Parálisis diafragmática bilateral idiopática tratada con ventilación mecánica no invasiva (Idiopathic bilateral diaphragmatic paralysis with noninvasive mechanical ventilation)

La paralisis diafragmatica bilateral es infrecuente y puede ser idiopatica o mas comunmente asociada a varias entidades. Describimos el caso de un varon de 61 anos con antecedentes de asma bronquial quien desarrollo paralisis difragmatica bilateral sin causa evidente, la cual es excepcional. El paciente presento disnea progresiva y ortopnea, que no mejoraban con antibioterapia ni esteroides sistemicos, por lo que se descartaron diversas etiologias como neuralgia lateral amiotrofica y finalmente se le diagnostico paralisis diafragmatica lateral en base a la exploracion fisica y las pruebas de imagen. Se inicio ventilacion mecanica no invasiva con gran mejoria clinica. Abstract Bilateral paralysis of the diaphragm is uncommon and can be either idiopathic or more frequently associated with several medical conditions. We describe the case of a 61-year-old man with a history of asthma who developed severe bilateral diaphragmatic paralysis without any obvius cause, which is exceptional. The patient manifested progressive dyspnea and debilitating orthopnea with no improvement with antibiotics or systemic steroids. Different etiologies were discarded as amyotrophic lateral neuralgia, and he was diagnosed of bilateral diaphragmatic paralysis based on physical examination and imaging tests. Noninvasive mechanical ventilation was started with great clinical improvement. DOI: http://dx.doi.org/10.21615/cesmedicina.30.1.9