Bilateral diaphragmatic paralysis presenting with orthopnoea and apparent radiological evidence of pulmonary embolism.

The value of lung scintigraphy in the diagnosis of pulmonary embolism

“…Totally absent perfusion of a complete lung is a rare finding, and one should be especially aware of congenital vascular abnormalities Pulmonary veno-occlusive disease [39] Fibrotic sarcoid [42] Perfusion defect with normal ventilation Acute pulmonary embolism [6-8, 19, 33] Old pulmonary thromboembolism [44,45] Atelectasis [48] Metastatic lung disease [49] (Microscopic) tumour embolism [51,52] Post radiotherapy [54] Haemangioendotheliomatosis [56] Traumatic pulmonary artery pseudoaneurysm [58] Air embolism [61] Idiopathic pulmonary fibrosis [63,64] Oesophageal hiatus hernia [65] Positive end expiratory pressure ventilation [67] Diaphragm paralysis [69] Mitral valve disease [71] Dogworm infestation [33] Congenital vascular abnormalities [36][37][38] Tumours in the hilar region [40,41] Histoplasmosis [43] Emphysema [46,47] Pneumonia [33,42] Sarcoidosis [49] Lymphangitis carcinomatosis [50] Intravenous drug abuse [53] Pulmonary artery sarcoma [49,55] Systemic arterial supply [57] Pulmonary contusion [59,60] Takayasu's arterities [49,62] Histoplasmosis [43] Intrathoracic stomach …”

“…Firstly, ventilatory support may cause perfusion defects resembling pulmonary embolism [67]. Secondly, these patients are often sedated, giving rise to postural difficulties as well as diaphragm paralysis [69,70]. Thirdly, the equipment used to monitor vital functions (i.e.…”