Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 5448

AbstractCase ReportDiscussionConclusionReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"

Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018

Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018

Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."

Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
On Sep 2018

Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."

Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata

Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Case report
Year : 2022 | Month : December | Volume : 16 | Issue : 12 | Page : AD01 - AD04 Full Version

Eventration of Diaphragm: A Rare Cadaveric Case Report

Published: December 1, 2022 | DOI:
MV Ravishankar, Prasanna K Santhekadur, S Hemamalini, K Pushpalatha

1. Assistant Professor, Department of Anatomy, JSS Medical College, AHER, Mysuru, Karnataka, India. 2. Associate Professor, Department of Biochemistry, JSS Medical College, AHER, Mysuru, Karnataka, India. 3. Associate Professor, Department of Anatomy, JSS Medical College, AHER, Mysuru, Karnataka, India. 4. Professor, Department of Anatomy, JSS Medical College, AHER, Mysuru, Karnataka, India.

Correspondence Address :
Dr. MV Ravishankar,
Assistant Professor, Department of Anatomy, JSS Medical College, AHER, Mysuru, Karnataka, India.


The respiratory diaphragm is a barrier between the thoracic and abdominal cavities. It is a chief skeletal muscle of respiration that plays a critical role in the process of inspiration. The defective diaphragm may be clinically present with or without obvious symptoms. Depending on the severity of its defects, it can lead to mild to severe fatal consequences. Protrusion of abdominal contents into the thoracic cavity through the weakened or defective part of the diaphragm is known as a diaphragmatic hernia. Such herniations will exist either in the form of congenital birth defects or acquired defects in the diaphragm. An acquired hernia may be due to spontaneous or iatrogenic causative factors. Congenital Diaphragmatic Hernia (CDH) can occur due to the disruption of various cellular mechanisms involved in organogenesis during the gestation period. Such herniations may exist with or without content protrusions into the cavity of the thorax, later referred to as Eventration of the Diaphragm (ED). In the Department of Anatomy at JSS Medical College, Mysuru, Karnataka, India, a rare case of diaphragmatic eventration was noticed in a male cadaver aged about 70 years, during the routine dissection class of preclinical medical students. In this rare case report, diaphragmatic eventration along with various factors involved in its presentation would be considered holistically.


Congenital, Gestation, Organogenesis

Case Report

In the Department of Anatomy at JSS Medical College, Mysuru, Karnataka, India a rare case of eventration of the diaphragm of the left-side was noticed during the dissection of the thorax in a male cadaver aged about 70 years (Table/Fig 1). It was initially noticed as a protruding blind pouch from the posterolateral aspect of the superior surface of the diaphragm facing toward the thoracic cavity. It was lying close to the mediastinal surface of the left lung and pericardium of the heart (Table/Fig 2). The development of both lungs was found normal. Later, on opening the abdominal cavity the same herniated diaphragmatic pouch was followed and it was found to be an empty sac (Table/Fig 3) without protrusion of any contents of the abdomen into the thoracic cavity. Later the condition was identified as an “Eventration of the Diaphragm”.


The diaphragm is a musculoaponeurotic organ which acts as a barrier between the thoracic and abdominal cavity; plays an important role in respiration. Its normal development is essential for infant breathing after birth. Organogenesis is a crucial part; it starts during the embryonic period. The first trimester of gestation is a critical phase; disruption of the molecular signalling mechanism may result in teratogenic effects causing foetal malformations. Morphogenesis is further driven through intercellular signalling mechanisms between groups of cells that are derived from different germ cell lines. During this phase molecular events are tightly regulated; their subtle disruptions can result in a wide range of defects in an organ or system formation (1).

At the end of the gastrulation process, the germ layers are formed. Later the actual phase of organogenesis begins, which will continue till the end of 2nd month of the gestation period. The cells of each germ layer will differentiate into specialised and super-specialised groups which in turn form a basis for specific tissue or organ formation (2). The diversified embryological components are involved in the development of the human diaphragm which occurs during the 4th-12th weeks of the gestation period (3). They are including, the septum transversum-which gives rise to the central tendon of the diaphragm, the pleuroperitoneal membrane-which divides the coelomic cavity into the thoracic and abdominal cavities and somites which are derived from paraxial mesoderm contributing the musculature of the diaphragm (4). By birth, if the diaphragm wall is defective, the herniation of visceral contents protruding into the thoracic cavity is referred to as CDH (5).

The CDH occurs in about 1 of 2500 live births. The left-side of the diaphragm defect is involved more often than the right i.e., in 80% of cases. Posterolateral CDH is known as Bochdalek hernia; it may possess protruded contents of the abdomen into the thorax, which is a relatively common clinical anomaly. The probable reason being the left pericardioperitoneal canal is larger and closes much later than the right (6). Sometimes such diaphragmatic herniations are clinically presented as a hallow protrusion of part of the diaphragm or the entire diaphragm without any protrusion of contents into the cavity of the thorax called “Eventration of Diaphragm” (ED). It may be a congenital or acquired anomaly (7). Eventration is a rare presentation seen in 1 in 10,000 live births (8). This is usually seen as secondary to defective diaphragm formation with weak musculature or defective nerve innervations (5).

A study has underscored the importance of molecular signalling interactions between the diaphragmatic muscle fibres and its innervating phrenic nerve fibres in establishing proper neuromuscular junctions. This is crucial in the existence of a fully functional diaphragm; its failure can cause undue protrusions of the weakened diaphragmatic wall leading to eventration (4). The aetiology of CDH largely remains unclear and is currently thought to be multifactorial. CDH can be associated with cardiac, gastrointestinal, and genitourinary anomalies or with chromosomal aneuploidy such as trisomy 18,13, and 21 (9). The present case report highlighted one such rare case of ED herniation which could be caused due to neurogenic or muscular aplasia.

Pregnancy is a critical period and adequate dietary supplementation is vital during this period to avoid congenital birth defects. Micronutrient deficiency may result in the death of the foetus or it can lead to congenital malformations. Vitamin A (Retinoic acid) is one such micronutrient that plays an important role in achieving the uninterrupted growth and development of the foetus. Basic experiments have shown that vitamin A deficiency can disrupt the subtle molecular signalling patterns resulting in CDH (10). Altered values of vitamin A or Retinoic Acid (RA) can influence the neurectoderm and endodermal germ layers which are involved in the development of several organs like the spinal cord, brain, limbs, pancreas, lungs, somites, etc. RA-targeted genes could be a cause behind developmental organ malformations (11).

The diaphragm is a chief inspiratory skeletal muscle that plays an important and active role in the process of respiration. The central tendon of the diaphragm is a “crux” point where different myofibres will come for their insertion around it. Diaphragm muscle progenitors are derived from C3-5 cervical somites which are influenced by different genes for their formation. Mutations in Pax3 genes are dominantly expressed in somitomeres which can lead to defective or weak musculature resulting in ED. The abnormal migration of myoblast cells may result in the improper or incomplete formation of the musculotendinous wall (12).

There are different types of congenital diaphragmatic hernias, the most commonly reported one is Bochdalek type hernia which constitutes about 70%, Morgagni type hernia 27%, and central type hernia 2-3% (13). Posterior ED without any visceral contents may resemble the ‘Bochdalek hernia of the diaphragm” where radiological investigations play an important role in the differential diagnosis (14). Developmental weakness in diaphragmatic muscle fibres or their improper formation may lead to herniation. Such herniations may contain visceral (abdominal) organs that lead to the incidences of CDH. Sometimes such herniations may remain as a point of protrusion of the diaphragmatic wall toward the thoracic cavity without any contents referred to as ED usually it is presented without pulmonary hypoplasia (8). Based on the clinical findings, the severity effect of ED can be noticed in infants; it may be associated with symptoms of severe respiratory distress. But in the case of adults, it may remain asymptomatic, hence often ED is found as an incidental finding in radiological investigations. In a symptomatic patient, it is presented with dyspnoea on physical exertion, or with signs of orthopnoea due to elevated movements of the diaphragm (7).

The ED may be seen as unilateral or bilateral wall protrusion; it shows paradoxical movements in breathing. Being an important inspiratory muscle, the tone of the diaphragm musculature is crucial for effective breathing. Paralysed or weakness in the diaphragm musculature can affect optimum lung functionality, showing reduced lung function parameters like Vital Capacity (VC), Total Lung Capacity (TLC), and Residual Capacity (RC) with hypoxia. The surgical repair to strengthen the weak diaphragmatic musculature can be attempted through thoracotomy or laparotomy. The surgical repairing through strengthening the musculature of the diaphragm called “Plication” has shown considerable improvement in establishing pulmonary functions. A surgically strengthened diaphragm will help to accommodate good air space for the proper expansion of the lungs (15).

The clinical manifestations of CDH and ED are often overlapping. Hence to differentiate between these conditions’ surgeons need a keen clinical evaluation. The CDH contains protruded abdominal contents like intestines (viscera) into the thoracic cavity through the malformed or disrupted structure of the diaphragm. Often such events will cause mechanical compression of the lung, which may be associated with the underdevelopment of lungs called congenital pulmonary hypoplasia (16). The CDH associated with pulmonary hypoplasia is seen with reduced formation of airway branching pathways caused due to the compression of developing lung buds because of undue protrusion of abdominal contents into the thoracic cavity on developing foetal lung tissue (13).

Explicit manifestation of Bochdalek hernia is relatively rare in adults most often it will clinically manifest during the very early life of an individual (17). Such incidences are likely to be associated with respiratory symptoms due to pulmonary hypoplasia. Persistent pulmonary hypertension is likely to manifest as a tertiary symptom associated with an underlining congenital diaphragmatic defect followed by developmental lung hypoplasia. If Bochdalek hernia is found in adults it is likely to present with complications related to the gastrointestinal tract probably due to compression of viscera-like intestines (5).

The prognosis of isolated CDH is generally better than CDH complicated by other associated multiple anomalies. Despite the unclear aetiology of CDH over the past few decades, reports have suggested increasing trends of survival in infants with CDH with the medical and surgical advances in the management of CDH, with the reported overall 70-90% of survival (18). The symptoms of diaphragmatic hernias may range from an asymptomatic condition to a life-threatening clinical manifestation. In the present case, the development and morphology of the lungs were seen as normal. Any visceral organ protrusion or displacement into the thoracic cavity had not been noticed which may indicate the probability of weak phrenic nerve innervations or injury to the phrenic nerve itself or weak muscle tone. Hence these cadaveric findings may be suggestive of probable weakness in the diaphragm causing the eventration-like manifestation.

Some cases of eventrations were found with a previous history of infections coincidentally associated with ED (19),(20). Some cases were reported with eventration of the solid organ like the liver on the right-side (21). Two separate rare cases were noticed, one with multiple organ protrusion along with the displacement of the right kidney into the thorax (22). A rare case was reported with organoaxial gastric volvulus, both were associated with the incidental eventration of diaphragm findings (23). But most of the incidental radiological findings were frequently associated with the protrusion of coils of intestines as a common entity towards the chest cavity from the point of diaphragm wall weakness (24),(25).

In the present case study, the unilateral ED could be due to the weak tone of its musculature rather than the explicit lack of muscle fibres. But in the case of herniation, the muscle fibre continuity may be affected, it may involve the whole or a part of the diaphragm musculature, probably due to myoblast cell migration failure. The lungs were well formed without any grossly identifiable defect. Any traumatic injury had not been noticed on the body or injury to the diaphragmatic musculature hence any accidental injury can be ruled out because donated cadavers were having a history of natural death. The eventration may facilitate just protrusion of abdominal contents to some extent without affecting the functionality of lungs or other mediastinal contents because the existing pouch of musculature can act as a physical barrier to some extent. In the present case, the cadaver was devoid of any abdominal contents in the pouch space (eventration), and no physical sign of compression of contents in the thorax cavity was found. (Table/Fig 4) shows the previous studies on the ED (19),(20),(21),(22),(23),(24),(25).


In the present case, a report of left-sided eventration of the diaphragm was noticed in a male cadaver during the routine dissection class of preclinical medical students. The ED is a rare clinical presentation, its explicit clinical manifestations are rare and often they are incidental radiological findings. Its symptoms may mimic or overlap with other types of diaphragmatic hernias, need to elucidate the exact pathology for its presentation. An incidental radiological finding of ED may require a detailed evaluation of the previous surgical history of the patients. In the event of preclinical medical teaching and learning anomalous cadaveric findings with ED act as a real trigger that can create synchronisation of preclinical subject understanding in the direction of their clinical applications.


Donovan MF, Cascella M. Embryology, Weeks 6-8. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan. Available from:
Sadler TW, Jan Langman. 6th chapter. The embryonic Period. Langman’s Medical Embryology. 12th ed. Philadelphia: Wolters Kluwer Health (India) Pvt. Ltd. New Delhi 2019.
Chandrasekharan PK, Rawat M, Madappa R, Rothstein DH, Lakshminrusimha S. Congenital diaphragmatic hernia-A review. Matern Health Neonatol Perinatol. 2017;11;3:06. [crossref] [PubMed]
Merrell AJ, Kardon G. Development of the diaphragm-a skeletal muscle essential for mammalian respiration. FEBS J. 2013;280(17):4026-35. [crossref] [PubMed]
Gue RS, Winkler L. Bochdalek Hernia. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022 Jan. Available from:
Schoenwolf GC, Bleyl SB, Philip R, Brauer, Philippa H, Francis-West. Larsen’s Human Embryology. Chapter 11- Development of the Respiratory system and body cavities. Sixth Edition. Elsevier Churchill Livingstone. 2021;644-46.
Shwaartz C, Duggan E, Lee DS, Divino CM, Chin EH. Diaphragmatic eventration presenting as a recurrent diaphragmatic hernia. Ann R Coll Surg Engl. 2017;99(7):e196-99. [crossref] [PubMed]
Sinha R, Dalal S, Sodhi K. A neonate with eventration of diaphragm. Open Access Library Journal. 2015;2:01-03. [crossref]
Pober BR, Lin A, Russell M, Ackerman KG, Chakravorty S, Strauss B, et al. Infants with bochdalek diaphragmatic hernia: Sibling precurrence and monozygotic twin discordance in a hospital-based malformation surveillance program. Am J Med Genet A. 2005;138A(2):81-88. [crossref] [PubMed]
Rocke AW, Clarke TG, Dalmer TRA, McCluskey SA, Garcia rivas J, Clugston R, et al. Low maternal vitamin A intake increases the incidence of teratogen-induced congenital diaphragmatic hernia in mice. Pediatric Research. 2022;91(1):83-91. [crossref] [PubMed]
Duester G. Retinoic acid synthesis and signaling during early organogenesis. Cell. 2008;134(6):921-31. [crossref] [PubMed]
Buckingham M. Skeletal muscle progenitor cells and the role of Pax genes. C R Biol. 2007;330(6-7):530-33. [crossref] [PubMed]
Keijzer R, Puri P. Congenital diaphragmatic hernia, Seminars in Pediatr Surg, 2010;19(3):180-85. [crossref] [PubMed]
Karmazyn B, Shold AJ, Delaney LR, Brown BP, Marine MB, Jennings SG, et al. Ultrasound evaluation of right diaphragmatic eventration and hernia. Pediatr Radiol. 2019;49(8):1010-17. [crossref] [PubMed]
Graham DR, Kaplan D, Evans CC, Hind CR, Donnelly RJ. Diaphragmatic plication for unilateral diaphragmatic paralysis: A 10-year experience. Ann Thorac Surg. 1990;49(2):248-51. [crossref] [PubMed]
Bishara J, Burjonrappa S, Pirzada M, Halaby C. Diaphragmatic eventration misdiagnosed as diaphragmatic hernia in a preterm infant with respiratory distress: A case report and review of diagnosis and management. Open J Pediatr Child Health. 2015;1(1):001-04. [crossref]
Hamid KS, Rai SS, Rodriguez JA. Symptomatic bochdalek hernia in an adult. JSLS. 2010;14(2):279-81. [crossref] [PubMed]
Hagadorn JI, Brownell EA, Herbst KW, Trzaski JM, Neffs S, Campbell BT, et al. Trends in treatment and in-hospital mortality for neonates with congenital diaphragmatic hernia. J Perinatol. 2015;35:748-54. [crossref] [PubMed]
Paudel K, Dahal S. Diaphragmatic eventration case report: A possible sequelae of past tuberculosis infection. Authorea. 2021:01-08. [crossref]
Pradhan P, Karmacharya RM, Vaidya S, Singh AK, Thapa P, Dhakal P, et al. Case report of eventration of diaphragm due to an unknown febrile illness causing phrenic nerve palsy and other multiple nerve palsies. Ann Med Surg (Lond). 2020;25;54:74-78. [crossref] [PubMed]
Andrew O, Sriharsha D, Tagore S, Andrea C, Gaduputi, Vinaya. A rare case of partial diaphragmatic eventration with hepatic herniation. Am J Gastroenterol. 2018;113:S1315. [crossref]
Carrasco A, Castro R. Right diaphragmatic eventration with an intrathoracic kidney: Case report and review of the literature. Case Reports in Surgery. 2018;01-07. [crossref] [PubMed]
Souza-Gallardo LM, Centellas-Hinojosa S, Parra-Flores M, Fregoso-Arteaga LE, García-Quintero JA, Rosales-Castañeda E, et al. Diaphragmatic eventration in adults. Case report. Rev Fac Med UNAM. 2016;59(3):17-21.
Shah NN, Mohsin M, Khursheed SQ, Farooq SSA, Buchh AA, Quraishi AQ. Eventration of diaphragm with gastric volvulus: A case report. Cases Journal. 2008;1;404. [crossref] [PubMed]
Mantoo SK, Mak K. Congenital diaphragmatic eventration in an adult: A diagnostic dilemma. Singapore Med J. 2007;48(5):136-37.

DOI and Others

DOI: 10.7860/JCDR/2022/59522.17233

Date of Submission: Aug 06, 2022
Date of Peer Review: Sep 13, 2022
Date of Acceptance: Oct 19, 2022
Date of Publishing: Dec 01, 2022

• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? No
• For any images presented appropriate consent has been obtained from the subjects. No

• Plagiarism X-checker: Aug 13, 2022
• Manual Googling: Oct 11, 2022
• iThenticate Software: Oct 22, 2022 (5%)

ETYMOLOGY: Author Origin

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)