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Left hemidiaphragm paralysis

Case contributed by Henry Knipe
Diagnosis certain

Presentation

Shortness of breath.

Patient Data

Age: 75
Gender: Female
x-ray

Left hemidiaphragm is markedly elevated. Cardiomegaly. Left mastectomy noted, aortic valve replacement and sternotomy wires noted. 

18 months prior

x-ray

Hemidiaphragm is not elevated. Note sternotomy wires and aortic valve replacement is not present. 

Case Discussion

Sniff test (not shown) confirmed paralysis of the left hemidiaphragm.

Key learning points:

  • incidence of phrenic nerve palsy post cardiac surgery is reported between 10-60%
  • usually unilateral but very rarely may be bilateral
  • diaphragm contributes the majority of total ventilatory effort and palsy can result in fatigue of other respiratory muscles and result in ventilatory failure

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