Three cases of diaphragmatic paralysis: the utility of electromyographic studies

Abstract

Diaphragmatic paralysis (DP) is an infrequent entity that may cause respiratory distress. An early and accurate diagnosis is important to preserve an appropriate lung function in children. DP is suspected by chest x-ray and confirmed with ultrasound. Recently, electromyography (EMG) has been proven to be useful in the functional evaluation of the diaphragm and phrenic nerve (PN). The purpose of this study was to evaluate and report 3 children with DP who underwent EMG studies. Case 1: a 2 month old boy developed DP secondary to a neuromuscular acquired disease with respiratory distress. His EMG showed severe complete denervation and permanent ventilation was indicated. Case 2: an 8 month old boy with unilateral DP secondary to brachial plexus surgery, the EMG findings permitted a conservative management. Case 3: a 3 year old girl with complex congenital heart disease and bilateral DP after heart surgery, on mechanical ventilation. Bilateral diaphragmatic plication was performed. Because of recurrent DP, a new left plication was performed according to the EMG findings. According to our results we suggest that EMG is an important tool for the diagnosis and follow-up of patients with DP.