CTICasesLeft Hemidiaphragm Dysfunction from Phrenic Nerve Injury Post-CABG
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Imaging findings
A postoperative chest radiograph following thoracic surgery (CABG) demonstrated an elevated left hemidiaphragm with some associated pleural fluid. A sniff maneuver on fluoroscopy confirmed left hemidiaphragm dysfunction, showing paradoxical upward motion during sniff and diminished descent during deep breathing, indicating weakness rather than complete paralysis.
Key takeaways
Elevation of a hemidiaphragm after thoracic surgery, particularly CABG, should prompt consideration of phrenic nerve injury. The sniff test is a valuable tool to confirm diaphragmatic dysfunction by demonstrating paradoxical movement. The degree of dysfunction can range from paresis (weakness, with some movement) to complete paralysis (no movement), and some injuries (neuropraxia) may recover over time.
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