Brachial plexus trauma: the morbidity of hemidiaphragmatic paralysis.
Phrenic nerve palsy has previously been associated with brachial plexus root avulsion; severe unilateral phrenic nerve injury is not uncommonly associated with brachial plexus injury. Brachial plexus injuries can be traumatic (gunshot wounds, lacerations, stretch/contusion and avulsion injuries) or non-traumatic in aetiology (supraclavicular brachial plexus nerve block, subclavian vein catheterisation, cardiac surgeries, or obstetric complications such as birth palsy). Despite the known association, the incidence and morbidity of a phrenic nerve injury and hemidiaphragmatic paralysis associated with traumatic brachial plexus stretch injuries remains ill-defined. The incidence of an associated phrenic nerve injury with brachial plexus trauma ranges from 10% to 20%; however, because unilateral diaphragmatic paralysis often presents without symptoms at rest, a high number of phrenic nerve injuries are likely to be overlooked in the setting of brachial plexus injury. A case report is presented of a unilateral phrenic nerve injury associated with brachial plexus stretch injury presenting with a recalcitrant left lower lobe pneumonia.
Franko
O I
OI
Department of Surgery, Brigham and Womens Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
Khalpey
Z
Z
Gates
J
J
D000063:Accidents, Traffic; D000328:Adult; D001917:Brachial Plexus / Q000293:injuries*; D006801:Humans; D008297:Male; D016106:Methicillin Resistance; D010791:Phrenic Nerve / Q000293:injuries*; D018410:Pneumonia, Bacterial / Q000000981:diagnostic imaging / Q000188:drug therapy; D001261:Pulmonary Atelectasis / Q000000981:diagnostic imaging; D012133:Respiratory Paralysis / Q000000981:diagnostic imaging / Q000209:etiology*; D013203:Staphylococcal Infections / Q000000981:diagnostic imaging / Q000188:drug therapy; D013211:Staphylococcus aureus; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography