Left phrenic nerve palsy

Case contributed by Dr Derek Smith

Presentation

Selective left neck dissection for thyroid operation. Cough post-operatively.

Patient Data

Age: 50 years
Gender: Female

Pre-operative study

CT

Pre-operative CT.

3 cm nodule at the base of the neck with peripheral enhancement and low attenuation centrally in keeping with thyroid malignancy.

Intrathoracic stomach, but otherwise normal chest appearances.

X-ray

Elevated left hemidiaphragm. No evidence of consolidation or atelectasis. No pneumothorax.

Surgical clips at base of left neck.

Case Discussion

Phrenic nerve palsy or paralysis occurs in about 10% of neck dissection cases.

Symptoms include dyspnea, coughing, chest pain and an increased risk of atelectasis.

A gradual improvement in symptoms could be expected, however the patient is likely to be left with a raised hemidiaphragm.

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