Intractable Hiccups Caused by Diaphragmatic Eventration

Abstract

Intractable hiccups are a rare yet debilitating pathology with a broad differential and often indicate a more serious underlying pathology, which can range from neoplasms to structural abnormalities. In this case report, we present a 64-year-old male with seven months of intractable hiccups determined to be caused by eventration of the right hemidiaphragm. The patient was treated with baclofen to treat the hiccups pharmacologically. He was also prescribed voice therapy to establish rescue breathing techniques and reduce laryngospasm. Finally, he was referred to thoracic surgery for further evaluation and potential surgical intervention should his diaphragmatic eventration worsen or cause hypoxemia. To our knowledge, this is the first reported case of an association between diaphragmatic eventration and intractable hiccups. It is important to highlight this addition to the broad differential of intractable hiccups and to emphasize an interdisciplinary approach to workup and treatment of intractable hiccups.

Keywords: diaphragmatic eventration; eventration; hiccups; intractable hiccups; voice therapy.

Figure 1. Granuloma of the right vocal fold

Flexible laryngoscopy image of vocal fold granuloma on the posterior third of the right vocal fold (white arrow indicates the location of the granuloma).

Figure 2. Eventration of the right hemidiaphragm

CT scan of the chest demonstrating eventration of the right hemidiaphragm. The white arrow in the coronal view (Panel A) indicates the area of diaphragmatic eventration. Panel B shows a sagittal view of the diaphragmatic eventration.