CTICasesTransient Post-Heart-Transplant Phrenic Nerve Injury (Neuropraxia)
Imaging findings
Serial post-operative chest radiographs show a severely elevated right hemidiaphragm that persists across the posterior chest wall on lateral view, with no motion demonstrated on a sniff test. Sequential CT scans reveal marked thinning and atrophy of the right diaphragmatic crus compared to the preoperative baseline. Subsequent radiographs over 11 months demonstrate gradual reduction of the hemidiaphragm to a normal position.
Key takeaways
Phrenic nerve injury resulting in diaphragmatic paralysis is a known complication of cardiothoracic surgery, such as heart transplantation, often caused by surgical traction, cold injury (frostbite from topical ice slush), or direct trauma. When the nerve sheath remains intact, axonal regeneration can occur over several months, leading to clinical recovery and restoration of normal diaphragmatic position and crus thickness.
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