CTICasesPembrolizumab-Induced Diaphragmatic Crus Atrophy
Imaging findings
CT chest shows progressive, unilateral left hemidiaphragm elevation associated with severe thinning and fatty atrophy of the left diaphragmatic crus, developing after initiation of pembrolizumab therapy for lung adenocarcinoma.
Key takeaways
Immune checkpoint inhibitors like pembrolizumab (anti-PD-1) can trigger immune-mediated neuropathies or myositis, including phrenic nerve palsy. This leads to diaphragmatic paralysis, manifesting as persistent hemidiaphragmatic elevation and progressive muscular atrophy/fatty degeneration on CT.
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