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Lung diseases

Shortness of breath, diaphragm malfunctioning

02/27/2006

Question:

My friend has trouble breathing, a sniff test on the diaphragm shows that the right one is not fully functioning. This problem started immediately after the last surgery where the surgeon did extensive damage to the inner right chest wall cutting into tissue to separate the lung from the chest wall where attachments occurred from a previous surgery of removal of a lobe that had a spot suspicious for cancer. Now it seems that the phrenic nerve or something related to the diaphragm is not working. Which tests can be done to determine if the nerve is pinched, damaged and what is causing the diaphragm to malfunction? Thanks for your help. We have no faith in our current pulmonoligist...he never does any tests unless we find out about a test and request him to do it...seems he doesn`t want to heal the patient!

Answer:

The diaphragm is the muscle that separates the chest from the abdomen and is important for breathing.  It is innervated by the phrenic nerve.  If there is injury to the phrenic nerve due to tumor invasion, trauma, surgery, or other processes the diaphragm may become paretic-able to move partially or paralyzed-unable to move.  Depending upon the cause, the changes can be permanent or transitory.  For example, if the nerve is compressed by swelling, it will not function currently; when the swelling resolves, the nerve will usually return to normal function.  If the nerve is cut, it is much less likely to return to normal function.

The sniff test is a radiographic test in which the radiologist watches the diaphragm move with various maneuvers.  If done correctly, it is usually diagnostic for diaphragmatic paresis or plegia.  EMG electromyelograms of the diaphragm can also be performed in which needles are inserted into the diaphragm muscle and nerve activity measured.  This test can be painful and is usually only done in specialized centers.

Unfortunately, there is very little that can be done for diaphragmatic paralysis.  Conservative measures include using a hospital bed at night to elevate the head-the upright posture maximizes diaphragmatic positioning and minimizes breathlessness.  Diaphragmatic pacemakers are available but are usually only used for bilateral paralysis and are only placed in a few centers nationally.

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Response by:

Ralph   Panos, MD Ralph Panos, MD
Associate Professor
College of Medicine
University of Cincinnati