Tissier-Ducamp D, Martinez S, Alagha K, Charpin D, Chanez P, Palot A
Clinique des bronches, allergies et du sommeil, Aix Marseille université, AP-HM, 13000 Marseille, France.
Clinique des bronches, allergies et du sommeil, Aix Marseille université, AP-HM, 13000 Marseille, France.
Rev Mal Respir. 2015 Sep;32(7):742-6. doi: 10.1016/j.rmr.2014.11.067. Epub 2014 Dec 18.
We report the case of a 49-years-old patient who presented to the accident and emergency department with sudden onset dyspnea associated with acute shoulder pain. He was breathless at rest with supine hypoxemia. He had an amyotrophic left shoulder with localized paresis of the shoulder. Both hemi-diaphragms were elevated on chest X-rays. Pulmonary function tests showed a restrictive pattern and both phrenic nerve conduction velocities were decreased. At night, alveolar hypoventilation was evidenced by elevated mean capnography (PtcCO2: 57mmHg). Neuralgic amyotrophy, Parsonage-Turner syndrome was the final diagnosis. This syndrome is a brachial plexus neuritis with a predilection for the suprascapular and axillary nerves. Phrenic nerve involvement is rare but where present can be the most prominent clinical feature as in our case report.
我们报告了一例49岁患者的病例,该患者因突发呼吸困难并伴有急性肩部疼痛而就诊于急诊科。他静息时即感呼吸急促,伴有仰卧位低氧血症。他左侧肩部肌肉萎缩,肩部局部轻瘫。胸部X线片显示双侧膈肌抬高。肺功能测试显示为限制性模式,双侧膈神经传导速度均降低。夜间,平均二氧化碳图升高(经皮二氧化碳分压:57mmHg)证明存在肺泡通气不足。最终诊断为神经性肌萎缩,即帕森斯-特纳综合征。该综合征是一种臂丛神经炎,好发于肩胛上神经和腋神经。膈神经受累罕见,但正如我们的病例报告所示,一旦出现,可能是最突出的临床特征。