Phrenic nerve palsy

Case contributed by Dr Naim K

Presentation

Exertional dyspnea.

Patient Data

Age: 45 years
Gender: Male

Chest

X-ray

An elevated right hemidiaphragm is seen with underlying bowel gas shadow "Chilaiditi syndrome" causing a contralateral shift of the mediastinum.

Bibasal atelectatic bands are seen.

Otherwise clear lungs and left costophrenic angle.

Chest

Fluoroscopy

Significant elevation of the right hemidiaphragm is seen with interposition of the large bowel loops between the liver and the diaphragm.

Under fluoroscopy during inspiration and expiration, there was paradoxical movement of the right hemidiaphragm consistent with right phrenic nerve paralysis.

Case Discussion

This case illustrates the typical appearance of unilateral phrenic nerve palsy. Elevation of the right hemidiaphragm on frontal chest radiograph was followed by Sniff test and showed paradoxical movement on inspiration.

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