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A mysterious case of an elevated dome of the right diaphragm

Dipti Gothi, Mahismita Patro, Mohit Agarwal, Sameer Vaidya
Breathe 2020 16: 190334; DOI: 10.1183/20734735.0334-2019
Dipti Gothi
Dept of Pulmonary Medicine, ESI PGIMSR, New Delhi, India
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  • For correspondence: diptigothi@gmail.com
Mahismita Patro
Dept of Pulmonary Medicine, ESI PGIMSR, New Delhi, India
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Mohit Agarwal
Dept of Pulmonary Medicine, ESI PGIMSR, New Delhi, India
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Sameer Vaidya
Dept of Pulmonary Medicine, ESI PGIMSR, New Delhi, India
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  • Figure 1
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    Figure 1

    Chest radiograph of the patient in posteroanterior projection.

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    Figure 2

    CT of the chest: a) axial section of the lung window; b–d) axial sections of the mediastinal window at different levels of cross-section. The abnormalities are marked with arrows, arrowheads and dashed arrows; the key to which is provided answer 1.

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    Figure 3

    CT of the chest: a and b) coronal sections of the lung window; c) sagittal section of the lung window. The abnormalities are marked with arrows, arrowheads and dashed arrow, the key to which is provided in answer 1.

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    Figure 4

    Bronchoscopic images: trachea during a) inspiration and b) expiration; bronchus intermedius during c) inspiration and d) expiration.

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    Figure 5

    Various subtypes of excessive central airway obstruction: a) normal shape of trachea; b) crescent-type tracheobronchomalacia (TBM); c) sabre sheath-type TBM; d) circumferential TBM; e) excessive dynamic airway collapse.

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    Figure 6

    a) Flow–volume loop; b) volume–time graphic.

Tables

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  • Table 1

    Spirometry findings of the patient

    ParameterPredictedLLNObserved% predicted
    FVC L3.792.791.3937
    FEV1 L3.012.171.2541
    FEV1/FVC %86.1474.3589.85104
    PEF L·s−17.915.922.9037
    PIF L·s−12.64
    MEF L·s−13.401.691.8554
    MEF50 L·s−14.172.022.0148
    FIF50 L·s−12.62
    Empey's index6.9
    Miller and Hyatt index0.76

    LLN: lower limit of normal; FVC: forced vital capacity; FEV1: forced expiratory volume in 1 s; PEF: peak expiratory flow; PIF: peak inspiratory flow; MEF: mean mid-expiratory flow from 25 -75% of FVC; MEF50: mid-expiratory flow at 50% of FVC; FIF50: forced inspiratory flow at 50% FVC; Empey's index: FEV1/PEF; Miller and Hyatt index: FEF50/FIF50.

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    A mysterious case of an elevated dome of the right diaphragm
    Dipti Gothi, Mahismita Patro, Mohit Agarwal, Sameer Vaidya
    Breathe Jun 2020, 16 (2) 190334; DOI: 10.1183/20734735.0334-2019

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    A mysterious case of an elevated dome of the right diaphragm
    Dipti Gothi, Mahismita Patro, Mohit Agarwal, Sameer Vaidya
    Breathe Jun 2020, 16 (2) 190334; DOI: 10.1183/20734735.0334-2019
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