Paralysis of the Phrenic Nerve (Differential Diagnosis Respiratory Distress Syndrome)

Chest x-rays of a newborn with respiratory distress syndrome (left picture) and 2 years later (right picture). The bright x-ray on the right shows - in addition to the normal heart silhouette - the diaphragm whose right side is sligthly higher. By contrast, the area of lung structure in the left x-ray is only half the size of the corresponding hemithorax. During the following fluoroscopy the right diaphragm moves paradoxicallly. The cause of the right-sided high position of the diaphragm is a phrenic nerve paralysis after birth injury = acquired type of diaphragmatic eventration. In case of bilateral involvement, the neonate needs immediate intubation and long term ventilation, in case of unilateral paresis, a less severe respiratory distress syndrome results. In the meantime, the patient has been operated on by a duplication of the diaphragm and the paralysis has recovered. A paralysis of the diaphragm may also occur after surgery of the heart and the large vessels.