title: Diaphragm paralysis caused by transverse cervical artery compression of the phrenic nerve: the Red Cross syndrome.
abstract: BACKGROUND
  The etiology of diaphragm paralysis is often elusive unless an iatrogenic or traumatic injury to the phrenic nerve can be clearly implicated. Until recently, there has been little interest in the pathophysiology of diaphragm paralysis since few treatment options existed.
  
  
  METHODS
  We present three cases of symptomatic diaphragm paralysis in which a clear clinico-pathologic diagnosis could be identified, specifically a vascular compression of the phrenic nerve in the neck caused by a tortuous or adherent transverse cervical artery.
  
  
  RESULTS
  In two patients the vascular compression followed a preceding traction injury, whereas in one patient an inter-scalene nerve block had been performed. Following vascular decompression, all three patients regained diaphragmatic motion on fluoroscopic chest radiographs, and experienced a resolution of respiratory symptoms.
  
  
  CONCLUSIONS
  We suggest that vascular compression of the phrenic nerve in the neck may occur following traumatic or iatrogenic injuries, and result in symptomatic diaphragm paralysis.
authors.affiliation: The Institute for Advanced Reconstruction, Shrewsbury, NJ 07702, USA. matthewrkmd@gmail.com
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Kaufman
authors.forename: Lourens J
authors.initials: LJ
authors.lastname: Willekes
authors.forename: Andrew I
authors.initials: AI
authors.lastname: Elkwood
authors.forename: Michael I
authors.initials: MI
authors.lastname: Rose
authors.forename: Tushar R
authors.initials: TR
authors.lastname: Patel
authors.forename: Russell L
authors.initials: RL
authors.lastname: Ashinoff
authors.forename: Alan R
authors.initials: AR
authors.lastname: Colicchio
mesh_terms: D000328:Adult; D001158:Arteries / Q000293:injuries* / Q000473:pathology*; D004576:Electromyography; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007049:Iatrogenic Disease; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000098:blood supply; D009407:Nerve Block / Q000009:adverse effects; D009408:Nerve Compression Syndromes / Q000150:complications* / Q000473:pathology; D009431:Neural Conduction; D010791:Phrenic Nerve / Q000473:pathology*; D012039:Regional Blood Flow; D012133:Respiratory Paralysis / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D012189:Retrospective Studies; D013147:Spirometry; D014057:Tomography, X-Ray Computed; D014143:Traction / Q000009:adverse effects; D016896:Treatment Outcome