Diaphragm dysfunction: a comprehensive review from diagnosis to management.

Area of Science:

• Pulmonology
• Neurology
• Respiratory Medicine

Background:

• The diaphragm is vital for respiration, but its dysfunction presents non-specifically, mimicking other causes of dyspnoea.
• Acute bilateral diaphragm dysfunction is dramatic, while progressive or unilateral cases may be subtle or incidental findings.

Purpose of the Study:

• To highlight the importance of considering diaphragm dysfunction in unexplained dyspnoea.
• To outline diagnostic approaches and management strategies for diaphragm dysfunction.

Main Methods:

• Systematic evaluation using non-invasive techniques: respiratory function testing and diaphragm imaging.
• Neurophysiological assessment to confirm dysfunction and identify underlying causes.
• Clinical suspicion in patients with unexplained dyspnoea, orthopnoea, or relevant comorbidities.

Main Results:

• Diaphragm dysfunction should be suspected with unexplained dyspnoea, restrictive lung function, or abnormal diaphragm position.
• High index of suspicion warranted in patients with profound orthopnoea, post-procedure proximity to phrenic nerves, or neuromuscular disorders.

Conclusions:

• Non-invasive testing and neurophysiological assessment can confirm diaphragm dysfunction and guide etiology.
• Early identification enables respiratory support and consideration of surgical interventions like plication or phrenic nerve pacing.