Saleem Muhammad Adnan, Mustafa Zeeshan, Qayyum Noman, Ganaie Muhammad Badar
Department of Respiratory Medicine, University Hospitals of North Midlands NHS Trust, Stoke on Trent, UK.
Department of Radiology, University Hospitals of North Midlands NHS Trust, Stoke on Trent, UK.
BMJ Case Rep. 2018 Jan 23;2018:bcr-2017-222229. doi: 10.1136/bcr-2017-222229.
Hemidiaphragmatic paralysis is usually caused by surgery, malignancy or trauma and rarely by viral infections. Herpes zoster (shingles) results in varied neurological complications, but peripheral motor involvement or diaphragmatic paralysis is rare. We report the case of an 87-year-old male who presented with worsening breathlessness soon after an episode of shingles, affecting his right neck and upper chest. He had no alarm symptoms, history of trauma or malignancy. Skin lesions resolved after a few weeks, but his breathing did not improve. Chest X-ray revealed a new finding of elevated right hemidiaphragm; diaphragmatic ultrasound confirmed paradoxical cranial movement of right hemidiaphragm on sniff testing. CT scan showed no lung mass and complete collapse of right lower lobe due to elevated right hemidiaphragm. Patient has required no treatment and is under regular follow-up with the ventilation clinic.
半侧膈肌麻痹通常由手术、恶性肿瘤或创伤引起，很少由病毒感染导致。带状疱疹（缠腰龙）会引发多种神经系统并发症，但外周运动受累或膈肌麻痹较为罕见。我们报告了一例87岁男性病例，该患者在患带状疱疹累及右颈部和上胸部后不久，出现了进行性加重的呼吸困难。他没有警示症状、创伤史或恶性肿瘤病史。皮肤病变在几周后消退，但他的呼吸并未改善。胸部X线检查发现新情况，即右半侧膈肌抬高；膈肌超声证实，在嗅气试验时右半侧膈肌出现反常的向颅侧运动。CT扫描显示没有肺部肿块，且由于右半侧膈肌抬高，右下叶完全萎陷。患者无需治疗，正在通气诊所定期随访。
