CTICasesPhrenic Nerve Paralysis in Myasthenia Gravis with Thymoma
Imaging findings
A patient with myasthenia gravis is shown to have a thymoma in the anterior mediastinum on CT, with close proximity to the left phrenic nerve. Post-surgical chest radiographs display findings consistent with phrenic nerve injury, including an elevated left hemidiaphragm and a high posterior costophrenic sulcus. On subsequent CT, the left crus is depicted as very small, thin, and almost non-existent compared to the normal right crus. The phrenic nerve is known to travel alongside the pericardiophrenic artery and vein.
Key takeaways
Phrenic nerve injury, frequently occurring iatrogenically during thymoma resection, leads to hemidiaphragm paralysis. This condition is clearly observable on both radiographs and CT, where the ipsilateral crus appears markedly thinned and inconspicuous. The pericardiophrenic vein can serve as a valuable anatomical landmark for the course of the phrenic nerve.
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