CTICasesPhrenic Nerve Injury with Hemidiaphragm Paralysis after Atrial Fibrillation Ablation
Imaging findings
A woman who underwent ablation for atrial fibrillation had a normal pre-procedure radiograph with well-positioned hemidiaphragms. Post-procedure inspiration/expiration radiographs show the right hemidiaphragm remaining fixed while the left moves normally, with a small pleural effusion. The lateral view shows right hemidiaphragm elevation extending fully posteriorly, distinguishing paralysis from eventration (which bulges anteriorly but not posteriorly).
Key takeaways
Phrenic nerve injury with hemidiaphragm paralysis is a recognized complication of atrial fibrillation ablation, demonstrated by paradoxical or absent diaphragmatic motion on inspiration/expiration imaging. It may be reversible if the nerve sheath is intact, allowing regrowth, or if the injury is a transient thermal effect; posterior extension of the elevation on the lateral view helps distinguish paralysis from eventration.
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