![]() ![]() The staff at the Women's Guild Lung Institute works as a team to determine the best treatment option for each patient. Some lung conditions can be difficult to diagnose, and it is important for patients to seek medical attention from a specialist who is familiar with diaphragm weakness or paralysis. The prognosis for bilateral paralysis also depends on the overall health of the patient, but surgery may be the best option for patients who continue to have a poor quality of life. Some patients recover without medical intervention. The prognosis for unilateral paralysis is good, providing there is no underlying significant pulmonary or cardiac disease. This approach is commonly used for patients with a life-threatening disease or a diagnosis of high quadriplegia. A tracheostomy and mechanical ventilation, the surgical formation of an opening in the trachea, which helps allow the passage of air.The devices may result in improved respiratory function and lower infection rates. Diaphragm pacemakers, which may be used in patients who have functioning phrenic nerves, such as patients with ALS or spinal cord injury.Plication is usually done by minimally invasive means. ![]() The surgery allows the lung to expand better and improve ventilation. This procedure is used in patients with unilateral paralysis (and occasionally bilateral). Diaphragmatic plication, a surgical procedure that pulls the diaphragm down by introducing a repeated series of continuous sutures across the diaphragm and pulling the muscle taut.Noninvasive ventilatory assistance, particulary at night.Observation with or without supportive treatment (if the patient has no symptoms or the symptoms are mild, and the patient is in otherwise good health or there is a chance that recovery can occur spontaneously).Physicians take into consideration the overall health of the patient, the severity of symptoms, the duration of diaphragm paralysis, other conditions, and any underlying cause for the paralysis. Ultrasound to see the activity of the diaphragm and to identify any unusual movement or lack of movement.Magnetic resonance imaging to determine if there is an underlying condition involving the spinal column or nerve roots.Computed tomography scanning of the chest, abdomen or both.Arterial blood gas test an abnormal result is a late sign of severe impairment.Electromyography, a test that evaluates and records electrical activity produced by skeletal muscles.Phrenic nerve stimulation in the neck by electric or magnetic stimulation.Measure of transdiaphragmatic pressure (measure of diaphragm strength).Maximum inspiratory mouth pressures (measure of breathing muscle strength).Ultrasound imaging to look at diaphragm motion and changes in the muscle thickness.Radiologic fluoroscopy (real-time viewing) with a sniff maneuver to show paradoxical motion.Lung function tests, including some tests done sitting and lying down.On examination, with the patient lying flat, the abdominal wall moves inward during inhalation (instead of the normal outward movement). Diagnosis of diaphragmatic paralysis usually begins with a physical exam and a review of the patient's medical history and symptoms. ![]()
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