Results: CT and chest radiography confirmed persistent right hemidiaphragm elevation without compressive lesions.The fluoroscopy sniff test demonstrated paradoxical upward motion of the right hemidiaphragm (Pictures 5-6), confirming right phrenic nerve palsy.Spirometry revealed a restrictive pattern with less than 20% reduction in forced expiratory volume in 1 second (FEV 1 ) from sitting (0.65 L) to supine (0.55 L).Maximal inspiratory pressure was reduced (74%) with normal expiratory pressure (98%), suggesting diaphragmatic weakness.Despite these findings, the patient remained asymptomatic with stable oxygenation.Conservative management with close monitoring was adopted, and she was discharged well with outpatient follow-up. Conclusion:This case highlights phrenic nerve palsy as an uncommon complication of central venoplasty in a hemodialysis patient.Diagnosis requires a multimodal approach, with the fluoroscopy sniff test providing definitive evidence.Recognition of this entity is essential, as diaphragmatic dysfunction may contribute to dyspnea, recurrent infections, and increased morbidity in ESKD patients with cardiopulmonary comorbidities.I have no potential conflict of interest to disclose.I did not use generative AI and AI-assisted technologies in the writing process.
Kurotori et al. (Wed,) studied this question.