What Does The Lung CT Scan Report Indicate?

Question : I have an elevated hemi-diaphragm on the right side. It is very stark in the CT scans I've had done for lung cancer. I don't know if it is congenital or from a past illness or injury. In any event, I have had shortness of breath problems for many years, long preceding my cancer diagnosis, and wonder if this might be the cause of the problem. It is with me all the time but gets better or worse. When worse, it feels as though I HAVE to yawn, but am unable to get that kind of breath. Very discomforting. If the diaphragm on that side is paralyzed, might it cause this type of symptom and, if so, is there anything that can be done to treat the problem? It is particularly bad when I am lying down or exerting myself, though when it is in a flared up state, it is bad pretty much at all times.

Yes, I do have metastatic lung cancer diagnosed in November 2012. I have done two courses of chemotherapy (Paclitaxel/Carboplatin/Avastin and Docitaxel with a period of Avastin maintenance in between), and have been off treatment entirely for the past nearly 11 months, though I get scanned every three months. I had a small tumor in my right lower lobe and another on the hepatic dome of my liver.

Your response really grabbed my attention, however, because I have been dealing with a spine/pain clinic about frequently recurring right-side neck/upper back/shoulder pain issues (ongoing for at least 13 years with no successful resolutions yet prescribed by various specialists). I have a report on that from March 6, 2015 that I have attached that may provide helpful information related to the diaphragm matter. These chronic, recurring problems have been so challenging to me for so many years because the doctors I've seen have not diagnosed them correctly so far and thus no treatments they've put me on have been successful. Your response is leading me to believe these problems may well be connected, and that's an exciting possibility to me if it might mean taking corrective measures to the cervical spine could potentially improve the breathing issue too (???).

This is the question I intend to ask of my spine/pain physician when I see him this Friday morning.

--Due to the “prominent right-sided uncovertebral joint hypertrophy with severe right neural foraminal stenosis” at C4-C5 and the “uncovertebral and facet joint hypertrophy with moderate to severe right and moderate left neural foraminal stenosis” at C5-C6, which were reported on my Spine & Pain center report dated March 6, 2015, is anterior cervical discectomy and fusion (ACDF surgery) something that should be considered?

It appears I am only permitted to upload one more file, so I've attached a PET scan report from Feb. 15, 2013. This was after I'd had three phase 1 chemo infusions. I do not, however, think the breathing issue is likely related to this, only because the problem existed for many, many years before my cancer diagnosis in November 2012. I just never seemed to get doctor's to aggressively help me find the cause for it, so I simply lived with it (uncomfortably, to say the least). I understand the potential connection with a lung tumor and the phrenic nerve, as you have written, but due to timing, this seems less likely to me as a cause.

By the way, as you might imagine, the malignant masses have grown and receded as one would expect based on chemotherapy treatments. In these past 11 months while I have been off treatment, the right lower lobe lung mass seems to not show up in CT scans, but the one on the hepatic dome remains. The last scan received conflicting reviews between the radiologist and my thoracic oncologist (who consulted with another oncologist for a double-check on his review of the scan pictures). The radiologist reported a growth to 4.5 x 3.7 cm of the mass on the hepatic dome, "concerning for tumor growth." The oncologists were agreed that they did not agree with those findings. They were using a scan from late November 2014 for comparison purposes.

I think this is my last follow-up response allotted. To answer your questions, I am a lifelong non-smoker, have not had exposure to radon, asbestos or other known lung cancer causing chemicals as far as I am aware. The only cancer in my immediate family was an early stage breast cancer (mother). No one in my household has smoked, so there's been no 2nd-hand smoke either. I do not have any of the genetic mutations tested for (EGFR or ALK, etc.).

My spine/pain doctor told me this morning at my appointment with him that the phrenic nerve is above where the right side neural foraminal stenosis is (C4-C5 and C5-C6) located and that he does not think the diaphragmatic breathing condition is related to the stenosis.

I will be speaking at a lung cancer conference the first weekend in May and hope I'll have the opportunity to chat with one or more pulmonologists at that gathering. I will share the communications you and I have had over these past couple of days, and will determine if it seems prudent for me to schedule an appointment locally with a pulmonologist to pursue the diaphragmatic breathing issue further. Since you told me in your initial response that there is no cure at this time for diaphragmatic paralysis, I am not certain if there is a good reason to spend additional time and money pursuing it. I do, however, want to make sure I understand that, even if the phrenic nerve is involved due to a constriction of some sort, that does NOT mean that releasing that constriction could or would reverse any paralysis. Is that a correct assumption?

Thank you kindly for your conversation with me about these issues and questions related to my elevated hemi-diaphragm and related breathing challenges.