Illustration of liver displacement due to diaphragmatic eventration.

Everted Liver: A Rare Twist in Diaphragmatic Eventration

Nico Varela monogram
Nico Varela in Health & Wellness October 2026 • 4 min read.

"Unveiling a unique case of liver displacement secondary to a diaphragmatic anomaly."


Diaphragmatic eventration, a condition characterized by abnormal elevation of the diaphragm, typically presents with respiratory or gastrointestinal symptoms. However, a recent case highlights an unusual consequence of this condition: an everted liver. This article delves into the details of this rare presentation, drawing from a published case report to shed light on its diagnosis and management.

The original research, documented in 'Clinical Gastroenterology and Hepatology,' presents the case of a 67-year-old male with a history of chronic obstructive bronchopneumopathy who presented with thoracic pain and cough. Investigations revealed an unexpected finding: the liver had become displaced, a condition termed 'everted liver,' due to diaphragmatic eventration.

This article aims to break down the complexities of this case, explaining the underlying mechanisms of diaphragmatic eventration and its potential impact on abdominal organs. We'll explore the diagnostic process, the specific findings in this patient, and the rationale behind the conservative management approach.

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Rarity and Clinical Impact

Diaphragmatic eventration involves loss of the diaphragm’s normal contour, with muscle replaced by fibroelastic tissue. A limited number of case reports cited by StatPearls suggest an incidence below 0.05%, with a predominance in men and more frequent involvement of the left side. The condition represents abnormal placement of the diaphragm, the main muscle involved in breathing, and may affect one or both sides; one cited overview reports bilateral eventration in 13% of affected infants.

Plication as Standard Treatment

Diaphragm plication is described as the preferred surgical intervention for elevation of a hemidiaphragm, including elevation caused by eventration. Plication may be performed through an open large incision or by minimally invasive techniques using several small incisions, with access through either the chest or abdomen. Laparoscopic and thoracoscopic approaches are reported as feasible and safe, but the available treatment literature also emphasizes the need to assess diaphragmatic function; Twitch Pdi is identified as the gold standard for quantifying diaphragmatic activity without interference.

Congenital and Acquired Origins

Diaphragmatic eventration is thought to be congenital in origin when incomplete muscularisation leaves a thin diaphragm. Adult cases may also be acquired rather than congenital. Reported acquired causes include injury to the phrenic nerve and phrenic nerve paralysis related to neoplasm or surgery.

What is Diaphragmatic Eventration?

Illustration of liver displacement due to diaphragmatic eventration.

Diaphragmatic eventration refers to an abnormal elevation of part or all of the diaphragm. Unlike diaphragmatic hernias, where there is a tear or opening in the diaphragm allowing abdominal organs to protrude into the chest cavity, eventration involves a weakening or thinning of the diaphragmatic muscle itself. This weakened area bulges upward, displacing the structures above it.

The causes of diaphragmatic eventration can vary. Some cases are congenital, meaning they are present at birth, often due to incomplete muscular development of the diaphragm. Acquired eventration can result from phrenic nerve paralysis (which controls diaphragm movement), trauma, or surgery. In the case presented, the eventration was attributed to atrophy (wasting) of the diaphragmatic muscle fibers, potentially leading to phrenic nerve paralysis.

  • Chest X-ray: Visualizes the elevated diaphragm.
  • CT Scan: Provides detailed images of the diaphragm and surrounding structures, helping to confirm the diagnosis and identify any associated abnormalities.
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Recent Case-Based Evidence

Recent reports continue to describe diaphragmatic eventration as an uncommon disorder in which abnormal diaphragm structure or function displaces the diaphragm into the thorax. A 2025 case report characterized diaphragmatic eventration as an exceedingly rare cause of Budd–Chiari syndrome and presented diaphragm plication as a therapeutic approach. Other reported acquired cases attribute the displacement to phrenic nerve injury and muscular atrophy, including cases involving the liver and right diaphragm.

Limits of the Evidence

Because diaphragmatic eventration is rare, conclusions about its causes, complications, and best treatment may be shaped by individual case reports rather than broad comparative studies. Clinical presentation and outcomes can vary according to whether the condition is congenital or acquired and how much diaphragmatic function is affected. This makes it difficult to generalize one reported diagnostic or surgical experience to every patient.

Imaging and Surgical Distinctions

Congenital diaphragmatic hernia and diaphragmatic eventration are distinct conditions that can be differentiated by imaging characteristics. A 2025 imaging review reports that congenital diaphragmatic hernia generally produces more severe lung compression and mediastinal displacement. Eventration is anatomically defined by thinning and cephalic displacement of all or part of an intact diaphragm, while open plication for eventration or paralysis can use central or radial techniques through a thoracotomy.

In this specific case, a 67-year-old man presented with thoracic pain and cough. A chest radiograph revealed an elevated right hemidiaphragm. Subsequent CT scanning confirmed right diaphragmatic eventration. Notably, the liver and gallbladder were displaced downwards, positioned just beneath the right hemidiaphragm, a finding consistent with liver eversion.

Living with Diaphragmatic Eventration

The management of diaphragmatic eventration depends largely on the severity of symptoms. Many individuals with eventration experience no symptoms and require no specific treatment. In cases where symptoms such as shortness of breath or gastrointestinal issues are present, various interventions may be considered.

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When Liver Position Matters

Eventration is usually congenital, whereas acquired cases associated with trauma or increased intra-abdominal pressure are reported as rare. Liver herniation is also relatively uncommon but may occur when diaphragmatic eventration is combined with compression of the diaphragm. In one report, imaging and symptoms suggested extrinsic right-atrial compression by the liver caused by diaphragmatic eventration. Another surgical case described the right colon, appendix, terminal ileum, and three accessory right liver lobes being drawn into the right thoracic cavity before reduction and repair.

Individualized Prognosis and Follow-Up

The prognosis of diaphragmatic eventration varies according to symptom severity, the underlying cause, and the response to treatment. In a report of two adults older than 40 years with left-sided eventration, laparoscopic plication was performed with and without mesh reinforcement. Both patients recovered uneventfully, became asymptomatic, and continued regular follow-up.

Challenges of a Rare Disorder

The rarity of diaphragmatic eventration can make recognition and evidence-based management challenging. Similar changes in diaphragm position may arise from different causes, including congenital abnormalities, phrenic nerve injury, or pressure-related acquired disease. As a result, diagnosis and treatment decisions may require careful interpretation of the individual clinical and imaging picture.

Living With Variable Symptoms

The real-world impact of diaphragmatic eventration can differ substantially between patients. Some cases may involve respiratory or pressure-related effects, while others are identified through symptoms or imaging associated with displacement of nearby organs. Treatment outcomes also vary, so clinicians must balance the reported benefits of plication with each patient’s symptoms, cause, and response to care.

In the reported case, the patient was asymptomatic despite the unusual liver displacement. As a result, the medical team opted for conservative management, involving observation and supportive care. This approach highlights that not all cases of diaphragmatic eventration require invasive intervention.

This case serves as a reminder of the diverse ways in which diaphragmatic eventration can manifest. While liver eversion is a rare occurrence, it underscores the importance of considering anatomical variations when evaluating patients with chest or abdominal complaints. Further research and case studies will help to better understand the long-term implications of this unusual condition and refine management strategies.

What the reported figures measure

  • 33% positive predictive valueA chest radiograph had a positive predictive value of 33% for diaphragm dysfunction, despite a reported sensitivity of 90%.[1]
  • 11 of 16 (69%) patientsIn a report on diaphragm paralysis, 11 of 16 patients (69%) recovered function; spontaneous recovery took 5 to 25 months, with a mean of 14.9 months.[2]

How eventration estimates and evidence compare

Eventration is described as elevation of an intact diaphragm after muscle is partly or wholly replaced by fibroelastic tissue. In contrast, reported liver herniation is a relatively rare associated occurrence, sometimes described alongside diaphragm compression; these descriptions do not establish that liver displacement passes through the diaphragm in every such case.[3] [4]

What remains uncertain about eventration

  • How often does an elevated diaphragm on imaging reflect eventration rather than another form of diaphragm dysfunction, given the limited predictive value reported for radiography?[1]
  • How often does acquired eventration occur alongside liver herniation, and what role does diaphragm compression play in that association?[4]
  • What imaging features distinguish an opacity caused by herniated viscera from other findings when movement artifact or body habitus makes interpretation difficult?[5]

Terms used in eventration reports

Diaphragmatic eventration
Elevation of an intact diaphragm[3]

Sources

  1. Diaphragm Dysfunction: Diagnostic Approaches and Management Strategies (pmc.ncbi.nlm.nih.gov)
  2. Long-term results of diaphragmatic plication in adults with unilateral diaphragm paralysis (pmc.ncbi.nlm.nih.gov)
  3. Congenital Diaphragmatic Eventration in the Neonatal Period: Systematic Review of the Literature and Report of a Rare Case Presenting with Gastrointestinal Disorders (pmc.ncbi.nlm.nih.gov)
  4. Acquired Localized Diaphragmatic Eventration with Liver Herniation (pmc.ncbi.nlm.nih.gov)
  5. Microsoft Word - 9.crim.v1n2.docx (www.sciedu.ca)

About this Article -

Written with AI assistance from published research, and reviewed by the Mystum team. See our About page for more information.

Everything You Need To Know

1

What exactly is diaphragmatic eventration, and how does it differ from a diaphragmatic hernia?

Diaphragmatic eventration describes an abnormal elevation of the diaphragm, where part or all of the muscle is weakened, causing it to bulge upwards. Unlike a diaphragmatic hernia, where there's a tear allowing organs to protrude, eventration involves the thinning, not a tear, of the diaphragm muscle. The causes can be congenital, due to incomplete muscle development, or acquired, resulting from phrenic nerve paralysis, trauma, or surgery. The diaphragm's inability to contract and descend properly leads to reduced space in the chest cavity and potential displacement of abdominal organs.

2

What does "everted liver" mean in the context of diaphragmatic eventration?

Everted liver, in the context of diaphragmatic eventration, refers to the displacement of the liver from its normal anatomical position due to the abnormal elevation of the diaphragm. The weakened diaphragm bulges upwards, pushing the liver downwards and causing it to become 'everted'. This condition is often discovered incidentally during imaging for other symptoms, such as thoracic pain or cough, as was the case with the 67-year-old patient in the 'Clinical Gastroenterology and Hepatology' case report.

3

How was diaphragmatic eventration with everted liver diagnosed in the 67-year-old patient?

In this specific case, the patient, a 67-year-old male, presented with thoracic pain and cough. Diagnostic imaging, including a chest X-ray and CT scan, revealed an elevated right hemidiaphragm indicative of diaphragmatic eventration. What was particularly notable was the downward displacement of the liver and gallbladder, positioned just beneath the right hemidiaphragm, confirming the everted liver. The diaphragmatic eventration was attributed to atrophy of the diaphragmatic muscle fibers, potentially leading to phrenic nerve paralysis.

4

What are the treatment options for diaphragmatic eventration, and why was a conservative approach chosen for the patient with everted liver?

The management approach for diaphragmatic eventration varies depending on the severity of symptoms. Many individuals with eventration are asymptomatic and require no specific treatment. However, when symptoms such as shortness of breath or gastrointestinal issues arise, interventions may be considered. In the specific case of the 67-year-old patient with everted liver, a conservative management approach was chosen. The reasoning behind conservative management often involves monitoring the patient's symptoms and providing supportive care, rather than immediate surgical intervention, especially if the patient's symptoms are mild or stable. Surgical plication can be considered for those with severe symptoms.

5

Besides X-rays and CT scans, what other diagnostic tests can help evaluate diaphragmatic eventration and its impact on respiratory function?

While imaging techniques like chest X-rays and CT scans are valuable for diagnosing diaphragmatic eventration and related conditions such as everted liver, other diagnostic modalities exist. Fluoroscopy, for instance, can assess diaphragm movement, while ultrasound may provide additional visualization. Furthermore, pulmonary function tests can evaluate the impact of diaphragmatic eventration on respiratory function, which wasn't explicitly mentioned in the case but is a relevant consideration. Understanding the degree of respiratory compromise can help guide management decisions and determine the need for interventions beyond conservative measures.

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