RIGHT PHRENIC-NERVE PALSY AS A COMPLICATION OF INDWELLING CENTRAL VENOUS CATHETERS

Five cases are reported of patients who developed a raised right hemid iaphragm while an indwelling central venous catheter was in situ. The patients were being treated with protracted venous infusions of chemot herapy for colorectal carcinoma, Ail five patients had a chest radiogr aph following insertion of the Hickman line which showed normal diaphr agmatic positions. A mean of 93 days later (range 55-134 days) elevati on of the right hemidiaphragm was noted in these patients on repeat ch est radiographs. Two of the patients had a right phrenic nerve palsy d emonstrated by magnetic stimulation of the nerve. The remaining three patients had paradoxical motion of the right hemidiaphragm on sonograp hy, but were unable to undergo studies of phrenic nerve function befor e death from metastatic disease, It is suggested that right phrenic ne rve palsy is a late complication of an indwelling central venous cathe ter.