CTICasesPhrenic Nerve Invasion by Lung Cancer
Imaging findings
Frontal scout CT scan shows a progressive elevation of the left hemidiaphragm compared to a prior study. Axial CT of the chest demonstrates a central lung cancer with extensive mediastinal lymphadenopathy directly invading the course of the left phrenic nerve. The left diaphragmatic crus is significantly thinned and atrophied compared to the normal contralateral side.
Key takeaways
Phrenic nerve involvement by a mediastinal or central lung tumor causes diaphragmatic paralysis, which can be identified on CT by progressive thinning and atrophy of the diaphragmatic crus. Assessing diaphragmatic thickness can help diagnose phrenic nerve invasion even before significant hemidiaphragmatic elevation is apparent on chest radiographs.
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