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Diaphragmatic eventration is either congenital or acquired. Congenital eventration is less common and may be difficult to distinguish from a congenital diaphragmatic hernia. The underlying pathophysiology is unknown. Acquired eventration is usually the result of phrenic nerve paralysis or injury. This may result from stretching of the brachial plexus (traumatic), infection or injury during thoracic or cardiac intervention. The etiology is important as the surgeon considers the possibility of future nerve function versus diaphragmatic pacing in selective, unique situations.