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 B-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

Cases of Diaphragm Paralysis