Diaphragmatic paralysis differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].

OR

[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].

Differentiating diaphragmatic paralysis from other Diseases

Unilateral diaphragmatic paralysis must be diffrentiated from eventration of the diaphragm. Eventration of the diaphragam is an abnormal elevation of the hemidiaphragm that some parts of hemidiaphragm are replaced by fibrous tissue. Clinical manifetations of diaphragmatic paralysis include asymptomatic, infection and respiratory distress.

Bilateral diaphragmatic paralysis must be differentiated from other diseases that cause elevation of the diaphragm such as pleural adhesions, subpulmonic effusions, obesity with decreased chest wall compliance, ascites, abdominal organomegaly and ileus.

The differential diagnosis of bilateral diaphragmatic elevation on the plain chest radiograph includes subpulmonic effusions, pleural adhesions, obesity with decreased chest wall and abdominal compliance, and subdiaphragmatic processes such as ascites, organomegaly, and ileus.

EVENTRATION OF THE DIAPHRAGM — Eventration of the diaphragm is a disorder in which all or part of the diaphragmatic muscle is replaced by fibroelastic tissue, leading to a thinned and pliable central portion of the diaphragm.

Etiology — Eventration may be congenital or acquired; the congenital form reflects a failure of the fetal diaphragm to muscularize, whereas the acquired form is associated with phrenic nerve injury or is idiopathic [4,25]. The continuity of the diaphragm and normal attachments to the costal margin are maintained. (See "Eventration of the diaphragm in infants".)

Clinical manifestations — In adults, diaphragmatic eventration is rarely symptomatic. When present, the symptoms associated with diaphragmatic eventration include dyspnea, palpitations, chest pain, dyspepsia, and recurrent pneumonia [26]. The degree of respiratory impairment ranges from the more common asymptomatic elevation of the diaphragmatic dome to the much less common degree of respiratory impairment seen in unilateral diaphragmatic paralysis. (See 'Clinical manifestations'above.)

The severe congenital diaphragmatic eventration seen in newborns is discussed separately. (See "Eventration of the diaphragm in infants".)

• [Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].
• [Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].

• As [disease name] manifests in a variety of clinical forms, differentiation must be established in accordance with the particular subtype. [Subtype name 1] must be differentiated from other diseases that cause [clinical feature 1], such as [differential dx1] and [differential dx2]. In contrast, [subtype name 2] must be differentiated from other diseases that cause [clinical feature 2], such as [differential dx3] and [differential dx4].

Preferred Table

Diseases	History and Symptoms				Physical Examination				Laboratory Findings				Other Findings
	Finding 1	Finding 2	Finding 3	Finding 4	Physical Finding 1	Physical Finding 2	Physical Finding 3	Physical Finding 4	Lab Test 1	Lab Test 2	Lab Test 3	Lab Test 4
Differential Diagnosis 1			+
Differential Diagnosis 2	↑			-
Differential Diagnosis 3		↓
Differential Diagnosis 4
Differential Diagnosis 5

Use if the above table can not be made

Differential Diagnosis	Similar Features	Differentiating Features
Differential 1	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Differential 2	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Differential 3	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Differential 4	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Differential 5	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].