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Q. How to manage unilateral paralysis of the diaphragm?

Answered by
Dr. Amolkumar W Diwan
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Jul 07, 2016 and last reviewed on: May 26, 2020

Hi doctor,

What health implications have been observed with a unilateral paralysis of the diaphragm? I have had a plication performed, but it failed and is back to the original issue. Currently, I am suffering from shortness of breath, chest pain with dizzy spells and increased heart rate. I am on Propranolol for the heart rate issue. Please help.

#

Hi,

Welcome to icliniq.com.

  • Unilateral diaphragmatic paralysis is most commonly seen on the left side.
  • The diaphragm is the most important muscle of ventilation. Unilateral diaphragmatic paralysis is usually well tolerated if there is no underlying lung or rib cage pathology. But, if severe, then it may cause dyspnea and hypoxemia and require treatment.
  • The most common cause is nerve compression either trauma or some cancer or it may go unidentified called as idiopathic.
  • Patients usually develop severe restrictive ventilatory impairment on spirometry. The vital capacity and total lung capacity frequently are below 50% of predicted for that patient. Lung capacity is reduced when the patient assumes the lying down position.
  • The main treatment is directed at the treatment of the underlying etiologic cause and chest physiotherapy.
  • But, in your case as you said, plication is already failed. The only way to increase its strength is by the inspiratory muscle strength and endurance training through physiotherapy.
  • In some cases there is spontaneous recovery if the impairment is mild or if the etiology is removed. But, ultimately it is the endurance training that will help in the long run.
  • Also, every attempt should be made to prevent any lung infection, which will become very difficult to treat in the future.

The Probable causes:

Traumatic or some cancer causing nerve compression.

Investigations to be done:

MRI Scan and spirometry.

Probable diagnosis:

Unilateral diaphragmatic paralysis.

Regarding follow up:

For further information consult a pulmonologist online.---> https://www.icliniq.com/ask-a-doctor-online/pulmonologist


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