Paresia diafragmática bilateral idiopática

Mônica Corso Pereira, Rodrigo Frange Miziara Mussi, Reinaldo Alexandre de Carvalho Massucio, Ana Maria Camino, Aristóteles de Souza Barbeiro, Wander de Oliveira Villalba, Ilma Aparecida Paschoal

We report the case of a patient with severe dyspnea upon reclining. Lung disease, neuromuscular disorders and heart disease were ruled out. However, during the course of the investigation, bilateral diaphragmatic paresis was discovered. A key sign leading to the diagnosis was evidence of paradoxical respiration in the dorsal decubitus position. When the patient was moved from the orthostatic position to the dorsal decubitus position, oxygenation and forced vital capacity worsened. The orthostatic fluoroscopy was normal. Maximal inspiratory pressure was severely reduced. The responses to transcutaneous electric stimulation of the diaphragm were normal. However, electric stimulation of the phrenic nerve produced no response, leading to the diagnosis of bilateral diaphragmatic paresis.