Dyspnea

Question 1

what causes unilateral diaphragmatic paralysis?

Answer 1

from phrenic nerve injury during cardiac surgery

phrenic nerve originates C3 to C5 to innervate diaphragm on both sides

Question 2

etiologies of unilateral diaphragmatic paralysis?

Answer 2

phrenic nerve injury in cardiac surgery
viral infections (herpes zoster or poliomyelitis)
other (trauma, tumor, cervical spondylosis, neck surgery)
idiopathic

Question 3

how to diagnose unilateral diaphragmatic paralysis

Answer 3

sniff test - see paradoxical upward movement

normal diaphragm will move down during inspiration

Question 4

imaging findings for unilateral diaphragmatic paralysis?

Answer 4

elevated hemidiaphragm

Question 5

spirometry of unilateral diaphragmatic paralysis

Answer 5

restrictive defect (low forced vital capacity) >50% when supine

normal decrease of <10% in supine position is seen more so with unilateral diaphragmatic paralysis

Question 6

presentation of unilateral diaphragmatic paralysis

Answer 6

dyspnea at rest or with exertion and see supine hypoxemia

Question 7

supine hypoxemia in unilateral diaphragmatic paralysis

Answer 7

seen because naturally there is dysplacement of abd viscera up but with already the elevated diaphragm this becomes much worse.

Question 8

treatment of unilateral diaphragmatic paralysis

Answer 8

asymptomatic pts no treatment.

many with mild to moderate dyspnea may improve spontaneously in 1-2 years

those with significant impairment may benefit from ipsilateral surgical diaphgramatic plication.