DOI: 10.12890/2025_005535
Radiation-induced unilateral diaphragmatic paralysis following breast and nodal radiotherapy
Authors
dr.skkrish@gmail.com
Keywords
Diaphragmatic paralysis, phrenic nerve injury, radiotherapy complications, hemidiaphragm elevation, non-invasive ventilationAbstract
Unilateral diaphragmatic paralysis is a rare but important complication of thoracic radiotherapy, typically resulting from unintended injury to the phrenic nerve when it lies within or adjacent to the radiation field. While radiation-induced pulmonary toxicities such as pneumonitis and fibrosis are well documented, neurological complications like phrenic neuropathy remain underrecognized and likely underreported, despite their potential to cause significant respiratory dysfunction. We present the case of a 52-year-old woman with triple-negative breast cancer who developed progressive dyspnoea and orthopnoea 2 months after completing adjuvant breast and nodal radiotherapy. Imaging revealed new elevation of the right hemidiaphragm, and pulmonary function tests showed a restrictive ventilatory pattern. A fluoroscopic sniff test confirmed paradoxical motion of the right hemidiaphragm, consistent with unilateral diaphragmatic paralysis. The patient’s symptoms improved with nocturnal non-invasive ventilation.
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