CTICasesPhrenic Nerve Paralysis secondary to Brachial Plexus Injury
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Imaging findings
Baseline radiograph (2013) shows normal hemidiaphragm height. A subsequent radiograph (2014) shows elevation of both hemidiaphragms. After a stabbing injury (October 2014) above the left clavicle, a CT scan three days later shows gas in soft tissues, atelectasis, possibly pleural effusion, and elevation of the left hemidiaphragm. Coronal images show marked thinning of the left diaphragmatic crus compared to the normal right crus. Fluoroscopy confirms complete paralysis of the left hemidiaphragm.
Key takeaways
Phrenic nerve injury, even from trauma, can rapidly lead to diaphragmatic paralysis, with diaphragmatic elevation and thinning of the crus visible on CT within days. Phrenic nerve recovery is possible over 1-2 years if the nerve sheath remains intact. Differentiating paralysis from eventration on plain films relies on diaphragm contour (a shallow arc elevated throughout suggests paralysis, a steep arc suggests eventration). The patient's history of being stabbed above the clavicle highlighted the dramatic nature of the injury.
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