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DrRussMD, Board Certified Physician
Category: Medical
Satisfied Customers: 64011
Experience:  Internal Medicine--practice all of internal medicine, all ages, family, health, prevention, complementary medicine, etc.
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I have been diagnosed with a paralyzed left diaphragm

Customer Question

Hello, I have been diagnosed with a paralyzed left diaphragm using a sniff test. Presumably caused by something related to the Phrenic nerve. I am 48 and in excellent health and train extensively for triathlons. I have no idea how this would have happened nor do I know how long I have had it. I did notice a big change in my breathing in January after pulling a muscle in my left shoulder during shoveling snow. After that I had trouble taking deep breaths for a couple weeks until the pulled muscle went away. I have been through a multitude of blood tests all of which are normal. I have had chest x rays and a stress test. I also had a breathing test to test for lung capacity which was slightly below normal. My question is this: My physician has ordered a CT chest scan to rule out and lung masses or PE causing the Phrenic nerve to be constricted. Can this CT be done using low radiation and no contrast?
Submitted: 1 year ago.
Category: Medical
Expert:  Dr Stan replied 1 year ago.
Hi this is Dr Stan here to assist you today. The chest CT would be ordered without contrast initially. If something suspicious is seen on the initial study, a repeat study with contrast may be indicated. CT has higher radiation than normal x-ray but your total radiation dose is evaluated so you do not receive an excess amount. Should your symptoms be severe, there is hope. UCLA medical center is doing surgery to restore normal function to the nerve and diaphragm. I hope this helps and you feel better.
Expert:  DrRussMD replied 1 year ago.
Hello.The new CT scans have low radiation compared to just a few years ago.You need a high resolution scan which is what I am taling about.You will need contrast.There is no such thing as a non-excess amount of radiation. [that is an arbitrary standard]. All radiation exposure is cumulative, as you know.However, what is happening here is that the risk of not diagnosing a tumor far exceeds the risk of one CT scan, even though radiation is not desirable, and there is no minimum about that is OK.CT scans are still widely over used. Not in this case however.I am board certified in integrative medicine, internal medicine, [US} trained in functional medicine and homeopathy, etc. I am here daily: use my request link as needed and “for Dr. Thomas” in the question title. Give that link to friends, family, associates, etc. Find me as needed for correct, safe and accurate answers.
Customer: replied 1 year ago.
Ok, I am a bit confused. It seems as though I got 2 answers that are a bit conflicting. One says that the test would use contrast and the other says not for the initial scan. I may be reading this incorrectly however.
Expert:  DrRussMD replied 1 year ago.
HiInitially they don't use the contrast.If they see a tumor or any other hint of abnormality, then they add the contrast.This is mainly to see if the mass enhances with contrast and has it's own blood supply, which gives an indication of malignancy.Sorry for the confusion.Please click a positive.
Customer: replied 1 year ago.
Ok, so doing the initial test without contrast in this case will be sufficient to see what they need to see? If so I will request that the initial test be done W/O contrast as it is currently ordered with contrast.
Expert:  DrRussMD replied 1 year ago.
You need to talk to them about the procedure.For initial identification of tumor, no they don't need it.For diagnosis of blood clot, they will need it.Those are the specific procedures, and contrast should not be an issue.They can use non ionic contrast. OK, so you might have more questions or want to give me more information: Please use reply to expert if you have further questions. When you are ready, please click a positive rating [hopefully excellent—that’s how we are paid, per rating]. If you forgot something, come back. I am here daily.