Diaphragmatic Paralysis is the loss of movement of the diaphragm. The diaphragm is a dome shaped muscle that separates the chest cavity from the abdominal inserted back injury level of the vertebrae, ribs and sternum arches,
Has openings which allow passage of the aorta, esophagus, and the vena cava.
Normally, during inspiration, the diaphragm moves downward allowing the lungs to expand to the maximum, and during exhalation, the diaphragm rises to allow the lungs to empty air. It is therefore the most important muscle of respiration.
It is innervated by the phrenic nerve.
Diaphragmatic paralysis may be more frequently bilateral or unilateral.
The most frequent cause of diaphragmatic paralysis and unilateral are tumors including lung cancer.
Other causes comprise:
Neurological diseases: Myelitis, Herpes zoster, poliomyelitis, Amyotrophic Lateral Sclerosis (ALS)
Trauma: toracoabominales, childbirth, thoracic surgery
Compressions: Goiter Aortic Aneurysm
Infections: Pneumonia, Tuberculosis
The most frequent causes of paralysis is bilateral spinal cord diseases (ALS, poliomyelitis, syringomyelia), peripheral neuropathy (Guillen-Barre disease, diphtheria, alcoholism, trauma), and muscle diseases (myotonic dystrophy, polymyositis).
In healthy subjects, the asymptomatic unilateral diaphragmatic paralysis. In patients with chronic lung disease, often exacerbated their respiratory symptoms. The bilateral paralysis usually present with orthopnea and respiratory disorders during sleep causing consequently daytime sleepiness.
Physical examination shows the displacement of the chest wall inward inspiration.
The chest radiograph suggests the diagnosis by showing a diaphragm high (or both). It is not uncommon to be an incidental finding on a radiograph requesting the patient for another reason.
The confirmatory diagnostic test is dynamic fluoroscopy shows paradoxical movement of the diaphragm during breathing (the diaphragm rises during inspiration and decreases during expiration).
If the damage is not usually treated unilateral because usually asymptomatic. Chest physiotherapy is also used to try to recover the functionalism of the diaphragm.
In bilateral cases, it may be necessary to resort to surgery with diaphragmatic plication.
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