CTICasesBilateral Diaphragm Paralysis with Diaphragm Muscle Atrophy after Breast Cancer Treatment
[...]. Bilateral Diaphragm Paralysis with Diaphragm Muscle Atrophy after Breast Cancer Treatment. CTICases. Published October 23, 2026. https://cticases.com/c/pyru8
Imaging findings
A standing sniff test looks almost normal, but the supine sniff test shows that the diaphragm moves paradoxically or not at all. CT shows marked bilateral diaphragm muscle thinning, worst on the right posteriorly and thin anteriorly on both sides, compared with a normal earlier scan. Lung volume is reduced, and the diaphragm rises with the clavicles on inspiration.
Key takeaways
Bilateral diaphragm paralysis can look normal upright because patients use their abdominal muscles to move the diaphragm, so the standing sniff test misses it. Supine imaging is essential, and CT muscle thickness helps. Radiologists should use lateral and spine views in sniff protocols, and the cause here was unclear, with taxane neuropathy the suspected trigger.
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