Hernias may also occur as a result of congenital malformation, a congenital diaphragmatic hernia. Many children with spinal muscular atrophy develop pectus excavatum due to their diaphragmatic breathing. The mediastinal and central portions of the diaphragmatic pleurae are innervated by the phrenic nerves. Mutations in this gene have been associated to cases of congenital diaphragmatic hernia. Absorption occurs into lymphatic vessels at the level of the diaphragmatic pleura. May result from diaphragmatic or peridiaphragmatic lesions, renal calculi, splenic injury or ruptured ectopic pregnancy. Ultrasound and radiography may both be used to diagnose diaphragmatic herniation. Presence of a diaphragmatic hernia is also common in these fetuses/infants. Foregut communication and associated anomalies, such as diaphragmatic hernia, are more common. The "diaphragmatic pleura" lines the convex surface of the diaphragm. In a newborn, it may represent a diaphragmatic hernia. Surgical intervention for cardiac, diaphragmatic and other associated defects is necessary. Diaphragmatic breathing causes the abdomen to rhythmically bulge out and fall back. Regular diaphragmatic breathing may be achieved by extending the outbreath by counting or humming. The procedure is two-part&colon; diaphragmatic breathing and rhythmic vowel play.