Diaphragmatic Paralysis Following Minor Blunt Trauma

Dalshaug, Gregory B.; Rothwell, Bruce

doi:10.1097/00005373-199908000-00041

Cited by 7 publications

(8 citation statements)

References 11 publications

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“…The actual incidence is unclear but is thought to be more common than clinically recognized. The mechanism of injury in blunt trauma is most likely related to traction or stretching of the nerve [2,3]. In the current case, the patient suffered a blunt force injury across his thorax and anterior neck with a long, metal pipe.…”

Section: Discussionmentioning

confidence: 76%

“…Review of the literature reveal case reports of phrenic nerve injury in trauma that describe mechanisms of injury including hyperextension of the neck, cervical neck lexion and rotation, blunt trauma to the anterior neck, crush injury of the thorax, and gunshot wound to the thorax and neck [2,3,[12][13][14][15]. Speci ically, unilateral diaphragmatic paralysis secondary to blunt trauma is rarely reported.…”

Section: Discussionmentioning

confidence: 99%

“…The differential diagnosis of an elevated hemidiaphragm in the setting of blunt trauma includes diaphragmatic rupture and presents a diagnostic challenge since both can present with similar radiological indings [12,13]. Typically, surgical treatment is indicated only if persistent and symptomatic [2]. Generally, patients recover in 6-12 months, with some recovering much earlier with no further complications [13,15].…”

Section: Discussionmentioning

confidence: 99%

“…Hemidiaphragmatic paralysis, also referred to as eventration in cases of congenital diaphragm malformations, is de ined as "an abnormally high elevated position of one leaf of the intact diaphragm of as a result of paralysis, aplasia or atrophy of varying degrees of the muscle ibers" [1][2][3]. The most common causes of hemidiaphragmatic paralysis with phrenic nerve involvement have been reported to be malignant in iltration by bronchial carcinoma and direct injury [4].…”

Section: Introductionmentioning

confidence: 99%

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Trauma to the neck: Manifestation of injuries outside the original zone of injury-A case report

O¹

2018

Arch Case Rep

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SummaryA 53-year-old male presented to the Emergency Department (ED) with multisystem trauma and respiratory distress following a blunt-force injury to his anterior left neck. CT imaging showed extensive subcutaneous emphysema and pneumomediastinum. A chest X-ray showed elevation of the left hemidiaphragm suggesting phrenic nerve injury which was confi rmed by bedside ultrasonographic examination of the left hemidiaphragm. Flexible bronchoscopy demonstrated tracheal rupture. The patient was treated supportively and recovered without surgical treatment. Trauma-induced hemidiaphragmatic paralysis is rarely reported. This case represents a clinical scenario with demonstrable anatomic correlations, and a clinical reminder that phrenic nerve injury should be included in the differential diagnosis of respiratory distress in a trauma patient.

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Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Trauma to the neck: Manifestation of injuries outside the original zone of injury-A case report

O¹

2018

Arch Case Rep

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“…4,10 -17 Cases are documented where the forces involved are relatively minor. 4,10,11,[13][14][15][16][17] Several cases have occurred following chiropractic manipulation of the neck, 11,16,17 and 2 cases as a consequence of whiplash injury occurring in a minor motor vehicle collision. 10,16 There is also a report of phrenic nerve palsy due to repetitive cervical hyperextension while using exercise equipment.…”

Section: Could Phrenic Nerve Injury Occur As a Results Of External Necmentioning

confidence: 99%

“C3, 4, 5 Keeps the Diaphragm Alive.” Is Phrenic Nerve Palsy Part of the Pathophysiological Mechanism in Strangulation and Hanging? Should Diaphragm Paralysis be Excluded in Survived Cases?

Davies¹

2010

American Journal of Forensic Medicine &Amp; Pathology

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The phrenic nerve arises in the neck. It is formed from C3, C4, and C5 nerve fibers and descends along the anterior surface of the scalenus anterior muscle before entering the thorax to supply motor and sensory input to the diaphragm. Its anatomic location in the neck leaves the nerve vulnerable to traumatic injury. Phrenic nerve injury can arise as a result of transection, stretching or compression of the nerve, and may result in paralysis of the diaphragm. Consequences of diaphragm paralysis include respiratory compromise, gastrointestinal obstruction, and cardiac arrhythmias. There may be serious morbidity and onset of symptoms may be delayed. Cases of diaphragm paralysis occurring as a consequence of neck trauma are documented in the literature. In some cases, the forces involved are relatively minor and include whiplash injury, occurring in minor motor vehicle collisions, chiropractic manipulation, and compression of neck structures, including a case involving external neck compression by industrial machinery. It is concluded that phrenic nerve palsy might be part of the pathophysiological mechanism in strangulation and hanging, and clinical investigation to exclude diaphragm paralysis in survived cases should be considered.

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