Hemidiaphragmatic paralysis is when one side of the diaphragm is immobilized, causing breathing problems. Causes include tumors, injury, and unknown origins. Treatment varies, with surgical options available. Complications can occur in those with existing respiratory disease.
The diaphragm is a dome-shaped flap of muscle needed for normal breathing that sits below the lungs and keeps the abdomen separate from the chest. In hemidiaphragmatic paralysis, one side of the diaphragm is immobilized. Findings can range from no symptoms, in someone otherwise fit and healthy, to severe breathing problems in someone with existing lung disease. Treatment varies accordingly, from nothing to a surgical procedure known as a diaphragmatic plication. Possible causes of paralysis include cancer, infection, and injury, but the origin is often unknown.
One of the most common causes of mid-diaphragmatic paralysis is a tumor pressing on the nerve that supplies the diaphragm, known as the phrenic nerve. This nerve can also be injured in accidents or surgical procedures involving the chest and neck. An enlarged thyroid gland or the presence of a swelling in a large artery known as the aorta can also affect the phrenic nerve, possibly leading to hemidiaphragmatic paralysis. In many cases, the cause of the paralysis goes undiscovered.
It is more common for paralysis to affect one side of the diaphragm rather than both sides, a condition known as bilateral diaphragmatic paralysis. Often, hemidiaphragmatic paralysis does not cause any symptoms and the patient may not be aware of the condition, which could be discovered with a routine x-ray. Where there are no symptoms and no existing lung disease, hemidiaphragmatic paralysis usually has a positive attitude and no treatment is required. In some people the condition causes severe shortness of breath during exercise and in those who have existing breathing problems this shortness of breath can also occur at rest. Surgical treatment may be helpful for some people whose breathlessness becomes extreme.
Surgical treatment of hemidiaphragmatic paralysis involves a procedure known as diaphragmatic plication. In a diaphragmatic plication operation, the paralyzed muscle is folded and stitched to make it less mobile, preventing it from moving upward during inspiration. A normally functioning diaphragm would drop during inspiration, increasing the volume of the lungs. The result of the operation is that more air enters the lung from the affected side during inspiration and the symptoms of hemidiaphragmatic paralysis such as shortness of breath are reduced.
Complications of hemidiaphragmatic paralysis can occur in people who have existing respiratory disease, due to worsening lung ventilation. Infections such as pneumonia are more likely to develop. Depending on the cause of the paralysis, medical and surgical treatments may be done, and artificial ventilation may be needed if you have severe breathing problems.
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