RCP Medicine Podcast Episode 92: Respiratory - diaphragm palsy
8 snips
Oct 15, 2025 Consultant respiratory physician Milind Savani shares his expertise on the intricate case of a 45-year-old woman facing progressive breathlessness. Foundation doctor Masooma Ali presents initial findings and engages in a lively discussion on differential diagnoses. They dive into the challenges of recognizing paradoxical breathing and diaphragm weakness. Topics include diagnostic testing for chronic respiratory failure, the potential for non-invasive ventilation, and when to consider surgical options like diaphragm plication. Listeners gain valuable insights into clinical reasoning and multidisciplinary collaboration.
AI Snips
Chapters
Transcript
Episode notes
Chronic Type 2 Failure Signals Longstanding Hypoventilation
- A compensated chronic type 2 respiratory failure with raised bicarbonate indicates longstanding hypoventilation rather than an acute process.
- Morning headaches and brain fog were key clinical clues to chronic hypercapnia in this patient.
Paradoxical Breathing Is Highly Suggestive
- Paradoxical abdominal movement on lying (abdomen sucked in on inspiration) strongly suggests diaphragmatic weakness.
- Observing breathing in supine position is essential because paradox can be missed when patients are only examined sitting up.
Compare Old X-Rays To Spot Progressive Palsy
- Sequential unilateral elevation of hemidiaphragms on serial chest x-rays can indicate progressive bilateral diaphragmatic palsy.
- Comparing current and prior chest radiographs is crucial and may reveal earlier unilateral changes missed on single films.