Delayed presentation of bilateral diaphragmatic palsy following trauma

Aditi Joshi,Ketaki Utpat,Unnati Desai,Ramesh Bharmal

doi:10.15761/mcrr.1000164

Abstract

Delayed presentation of bilateral diaphragmatic palsy following trauma

Highlights

The diaphragm is the primary respiratory muscle
Bilateral diaphragm palsy is a rare cause of acute respiratory failure and is often related to phrenic nerve injury as well as varieties of neuropathy and myopathies, the cause goes unidentified in two third of cases [2]
Though the diaphragm forms one continuous musculotendinous sheet between the thorax and the abdomen, both the diaphragms work as an independent unit, paralysis of one phrenic nerve might be expected to have little effect because tension in the whole diaphragm should be maintained by activity in the contralateral phrenic nerve

Summary

Introduction

Diaphragmatic dysfunction can be associated with respiratory symptoms, exercise intolerance, sleep disturbances, and in severe cases having negative impact on survival. The diagnosis and management of Unilateral and bilateral diaphragmatic dysfunction can be sometimes problematic due to its subtle presentation, relative rarity and difficulty in obtaining a physician confirmed diagnosis [1]. Unilateral diaphragm paralysis is often first suspected after the finding of an abnormally elevated hemidiaphragm on a chest radiograph, which can be defined as a right hemidiaphragm sitting >2 cm higher than its left counterpart or a left hemidiaphragm sitting equal or higher than the right hemidiaphragm. Bilateral diaphragm palsy is a rare cause of acute respiratory failure and is often related to phrenic nerve injury as well as varieties of neuropathy and myopathies, the cause goes unidentified in two third of cases [2]. We report a case of post traumatic bilateral diaphragmatic paralysis

Case report

Findings

Discussion