CTICasesPhrenic Nerve Palsy post-Interscalene Block
Imaging findings
Chest radiograph and fluoroscopy show a severely elevated right hemidiaphragm demonstrating paradoxical superior motion during rapid inspiration (sniff test), occurring after an interscalene nerve block for shoulder surgery.
Key takeaways
Interscalene brachial plexus blocks are commonly associated with ipsilateral phrenic nerve palsy due to local anesthetic spread. While typically transient, it can rarely result in permanent phrenic nerve injury and diaphragmatic paralysis, which can be treated surgically via nerve grafting or plication.
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