Diaphragmatic Paralysis Following Chest Tube Insertion in an Infant

Abstract

Diaphragmatic paralysis (DP) can occur due to central nervous system pathology or peripheral nerve injury. Direct injury to the phrenic nerve after intercostal chest drain (ICD) insertion for treatment of pneumothorax is an infrequent complication. We present a 4-month-old baby, ex-preterm 27 weeks, who was admitted to a tertiary care hospital pediatric intensive care unit in Muscat, Oman, in 2023 with severe respiratory syncytial virus bronchiolitis and required intubation and mechanical ventilation (MV). His illness was complicated by right-side pneumothorax that required ICD insertion. Post-extubation, he had persistent tachypnea with the inability to be weaned from noninvasive ventilation (NIV). Chest x-ray (CXR) and fluoroscopy showed a high right diaphragm dome with paradoxical movements. He improved dramatically after the plication of the right diaphragm and was discharged home on the 9th day after the plication.