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Suggest treatment for pain while breathing, breathlessness and musculoskeletal pain

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Posted on Fri, 4 Sep 2015
Question: Hi my husband went to hospital last year with pain when breathing in and shortness of breath. At first he was diagnosed with LRTI and given oral antibiotics, he was then taken of them and sent home as another doctor said it was musculoskeletal pain. He was readmitted with the development of severe chest pain on breathing and over the next 24 hours declined rapidly and ended up in intensive care. He was put into a coma and on a ventilator and they said he had severe pneumonia, they drained 900ml of fluid from a pleural effusion and he slowly recovered but it took 3 months for the pain to reside. He has now been told he has a raised right hemi-diagphram and suffers from shortness of breath and has trouble clearing mucus. Is this due to the pneumonia? He had no problems up to this point.
From what I have read there must be a cause for a raised hemidiaphragm either within the diaphragm, below or above. He had a CT to check for below and nothing untoward was found but all they have said is that the diaphragm is moving 2-3 intercostal spaces on deep inspiration/expiration, but they have given no cause for why it is raised,on discharge from hospital over a period of six weeks his breathing did get deeper but then stayed the same. he did have pleural fluid left in his lung after the chest drain as it was taken out because it became blocked with a gungy substance, his right lung was a complete white out and he had a medistinal shift. He did not have any breathing difficulties prior to this and his breathing has never returned to normal since.
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Answered by Dr. T Chandrakant (1 hour later)
Brief Answer:
Fibrosis is the most probable cause of raised diaphragm

Detailed Answer:
Hi.
Thanks for your query and an elucidate history for your husband; very clear cut to understand what happened from the beginning till now.

My thoughts and explanation for your findings and queries:
The right raised hemidiaphragm is most probably due to the following reasons:
- The CT scan shows white white-out of right lung with mediastinal shift, meaning there is now fibrosis of the right lung, obliteration of the pleural cavity above the diaphragm and hence pulling the diaghragm on the right side.

Due to fibrosis of the right lung the air/gases exchange will be reduced hence he will have breathlessness. This is a reflex mechanism of the body to increase the breathing rate to make up with the oxygen demand of the body.

Unless there is improvement in the right lung and the reduction or clearance of the left pleural effusion, the breathing difficulty will stay the same.

I hope this answer helps you to get a proper diagnosis, and get a proper further treatment. Please feel free to ask for more or if you need further clarifications or if you feel there is a gap of communication.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. T Chandrakant

General Surgeon

Practicing since :1984

Answered : 19695 Questions

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Suggest treatment for pain while breathing, breathlessness and musculoskeletal pain

Brief Answer: Fibrosis is the most probable cause of raised diaphragm Detailed Answer: Hi. Thanks for your query and an elucidate history for your husband; very clear cut to understand what happened from the beginning till now. My thoughts and explanation for your findings and queries: The right raised hemidiaphragm is most probably due to the following reasons: - The CT scan shows white white-out of right lung with mediastinal shift, meaning there is now fibrosis of the right lung, obliteration of the pleural cavity above the diaphragm and hence pulling the diaghragm on the right side. Due to fibrosis of the right lung the air/gases exchange will be reduced hence he will have breathlessness. This is a reflex mechanism of the body to increase the breathing rate to make up with the oxygen demand of the body. Unless there is improvement in the right lung and the reduction or clearance of the left pleural effusion, the breathing difficulty will stay the same. I hope this answer helps you to get a proper diagnosis, and get a proper further treatment. Please feel free to ask for more or if you need further clarifications or if you feel there is a gap of communication.