Diaphragmatic Palsy

Abstract

The diaphragm is the primary muscle of respiration, and its weakness can lead to respiratory failure. Diaphragmatic palsy can be caused by various causes. Injury to the phrenic nerve during thoracic surgeries is the most common cause for diaphragmatic palsy. Depending on the cause, the symptoms of diaphragmatic palsies vary from completely asymptomatic to disabling dyspnea requiring mechanical ventilation. On pulmonary function tests, there will be a decrease in the maximum respiratory muscle power. Spirometry shows reduced lung functions and a significant drop of lung function in supine position is typical of diaphragmatic palsy. Diaphragmatic movements with respiration can be directly visualized by fluoroscopic examination. Currently, this test is being replaced by bedside thoracic ultrasound examination, looking at the diaphragmic excursion with deep breathing or sniffing. This test is found to be equally efficient, and without risks of ionizing radiation of fluoroscope. Treatment of diaphragmatic palsy depends on the cause. Surgical approach of repair of diaphragm or nonsurgical approach of noninvasive ventilation has been tried with good success. Overall prognosis of diaphragmatic palsy is good, except when it is related to neuromuscular degeneration conditions.

Can't Breath: a case of unilateral diaphragmatic paralysis post CABG

“…Unilateral diaphragmatic paralysis can present with a wide range of severity which can be managed conservatively with noninvasive positive pressure ventilation (NIPPV) all the way to surgical interventions involving plication 3,4,7,10 . Surgical plication is a surgical approach where folds are created in the diaphragm and these folds are then sutured in place to reduce the mobility of the paralyzed diaphragm 4,5 .…”

“…The patient will also need imaging of the chest to look for etiologies of nerve compression 5 . The time frame for recovery of unilateral diaphragmatic paralysis is case dependent 7 . It may require months to years to fully heal if at all 10 .…”

“…Its presentation can range in severity from being asymptomatic to acute respiratory failure 1,7 . There are a variety of treatments available to improve symptoms.…”

“…However, time is the key determinant for recovery. Its etiologies can range from trauma secondary to cardiothoracic surgery, infectious diseases, malignancy, inflammatory and neuromuscular conditions 2,3,7 . In our case report, we present a 71 years old Caucasian male with an atypical presentation who was found to have unilateral diaphragmatic paralysis one-month post coronary artery bypass graft (CABG).…”

Diaphragmatic paralysis: Evaluation in infants with congenital Zika syndrome

“…Paralysis of the diaphragm in newborn infants can lead to recurrent infections and life‐threatening respiratory insufficiency (Kokatnur & Rudrappa, ). There are four reports of infants with laboratory evidence of congenital ZIKV infection and a clinical diagnosis of unilateral diaphragmatic paralysis (Melo et al, ; Meneses et al, ; Rajapakse et al, ; Souza et al, ); however, the mechanism of the diaphragmatic paralysis was not described in any of these infants.…”