What condition can cause bilateral diaphragmatic elevation as a radiographic sign?

Bilateral diaphragmatic elevation is often associated with conditions that affect the diaphragm's function or positioning, and heart failure is one such condition. In heart failure, especially when the heart's function is compromised, there is often an accumulation of fluid in the lungs and surrounding structures. This can lead to an upward shift of the diaphragm due to increased abdominal pressure or due to the presence of pleural effusions.

Moreover, this elevation can be a consequence of muscular fatigue or altered respiratory mechanics that often accompany heart failure. Unlike pneumonia or pneumothorax, which typically result in unilateral changes or other distinct patterns on imaging, the bilateral elevation seen in heart failure can serve as an indicator of the pathophysiological changes occurring in the thoracic cavity.

Obstructive lung disease generally results in a lung hyperinflation pattern that causes downward displacement of the diaphragm instead. Therefore, the context of bilateral diaphragmatic elevation points more directly to conditions associated with fluid overload and impaired lung mechanics, such as heart failure.