Diaphragmatic Paralysis: A Critical Review of its Use as a Therapeutic Measure in Respiratory Disease

Abstract

Diaphragmatic paralysis first suggested as a therapeutic measure in lung disease by Steurtz (1911), who did simple phrenicotomy. Felix (1922) showed in 25% of cases this was ineffective owing to the presence of an accessory phrenic, and suggested phrenic exairesis, i.e. complete evulsion of the phrenic nerve. Goetze (1922) suggested radical phrenicotomy, i.e. division of the phrenic and excision of the nerve to the subclavius. Effects of diaphragmatic paralysis.—The diaphragm rises to the full expiratory position (4–8 cm.). Paradoxical movement (Kienböch's phenomenon) on affected side. Muscle atrophies. Collapse of the lung produced, affecting base and apex also. Lung volume reduced by ⅙th to ⅓rd. Physical signs.—Indrawing of the epigastrium. Thoracic breathing. Litten's sign absent. Less resistance to abdominal palpation on affected side. Diminished resonance at border of sternum and at base. Deficient inspiratory murmur at base. Radiography.—Paradoxical movement. Bittorf's test. Indications.—(A) Pulmonary tuberculosis. I. As the sole therapeutic measure. (1) In cases where pneumothorax has failed. (2) For relief of symptoms such as: ( a) hæmoptysis; ( b) cough; ( c) tachycardia ( d) nausea and vomiting; ( e) pain; ( f) hiccup. II. Combined with pneumothorax. ( a) For basal adhesions; ( b) alternative to bilateral pneumothorax; ( c) to lengthen interval between refills; ( d) at conclusion of pneumothorax treatment. III. Combined with thoracoplasty. (B) Other diseases. Unresolved pneumonia, fibrosis of the lung, bronchiectasis, abscess of the lung, hydatid disease.

Right phrenic nerve palsy following transcatheter radiofrequency current atrial fibrillation ablation: Case report

“…Phrenic nerve palsy (PNP) is a well-known complication of cardiac surgery or jugular/ subclavian vein catheterization, presenting with cough, hiccups, dyspnoea/shortness of breath and, in some cases, ventilatory failure. 1,2 On rare occasions, PNP is a complication of transcatheter radiofrequency current atrial fibrillation ablation. This current report describes a case of PNP subsequent to transcatheter radiofrequency ablation for atrial fibrillation.…”