Unilateral diaphragm paralysis: a dysfunction restricted not just to one hemidiaphragm

Caleffi-Pereira, Mayra; Pletsch-Assunção, Renata; Cardenas, Letícia Zumpano; Ferreira, Jeferson; Iamonti, Vinicius C.; Caruso, Pedro; Fernandez, Ângelo; Carvalho, Carlos Roberto Ribeiro; Albuquerque, André Luís Pereira de

doi:10.1186/s12890-018-0698-1

Cited by 34 publications

(41 citation statements)

References 29 publications

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“…Furthermore, the improvement of her pulmonary function was necessary to safely perform the contralateral lung resection. In symptomatic patients with unilateral diaphragm paralysis, global inspiratory strength is reduced due not only to weakness in the paralyzed hemidiaphragm but also to impairment in the pressure generated by the non-paralyzed hemidiaphragm [8]. In our case, unilateral diaphragm plication might have influenced the contralateral diaphragm movement.…”

Section: Discussionmentioning

confidence: 83%

A strategy for pulmonary resection after contralateral diaphragm plication: a surgical case report

et al. 2019

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Background Pulmonary carcinoma patients with low pulmonary function cannot be treated surgically because of the high risk of complications. Diaphragmatic eventration is a disease characterized by diaphragmatic paralysis and dyspnea. Here, we report a surgical case of multiple pulmonary carcinomas with contralateral diaphragmatic eventration. Case presentation The patient was a 75-year-old woman with multiple metachronous right lung carcinomas complicated by left diaphragmatic eventration. When she was 70 years old, a right upper lobectomy and right S 6 b wedge resection were performed for double lung carcinomas. Five years later, two new lung tumors in her right lower lobe and left diaphragmatic eventration were identified, but resection was thought to be impossible because of her low pulmonary function. We performed video-assisted thoracoscopic surgery (VATS) plication with carbon dioxide (CO 2 ) insufflation for the left diaphragmatic eventration, and her pulmonary function improved. Subsequently, we performed a right S 6 wedge resection and right S 9 segmentectomy for the double lung tumors with no complications. The tumors were diagnosed as double primary carcinomas. Conclusions Our case presented with low pulmonary function and right multiple lung carcinomas with left diaphragmatic eventration. VATS plication for the left diaphragmatic eventration achieved improvement in her pulmonary function, and right pulmonary resection for the lung carcinomas was performed. VATS plication can expand the choice of treatments in such cases.

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Section: Discussionmentioning

confidence: 83%

A strategy for pulmonary resection after contralateral diaphragm plication: a surgical case report

et al. 2019

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“…This point has never been demonstrated to date. Only a recent study identified a reduced pressure generated by the healthy HD after phrenic nerve stimulation in patients with contralateral unilateral phrenic nerve paralysis (9).…”

Section: Discussionmentioning

confidence: 99%

Dynamic magnetic resonance imaging in unilateral diaphragm eventration: knowledge improvement before and after plication

Pimpec‐Barthes¹,

Hernigou²,

Mazzella³

et al. 2019

J. Thorac. Dis.

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Background: The assessment before surgical plication for unilateral hemidiaphragm (HD) eventration is not clearly defined and no precise criteria exist to really understand which patient is operated with which results depending on the technique used. The goal of this study was to evaluate the place of dynamic magnetic resonance imaging (dMRI) before and after plication by developing measurement criteria. Methods: Between 2006 and 2017, 18 patients (group1: Gp1) were operated for eventrations, 15 left-sided (Gp1L) and 3 right-sided (Gp1R). All had preoperative and postoperative evaluations including dMRI and pulmonary function tests. Five healthy volunteer subjects (group2: Gp2) had the same imaging protocol. For each HD, we measured the respiratory excursion at three fixed points (S1, S2, S3) and the height of curvature on sagittal plane. We also searched for upward paradoxical diaphragm movements. Results: Before surgery, no excursion (n=13) or extremely reduced excursion (n=5) was detected on the injured HD (IHD) in Gp1. Upward paradoxical movements were identified only in Gp1L (n=6). Compared with Gp2 subjects, the healthy HD for Gp1L patients had significantly reduced excursion values at three sites S1 (P=0.038), S2 (P=0.006), and S3 (P=0.004). After plication, the decreasing height of curvature confirmed a tightening of the IHD in all patients (median value from 100 to 39.5 mm in Gp1L and 92 to 74 mm in Gp1R, P=0.0001). All upward paradoxical movements disappeared. Healthy HD excursions in Gp1L normalised their values. All those imaging improvements were correlated with postoperative improvements of dyspnoea score (P<0.0001) and vital capacity (P=0.002). Conclusions: dMRI and the standardised grid we developed not only improve the knowledge of unilateral diaphragm eventration but also permit to evaluate the quality of its surgical repair. It also demonstrates that a dysfunction of the healthy HD contralateral to eventration is possible and reversible after plication of the IHD.

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“…These connections were also studied in patients with unilateral diaphragmatic dysfunction that show dyspnoea, where an impairment is seen in the pressure generated by the theoretically healthy diaphragm [31].…”

Section: Discussionmentioning

confidence: 99%

Incidence and predictive factors of diaphragmatic dysfunction in acute stroke

2020

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Background: The most characteristic clinical signs of stroke are motor and/or sensory involvement of one side of the body. Respiratory involvement has also been described, which could be related to diaphragmatic dysfunction contralateral to the brain injury. Our objective is to establish the incidence of diaphragmatic dysfunction in ischaemic stroke and analyse the relationship between this and the main prognostic markers. Methods: A prospective study of 60 patients with supratentorial ischaemic stroke in the first 48 h. Demographic and clinical factors were recorded. A diaphragmatic ultrasound was performed for the diagnosis of diaphragmatic dysfunction by means of the thickening fraction, during normal breathing and after forced inspiration. Diaphragmatic dysfunction was considered as a thickening fraction lower than 20%. The appearance of respiratory symptoms, clinical outcomes and mortality were recorded for 6 months. A bivariate and multivariate statistical analysis was designed to relate the incidence of respiratory involvement with the diagnosis of diaphragmatic dysfunction and with the main clinical determinants. Results: An incidence of diaphragmatic dysfunction of 51.7% was observed. 70% (23 cases) of these patients developed symptoms of severe respiratory compromise during follow-up. Independent predictors were diaphragmatic dysfunction in basal respiration (p = 0.026), hemiparesis (p = 0.002) and female sex (p = 0.002). The cutoff point of the thickening fraction with greater sensitivity (75.75%) and specificity (62.9%) was 24% (p = 0.003). Conclusions: There is a high incidence of diaphragmatic dysfunction in patients with supratentorial ischaemic stroke which can be studied by calculating the thickening fraction on ultrasound. Among these patients we have detected a higher incidence of severe respiratory involvement.

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Unilateral diaphragm paralysis: a dysfunction restricted not just to one hemidiaphragm

Cited by 34 publications

References 29 publications

A strategy for pulmonary resection after contralateral diaphragm plication: a surgical case report

A strategy for pulmonary resection after contralateral diaphragm plication: a surgical case report

Dynamic magnetic resonance imaging in unilateral diaphragm eventration: knowledge improvement before and after plication

Incidence and predictive factors of diaphragmatic dysfunction in acute stroke

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