%0 Journal Article %A Francesca Cemmi %A Thomas Galasso %A Valentina Conio %A Alessandro Cascina %A Andrea Cortese %A Federica Meloni %A Isa Cerveri %T An uncommon case of recumbent dyspnea - Have a look to the diaphragm %D 2016 %R 10.1183/13993003.congress-2016.PA3718 %J European Respiratory Journal %P PA3718 %V 48 %N suppl 60 %X A 56 years old man referred dyspnea only in supine position during the last 2 months, already investigated with chest X-ray, echocardiography and ECG resulting normal. Besides he had an history of 6-month shoulder pain and algoparesthesias at both arms. At our examination he was eupnoic in seated position with SpO2 97% on room air, dropping to 89% in supine position. An upper airway obstruction was excluded by bronchoscopy and PFT, which resulted in a moderate restrictive syndrome with a normal TLCO. A repeated chest X-ray showed a mild super-elevation of both emidiaphragms, not present earlier. Chest US revealed a reduced muscle thickness of the right hemi-diaphragm apposition zone (1.9 mm at the end of expiration) with paradoxical thinning in inspiration, compatible with diaphragm deficit. EMG detected a severe deficit of both phrenic nerves (right more affected). NIV with B-PAP was started, with resolution of nocturnal respiratory failure confirmed by polygraphy. No lesions were found at neck-chest CT scan and spine MRI. Infectious, neoplastic, inflammatory or autoimmune conditions were excluded by rachicentesis and autoimmunity tests. After a neurological consult, in consideration of asymmetrical weakness and atrophy of the arms and shoulder pain, a diagnosis of neuralgic amyotrophy with an unusual phrenic involvement was done. Systemic steroid was prescribed with no improvement at present. Apart from heart failure, shunt and upper airway obstruction the presentation of dyspnea upon reclining should always lead to consider the uncommon cause of diaphragmatic deficit, especially in case of new neurological symptoms, most likely expression of a more complex syndrome. %U