title: Idiopathic bilateral diaphragmatic paresis.
abstract: We report the case of a patient with severe dyspnea upon reclining. Lung disease, neuromuscular disorders and heart disease were ruled out. However, during the course of the investigation, bilateral diaphragmatic paresis was discovered. A key sign leading to the diagnosis was evidence of paradoxical respiration in the dorsal decubitus position. When the patient was moved from the orthostatic position to the dorsal decubitus position, oxygenation and forced vital capacity worsened. The orthostatic fluoroscopy was normal. Maximal inspiratory pressure was severely reduced. The responses to transcutaneous electric stimulation of the diaphragm were normal. However, electric stimulation of the phrenic nerve produced no response, leading to the diagnosis of bilateral diaphragmatic paresis.
authors.affiliation: Universidade Estadual de Campinas, School of Medical Sciences, Campinas, Brazil. corso@mpcnet.com.br
authors.forename: Mônica Corso
authors.initials: MC
authors.lastname: Pereira
authors.forename: Rodrigo Frange Miziara
authors.initials: RF
authors.lastname: Mussi
authors.forename: Reinaldo Alexandre de Carvalho
authors.initials: RA
authors.lastname: Massucio
authors.forename: Ana Maria
authors.initials: AM
authors.lastname: Camino
authors.forename: Aristóteles de Souza
authors.initials: Ade S
authors.lastname: Barbeiro
authors.forename: Wander de Oliveira
authors.initials: Wde O
authors.lastname: Villalba
authors.forename: Ilma Aparecida
authors.initials: IA
authors.lastname: Paschoal
mesh_terms: D000328:Adult; D005471:Fluoroscopy; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D012129:Respiratory Function Tests; D012133:Respiratory Paralysis / Q000175:diagnosis* / Q000503:physiopathology; D016683:Supine Position; D014057:Tomography, X-Ray Computed