image article Idiopathic Right Diaphragm Paralysis
Yash H Dubal*
Emergency Department, School of Medicine, Muhimbili University of Health and Allied Sciences, Tanzania
*Corresponding author: Yash H. Dubal, Division Emergency Department, School of Medicine, Muhimbili National Hospital, Tanzania, Tel: +255-22-2151680; E-mail: yash.dubal@akhst.org
Received Date: 3 December, 2016; Accepted Date: 3 December, 2016; Published Date: 10 December, 2016
Citation: Yash H. Dubal, (2016) Idiopathic Right Diaphragm Paralysis. Ann Case Rep 2016: J133. DOI: 10.29011/2574-7754/100033
A 56 years old female presents to the A&E with complains of difficulty in breathing as soon as she lies down especially at night when she lies down, which improves when she sits. She is known diabetic and hypertensive. She uses her medications irregularly. She is also a patient with depression (divorced, feels lonely) on Resperidone. A recent echocadiogram had shown normal left ventricular systolic function with impaired relaxation attributed to hypertensive heart disease. There was no significant valvular heart disease. There was moderate pulmonary hypertension.
On arrival her vitals were:
BP: 201/110
PR: 85 beats/min
RR: 23 cycles/min
SpO2: 99% at room air
Temp: 36.8 C
RBG: 9.7mmol/l
On examination: Alert, not cyanosed, not tachypneic when seated (but significant respiratory distress as soon as she lies down), no dehydration, no pallor. S1, S2 heard, no added cardiac sounds. Chest exam was normal. The patient had some bilateral lower limb pitting edema. Attached is the Chest X-ray
Attached is the fluoroscopy video: https://www.dropbox.com/s/ ow903ip38ffoatj/Diaphragm%20paralysis.mp4?dl=0 Case can be confused for PND. The observed immediate symptoms of breathing difficulty and chest roentgenogram findings served as the clue for diagnosis.
Subsequent CT of chest did not reveal any mass or any identifiable cause of the right phrenic nerve palsy.
Figure: Chest X-ray