A case of progressive orthopnoea and shoulder pain secondary to bilateral diaphragmatic paralysis

Abstract

A 45-year-old man with a raised body mass index presented with an acute history of right lower chest pain and increasing breathlessness. C reactive protein, D dimer and cardiac echocardiography were negative, with mild bibasal atelectasis the only positive reported finding from erect chest X-ray and CT pulmonary angiogram. He was discharged with antibiotics for a chest infection. He remained severely breathless and was referred to the sleep-related breathing disorders clinic. He described shoulder pain, daytime tiredness and sleeping upright due to a ââ'¬Ëœsuffocatingââ'¬â"¢ sensation. The video demonstrates the clinical findings. The CT topogram confirmed bilateral diaphragmatic paralysis. Spirometry demonstrated an 80% reduction in forced vital capacity in the supine position, when compared with erect. Consultation with a neurologist yielded the diagnosis of neuralgic amyotrophy, leading to bilateral diaphragmatic paralysis. The respiratory symptoms have been controlled with night-time non-invasive ventilation, allowing him to sleep supine.

Bilateral Phrenic Nerve Palsy Associated With Neuralgic Amyotrophy

“…Two cases were treated with immunotherapy, and none were treated with gammaglobulin. Some patients recovered within a few months, while others remained symptomatic for more than a year [6,[17][18][19][20] In clinical findings, our case presented with a characteristic medical history of a "slurping disturbance." The presence of being "unable to slurp noodles, water, or tea" has been reported as a characteristic medical history of BPP in Japan [4] because the habit of slurping food or drink is common in Japan [21].…”