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Updated: Sep 16, 2025

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Diaphragmatic Paralysis Following Chest Tube Insertion in an Infant: Case report and literature review

Mohammed Al Ghafri1, Said Al Hanshi1, Ahmad E Elkhamisy1

  • 1Department of Pediatric Cardiac Intensive Care Unit, National Heart Center, The Royal Hospital, Muscat, Oman.

Sultan Qaboos University Medical Journal
|July 11, 2025
PubMed

Insights

Phrenic nerve injury from intercostal chest drains can cause diaphragmatic paralysis. Surgical diaphragm plication successfully treated this rare complication in an infant with severe bronchiolitis.

Area of Science:

  • Pediatric Critical Care Medicine
  • Thoracic Surgery
  • Pediatric Pulmonology

Background:

  • Diaphragmatic paralysis (DP) is a rare complication of intercostal chest drain (ICD) insertion.
  • Phrenic nerve injury can lead to significant respiratory compromise, particularly in infants.

Purpose of the Study:

  • To report a case of diaphragmatic paralysis secondary to ICD insertion in an infant.
  • To highlight the successful surgical management of this complication.

Main Methods:

  • Case presentation of a 4-month-old ex-preterm infant with respiratory syncytial virus bronchiolitis and pneumothorax.
  • Diagnosis of right diaphragmatic paralysis confirmed by chest X-ray and fluoroscopy showing paradoxical movement.
  • Treatment involved surgical plication of the right diaphragm.

Main Results:

  • The infant experienced persistent tachypnea and ventilator dependence post-extubation, indicative of diaphragmatic paralysis.
  • Diaphragm plication led to a dramatic improvement in respiratory status.
  • The infant was successfully discharged home 9 days after the surgical procedure.

Conclusions:

  • Diaphragmatic paralysis is an infrequent but significant complication of ICD placement.
  • Diaphragm plication is an effective treatment for infant diaphragmatic paralysis.
  • Prompt diagnosis and surgical intervention can lead to favorable outcomes in affected infants.

Keywords:
Adverse EffectsCase ReportChest TubesDiaphragm ParalysisInjuriesOmanPhrenic Nerve

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