64-year-old man with a raised hemidiaphragm

A 64-year-old male retired firefighter and never-smoker presented to the ventilation team with a 6-month history of breathlessness on minimal exertion, orthopnoea, nocturia and preference to sleep on his left-hand side. His only medical history was atrial fibrillation (AF) that was treated with cardioversions and ablations a few months ago. The clinical examination was unremarkable except for reduced air entry at the right base. Oxygen saturation was 96% on room air. A chest radiograph (CXR) confirmed right base atelectasis and new elevated right hemidiaphragm (figure 1a,b) compared with a CXR 7 months earlier (figure 1a). CT confirmed a raised right hemidiaphragm and excluded pleural effusion, mediastinal lymphadenopathy or pathology to explain raised hemidiaphragm (figure 2). Figure 1 (a) Baseline normal chest radiograph (CXR), taken 7 months prior to symptom onset, (b) CXR 3 months after symptom onset, demonstrating elevated hemidiaphragm, (c) CXR after 18 months confirming …