diaphragmatic paralysis

Etiology: 1) chronic diaphragmatic paralysis (> 6 months) is generally idiopathic 2) hilar mass may cause acute unilateral diaphragmatic paralysis Clinical manifestations: 1) unilateral: frequently associated with hemiplegia 2) bilateral: orthopnea Pulmonary function testing: 1) unilateral - decreased total lung capacity by 35% - decreased vital capacity by 20% - decreased maximal voluntary ventilation by 20% 2) bilateral a) decreased vital capacity - 50% in the upright position - 60-75% in the upright position b) decreased maximal voluntary ventilation by 20% Laboratory: - diaphragmatic electromyography Radiology: 1) elevated diaphragm or hemidiaphragm on chest X-ray 2) diaphragmatic fluoroscopy: a) demonstration of paradoxical motion b) 6% of normal subjects have positive findings Management: - exclude hilar mass with acute unilateral diaphragmatic paralysis

General

diaphragm disorder paralysis

References

Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 793