From the Guidelines
A paralyzed hemidiaphragm typically presents with shortness of breath, especially during physical activity or when lying flat, reduced exercise tolerance, and occasionally chest or shoulder pain. The symptoms of a paralyzed hemidiaphragm can vary in severity, but most patients experience some degree of respiratory distress, which may be exacerbated by physical activity or certain positions, such as lying flat 1. Some patients may be asymptomatic, with the condition discovered incidentally on chest imaging. Treatment depends on symptom severity and underlying cause, with options ranging from conservative management with breathing exercises and pulmonary rehabilitation for mild symptoms, to surgical interventions like diaphragm plication or diaphragmatic pacing with nerve stimulation for more severe cases. Key symptoms to look out for include:
- Shortness of breath (dyspnea) during physical activity or when lying flat
- Reduced exercise tolerance
- Chest or shoulder pain
- Fatigue and weakness, similar to those experienced by patients with pulmonary arterial hypertension, as described in the ACCP evidence-based clinical practice guidelines 1. For patients with significant hypoxemia, supplemental oxygen may be prescribed. It's essential to note that the condition results from phrenic nerve damage or dysfunction, which can occur from various causes, including surgery, trauma, or neurological disorders. Most patients adapt well over time as the unaffected hemidiaphragm compensates, but those with underlying lung disease may experience more persistent symptoms requiring ongoing management. Breathing exercises, such as diaphragmatic breathing, incentive spirometry, and inspiratory muscle training, performed 15-20 minutes daily, can help strengthen accessory respiratory muscles and improve symptoms. Surgical options, including diaphragm plication, may be considered for patients with severe symptoms or significant impairment of lung function. Overall, the goal of treatment is to alleviate symptoms, improve quality of life, and prevent complications associated with a paralyzed hemidiaphragm.
From the Research
Symptoms of Paralyzed Hemidiaphragm
- Dyspnea (breathing difficulty) 2, 3
- Hypoxemia (low oxygen levels in the blood) 2
- Ventilatory failure (in severe cases) 2, 3
- Cor pulmonale (right-sided heart failure due to lung disease) 3
- Worsening of symptoms in supine posture 3
Treatment Options for Paralyzed Hemidiaphragm
- Non-invasive ventilation (e.g. Bi-PAP, NPPV) 4, 5
- Surgical plication of the diaphragm (for unilateral paralysis) 2, 6
- Diaphragmatic pacing (in some cases) 3
- Continuous positive airway pressure or mechanical ventilation and tracheostomy (for bilateral diaphragm paralysis or ventilatory failure) 3
- Robotic thoracoscopic plication (a minimally invasive surgical approach) 6
Prognosis and Outcomes
- Prognosis is generally good in unilateral paralysis, especially in the absence of underlying neurological or pulmonary disease 3
- Prognosis is usually poor in patients with advanced lung disease, bilateral paralysis, and chronic demyelinating conditions 3
- Treatment with non-invasive ventilation or surgical plication can improve symptoms and outcomes 2, 4, 5, 6