhalation. Diaphragm disorders encompass a range of conditions that affect the diaphragm, a critical muscle responsible for breathing and separating the thoracic and abdominal cavities. As thoracic surgeons, it’s essential to grasp these disorders because they can significantly impact respiratory function and patient health.
Conditions affecting the diaphragm:
- Congenital diaphragmatic hernia (CDH) is when an infant’s digestive organs move into the chest due to a hole in the diaphragm. This limits lung space, causing breathing problems.
- An acquired diaphragmatic hernia occurs due to trauma, such as blunt force, stabs, or gunshots, causing a hole in the diaphragm. This perforation hinders normal breathing by allowing digestive organs to move into the chest cavity.
- Diaphragmatic Eventration: This condition involves an abnormal elevation or bulging of a part of the diaphragm, often due to congenital issues or traumatic injuries. Eventration can limit lung expansion and respiratory function.
- Diaphragmatic tumors. Diaphragm neoplasms are rare and often benign. Tumors can spread to the diaphragm from the lungs or liver.
- Diaphragmatic paralysis is caused by phrenic nerve injury, resulting in one or both sides of the diaphragm being paralyzed and affecting lung function.
Symptoms of Diaphragm disorders include:
- Diaphragm complications can cause either temporary or long-lasting symptoms.
- Symptoms of diaphragm disorders can vary, but they often include
- Difficulty breathing or shortness of breath.
- Chest or abdominal pain, especially when taking deep breaths.
- Frequent respiratory infections.
- Gastrointestinal issues in the case of diaphragmatic hernias.
- Reduced ability to exercise.
- Unexplained weight loss.
Diagnosis:
- Doctors use various tests to diagnose diaphragm disorders
- Imaging: Chest X-rays, CT scans, and MRI scans help identify diaphragmatic abnormalities and their extent.
- Pulmonary Function Tests: These tests evaluate lung function, including spirometry and lung volume measurements, revealing respiratory problems.
- Electromyography (EMG): EMG assesses diaphragmatic nerve function and diagnoses paralysis.
Cigarette smoke contains carcinogens that damage lung cells, leading to uncontrolled cell growth. This damage can occur quickly, overwhelming the body’s natural repair mechanisms. Additional risk factors include:
Exposure to secondhand smoke
Previous radiation therapy
Exposure to radon gas
Occupational exposure to carcinogens like asbestos
Family history of lung cancer
Surgical Interventions:
Thoracic surgeons employ different surgical approaches to treat diaphragm disorders, including:
Conclusion
Diaphragm disorders can significantly affect breathing and overall well-being. As thoracic surgeons, understanding the causes, symptoms, diagnostic methods, and surgical interventions related to these disorders is vital for providing effective care and enhancing the quality of life for affected individuals. Timely diagnosis and precise surgical interventions, including minimally invasive techniques like VATS and RATS, often lead to successful outcomes in these challenging cases.
Lung and Trachea
- Lung Cancer
- Tracheal Disease
- Infective Lung Disease
- Non Infective Lung Disease
- Biopsy
Pleural and Mediastinum
- Mediastinal Cancer
- Thymic Cancer and Thymoma
- Myasthenia Gravis
- Pneumothorax
- Pleural Effusion Drainage
- Chylothorax Management
- Pericardial Disease
- Intra Pleural Heated Chemotherapy
Chest wall and Diaphragm
- Pectus Deformity
- Rib Fracture Repair
- Diaphragm Disorder
- Hyperhidrosis Treatment
- Chestwall Reconstruction
- Thoracic outlet syndrome
Key Hole Surgeries
- Video-assisted Thorracoscopic Surgery
- Robotic-assisted Thorracoscopic Surgery