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Virtual Pediatric Hospital: Paediapaedia: Phrenic Nerve Paralysis Paediapaedia: Neonatal Chest Diseases

Phrenic Nerve Paralysis

Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed


Clinical Presentation:
Usually develop respiratory distress within 24 hours. Fifty percent recover fully. Erb's paralysis of the ipsilateral upper extremity is seen in 75% of patients with phrenic nerve paralysis.

Etiology/Pathophysiology:
In a difficult delivery such as breech, difficult forceps or shoulder dystocia, traction on an extremity or cervical hyperextension during birth can stretch cervical nerves 3-5 in the brachial plexus, thereby damaging the phrenic nerve. This causes unilateral paralysis of the diaphragm in the newborn leading to decreased respiratory effort.

Pathology:
Not applicable

Imaging Findings:
On fluoroscopy paradoxical motion of hemidiaphragm is seen with elevation on inspiration and descent on expiration. The mediastinum has a to-and-fro motion and shifts away from the affected side in inspiration and shifts back towards the midline on expiration. icon gif

DDX:
Not applicable

References:
See References Chapter.

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