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Case report
Unilateral diaphragm paralysis with COVID-19 infection
  1. Thomas Simon FitzMaurice1,2,
  2. Caroline McCann3,
  3. Martin Walshaw1,4 and
  4. James Greenwood1,5,6
  1. 1Department of Respiratory Medicine, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
  2. 2Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
  3. 3Department of Radiology, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
  4. 4Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
  5. 5Faculty of Life Sciences, University of Liverpool, Liverpool, UK
  6. 6Department of Intensive Care, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
  1. Correspondence to Dr Thomas Simon FitzMaurice; thomas.fitzmaurice{at}lhch.nhs.uk

Abstract

Neurological complications are well described in SARS-CoV-2, but for the first time we report a case of unilateral diaphragm paralysis occurring early in mechanical ventilation for respiratory failure due to such an infection. The patient subsequently required tracheostomy and ventilator support for 37 days, and had increased breathlessness and an elevated diaphragm at clinic review 9 months later. Dynamic chest radiography demonstrated persistent diaphragm paralysis with an accompanying postural change in lung volumes, and he subsequently underwent surgical plication. This case demonstrates that although persistent dyspnoea is a common feature following SARS-CoV-2 infection and is usually due to deconditioning or persistent parenchymal involvement, it can be due to other causes and needs to be investigated appropriately.

  • COVID-19
  • mechanical ventilation
  • lung function
  • radiology

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

https://bmj.com/coronavirus/usage

https://doi.org/10.1136/bcr-2021-243115

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    Footnotes

    • Contributors TSF was the lead author of this work. CM, JG and MW helped write the work. MW provided expert opinion on interpretation of pulmonary physiology. CM provided images and expert thoracic radiological advice. JG provided overall guidance for the work.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.