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Chronic Diaphragmatic Impairment with Kyphosis: Yielding to Pressure. | OMICS International
ISSN: 2165-7920
Journal of Clinical Case Reports
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Chronic Diaphragmatic Impairment with Kyphosis: Yielding to Pressure.

Sacha Bhinder1 and William Cherniak2*
1Rouge Valley Health System, Centenary Site, Canada
2Health Medical and Dental,Department of Family and Community Medicine, University of Toronto, Toronto, Canada
Corresponding Author : William Cherniak
Assistant Professor
Department of Family and Community Medicine
University of Toronto, Canada
Tel: +1 416-978-201
E-mail: [email protected]
Received May 19, 2015; Accepted May 27, 2015; Published May 29, 2015
Citation: Bhinder S, Cherniak W (2015) Chronic Diaphragmatic Impairment with Kyphosis: Yielding to Pressure. J Clin Case Rep 5:i111. doi:10.4172/2165-7920.1000i111
Copyright: © 2015 Bhinder S, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract

A 90 year-old patient with a clinical diagnosis of COPD presented to an urban Canadian emergency department with a complaint of progressive dyspnea for two years despite multiple courses of bronchodilator, antibiotic, and prednisone therapy. Prior chest imaging had not been performed.

Clinical Image
A 90 year-old patient with a clinical diagnosis of COPD presented to an urban Canadian emergency department with a complaint of progressive dyspnea for two years despite multiple courses of bronchodilator, antibiotic, and prednisone therapy. Prior chest imaging had not been performed. The patient had a history of progressive functional decline, dyspnea at rest, non-productive cough with wheeze, and progressive height loss. A routine chest radiograph performed by the Emergency Physician demonstrated a kyphotic spine with marked elevation of an intact left hemidiaphragm (Figure 1A), with migration of abdominal contents cranially into the left hemithorax. Cardiac deviation into the right hemithorax was associated with compressive atelectasis of the right lung, rightward tracheal deviation, and rightward migration of the descending aorta and cardiac apex (Figure 1 B). Diaphragmatic paralysis is an uncommon cause of dyspnea with a broad differential diagnosis. Potentially masquerading as obstructive airways disease, it requires imaging to exclude (Figure 2).
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