Idiopathic bilateral diaphragmatic paresis

We report the case of a patient with severe dyspnea upon reclining. Lung disease, neuromuscular disorders and heart disease were ruled out. However, during the course of the investigation, bilateral diaphragmatic paresis was discovered. A key sign leading to the diagnosis was evidence of paradoxical...

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Published inJornal brasileiro de pneumologia Vol. 32; no. 5; pp. 481 - 485
Main Authors Pereira, Mônica Corso, Mussi, Rodrigo Frange Miziara, Massucio, Reinaldo Alexandre de Carvalho, Camino, Ana Maria, Barbeiro, Aristóteles de Souza, Villalba, Wander de Oliveira, Paschoal, Ilma Aparecida
Format Journal Article
LanguageEnglish
Portuguese
Published Brazil 01.09.2006
Subjects
Adult
Fluoroscopy
Humans
Magnetic Resonance Imaging
Male
Respiratory Function Tests
Respiratory Paralysis - diagnosis
Respiratory Paralysis - physiopathology
Supine Position
Tomography, X-Ray Computed
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Summary:We report the case of a patient with severe dyspnea upon reclining. Lung disease, neuromuscular disorders and heart disease were ruled out. However, during the course of the investigation, bilateral diaphragmatic paresis was discovered. A key sign leading to the diagnosis was evidence of paradoxical respiration in the dorsal decubitus position. When the patient was moved from the orthostatic position to the dorsal decubitus position, oxygenation and forced vital capacity worsened. The orthostatic fluoroscopy was normal. Maximal inspiratory pressure was severely reduced. The responses to transcutaneous electric stimulation of the diaphragm were normal. However, electric stimulation of the phrenic nerve produced no response, leading to the diagnosis of bilateral diaphragmatic paresis.
Bibliography:ObjectType-Case Study-2
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ISSN:1806-3713
1806-3756
DOI:10.1590/S1806-37132006001300017