Yesterday, I had a business meeting with a representative of a particular company and the topics were far from medical. After the meeting the representative from the company asked me to listen to a problem occurring with a close family member. It was a problem that his dad was having concerning shortness of breath and whether or not it was related to paralysis of his diaphragm. The diaphragm has a right and left side and these are the bellows that make us breath. He told me that his father’s physicians were uncertain about this diagnosis. I asked if the father ever had a Sniff Test.
Paralysis of the diaphragm may be caused by injury to the phrenic nerve which controls it. Infections such as shingles virus or polio can cause this, along with certain types of injury to the neck and cervical spine, and sometimes injury to the nerve network that controls the arm can lead to paralysis. Making the diagnosis is usually not that difficult, particularly if a chest x-ray is performed. One side of the diaphragm will look elevated but this finding is only circumstantial. The test that follows is a Sniff Test.
In the Sniff Test the patient is asked to stand in front of a fluoroscope and sniff. The diaphragm can be seen moving and if one side of the diaphragm does not move it is paralyzed. One or both sides of the diaphragm may be paralyzed and this can lead to shortness of breath.