CHEST Guidelines-A-Woman-in-Her-70s-With-a-History-of-Myasthenia-Gr (1)

A-Woman-in-Her-70s-With-a-History-of-Myasthenia-Gr (1)

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This case study discusses a woman in her 70s with a history of myasthenia gravis (MG) who presented with worsening dyspnea over three days. Despite chronic diplopia and lower extremity weakness, she denied any slurred speech or dysphagia. Vital signs were stable, but her respiratory rate was elevated. Physical examination showed right eye ptosis and decreased breath sounds in the right lung field. Concern arose due to her history of myasthenia crisis, her vital capacity (VC), and negative inspiratory force (NIF) measures were low. <br /><br />An ICU consultation was sought for impending respiratory failure. Diaphragm ultrasound was used to evaluate dysfunction, showing normal diaphragmatic excursion and a normal thickening fraction, thus ruling out an MG crisis as the cause. Instead, symptoms were attributed to pulmonary edema, indicated by ultrasound findings of B-lines and small pleural effusions.<br /><br />The study highlighted the importance of using diaphragm ultrasound in suspected myasthenia crisis scenarios, as it provides noninvasive, reliable insights into diaphragm function and can inform management decisions. The focused ultrasound revealed that despite concerning VC and NIF values, the diaphragm was functioning normally, avoiding unnecessary mechanical ventilation and crisis treatment.<br /><br />This case underscores the critical utility of bedside ultrasound in distinguishing between myasthenia-related issues and other respiratory concerns, such as pulmonary edema. It highlights the need for further research into using ultrasound for MG patient evaluations. The technique’s ability to provide real-time dynamic assessment makes it a preferred tool over traditional imaging modalities, providing clinicians with actionable data to guide treatment effectively. This approach led to the patient’s management through diuresis, avoiding inappropriate mechanical intervention.

Keywords

myasthenia gravis

dyspnea

diaphragm ultrasound

pulmonary edema

myasthenia crisis

respiratory failure

bedside ultrasound

diuresis

mechanical ventilation

patient management