Abstract
Unilateral diaphragmatic paralysis is often discovered incidentally on a chest radiograph and is an underreported cause of dyspnea on exertion. The common causes of diaphragmatic paralysis seen in clinical practice are phrenic nerve injury following blunt neck trauma or surgery, viral infections (e.g., herpes zoster, poliomyelitis), cervical spondylosis, and cervical or mediastinal compressive tumors. Herein, we describe a case of a middle-aged male who presented with breathlessness on exertion, preceded by a history of acute right-sided shoulder, and neck pain. On examination, there were reduced movements of the right hemithorax, and his chest radiograph showed an elevated right hemidiaphragm. On detailed evaluation and based on his clinicoradiological profile along with nerve conduction studies, he was diagnosed as a case of unilateral paralysis of the right hemidiaphragm secondary to neuralgic amyotrophy. Diaphragmatic dysfunction in the form of weakness or paralysis can be a rare consequence of neuralgic amyotrophy. The clinical outcome of neuralgic amyotrophy with phrenic nerve palsy leading to diaphragmatic paralysis is variable, and many patients may show slow spontaneous recovery.
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References
McCool FD, Tzelepis GE. Dysfunction of the diaphragm. N Engl J Med. 2012;366(10):932–42.
Ridyard JB, Stewart RM. Regional lung function in unilateral diaphragmatic paralysis. Thorax. 1976;31(4):438–42.
Chetta A, Rehman AK, Moxham J, Carr DH, Polkey MI. Chest radiography cannot predict diaphragm function. Respir Med. 2005;99(1):39–44.
Nason LK, Walker CM, McNeeley MF, Burivong W, Fligner CL, Godwin JD. Imaging of the diaphragm: anatomy and function. Radiographics. 2012;32(2):E51-70.
Tsao BE, Ostrovskiy DA, Wilbourn AJ, Shields RW. Phrenic neuropathy due to neuralgic amyotrophy. Neurology. 2006;66(10):1582–4.
Rice BL, Ashton RW, Wang XF, Shook SJ, Mireles-Cabodevila E, Aboussouan LS. Modeling of lung function recovery in neuralgic amyotrophy with diaphragm impairment. Respir Care. 2017;62(10):1269–76.
Van Alfen N, Van Engelen BG. The clinical spectrum of neuralgic amyotrophy in 246 cases. Brain. 2006;129(2):438–50.
Holtbernd F, am Zehnhoff-Dinnesen A, Duning T, Kemmling A, Ringelstein EB. An unusual case of neuralgic amyotrophy presenting with bilateral phrenic nerve and vocal cord paresis. Case Rep Neurol 2011;3(1):69–74.
Marvisi M, Balzarini L, Mancini C, Confortini M, Betri E. A rare case of dyspnoea the parsonage-turner syndrome. Journal of Medical Cases. 2012;3(3):169–71.
Kumar A, Mireles-Cabodevila E, Mehta AC, Aboussouan LS. Sudden onset of dyspnea preceded by shoulder and arm pain. Ann Am Thorac Soc. 2016;13(12):2261–5.
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NS and RC were responsible for the concept, designing, writing of the draft, and final approval; KK and JS helped in editing the draft; RC and S collected relevant data.
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Sharma, N., Chaudhary, R., Kumar, K. et al. Unilateral Diaphragmatic Paralysis Secondary to Neuralgic Amyotrophy—a Case Report. SN Compr. Clin. Med. 5, 288 (2023). https://doi.org/10.1007/s42399-023-01623-9
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DOI: https://doi.org/10.1007/s42399-023-01623-9