Open AccessUnilateral diaphragmatic paresis following supracostal post-percutaneous nephrolithotomy
Author(s) -
Abhishek Bhat,
Jordan Katz,
Nicholas A. Smith,
HemendraN Shah
Publication year - 2022
Publication title -
journal of postgraduate medicine/journal of postgraduate medicine
Language(s) - Uncategorized
Resource type - Journals
SCImago Journal Rank - 0.405
H-Index - 52
eISSN - 0972-2823
pISSN - 0022-3859
DOI - 10.4103/jpgm.jpgm_13_21
Subject(s) - medicine , percutaneous nephrolithotomy , paresis , surgery , complication , fluoroscopy , chest radiograph , diaphragmatic breathing , intercostal space , radiography , radiology , percutaneous , alternative medicine , pathology
Unilateral acquired diaphragmatic paresis is a known complication of thoracic surgeries. Direct mechanical injury to the phrenic nerve during surgery results in this complication. However its occurrence post-percutaneous nephrolithotomy (PCNL) has not been described. We report a 43-year-old man who underwent prone PCNL for endourological management of left complete staghorn calculus. Access via the 10 th left intercostal space, under fluoroscopy, was carried out to remove the calculus. Post-operative, the routine chest radiograph revealed left hemidiaphragmatic blunting. Computerized tomography of the chest confirmed left hemidiaphragmatic elevation, suggesting unilateral diaphragmatic paresis. He did not have any respiratory symptoms, was managed conservatively with chest physiotherapy and incentive spirometry and responded extremely well. The absence of reported cases of diaphragmatic paresis post PCNL lends to a dearth in knowledge regarding recognition and management. This case report aims to acquaint urologists with this rare complication associated with supracostal PCNL and provide a rational management plan.