Idiopathic bilateral diaphragmatic paresis.
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.
Pereira
Mônica Corso
MC
Universidade Estadual de Campinas, School of Medical Sciences, Campinas, Brazil. corso@mpcnet.com.br
Mussi
Rodrigo Frange Miziara
RF
Massucio
Reinaldo Alexandre de Carvalho
RA
Camino
Ana Maria
AM
Barbeiro
Aristóteles de Souza
Ade S
Villalba
Wander de Oliveira
Wde O
Paschoal
Ilma Aparecida
IA
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