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