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What Are The Symptoms Of Phrenic Nerve Dysfunction?

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Posted on Thu, 20 Feb 2014
Question: I have been suffering from dyspnea and orthopnea for over a year. My pulmunologist is convinced that it is not a lung disease issue. I recently had a sniff test and there was no abnormal movement of the diaphragm. There is evidence of a discoid atelectatic changes at the left base with initial elevation of the left hemidiaphragm. Some blunting of the right CP angle was also noted. NO infitrates in the lunch and the heart is normal in size. When this problem started a year ago, my thyroid (TSH) was out of wack at 90.63 mIU/L (collected January 17, 2013). During that same period, I had a crippleing problem with back spams (neck/upper back area) and was diagnosed and treated for walking pnemonia (M. Pneumoniae AB (IGG), EIA. By July, my TSH was back to normal (0.50 mIU/L). My question to you is the following: Could this be a phrenic nerve dysfunction? I forgot to mention that I've had a heart cathederization to measure arterial pressure inside the lung and everything was fine and nothing wrong with the heart either.
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Answered by Dr. Dr.Raju.A.T (3 hours later)
Brief Answer: Yes, it could be Detailed Answer: Hi, Thanks for your query. Yes, considering the spirometry result phrenic nerve dysfunction can be a possibility. Phrenic nerve dysfunction usually starts with a hiccough. This progresses to restrictive pattern of breathing where in the TLC and the alveolar capillary surface remains normal. With elevation of hemidiaphragm, more than orthopnia one can experience trepopnea (dyspnea when lying on the affected side). Such presentation is typical in unilateral phrenic nerve dysfunction which is a common complication of pneumonia affecting the lower lobes. Also, I would recommend a HRCT (High Resolution CT scan) to rule out fibrosis which can present as atelectatic change post pneumonia. Fibrosis also presents a restrictive pattern on spirometry but with reduced TLC and alveolar capillary surface. Wish you god health. regards,
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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Dr.Raju.A.T

General & Family Physician

Practicing since :2008

Answered : 4933 Questions

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What Are The Symptoms Of Phrenic Nerve Dysfunction?

Brief Answer: Yes, it could be Detailed Answer: Hi, Thanks for your query. Yes, considering the spirometry result phrenic nerve dysfunction can be a possibility. Phrenic nerve dysfunction usually starts with a hiccough. This progresses to restrictive pattern of breathing where in the TLC and the alveolar capillary surface remains normal. With elevation of hemidiaphragm, more than orthopnia one can experience trepopnea (dyspnea when lying on the affected side). Such presentation is typical in unilateral phrenic nerve dysfunction which is a common complication of pneumonia affecting the lower lobes. Also, I would recommend a HRCT (High Resolution CT scan) to rule out fibrosis which can present as atelectatic change post pneumonia. Fibrosis also presents a restrictive pattern on spirometry but with reduced TLC and alveolar capillary surface. Wish you god health. regards,