Epidemiology of Eventration: Predicting Prevalence

Introduction Diaphragmatic eventration (DE) is characterized by an abnormal elevation of the diaphragm. While typically asymptomatic and incidentally discovered on imaging, DE can pose diagnostic challenges due to its ability to mimic other pathologies. We hypothesize that the prevalence of DE is underreported, owing to the lack of existing reliable literature exploring the true epidemiology of DE. Methods A retrospective review of chest X-rays (CXRs) was conducted using the MIT Medical Information Mart for Intensive Care, Fourth Edition (MIMIC-IV) database. Preoperative CXRs were screened for evidence of DE, defined as a >2.5-cm elevation of one hemidiaphragm on the frontal view and confirmed on lateral imaging. Diaphragmatic heights were measured using DICOM imaging software, and inter-rater reliability was assessed among four reviewers, including a board-certified radiologist, to confirm visualization. A larger review of CXR data was performed by the board-certified radiologist to assess for a possible true prevalence of DE. Results Of the 279 formally reviewed cases by the diagnostic radiologist, 196 (70.3%) met the inclusion criteria. Among those, 46 (23.5%) patients exhibited radiographic evidence of DE, significantly exceeding previously reported prevalence rates. Conclusion Our findings suggest that DE may be more common than previously reported. Unrecognized DE can lead to unnecessary workups for other pathologies. Recognizing DE as a frequently seen normal anatomical variation can reduce diagnostic uncertainty. Further research is needed to refine the epidemiology and clinical relevance of DE.