Diaphragm paralysis: a case report

  • Fausta Viccaro Department of Clinical and Molecular Medicine, Division of Respiratory Diseases, Umberto I Hospital, Sapienza University, Rome, Italy.
  • Antonella Sotgiu Department of Clinical and Molecular Medicine, Division of Respiratory Diseases, Umberto I Hospital, Sapienza University, Rome, Italy.
  • Krisstopher Richard Flores Division of Respiratory Diseases, Regina Apostolorum Hospital, Sapienza University, Rome, Italy.
  • Ernesto Maria Di Biase Department of Clinical and Molecular Medicine, Division of Respiratory Diseases, Umberto I Hospital, Sapienza University, Rome, Italy.
  • Letizia D’Antoni | l.dantoni@policlinicoumberto1.it Department of Clinical and Molecular Medicine, Division of Respiratory Diseases, Umberto I Hospital, Sapienza University, Rome, Italy.
  • Paolo Palange Department of Clinical and Molecular Medicine, Division of Respiratory Diseases, Umberto I Hospital, Sapienza University, Rome, Italy.

Abstract

Introduction. Bilateral paralysis of the diaphragm may be an idiopathic clinical condition or associated with several diseases such as trauma, surgery, viral infections, neurologic disorders. The diaphragm is the main respiratory muscle. It is a cupoliform muscle-tendon structure, innervated bilaterally by phrenic nerve, which originates from C3-C5 nerve roots. Diaphragmatic paralysis is a clinical disorder that generates hypoventilation and basal pulmonary atelectasis, predisposing to hypercapnic respiratory failure. The clinic manifestations mimic cardio-respiratory pathologies, therefore often misdiagnosticated. Case presentation. A 55-year-old man with a previous C6-7 traumatic fracture, referred multiple accesses to the emergency room for acute nocturnal dyspnoea, treated with antibiotic therapy, diuretic therapy and long-term oxygen therapy, without beneficial effects. He referred to our pulmonary clinic for evaluation of persistent and worsening orthopnoea due to unknown cause for about 2 years. Clinical examination, respiratory functional tests and diaphragm ultrasound revealed a strong suspicion of diaphragmatic deficit, confirmed by electromyography. Conclusions. The patient accesses to the emergency room numerous times and the clinical frame have been always oriented towards a cardio-respiratory origin. From the onset of the symptom to the respiratory evaluation, about 2.5 years have passed. The manifestation of clear orthopnoea has addressed the functional respiratory study towards a more thorough diaphragmatic evaluation assessed by ultrasound.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

References

Podnar S. Idiopathic phrenic neuropathies: A case series and review of the literature. Muscle Nerve 2015;52:986-92. DOI: https://doi.org/10.1002/mus.24673

Fromageot C, Lofaso F, Annane D, Falaize L, Lejaille M, Clair B, et al. Supine fall in lung volumes in the assessment of diaphragmatic weakness in neuromuscular disorders. Arch Phys Med Rehabil 2001;82:123-8. DOI: https://doi.org/10.1053/apmr.2001.18053

Ko MA, Darling GE. Acquired paralysis of the diaphragm. Thorac Surg Clin 2009;19:501-10. DOI: https://doi.org/10.1016/j.thorsurg.2009.08.011

Caruso P, Albuquerque ALP de, Santana PV, Cardenas LZ, Ferreira JG, Prina E, et al. Diagnostic methods to assess inspiratory and expiratory muscle strength. J Bras Pneumol 2015;41:110-23. DOI: https://doi.org/10.1590/S1806-37132015000004474

Kokatnur L, Rudrappa M. Diaphragmatic palsy. Diseases 2018;6:16. DOI: https://doi.org/10.3390/diseases6010016

Ricoy J, Rodríguez-Núñez N, Álvarez-Dobaño JM, Toubes ME, Riveiro V, Valdés L. Diaphragmatic dysfunction. Pulmonology 2019;25:223-35. DOI: https://doi.org/10.1016/j.pulmoe.2018.10.008

Published
2020-03-18
Info
Issue
Section
Case Reports
Keywords:
Diaphragm paralysis, dyspnoea, respiratory failure, diaphragmatic ultrasound
Statistics
  • Abstract views: 972

  • PDF: 410
  • HTML: 8
How to Cite
Viccaro, F., Sotgiu, A., Flores, K. R., Di Biase, E. M., D’Antoni, L., & Palange, P. (2020). Diaphragm paralysis: a case report. Multidisciplinary Respiratory Medicine, 15. https://doi.org/10.4081/mrm.2020.415

Most read articles by the same author(s)