A rare cause of respiratory insufficiency: case presentation

• Authors: Camelia Diaconu , Bianca Paraschiv , Răzvan Lungu , Daniela Bartoş
• Languages of publication: EN

Abstracts

EN

We report the case of a 73 year old woman who presented for progressive dyspnea. Her medical history included thyroidectomy 15 years ago, myocardial infarction, recurrent paroxysmal atrial fibrillation and femoral fracture two weeks previously, conservatively treated. Physical examination revealed absent breath sounds in the left hemithorax, up to the apex, and crackles in the right hemithorax. The acid-base balance showed acute hypoxemic respiratory failure. The chest X-Ray revealed left diaphragmatic paralysis. Thoracic CT-scan was performed, which excluded the pulmonary embolism and revealed left diaphragmatic relaxation, ascension of the splenic angle of the colon, stomach and spleen up to the projection of left lung hilum, and right postero-basal alveolar condensation process. Diaphragm dysfunction can be caused by various disorders, including phrenic paralysis. This pathology should be considered in the differential diagnosis of acute respiratory failure.

Keywords

EN

Diaphragm; Paralysis; Surgery

• Publisher: De Gruyter Open
• Journal: Open Medicine
• Year: 2014
• Volume: 9
• Issue: 1
• Pages: 141-143

Dates

published

1 - 2 - 2014

online

4 - 2 - 2014

Contributors

author

Camelia Diaconu

• Internal Medicine Clinic, University of Medicine and Pharmacy Carol Davila, Clinical Emergency Hospital of Bucharest, Bucharest, Romania

author

Bianca Paraschiv

• National Institute of Pneumology Marius Nasta, Bucharest, Romania

author

Răzvan Lungu

• Internal Medicine Clinic, Clinical Emergency Hospital of Bucharest, Bucharest, Romania

author

Daniela Bartoş

• Internal Medicine Clinic, University of Medicine and Pharmacy Carol Davila, Clinical Emergency Hospital of Bucharest, Bucharest, Romania

References

• [1] Al-Bilbeisi F, McCool FD. Diaphragm recruitment during nonrespiratory activities. Am J Respir Crit Care Med 2000;162:456–459 http://dx.doi.org/10.1164/ajrccm.162.2.9908059[Crossref]
• [2] Ben-Dov I, Kaminski N, Reichert N, Rosenman J, Shulimzon T. Diaphragmatic paralysis: a clinical imitator of cardiorespiratory diseases. Israel Medical Association Journal 2008, Vol.10(8–9):579–583
• [3] Laghi F, Tobin MJ. Disorders of the respiratory muscles. Am J Respir Crit Care Med 2003;168:10–48 http://dx.doi.org/10.1164/rccm.2206020[Crossref]
• [4] Loring SH, Mead J. Action of the diaphragm on the rib cage inferred from a force-balance analysis. J Appl Physiol 1982;53:756–760 http://dx.doi.org/10.1063/1.329944[Crossref]
• [5] Wilcox PG, Pardy RL. Diaphragmatic weakness and paralysis. Lung 1989;167:323–341 http://dx.doi.org/10.1007/BF02714961[Crossref]
• [6] Mier-Jedrzejowicz A, Brophy C, Moxham J, Green M. Assessment of diaphragm weakness. Am Rev Respir Dis 1988;137:877–883 http://dx.doi.org/10.1164/ajrccm/137.4.877[Crossref]
• [7] Gayan-Ramirez G, Gosselin N, Troosters T, Bruyninckx F, Gosselink R, Decramer M. Functional recovery of diaphragm paralysis: a long-term follow-up study. Respiratory Medicine 2008,Vol.102(5):690–698 http://dx.doi.org/10.1016/j.rmed.2008.01.001[Crossref][WoS]
• [8] Maish MS. The diaphragm. Surgical Clinics of North America 2010, Vol. 90(5):955–968 http://dx.doi.org/10.1016/j.suc.2010.07.005[Crossref]
• [9] Crausman RS, Summerhill EM, McCool FD. Idiopathic diaphragmatic paralysis: Bell’s palsy of the diaphragm? Lung 2009, vol. 187(3):153–157 http://dx.doi.org/10.1007/s00408-009-9140-z[WoS][Crossref]
• [10] Dennis McCool F, Tzelepis GE. Dysfunction of the diaphragm. N Engl J Med 2012;366:932–942 http://dx.doi.org/10.1056/NEJMra1007236[Crossref]
• [11] Salati M, Cardillo G, Carbone L, et al. Iatrogenic phrenic nerve injury during thymectomy: the extent of the problem. J Thorac Cardiovasc Surg 2010;139(4):e77–e78 http://dx.doi.org/10.1016/j.jtcvs.2008.06.051[Crossref][WoS]

Identifiers

DOI

10.2478/s11536-013-0258-2