%0 Journal Article
%T Explorations of Unilateral Diaphragmatic Paralysis
%A Alexandre Quesnel
%A Fran£żoise Beuret Blanquart
%A Jean Paul Marie
%A Eric Verin
%J Journal of Respiratory Medicine
%D 2014
%R 10.1155/2014/683852
%X Objective. The aim of the present study was to evaluate sniff test, maximal inspiratory pressure, and presence of paradoxical inspiratory diaphragmatic movements and their diagnostic value in patients referred for suspicion of diaphragmatic dysfunction. Methods. Twenty-two patients (8 men and 14 women, years) with suspected diaphragmatic dysfunction were included. Pulmonary function test was evaluated by spirometry. Diaphragm dysfunction was diagnosed with unilateral phrenic nerve stimulation. Esophageal pressure was recorded during sniff test and maximal static inspiratory movements. Detection of paradoxical diaphragmatic movement was performed with anteroposterior projection of chest X-ray fluoroscopic video. Results. Phrenic nerve stimulation enabled diagnosis of diaphragmatic paralysis in 15 of the 22 patients. The remaining 7 patients had normal explorations. Lung volumes were significantly lower in patients with diaphragmatic paralysis than in control subjects, as maximal inspiratory pressure. No patient with normal diaphragmatic exploration had paradoxical inspiratory movement. The combined diagnostic value of reduced esophageal pressure during sniff test, reduced esophageal pressure during maximal static inspiratory movements, and presence of paradoxical inspiratory movement had a sensitivity of 87% and a specificity of 71%. Conclusion. Our results suggest that, in most cases, a combination of sniff test, maximal inspiratory pressure, and paradoxical inspiratory movement could help to diagnose diaphragmatic dysfunction. Nevertheless, phrenic nerve stimulation remains the best test for assessing diaphragmatic dysfunction. 1. Introduction Diaphragmatic paralysis is common and may be due to infectious, iatrogenic, or malignant causes, although the most common is frigore paralysis. Damage to the diaphragm or the phrenic nerve decreases inspiratory pressure, leading to diaphragmatic weakness and reduction in inspiratory muscle capacity [1] and lung volume, which in turn impair respiratory muscle endurance [2] and produce dyspnea [3]. Diaphragmatic dysfunction should thus be considered as a differential diagnosis of unexplained dyspnea, but its definitive diagnosis is difficult to assert. Definitive diagnosis can be obtained by phrenic nerve stimulation combined with measurement of twitch transdiaphragmatic pressure [4, 5], but the technique may be difficult in some patients. In clinical practice, suspicion of diaphragmatic paralysis is usually based on diaphragmatic curse during diaphragmatic fluoroscopic examination [6], inspiratory muscle strength
%U http://www.hindawi.com/journals/jrm/2014/683852/