Diaphragmatic paralysis

Case contributed by Dr Mostafa Mahmoud El Feky

Presentation

Smoker, cough, dyspnoea. No history of previous trauma or current tumour at the neck or chest. No history of previous surgical intervention.

Patient Data

Age: 60 years
Gender: Male
X-ray

X-Ray chest (PA view)

Elevated left diaphragmatic copula with partial collapse of lower lobe of left lung.

CT

CT Chest

Elevated left diaphragmatic copula with significantly thinned out left diaphragmatic crura reaching 2 mm in comparison to the right sided one averaging 10 mm. Consequent sub segmental consolidative patches and mild atelectasis noted involving the inferior lingular, anterior and apical segments of the left lower lobe as well as mild diaphragmatic shift to the right side. No suspicious parenchymal lesions identified.

Case Discussion

Elevation of hemidiaphragm is a radiological finding seen in conditions such as diaphragmatic eventration, lobar lung collapse, subphrenic mass or abscess and phrenic nerve paralysis

Diaphragmatic eventration typically affects only a segment of the hemidiaphragm, compared to paralysis where the entire hemidiaphragm is typically affected. The atrophic changes of the left hemidiaphragm, combined with the lack of a sharp peak strongly suggests phrenic nerve paralysis rather than diaphragmatic eventration.

In this case, no history of previous trauma or current tumour in the neck or chest. No history of previous surgical intervention. Cervical spondylotic changes are noted. The aetiologic possibilities are previous infection that may have affected the phrenic nerve or phrenic nerve paralysis due to compression by the cervical spondylosis.

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Case information

rID: 53724
Case created: 2nd Jun 2017
Last edited: 19th Jun 2017
System: Chest
Inclusion in quiz mode: Included

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