A raised hemidiaphragm on a chest film can reflect paralysis, eventration, subpulmonic effusion, volume loss in the lung above, or something pushing up from below. Start with old films: a long-standing, unchanged elevation is far less worrying than a new one. Then look for a cause, including a mass in the chest that could involve the phrenic nerve. When the finding is new and unexplained, suggest a dynamic assessment in the report.
- Compare with every available previous chest image.
- Look for lung volume loss, effusion and subdiaphragmatic causes.
- Look along the phrenic nerve course for a mass in the neck or mediastinum.
- Recommend a dynamic study when the elevation is new and unexplained.
Why it matters
A new raised hemidiaphragm can be the first sign of a mediastinal tumour affecting the phrenic nerve.
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