Diaphragmatic palsy is a paralytic rise of the diaphragm on one or both sides due to damage to the phrenic nerve and blockage of nerve impulses, resulting in impaired movement. Let’s take a look at what causes diaphragmatic palsy. Long-term diaphragmatic palsy can produce a membrane of diaphragm atrophy. One side of diaphragmatic palsy can reduce lung volume by 37% and ventilation by 20%, but due to compensatory effects, patients are often asymptomatic and have shortness of breath only in the prone position, which is due to the restricted movement of the healthy diaphragm in the prone position. Left-sided diaphragmatic palsy may have belching due to an elevated gastric fundus, and gastrointestinal symptoms such as bloating and abdominal pain. Bilateral diaphragmatic palsy presents with cyanosis, marked dyspnea, telangiectatic breathing, and hypoxemia. The etiology is widespread, the most common being lymph nodes from lung cancer metastasizing to the mediastinum compressing or infiltrating the phrenic nerve causing diaphragmatic paralysis. Other causes include anterior spinal cord horn infection, motor nerve unit disease, herpes zoster, tuberculosis, diphtheria, pericarditis, mediastinitis, pneumonia, lead poisoning, giant aortic aneurysm, deep neck surgery or trauma, and excessive cervical stretching of the infant during delivery, which can also involve the phrenic nerve and cause diaphragmatic paralysis. Occasionally, the nerve is injured by inadvertent thoracic surgery. The etiology of some patients is unknown.