Étirement du nerf phrénique droit avec parésie diaphragmatique au décours d'une décélération chez un patient de 54 ans

Traumatic interruption or stretch of the phrenic nerve is a well-recognized complication of blunt thoracic trauma and may involve dysfunction of the main respiratory muscle, with respiratory insufficiency and consequent ventilation problems. Althougt symptoms often occur shortly after the injury, patients without clinical symptoms or the presence of concomitant thoraco-abdominal lesion may pose a diagnostic quandary and lead to a delayed presentation. Diaphragm's palsy generally heals spontaneously in six to twelve months, with a concomitant gradual return of diaphragm function, provided that it doesn't result from permanent damage to the phrenic nerve. The indication of surgical implication are becoming rarer but patients who remain symptomatic or the imbrication of a diaphragmatic hernia may require a surgical treatment. We report the case of a right sided diaphragmatic paresis after a blunt thoracic trauma in a 54-year-old patient. The elevation of the right diaphragm, showed by the initial chest x-ray, led to a thoracoabdominal CT scan, despite the absence of suggestive clinical symptoms and pose the diagnosis of diaphragmatic hernia. The delayed respiratory degradation involved an explorer thoracotomy, finding a diaphragmatic paresis induced by phrenic nerve stretch who was sticked by the deceleration during the car accident.