CTICasesLeft Hemidiaphragm Paralysis due to Phrenic Nerve Injury (Iatrogenic)
Imaging findings
Pre-operative CT showed mediastinal lymphadenopathy (for breast cancer staging). Post-VATS biopsy of paratracheal/aortic lymph nodes, a plain radiograph and follow-up CT demonstrated new, substantial elevation of the left hemidiaphragm with marked atrophy of the diaphragmatic muscle, including the crus.
Key takeaways
Phrenic nerve injury, often occurring during thoracic surgical procedures (e.g., VATS lymph node biopsy), can lead to ipsilateral hemidiaphragm paralysis. Radiographic findings include elevated hemidiaphragm and, on CT, atrophy of the diaphragmatic muscle. Recognition of this iatrogenic complication is important for patient management, which may include plication.
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