X-ray
Frontal
What is the main finding on this chest X-ray?
This patient has an elevated left hemidiaphragm.
What are the likely causes in this case?
The most likely cause is damage or disruption to the left phrenic nerve. Phrenic nerve palsy occurs in around 10% of neck dissections which this patient underwent (see the surgical clips over the apex of the left lung). There are also recorded cases of phrenic paralysis in patients who have had central venous catheters in the neck, however these were not used.
Are there other important causes to investigate?
Spinal cord injury or malignant infiltration are important causes to exclude. In some groups, phrenic paralysis occurs following cardiac surgery.
Elevated left hemidiaphragm. No evidence of consolidation or atelectasis. No pneumothorax.
Surgical clips at base of left neck.