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Fluorographic findings of diaphragmatic paralysis with spontaneous recovery
Takahiro Hosokawa1, Saki Shibuki1, Yutaka Tanami1
1Department of Radiology, Saitama Children's Medical Center, Saitama, Japan.
Insights
Pediatric diaphragmatic paralysis after surgery often resolves spontaneously. Fluorography showing no paradoxical mediastinal movement indicates recovery within a year, with varied recovery times.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Diagnostic Imaging
Background:
- Postoperative diaphragmatic paralysis is a known complication of cardiovascular surgery.
- Spontaneous recovery is possible, but diaphragmatic plication can be performed.
- Identifying predictors of spontaneous recovery is crucial for patient management.
Purpose of the Study:
- To determine fluorographic differences in pediatric diaphragmatic paralysis between patients with and without spontaneous recovery within one year.
- To assess the correlation between mediastinal/diaphragmatic paradoxical movement and spontaneous recovery.
Main Methods:
- Ten pediatric patients without diaphragmatic plication were studied for at least one year post-intrathoracic surgery.
- Fluorographic findings of paradoxical movement of the diaphragm and mediastinum were evaluated.
- Fisher's exact test compared movement presence/absence between recovery groups.
Main Results:
- Eight of ten patients showed spontaneous recovery, averaging 150 ± 114 days.
- No spontaneous recovery group patients exhibited paradoxical mediastinal movement (P=0.02).
- Paradoxical diaphragmatic movement showed no significant difference between groups (P=0.07).
Conclusions:
- Absence of paradoxical mediastinal movement on fluorography predicts spontaneous diaphragmatic paralysis recovery within one year in pediatric patients.
- The timing of spontaneous recovery in pediatric patients varies.
Background:
Postoperative diaphragmatic paralysis is an unavoidable complication of cardiovascular surgery. Although diaphragmatic plication, as a surgical treatment, can be performed, spontaneous recovery is possible. We aimed to identify differences in fluorographic findings of diaphragmatic paralysis between pediatric patients with and without spontaneous recovery within 1 year of intrathoracic surgery.
Methods:
Ten children, who had been followed-up for at least 1 year post-surgery and who had not received diaphragmatic plication were included and classified into those with or without spontaneous recovery. The presence or absence of the paradoxical movement of the diaphragm and mediastinum was evaluated based on fluorographic findings. Fisher's exact test was used to compare the presence or absence of paradoxical movement between the groups.
Results:
Eight patients experienced spontaneous recovery. The mean ± standard deviation time to spontaneous recovery was 150 ± 114 days (range, 18-338 days). In the spontaneous recovery group, no patient had paradoxical movement of the mediastinum, and a significant between-group difference was observed in the presence of the paradoxical movement of the mediastinum (present/absent in patients with vs. without spontaneous recovery: 0/8 vs. 2/0, P = 0.02). There was no significant between-group difference in paradoxical movement of the diaphragm (present/absent in patients with vs. without spontaneous recovery: 1/7 vs. 2/0, P = 0.07). Pediatric patients without paradoxical movement of the mediastinum spontaneously recovered within 1 year of intrathoracic surgery.
Conclusions:
Pediatric patients without paradoxical movement of the mediastinum, based on fluorography findings, spontaneously recovered within 1 year of surgery. The timing of spontaneous recovery varied between cases.
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