CTICasesBilateral Diaphragm Paralysis from Cervical Cord Compression
Imaging findings
Chest radiograph shows elevated bilateral hemidiaphragms with basal atelectasis. Sniff test under fluoroscopy confirms failure of excursion of both hemidiaphragms. Cervical spine MRI shows severe spinal cord compression at the C3/C4 level. Diaphragm muscle thickness on CT is normal.
Key takeaways
Diaphragm paralysis can result from upper motor neuron lesions like cervical cord compression (above C3-C5, the origin of the phrenic nerve). Because the lower motor neurons in the phrenic nerve remain intact, muscle trophic stimulation is maintained, resulting in normal diaphragmatic thickness on CT despite complete functional paralysis.
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