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El Labban M, Bauer PR. Orthopnea secondary to brachial plexitis with bilateral diaphragmatic paralysis. BMC Pulm Med 2024; 24:31. [PMID: 38216939 PMCID: PMC10785406 DOI: 10.1186/s12890-023-02828-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 12/26/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Diaphragmatic paralysis can present with orthopnea. We report a unique presentation of bilateral diaphragmatic paralysis, an uncommon diagnosis secondary to an unusual cause, brachial plexitis. This report thoroughly describes the patient's presentation, workup, management, and outcome. It also reviews the literature on diaphragmatic paralysis and Parsonage-Turner syndrome. CASE PRESENTATION A 50-year-old male patient developed insidious orthopnea associated with left shoulder and neck pain over three months with no associated symptoms. On examination, marked dyspnea was observed when the patient was asked to lie down; breath sounds were present and symmetrical, and the neurological examination was normal. The chest radiograph showed an elevated right hemidiaphragm. Echocardiogram was normal. There was a 63% positional reduction in Forced Vital Capacity and maximal inspiratory and expiratory pressures on pulmonary function testing. The electromyogram was consistent with neuromuscular weakness involving both brachial plexus and diaphragmatic muscle (Parsonage and Turner syndrome). CONCLUSIONS Compared to unilateral, bilateral diaphragmatic paralysis may be more challenging to diagnose. On PFT, reduced maximal respiratory pressures, especially the maximal inspiratory pressure, are suggestive. Parsonage-Turner syndrome is rare, usually with unilateral diaphragmatic paralysis, but bilateral cases have been reported.
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Affiliation(s)
- Mohamad El Labban
- Department of Internal Medicine, Mayo Clinic Health System, 101 Martin Luther King Dr, Mankato, MN, USA.
| | - Philippe R Bauer
- Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
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Tryfon S, Papadopoulou E, Chatzis C. A breathtaking clinical challenge. Hippokratia 2021; 25:97. [PMID: 35937512 PMCID: PMC9347349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- S Tryfon
- Pulmonary Department, General Hospital "G. Papanikolaou", Thessaloniki, Greece
| | - E Papadopoulou
- Pulmonary Department, General Hospital "G. Papanikolaou", Thessaloniki, Greece
| | - C Chatzis
- Primary Health Center, N. Madytos, Greece
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Kawaguchi Y, Saito T, Mitsunaga T, Terui K, Nakata M, Matsuura G, Kouchi K, Yoshida H. Prediction of respiratory collapse among pediatric patients with mediastinal tumors during induction of general anesthesia. J Pediatr Surg 2018; 53:1365-1368. [PMID: 29037532 DOI: 10.1016/j.jpedsurg.2017.09.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 08/26/2017] [Accepted: 09/19/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Fatality resulting from respiratory collapse (RC) during general anesthesia (GA) induction in children with mediastinal tumors has been reported. We explored potentially useful parameters for predicting the risk of RC based on objective imaging results. METHODS We retrospectively reviewed the records of 31 patients (median age: 4years; range: 4months-15years) with mediastinal tumors treated between 2000 and 2015. Comparing those with RC under GA induction to those without (RC group vs. non-RC group), we analyzed a variety of factors that might predict respiratory obstruction during GA induction, including our new parameter, the standardized tumor volume (STV), which is adapted from the formula for the volume of an ellipsoid. RESULTS All eight patients in the RC group had large tumors in the anterior mediastinum, including lymphoma, teratoma, and germ cell tumor. The mean STV value of the RC group was significantly larger than that of the non-RC group (3.6±1.4 vs. 1.4±1.0, p=0.006). Using an STV cut-off value of 2.5, the sensitivity and specificity for predicting RC under GA induction were both 0.86, making STV more useful than previously reported risk factors. CONCLUSION Anterior mediastinal tumors in children can often cause airway obstruction under GA induction. Measuring STV can help predict the respiratory risk during GA among pediatric patients with anterior mediastinal tumors. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Yunosuke Kawaguchi
- Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba 260-8677, Japan
| | - Takeshi Saito
- Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba 260-8677, Japan.
| | - Tetsuya Mitsunaga
- Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba 260-8677, Japan
| | - Keita Terui
- Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba 260-8677, Japan
| | - Mitsuyuki Nakata
- Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba 260-8677, Japan
| | - Gen Matsuura
- Department of Pediatric Surgery, Matsudo City Hospital Children's Medical Centre, 4005 Kamihongo, Matsudo City, Chiba 271-8511, Japan
| | - Katsunori Kouchi
- Department of Pediatric Surgery, Tokyo Women's Medical University Yachiyo Medical Center, 477-96 Owadashinden, Yachiyo City, Chiba 276-8524, Japan
| | - Hideo Yoshida
- Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba 260-8677, Japan
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Roche L, Rioufol G, Piszker G, Genety C, Ritz B, Ferrini M, Finet G, Aupetit JF. [Platypnea-orthodeoxia syndrome: case report]. Ann Cardiol Angeiol (Paris) 2013; 62:354-7. [PMID: 24060466 DOI: 10.1016/j.ancard.2013.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 08/12/2013] [Indexed: 10/26/2022]
Abstract
We report the case of an 80-year-old woman with symptomatic postural hypoxaemia caused by a right-to-left shunt through a patent foramen ovale. The hypoxaemia was enhanced by the supine position and disappeared in upright position. Potential mechanisms underlying postural variations of the shunt seemed to be similar to those describe in platypnea-orthodeoxia syndrome. Patient became asymptomatic after shunt resolution.
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Affiliation(s)
- L Roche
- Département de cardiologie, centre hospitalier Saint-Joseph-Saint-Luc, 20, quai Claude Bernard, 69365 Lyon cedex 07, France
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Behzadnia N, Hossein-Ahmadi Z, Sharif-Kashani B, Sheybani-Afshar F, Naghash-Zadeh F, Ansari-Aval Z, Mirhosseini SM. Pericardial hydatid cyst in oblique sinus, obstructing all pulmonary veins: a rare presentation. Tanaffos 2013; 12:78-80. [PMID: 25191454 PMCID: PMC4153237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Accepted: 09/06/2012] [Indexed: 11/08/2022]
Abstract
Hydatid cyst of the heart is an uncommon presentation of hydatidosis. We present a case of pericardial hydatid cyst in pericardial oblique sinus with extension to posterior wall of left atrium (LA), occluding all pulmonary vein ostia in a 35 year-old female with progressive dyspnea and severe orthopnea.
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Affiliation(s)
- Neda Behzadnia
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences
| | - Zargam Hossein-Ahmadi
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences
| | - Babak Sharif-Kashani
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences
| | - Faezeh Sheybani-Afshar
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences
| | - Farah Naghash-Zadeh
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences
| | - Zahra Ansari-Aval
- Pediatric Respiratory Diseases Research Center, NRITLD, Shahid Beheshti University of Medical Sciences
| | - Seyed Mohsen Mirhosseini
- Chronic Respiratory Diseases Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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