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Paradoxical abdominal wall movement in bilateral diaphragmatic paralysis
  1. Rebekah Ahmed1,
  2. Stephen McNamara2,
  3. Simon Gandevia3,
  4. G Michael Halmagyi1
  1. 1Department of Neurology, Royal Prince Alfred Hospital, Sydney, Australia
  2. 2Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, Australia
  3. 3Neuroscience Research Australia, University of New South Wales, Sydney, Australia
  1. Correspondence to Rebekah Ahmed, Department of Neurology, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, Sydney, New South Wales 2050, Australia; rebekahahmed{at}


A 56-year-old man gave a 6-month history of progressive dyspnoea and orthopnoea. During breathing, his abdominal muscles showed paradoxical movement and he rapidly and reproducibly developed difficulty breathing when lying supine. The most likely explanation was severe weakness or paralysis of both hemidiaphragms. This was confirmed with electrophysiology and ultrasonography. Extensive investigation identified no underlying cause, suggesting this is a case of bilateral isolated phrenic neuropathy. We present a video showing how easily bilateral diaphragmatic palsy can be detected clinically through identifying paradoxical abdominal wall movement.

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  • Competing interests None.

  • Provenance and peer review Not commissioned; externally reviewed This paper was reviewed by Robin Howard, London, UK.

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