• Matthew R Kaufman, Lourens J Willekes, Andrew I Elkwood, Michael I Rose, Tushar R Patel, Russell L Ashinoff, and Alan R Colicchio.
• The Institute for Advanced Reconstruction, Shrewsbury, NJ 07702, USA. matthewrkmd@gmail.com
• Clin Neurol Neurosurg. 2012 Jun 1; 114 (5): 502-5.

BackgroundThe etiology of diaphragm paralysis is often elusive unless an iatrogenic or traumatic injury to the phrenic nerve can be clearly implicated. Until recently, there has been little interest in the pathophysiology of diaphragm paralysis since few treatment options existed.MethodsWe present three cases of symptomatic diaphragm paralysis in which a clear clinico-pathologic diagnosis could be identified, specifically a vascular compression of the phrenic nerve in the neck caused by a tortuous or adherent transverse cervical artery.ResultsIn two patients the vascular compression followed a preceding traction injury, whereas in one patient an inter-scalene nerve block had been performed. Following vascular decompression, all three patients regained diaphragmatic motion on fluoroscopic chest radiographs, and experienced a resolution of respiratory symptoms.ConclusionWe suggest that vascular compression of the phrenic nerve in the neck may occur following traumatic or iatrogenic injuries, and result in symptomatic diaphragm paralysis.Copyright © 2012 Elsevier B.V. All rights reserved.

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