185 Paralyzed Diaphragm

CASE 185


image Clinical Presentation


45-year-old man 6-weeks status post CABG with complaints of increasing dyspnea on exertion and orthopnea who cannot tolerate lying flat and must sleep with his head elevated on 4–5 pillows


image Radiologic Findings


Preoperative frontal chest X-ray (Fig. 185.1A) shows mild cardiomegaly and a normal relationship of the right and left diaphragms. No underlying lung disease is present. Follow-up postoperative frontal (Fig. 185.1B) and lateral (Fig. 185.1C) chest radiographs demonstrate marked elevation of the left diaphragm relative to the right. Note the median sternotomy. Subsequent fluoroscopic “sniff test” revealed paradoxical motion of the left diaphragm.



image


Fig. 185.1


image Diagnosis


Paralyzed Left Diaphragm


image Differential Diagnosis


• Eventration of the Diaphragm


image Congenitally thin muscular portion of diaphragm; appearance increases with age


image 5R:1L


image Anteromedial on right; usually involves entire left diaphragm


• Elevation of the Diaphragm


image Subpulmonic Effusion (see Case 171)


image Atelectasis


image Hypoplastic Lung


image Abdominal Disease (e.g., subphrenic abscess; liver mass; ascites)


image Idiopathic


• Diaphragmatic Hernia (see Cases 94 and 184)


image Discussion


Background

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Jan 14, 2016 | Posted by in RESPIRATORY IMAGING | Comments Off on 185 Paralyzed Diaphragm

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