Paralyzed Diaphragm

2015 ◽  
Author(s):  
Raymond P. Onders ◽  
Philip A. Linden
Keyword(s):  
Chest Radiograph ◽  
Systemic Disease ◽  
Main Pulmonary Artery ◽  
Diaphragmatic Paralysis ◽  
Anterior Mediastinal Mass ◽  
Injured Child ◽  
Diaphragmatic Dysfunction ◽  
Diaphragm Pacing ◽  
Postoperative Radiograph ◽  
Left Upper Lobectomy

Diaphragmatic dysfunction may be unilateral or bilateral, with symptoms ranging from dyspnea only on extreme exertion to ventilator dependence. The etiology, treatment, and prognosis are quite different in unilateral and bilateral paralysis. A paralyzed hemidiaphragm may occur in isolation or as part of a systemic disease, whereas bilateral diaphragmatic paralysis usually occurs as a result of a traumatic or neuromuscular degenerative process. This review covers clinical evaluation, investigative studies, and management of diaphragmatic dysfunction. Figures show diaphragmatic motion during respiration, a postoperative radiograph from a 55-year-old woman who underwent left upper lobectomy, a postoperative radiograph of a 70-year-old man who underwent left upper lobectomy for removal of a peripheral 3 cm lesion, three chest radiographs of a 25-year-old man with a residual anterior mediastinal mass after treatment for germ cell tumor, chest radiograph showing left diaphragmatic paralysis in a breast cancer patient with malignant adenopathy involving the left phrenic nerve near the left main pulmonary artery, several parallel rows of sutures placed in the muscular portion and central tendon of the diaphragm and tied with the aid of a knot pusher, a laparoscopic mapping probe  held onto the left diaphragm with suction and which receives electrical stimuli from an external clinical station, an electrode implant device that houses the electrode in the needle and is placed into the diaphragm tangentially, and the diaphragm pacing system programmed for conditioning and attached via percutaneously placed diaphragm electrodes in a spinal cord-injured child for early conditioning and weaning from the ventilator. Tables list causes of isolated diaphragmatic paralysis, general causes of unilateral and bilateral diaphragmatic paralysis, and differential diagnosis of elevated hemidiaphragm on chest radiograph. A video shows current technique of laparoscopic diaphragm pacemaker insertion.   This review contains 9 highly rendered figures, 3 tables, 1 video, and 22 references

Effect of superior trunk block on diaphragm function and respiratory parameters after shoulder surgery

2022 ◽  
pp. rapm-2021-102962
Author(s):  
Constantin Robles ◽  
Nick Berardone ◽  
Steven Orebaugh
Keyword(s):  
Total Sample ◽  
Shoulder Surgery ◽  
Diaphragmatic Paralysis ◽  
Postanesthesia Care Unit ◽  
Phrenic Nerve Palsy ◽  
Diaphragmatic Dysfunction ◽  
Postoperative Assessment ◽  
Respiratory Parameters ◽  
Breath Sounds ◽  
Arthroscopic Shoulder Surgery

BackgroundThe interscalene brachial plexus block has been used effectively for intraoperative and postoperative analgesia in patients undergoing shoulder surgery, but it is associated with high rates of diaphragmatic dysfunction. Performing the block more distally, at the level of the superior trunk, may reduce the incidence of phrenic nerve palsy. We hypothesized that superior trunk block would result in diaphragmatic paralysis rate of less than 20%.Methods30 patients undergoing arthroscopic shoulder surgery received superior trunk block under ultrasound guidance. Measurements of diaphragm excursion were determined with ultrasound prior to the block, 15 min after the block, and postoperatively in phase II of postanesthesia care unit, in conjunction with clinical parameters of respiratory function.Results10 patients (33.3%, 95% CI 17.3% to 52.8%) developed complete hemidiaphragmatic paralysis at the postoperative assessment. An additional eight patients (26.7%) developed paresis without paralysis. Of the 18 patients with diaphragm effects, seven (38.9%) reported dyspnea. 83.3% of patients with abnormal diaphragm motion (56.7% of the total sample) had audibly reduced breath sounds on auscultation. Oxygen saturation measurements did not correlate with diaphragm effect and were not significantly reduced by the postoperative assessment.ConclusionAlthough injection of local anesthetic at the superior trunk level is associated with less diaphragmatic paralysis compared with traditional interscalene block, a significant portion of patients will continue to have ultrasonographic and clinical evidence of diaphragmatic weakness or paralysis.

scholarly journals Neuralgic Amyotrophy: A Rare Cause of Bilateral Diaphragmatic Paralysis

1998 ◽  
Vol 5 (2) ◽  
pp. 139-142 ◽  
Author(s):  
Neil Shinder ◽  
Alasdair Polson ◽  
Elizabeth Pringle ◽  
Denis E O'Donnell
Keyword(s):  
Neurological Disorders ◽  
Clinical Course ◽  
Diaphragmatic Paralysis ◽  
Diaphragmatic Dysfunction ◽  
Neuralgic Amyotrophy ◽  
Brachial Neuritis ◽  
Electrophysiological Studies ◽  
Entrapment Syndromes ◽  
Cervical Roots ◽  
Nerve Root Involvement

Neuralgic amyotrophy, also known as brachial neuritis, is a well described clinical entity. Diaphragmatic dysfunction, as a result of phrenic nerve root involvement (cervical roots 3 to 5), is an uncommon, but increasingly recognized association. The case of a previously healthy 61-year-old woman who, after a prodrome of neck and shoulder discomfort, presented with severe orthopnea is described. Pulmonary function and electrophysiological studies led to a diagnosis of bilateral diaphragmatic paralysis. The patient's clinical course and the exclusion of other nerve entrapment syndromes and neurological disorders strongly favoured the diagnosis of neuralgic amyotrophy.

scholarly journals Massive Thymic Hyperplasia Mimicking Anterior Mediastinal Neoplasia in Occult Graves' Disease

2019 ◽  
Vol 08 (01) ◽  
pp. e24-e26 ◽  
Author(s):  
Christopher James Kennedy ◽  
David James William Paton
Keyword(s):  
Mediastinal Mass ◽  
Systemic Disease ◽  
Thymic Hyperplasia ◽  
Anterior Mediastinal Mass ◽  
Graves Disease ◽  
Case Description ◽  
Unique Case ◽  
History Of ◽  
Comprehensive Search ◽  
Work Up

Background Thymic hyperplasia is a recognized complication of Graves' disease that can present radiologically as an anterior mediastinal mass. Case Description We present a unique case of massive thymic hyperplasia occurring in a 24-year-old female without a known history of thyroid or other systemic disease in whom Graves' disease first manifested intraoperatively during thymectomy for presumed neoplasia. Conclusion We suggest that the work-up of all anterior mediastinal masses should include a comprehensive search for medical causes of reversible thymic enlargement.

scholarly journals Diaphragmatic Plication for Acquired Phrenic Nerve Injury after Congenital Cardiac Surgeries

2020 ◽  
Vol 2 (1) ◽  
pp. 33-38
Author(s):  
Osman Al-Radi
Keyword(s):  
Nerve Injury ◽  
Phrenic Nerve ◽  
Ventilatory Support ◽  
Diaphragmatic Paralysis ◽  
Diaphragmatic Dysfunction ◽  
Common Procedure ◽  
Phrenic Nerve Injury ◽  
Diaphragmatic Plication ◽  
Initial Surgery ◽  
The Mean

Background: Phrenic nerve injury and diaphragmatic dysfunction are common after pediatric cardiac surgery leading to failure to wean from ventilatory support. Diaphragmatic plication is the standard management of diaphragmatic paralysis. The aim of this retrospective study is to review our experience with diaphragmatic plication and its effect on the operative outcome. Methods: This retrospective cohort study included all patients who underwent diaphragmatic plication from June 2010 to June 2017. Seventy-six patients (2.87%) had unilateral diaphragmatic paralysis following 2646 congenital cardiac procedures. Sixty-four patients (2.4%) underwent diaphragmatic plication. Results: The median age for the patients who had plication was 2.75 months (range 0.5- 36) and 3.7 months (range 0.66 to 123) for non-plicated patients. Thirty-six were males (56.25%), and the most common procedure associated with diaphragmatic plication was modified Blalock Taussig Shunt (n= 13; 20.3%). Left-sided diaphragmatic plication was performed in 44 patients (68.7%). The mean time between the primary surgery and diaphragm plication was 6.42±4.51 days. The mean ventilation period before plication was 4.93±3.71 days, and post plication ventilation median time was 2.11±1.82 days. Two patients (3.1%) required tracheostomy for prolonged respiratory insufficiency. One patient (1.6%) needed surgical revision, and two patients (3.1%) had their diaphragmatic plication during the initial surgery. Conclusion: Diaphragmatic plication is an effective procedure in the management of postoperative diaphragmatic paralysis. We recommend early plication for patients with symptomatic diaphragmatic paralysis causing prolonged ventilation

scholarly journals Explorations of Unilateral Diaphragmatic Paralysis

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Alexandre Quesnel ◽  
Françoise Beuret Blanquart ◽  
Jean Paul Marie ◽  
Eric Verin
Keyword(s):  
Nerve Stimulation ◽  
Phrenic Nerve ◽  
Esophageal Pressure ◽  
Diagnostic Value ◽  
Diaphragmatic Paralysis ◽  
Inspiratory Pressure ◽  
Maximal Inspiratory Pressure ◽  
Phrenic Nerve Stimulation ◽  
Diaphragmatic Dysfunction ◽  
Chest X Ray

Objective. The aim of the present study was to evaluate sniff test, maximal inspiratory pressure, and presence of paradoxical inspiratory diaphragmatic movements and their diagnostic value in patients referred for suspicion of diaphragmatic dysfunction. Methods. Twenty-two patients (8 men and 14 women, 58±13 years) with suspected diaphragmatic dysfunction were included. Pulmonary function test was evaluated by spirometry. Diaphragm dysfunction was diagnosed with unilateral phrenic nerve stimulation. Esophageal pressure was recorded during sniff test and maximal static inspiratory movements. Detection of paradoxical diaphragmatic movement was performed with anteroposterior projection of chest X-ray fluoroscopic video. Results. Phrenic nerve stimulation enabled diagnosis of diaphragmatic paralysis in 15 of the 22 patients. The remaining 7 patients had normal explorations. Lung volumes were significantly lower in patients with diaphragmatic paralysis than in control subjects, as maximal inspiratory pressure. No patient with normal diaphragmatic exploration had paradoxical inspiratory movement. The combined diagnostic value of reduced esophageal pressure during sniff test, reduced esophageal pressure during maximal static inspiratory movements, and presence of paradoxical inspiratory movement had a sensitivity of 87% and a specificity of 71%. Conclusion. Our results suggest that, in most cases, a combination of sniff test, maximal inspiratory pressure, and paradoxical inspiratory movement could help to diagnose diaphragmatic dysfunction. Nevertheless, phrenic nerve stimulation remains the best test for assessing diaphragmatic dysfunction.

Dynamic Anterior Mediastinal Mass Physiology After Thoracotomy and Dissection for Left Upper Lobectomy

2014 ◽  
Vol 28 (4) ◽  
pp. 1030-1031
Author(s):  
John P. Lawrence ◽  
Sarah B. Hull ◽  
Michael F. Reed ◽  
William E. Hurfurd
Keyword(s):  
Mediastinal Mass ◽  
Anterior Mediastinal Mass ◽  
Left Upper Lobectomy

scholarly journals Case Report: Bilateral diaphragmatic dysfunction due to Borrelia Burgdorferi

F1000Research ◽  
2014 ◽  
Vol 3 ◽  
pp. 235 ◽  
Author(s):  
Suhail Basunaid ◽  
Chris van der Grinten ◽  
Nicole Cobben ◽  
Astrid Otte ◽  
Roy Sprooten ◽  
...  
Keyword(s):  
Case Report ◽  
Lyme Disease ◽  
Borrelia Burgdorferi ◽  
Invasive Mechanical Ventilation ◽  
Ventilatory Support ◽  
Diaphragmatic Paralysis ◽  
Diaphragmatic Dysfunction ◽  
Recent Infection ◽  
Non Invasive ◽  
Nocturnal Hypoventilation

Summary:In this case report we describe a rare case of bilateral diaphragmatic dysfunction due to Lyme disease.Case report:A 62-years-old male presented to the hospital because of flu-like symptoms. During initial evaluation a bilateral diaphragmatic weakness with orthopnea and nocturnal hypoventilation was observed, without a known aetiology. Bilateral diaphragmatic paralysis was confirmed by fluoroscopy with a positive sniff test. The patient was referred to our centre for chronic non-invasive nocturnal ventilation (cNPPV). Subsequent investigations revealed evidence of anti-Borrelia seroactivity in EIA-IgG and IgG-blot, suggesting a recent infection with Lyme disease, and resulted in a 4-week treatment with oral doxycycline. The symptoms of nocturnal hypoventilation were successfully improved with cNPPV. However, our patient still shows impaired diaphragmatic function but he is no longer fully dependent on nocturnal ventilatory support.    Conclusion:Lyme disease should be considered in the differential diagnosis of diaphragmatic dysfunction. It is a tick-borne illness caused by one of the three pathogenic species of the spirochete Borrelia burgdorferi, present in Europe. A delay in recognizing the symptoms can negatively affect the success of treatment. Non-invasive mechanical ventilation (NIV) is considered a treatment option for patients with diaphragmatic paralysis.

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