Paradoxical abdominal wall movement in bilateral diaphragmatic paralysis.
A 56-year-old man gave a 6-month history of progressive dyspnoea and orthopnoea. During breathing, his abdominal muscles showed paradoxical movement and he rapidly and reproducibly developed difficulty breathing when lying supine. The most likely explanation was severe weakness or paralysis of both hemidiaphragms. This was confirmed with electrophysiology and ultrasonography. Extensive investigation identified no underlying cause, suggesting this is a case of bilateral isolated phrenic neuropathy. We present a video showing how easily bilateral diaphragmatic palsy can be detected clinically through identifying paradoxical abdominal wall movement.
Department of Neurology, Royal Prince Alfred Hospital, Sydney, Australia. rebekahahmed@gmail.com
Rebekah
R
Ahmed
Stephen
S
McNamara
Simon
S
Gandevia
G Michael
GM
Halmagyi
D034861:Abdominal Wall / Q000294:innervation / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010791:Phrenic Nerve / Q000000981:diagnostic imaging*; D011859:Radiography; D012133:Respiratory Paralysis / Q000150:complications / Q000175:diagnosis*