PMC

Typical chest film presentations of patients with and without significant diaphragm elevation after VATS lobectomy for lung cancers. (A,B) Chest films of a 54-year-old female patient before and after left upper lobectomy. The distance between the apex of the diaphragm and the apex of the chest on pre- and post-operative chest X-ray was 166.02 mm (A) and 147.62 mm (B), respectively. Diaphragm elevation calculated by [(DB−DA)/DB]×100 was 11.1%. (C,D) Chest films of a 51-year-old female patient before and after right upper lobectomy. The distance between the apex of the diaphragm and the apex of the chest, on pre- and post-operative chest X-ray was 193.65 mm (C) and 133.82 mm (D), respectively. Diaphragm elevation calculated by [(DB−DA)/DB]×100 was 31%.

Diaphragm selection operation screen showing coronal, axial, and sagittal views of the diaphragm. (a) The location of the diaphragm attached to the chest wall. (b) Location of the diaphragm attached to the liver. (c) Location of the diaphragm attached to the heart. (d) Location of the diaphragm without attachment to any surrounding organs.

Measurements in sagittal images. (A) Image at the level in which the rib cage of the right hemi-thorax looks widest. (a) Widest anteroposterior dimension of the thorax (‘chest AP–sagittal’). (b) Dimension between the top of the right diaphragm and the highest level of the thoracic inlet (‘chest height–sagittal’). (B) Image at midline (in which the spinal canal is widest). (c) Widest anteroposterior dimension of the thorax (‘mid AP–sagittal’). (d) Level of the diaphragm according to the number of the thoracic spine (‘mid diaphragm’; in this example, the mid diaphragm is 11.5 designating a level between T11 and T12). (C) Images at the midline and the level at which the top of the right diaphragm is highest. (e) Level of the top of the right diaphragm according to the number of the thoracic spine (‘right diaphragm’; in this example, the right diaphragm is 10 designating a level of T10). (f) Vertical distance between the midline diaphragm level and the highest top of the right diaphragm (‘Δdiaphragm’). AP: anteroposterior.

Catheter ablation for atrial fibrillation and flutter and the findings on chest radiographs obtained before and after ablation. (A) Bilateral pulmonary vein isolation, superior vena cava isolation, and cavotricuspid isthmus line ablation were performed. (B) Chest radiograph obtained before catheter ablation. (C) Chest radiograph obtained on the day after catheter ablation. (D) Chest radiograph obtained 2 weeks after catheter ablation showing clear elevation of the right diaphragm. (E) Chest radiograph obtained 6 months after catheter ablation showing clear elevation of the right diaphragm unchanged. (F) Chest radiograph obtained after diaphragm plication through video‐assisted thoracoscopic surgery showing some improvement in elevation of the right diaphragm.