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Wednesday, December 11, 2013
A patient 2 yrs old suffering from acute lymphatic leukemia is on chemotherapy. He has frequent history of pneumonia. X-ray shows left dome of diaphragm is raised. CT scan is normal. What can be the cause of raised diaphragm? Could it be the cause of frequent pneumonia?
Raised diaghragm could be pathologic. Causes include phrenic nerve (the nerve that controlls the diaghram) paralysis that can result from compression caused by enlarged lymph nodes in the chest. This should be seen on the CT scan if present. Also the phrenic verve may be affected by a nerve disorder or compression at the plexus exit (neck and shoulder area) from the spinal cord. Diaghragm elevation can also occur on the right side because of enlarged liver that will push the diaphragm up. Raised diaghragm can cause local atelectasis in the lung lobe above it.
If the pneumonia is mostly localized to the left lower lobe where the diaghragm is raised, then this abnormality may be contributing to the pneumonia. Having said that, it is common for ALL patients receiving chemotherapy, to suffer from pneumonia and from recurrent episode of this infection or any other infection. I would involve pulmonary specialists to evaluate for anantomical causes that may predispose this child to more lung infections including atelectasis because of lower lobe compression.
Huda Salman, MD
Assistant Professor of Medicine
School of Medicine
Case Western Reserve University