Periodic hemidiaphragmatic paresis: a puzzling diaphragm

Diaphragmatic dysfunction is an uncommon and often overlooked cause of dyspnoea, particularly when symptoms progress insidiously. We present the case of a 50-year-old man with a history of a bicycle accident, without associated thoracic trauma. A routine chest X-ray revealed an elevated left hemidiaphragm (figure 1A,B), initially presumed to be trauma-related. Despite this finding, the patient remained asymptomatic, and the condition resolved spontaneously within a year (figure 1C). Figure 1 Radiographic evolution: (A) Baseline chest X-ray. (B) Asymptomatic left diaphragmatic paresis. (C) Complete resolution of the left hemidiaphragm elevation. (D) Symptomatic right diaphragmatic involvement. For nearly a decade, he remained asymptomatic until presenting with right shoulder pain, initially diagnosed as bursitis. This was followed by exertional dyspnoea, orthopnoea, and trepopnoea. A chest X-ray showed right hemidiaphragm elevation (figure 1D). Spirometry demonstrated a marked reduction in forced vital capacity (53% of the predicted value) with a significant decline …