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

Article Sidebar

PDF HTML
Submitted: February 2 2018
Published: Feb 6, 2018
DOI: 10.29328/journal.acr.1001006
Keywords:
Trauma, Phrenic nerve pslsy, Hemidiaphragmatic paralysis, Pneumomediastinum, Anatomage, Clinical anatomy

Main Article Content

Alexander Christakis
Department of Pathology, Brigham and Women’s Hospital Boston, MA 02115, USA
Brian Tashjian
University of Massachusetts Medical School, Worcester MA 01655, USA
Anne M Gilroy
Department of Radiology, University of Massachusetts Medical School, Worcester MA 01655, USA
Stephen O Heard*
Department of Anesthesiology and Perioperative Medicine, University of Massachusetts Medical School and UMass Memorial Medical Center, Worcester MA 01655, USA

Abstract

A 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 confirmed 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.

Article Details

Christakis, A., Tashjian, B., Gilroy, A. M., & Heard, S. O. (2018). Trauma to the neck: Manifestation of injuries outside the original zone of injury-A case report. Archives of Case Reports, 2(1), 004–009. https://doi.org/10.29328/journal.acr.1001006
Case Reports

Copyright (c) 2018 Christakis A, et al.

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Bisgard JD. Congenital eventration of the diaphragm. J Thorac Surg. 1947; 16: 484-491. Ref.: https://goo.gl/Nve8fE

Dalshaug GB, Rothwell BC. Diaphragmatic paralysis following minor blunt trauma. The Journal of trauma. 1999; 47: 413-415. Ref.: https://goo.gl/nTDUUW

Iverson LI, Mittal A, Dugan DJ, Samson PC. Injuries to the phrenic nerve resulting in diaphragmatic paralysis with special reference to stretch trauma. Am J Surg. 1976; 132: 263-269. Ref.: https://goo.gl/L9qMmC

Gibson GJ. Diaphragmatic paresis: pathophysiology, clinical features, and investigation. Thorax. 1989; 44: 960-970. Ref.: https://goo.gl/nKsjJv

Moore KL, Dalley AF, Agur AMR. Clinically oriented anatomy. 7th ed. Philadelphia: Wolters Kluwer-Lippincott Williams & Wilkins. 2014. Ref.: https://goo.gl/tftMAJ

Aguirre VJ, Sinha P, Zimmet A, Lee GA, Kwa L, Rosenfeldt F. Phrenic nerve injury during cardiac surgery: mechanisms, management and prevention. Heart, lung & circulation. 2013; 22: 895-902. Ref.: https://goo.gl/tnS4FW

Harris K, Maniatis G, Siddiqui F, Maniatis T. Phrenic nerve injury and diaphragmatic paralysis following pacemaker pulse generator replacement. Heart & lung: The journal of critical care. 2013; 42: 65-66. Ref.: https://goo.gl/Nxpvjk

McCaul JA, Hislop WS. Transient hemi-diaphragmatic paralysis following neck surgery: report of a case and review of the literature. J R Coll Surg Edinb. 2001; 46: 186-188. Ref.: https://goo.gl/ojLgp6

Ostrowska M, de Carvalho M. Prognosis of phrenic nerve injury following thoracic interventions: four new cases and a review. Clin Neurol Neurosurg. 2012; 114: 199-204. Ref.: https://goo.gl/89Y3h7

Schram DJ, Vosik W, Cantral D. Diaphragmatic paralysis following cervical chiropractic manipulation: case report and review. Chest. 2001; 119: 638-640. Ref.: https://goo.gl/vozTyf

Swallow EB, Dayer MJ, Oldfield WL, Moxham J, Polkey MI. Right hemi-diaphragm paralysis following cardiac radiofrequency ablation. Respiratory Medicine. 2006; 100: 1657-1659. Ref.: https://goo.gl/ipKj3G

Bell D, Siriwardena A. Phrenic nerve injury following blunt trauma. Journal of Accident & Emergency Medicine. 2000; 17: 419-420. Ref.: https://goo.gl/BViSYN

Hashim ND, Yunus MRM, Baki MM, Ami M. Laryngeal Trauma with Phrenic Nerve Injury: A Rare Association. Philipp J Otolaryngol Head Neck Surg. 2010; 25: 39-41. Ref.: https://goo.gl/o6aj15

Snyder RW, Kukora JS, Bothwell WN, Torres GR. Phrenic nerve injury following stretch trauma: case reports. The Journal of trauma. 1994; 36: 734-736. Ref.: https://goo.gl/wbpJpA

Ulku R, Onat S, Balci A, Eren N. Phrenic nerve injury after blunt trauma. International surgery. 2005; 90: 93-95.