Differential diagnosis of acquired diaphragmatic paralysis:
(1) penetrating trauma
(2) traction injury (motor vehicle collision, cervical manipulation)
(3) surgery (head and neck, cardiothoracic)
(4) central venous catheter insertion
(5) anesthetic blockade
(6) lung tumor (primary or metastatic)
(7) mediastinal tumor (thymoma, lymphoma, intrathoracic goiter, etc)
(8) paraneoplastic syndrome
(9) phrenic nerve stimulation test
(10) aortic aneurysm
(11) von Recklinghausen’s disease
(12) cervical osteoarthritis or disc disease (with compression of the C3 to C5 nerve roots)
(13) multiple sclerosis
(14) neuropathy (chronic inflammatory demyelinating neuropathy, diabetes)
(15) amyotrophic lateral sclerosis (ALS)
(16) brainstem injury (stroke, compression, etc)
(17) pulmonary infection (pneumonia, tuberculosis, etc)
(18) viral infection (Herpes zoster, polio, etc)
(19) inclusion body myositis
(20) vasculitis
(21) radiation therapy
If no cause is found after an extensive workup then it is designated idiopathic.
