Abstract

Case Report

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

Stephen O Heard*, Alexander Christakis, Brian Tashjian and Anne M Gilroy3

Published: 06 February, 2018 | Volume 2 - Issue 1 | Pages: 004-009

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.

Read Full Article HTML DOI: 10.29328/journal.acr.1001006 Cite this Article Read Full Article PDF

Keywords:

Trauma; Phrenic nerve pslsy; Hemidiaphragmatic paralysis; Pneumomediastinum; Anatomage; Clinical anatomy

References

  1. Bisgard JD. Congenital eventration of the diaphragm. J Thorac Surg. 1947; 16: 484-491. Ref.: https://goo.gl/Nve8fE
  2. Dalshaug GB, Rothwell BC. Diaphragmatic paralysis following minor blunt trauma. The Journal of trauma. 1999; 47: 413-415. Ref.: https://goo.gl/nTDUUW
  3. 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
  4. Gibson GJ. Diaphragmatic paresis: pathophysiology, clinical features, and investigation. Thorax. 1989; 44: 960-970. Ref.: https://goo.gl/nKsjJv
  5. Moore KL, Dalley AF, Agur AMR. Clinically oriented anatomy. 7th ed. Philadelphia: Wolters Kluwer-Lippincott Williams & Wilkins. 2014. Ref.: https://goo.gl/tftMAJ
  6. 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
  7. 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
  8. 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
  9. 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
  10. 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
  11. 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
  12. Bell D, Siriwardena A. Phrenic nerve injury following blunt trauma. Journal of Accident & Emergency Medicine. 2000; 17: 419-420. Ref.: https://goo.gl/BViSYN
  13. 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
  14. 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
  15. Ulku R, Onat S, Balci A, Eren N. Phrenic nerve injury after blunt trauma. International surgery. 2005; 90: 93-95.a

Figures:

Figure 1

Figure 1

Figure 1

Figure 2

Figure 1

Figure 3

Figure 1

Figure 4

Figure 1

Figure 5

Similar Articles

Recently Viewed

Read More

Most Viewed

Read More

Help ?