CTICasesBilateral Diaphragm Paralysis
Imaging findings
A post-surgical patient presented with respiratory distress and difficulty lying flat. Upright diaphragm fluoroscopy showed paradoxical motion, but also apparent motion that suggested preserved function. Supine imaging, however, revealed no diaphragm function, demonstrating that the patient was utilizing abdominal muscle recruitment to simulate breathing.
Key takeaways
Upright fluoroscopy can be misleading in bilateral diaphragm paralysis due to compensatory abdominal muscle use. Supine positioning is critical to defeat this mechanism and accurately unmask true diaphragmatic paralysis.
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