eMedicine Specialties > Pulmonology > Diaphragmatic Disorders

Diaphragm Disorders: Follow-up

Author: Abhijit A Raval, MD, Pulmonary Diseases and Critical Care Fellow, James H Quillen College of Medicine
Coauthor(s): Ryland P Byrd Jr, MD, Professor, Department of Internal Medicine, Division of Pulmonary Medicine and Critical Care Medicine, James H Quillen College of Medicine, East Tennessee State University; Chief of Pulmonary Medicine, Medical Director of Respiratory Therapy, Intensive Care Unit, Program Director of Pulmonary Diseases and Critical Care Medicine Fellowship, James H Quillen Veterans Affairs Medical Center
Contributor Information and Disclosures

Updated: Apr 16, 2009

Follow-up

Further Outpatient Care

  • Once an anatomic defect is corrected, the patient should undergo periodic chest radiography and assessment of pulmonary function. Although the rate of spontaneous recurrence of a repaired diaphragmatic hernia is low, small defects in the repair site have been reported. Therefore, surveillance is important.
  • If dysfunction was secondary to a tumor encroaching on the phrenic nerve, maintaining close follow-up contact with the patient is important to ensure that the neoplasm has not recurred.

Complications

  • Anatomic defects may lead to respiratory failure, incarceration or strangulation of bowel, or hypoplasia of the lung in congenital defects.
  • Neurologic problems may lead to respiratory failure.

Prognosis

  • Patients with anatomic repairs
    • The prognosis for patients with anatomic repairs from traumatic rupture directly correlates with the extent of concomitant injuries.
    • Neonates generally have a good prognosis after repair of congenital diaphragmatic hernias, but the prognosis is directly related to the development of the lung on the affected side.
  • Patients with neurologic conditions
    • The prognosis for patients with neurologic conditions generally correlates with etiology.
    • Persons with high cervical spine fractures generally fare worse than individuals with transient neuropathies such as Guillain-Barré syndrome.
    • Idiopathic diaphragmatic disease has a variable prognosis, with some patients recovering spontaneously.

Miscellaneous

Medicolegal Pitfalls

  • Failure to conduct periodic chest radiography and assessment of pulmonary function once an anatomic defect is corrected
  • Failure to maintain close follow-up contact if dysfunction was secondary to a tumor encroaching on the phrenic nerve
  • In patients with bilateral diaphragmatic dysfunction, failing to recognize the diagnosis until the patient presents with cor pulmonale and/or cardiorespiratory failure
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors, Anne T. Saladyga, MD, Jason M. Johnson, DO, and Sidney R. Steinberg, MD, FACS, to the development and writing of this article.



More on Diaphragm Disorders

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References
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Further Reading

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Keywords

diaphragm disorders, diaphragm dysfunction, phrenic nerve injury, diaphragm, respiratory dysfunction, Bochdalek hernias, congenital diaphragmatic hernia, Guillain-Barré syndrome, lead neuropathy, postinfectious neuropathies, chiropractic cervical spine manipulation, uremia, diaphragmatic rupture, Morgagni hernia, eventration of the diaphragm, diaphragmatic agenesis, syringomyelia, poliomyelitis, motor neuron disease, brachial plexus neuritis, diabetic neuropathy, nutritional neuropathy, alcoholic neuropathy, vasculitic neuropathy, infection-related nerve injury, myasthenia gravis, myotonic dystrophies, Duchenne muscular dystrophy, metabolic myopathies, polymyositis, acquired diaphragmatic disorders, innervation defects, cerebral stroke, spinal cord disorders, phrenic nerve neuropathy

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Contributor Information and Disclosures

Author

Abhijit A Raval, MD, Pulmonary Diseases and Critical Care Fellow, James H Quillen College of Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Ryland P Byrd Jr, MD, Professor, Department of Internal Medicine, Division of Pulmonary Medicine and Critical Care Medicine, James H Quillen College of Medicine, East Tennessee State University; Chief of Pulmonary Medicine, Medical Director of Respiratory Therapy, Intensive Care Unit, Program Director of Pulmonary Diseases and Critical Care Medicine Fellowship, James H Quillen Veterans Affairs Medical Center
Ryland P Byrd Jr, MD is a member of the following medical societies: American College of Chest Physicians, American Thoracic Society, and Southern Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Ryland P Byrd Jr, MD, Professor, Department of Internal Medicine, Division of Pulmonary Medicine and Critical Care Medicine, James H Quillen College of Medicine, East Tennessee State University; Chief of Pulmonary Medicine, Medical Director of Respiratory Therapy, Intensive Care Unit, Program Director of Pulmonary Diseases and Critical Care Medicine Fellowship, James H Quillen Veterans Affairs Medical Center
Ryland P Byrd Jr, MD is a member of the following medical societies: American College of Chest Physicians, American Thoracic Society, and Southern Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Om Prakash Sharma, MD, FRCP, FCCP, DTM&H, Professor, Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Southern California Keck School of Medicine
Om Prakash Sharma, MD, FRCP, FCCP, DTM&H is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, American Osler Society, American Thoracic Society, New York Academy of Medicine, and Royal Society of Medicine
Disclosure: Keck School of Medicine, USC None None

CME Editor

Timothy D Rice, MD, Associate Professor, Departments of Internal Medicine and Pediatrics and Adolescent Medicine, Saint Louis University School of Medicine
Timothy D Rice, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Physicians
Disclosure: Nothing to disclose.

Chief Editor

Zab Mosenifar, MD, Director, Division of Pulmonary and Critical Care Medicine, Director, Women's Guild Pulmonary Disease Institute, Executive Vice Chair, Department of Medicine, Cedars Sinai Medical Center; Professor of Medicine, David Geffen School of Medicine at UCLA
Zab Mosenifar, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, and American Thoracic Society
Disclosure: Nothing to disclose.

 
 
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