Bulging diaphragm

Introduction to diaphragmatic bulging Diaphragm bulging refers to the formation of a fibrous membrane caused by the diaphragmatic muscle insufficiency caused by paralysis, hypoplasia or atrophy caused by paralysis of the diaphragm, and the position of the diaphragm is abnormally increased due to the apparent increase of the top position of the diaphragm. More often occurs on the left side. Occasionally, some of the diaphragm muscles may be involved, and the anterior medial part of the right side is common, and the bilateral diaphragm muscle bulge is rare. The disease can occur at any age, with adults on the left and infants on the right. More men than women, about 2:1. basic knowledge The proportion of illness: the incidence rate of infants and young children is about 0.001% - 0.002% Susceptible people: no specific population Mode of infection: non-infectious Complications: abdominal pain, abdominal distension, intestinal obstruction

Cause of diaphragmatic bulging

(1) Causes of the disease

At present, the etiology of diaphragmatic bulging is not completely clear, but it is generally considered to be related to congenital and acquired factors. Congenital diaphragmatic bulging is only dysplasia of diaphragmatic muscle, relatively thin and weak, severely like semi-permeable membrane, no lesion of phrenic nerve, Most scholars believe that the embryonic period of peri-thoracic insufficiency or non-muscleization leads to weak diaphragm, often associated with abnormal development, some patients have abnormal chromosome performance, and acquired muscle bulge is caused by radial nerve injury or lesions. Injuries in infants, birth injuries, congenital heart disease or mediastinal tumor surgery are the most common cause; in adults, malignant tumors (such as lung cancer, thymoma, malignant germ cell tumor, non-Hodgkin's disease), heart The effect of cooling on the surface of the heart during open surgery, surgical injury (such as mediastinal incision, intrathoracic or cervical mass resection, subclavian vein or jugular vein catheter and electrode placement) and high cervical spinal cord trauma It is easy to cause radial nerve palsy and diaphragmatic bulging. Adult idiopathic phrenic nerve palsy and diaphragmatic bulging may be caused by subclinical viral infection.

(two) pathogenesis

Congenital hypoplasia of the diaphragmatic muscle fibers or injury to the phrenic nerve at birth, causing diaphragmatic paralysis, muscle fiber atrophy, a membrane of the diaphragm is film-like, and the position of the dome is significantly increased. This condition is called diaphragmatic bulging, and most cases are diaphragmatic muscles. The bulging occurs only on one side, the adult is more common in the left lobe, and the infant is more common in the right lobe. The clinical symptoms of diaphragmatic bulging vary in severity. In infants and young children, the lower lobe is depressed due to the increased position of the diaphragm. Increased position of the abdominal organs can cause acute respiratory distress and difficulty in feeding.

Diaphragm bulging prevention

There is no effective preventive measure for congenital diaphragmatic bulging, and the diaphragmatic bulging caused by acquired factors is mainly to actively treat primary diseases and control infection. Patients with nerve damage should be actively treated, especially the phrenic nerve and neck. Patients with nerve damage.

Diaphragm bulging complications Complications abdominal pain, abdominal distension, intestinal obstruction

Symptoms of this disease vary in severity. Infants and young children may cause acute respiratory distress and circulatory dysfunction due to increased diaphragmatic position and intra-abdominal organ position. In severe cases, abnormal respiratory movements and mediastinal flapping may occur in the short term. Respiratory, circulatory failure, may also be complicated by intermittent intestinal obstruction, and bronchitis and lung infection.

There are four typical symptoms of intestinal obstruction: abdominal pain, vomiting, bloating, and anal to stop defecation.

Diaphragm bulging symptoms Common symptoms Dyspepsia Hernia loss of appetite Shortness of breath Breathing nausea Refractory

Diaphragm bulging disease is basically the same in both congenital and acquired pathological changes. Under normal conditions, the calming and breathing muscles are displaced up and down by 1 to 2 cm. The air that enters the lungs due to diaphragmatic muscle movement is 75% to 80% of the inhaled volume. When the bulge is lifted, the diaphragm is extremely relaxed and elevated, and the effective ventilation volume of the lung is reduced. At the same time, the contralateral movement of the diaphragm causes severe ventilatory dysfunction. The patient may have shortness of breath, difficulty breathing, and even purpura. The diaphragmatic muscle changes the gastroesophageal angle. Normal anatomy, bloating, loss of appetite, indigestion and other gastrointestinal symptoms may occur, and severe partial intestinal obstruction may occur.

Examination of diaphragmatic bulging

The examination of this disease generally has the following types:

If the lung is infected, the white blood cells can be increased.

1. X-ray examination of the lateral side of the chest is abnormally elevated in the diaphragmatic side of the lesion, and sometimes the manifestation of atelectasis in the basal segment can be seen. When fluoroscopy, the patient can make a sudden inhalation action, and the diaphragmatic muscle of the lesion can be clearly seen. Contradictory movements, especially acquired muscle bulging, are more obvious. For example, the chest radiograph shows that one side of the diaphragm is lifted in whole or in part and the continuous uninterrupted diaphragm is confirmed.

2, chest CT, MRI, ultrasound or isotope scan helps identify diaphragmatic paralysis and paralysis.

3, pulmonary function test to determine the degree of diaphragmatic weakness, the current use of the difference between the standing and lying position tidal volume ( Vc) to assess diaphragm function, the literature reported that diaphragmatic swelling is generally characterized by localized ventilatory disorders, tidal volume The average reduction of the predicted value of 74% to 81%, the limited pulmonary function of patients with limited.

Diagnosis and differentiation of diaphragmatic bulging

diagnosis

Summarize the main points of diagnosis of this disease are as follows:

1. Chest tightness, shortness of breath, difficulty breathing, severe heart rate or arrhythmia may occur, and symptoms such as purpura may increase after satiety;

2. During the physical examination, the heart is displaced to the healthy side, and the affected side has signs such as lung compression.

3. Hernia, bloating, indigestion, loss of appetite, etc.

4. X-ray chest examination showed an increase in diaphragmatic muscles.

5. Infants due to diaphragmatic elevation, increased position of the abdominal organs, resulting in compression of the lower lobe of the lungs, can occur anorexia, nausea, vomiting, difficulty breathing, purpura, and even acute respiratory distress and heart, vascular dysfunction and other serious symptoms.

According to the typical clinical manifestations, the possibility of diaphragmatic bulging should be considered. The diagnosis should be determined by chest X-ray and fluoroscopy.

Differential diagnosis

1,

Clinically, there are many similarities between sputum and diaphragmatic bulging. The congenital or acquired causes cause the intra-abdominal organs to enter the thoracic cavity through the diaphragm defect. The sacral muscles can also be seen in the chest, but the stomach is visible in the upper iliac bulge. Cavity or intestine cavity cavity shadow, using pneumoperitoneum examination can be seen when the patient is in the upright position, the gas rises into the thoracic cavity, that is, in the hernia sac on the sputum, while the swell of the sputum sees the gas under the armpit, gastrointestinal angiography Or barium enema can more clearly see the relationship between elevated stomach or colon and diaphragm. The symptoms of hernia vary according to their type. Newborns with thoracic and peritoneal hernia are mainly characterized by difficulty in breathing after graduation, purpura, various tissues and internal organs. Intrusion into the chest is often life-threatening, because the intra-abdominal organs occupy the chest and oppress the heart and lungs. The contents of the para-sternal sac can have the omentum and the transverse colon. The stomach and liver are most asymptomatic. If the internal organs are twisted, they are embedded. Can cause abdominal pain, vomiting, diarrhea, etc., infants and young children often have difficulty breathing except gastrointestinal symptoms, 3% of patients with esophageal hiatal hernia are asymptomatic, can cause sore throat when refluxing gastric juice Oral burning sensation, even irritating vocal cords, dullness, sternal discomfort and heartburn, reflux fluid can cause aspiration pneumonia if inhaled into the respiratory tract. The difference with sputum is that the diaphragm is intact, but due to muscle fiber dysplasia or atrophy, sputum occurs. The position of the two up, the meal X-ray examination and artificial pneumoperitoneum can also identify the two diseases.

2, diaphragmatic paralysis

Diaphragmatic paralysis and diaphragmatic bulging are difficult to identify in clinical manifestations. The left ricin may have gastrointestinal symptoms such as hernia, abdominal distension, abdominal pain due to elevated gastric fundus, purpura on both sides of the diaphragm, obvious breathing difficulties, sitting breathing and Hypoxemia, X-ray showed elevated unilateral diaphragmatic paralysis, decreased or disappeared activity, and the contradictory movement of the diaphragmatic muscle and the diaphragmatic muscle of the affected side during inhalation. This phenomenon is more obvious when rushing inhalation. When breathing, there may be a mediastinal swing. When inhaling, the heart, mediastinum shifts to the healthy side, and exhales to the affected side. However, the diaphragmatic paralysis has some typical clinical symptoms, such as a history of sacral nerve damage, increased diaphragm, Contradictory movements and mediastinal shifts are not as obvious as sacral bulging.

3, lung bottom effusion

Patients with pulmonary effusion often have an episode of "diaphragm elevation" on the X-ray examination, which can be distinguished after a change in chest position or B-ultrasound.

4, transverse tumor

Very rare, no specific symptoms, X-ray examination showed a smooth round or oval dense shadow on the diaphragm, which can move up and down with the diaphragm muscle movement, its shape and size do not change with breathing, diagnostic pneumoperitoneum Help with diagnosis.

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