Diaphragmatic Eventration and Positive Pressure Ventilation

Selzer et al present a case of a 72-year-old man with a long history of left hemidiaphragm eventration, who was admitted with acute pancreatitis. He developed worsening respiratory distress that necessitated transfer to the ICU and, ultimately, intubation. Preintubation chest imaging revealed an elevated left hemidiaphragm and distended loops of bowel together with adjacent compression atelectasis of the left lung. Although diaphragmatic eventration can be a cause of respiratory distress in newborns, it is typically asymptomatic in adults. However, in this patient with intraabdominal pathology, a chronically weakened diaphragm was unable to prevent distended gastrointestinal contents from compromising the lung and causing respiratory failure. The increased intrathoraac pressure created by invasive positive pressure ventilation was sufficient to depress the diaphragm and improve left lung expansion.