Imaging the diaphragm and its disorders

Although a radiologic evaluation of the diaphragm is important in many clinical situations, visualization of the diaphragm is difficult because of its thinness, its domed contour, and its contiguity with abdominal soft tissues. Each clinical situation involving the diaphragm presents its own imaging difficulties, and each radiographic technique has advantages and disadvantages. No one modality is best for all situations. Often, several imaging modalities must be used to resolve the clinical question. The particular difficulties in diaphragmatic imaging are (1) distinguishing eventration from paralysis or hernia, (2) distinguishing lipoma from herniated omental fat, and (3) distinguishing unilateral paralysis from weakness and bilateral paralysis from respiratory fatigue. By selecting and applying the appropriate radiographic techniques, the radiologist can serve an essential role in assessing the disorders of the diaphragm.