Pediatric Diaphragm Paralysis

  • Etiology: paralyzed phrenic nerve from traumatic breech delivery damaging brachial plexus C3-C5 (Erb palsy) or from thoracic surgery, muscular dystrophies
  • CXR: complete elevation of the hemidiapragm
  • US: on grayscale hemidiaphragm does not show normal excursion during inspiration and expiration, on M-mode see decreased motion in hemidiaphragm
  • Fluoroscopy: diaphragm does not descend during inspiration (paradoxical diaphragm motion), heart swings towards paralyzed side in inspiration and towards unparalyzed side in expiration (rocker heart)
  • Treatment: diaphragm plication

Radiology Cases of Diaphragm Paralysis

CXR of diaphragm paralysis
CXR AP shows marked elevation of the right hemidiaphragm, which was a persistent finding on subsequent CXRs.
CXR and US of diaphragm paralysis
CXR AP (above) shows elevation of the left hemidiaphragm. Sagittal M-mode US of the right hemidiaphragm (lower left) shows normal sinuous motion of the right hemidiaphragm while sagittal M-mode US of the left hemidiaphragm (lower right) shows no motion of the left hemidiaphragm.