Acute diaphragmatic paralysis caused by chest-tube trauma to phrenic nerve

A 3(1)/(2)-year-old child developed unilateral diaphragmatic paralysis afte r chest drain insertion. Plain chest X-ray demonstrated paravertebral posit ioning of the chest-tube tip, and magnetic resonance imaging revealed hemat omas in the region of the chest-tube tip and the phrenic nerve fibers. The trauma to the phrenic nerve was apparently secondary to malposition of the chest tube. This is a rare complication and has been reported mainly in neo nates. Radiologists should notify the treating physicians that the correct position of a chest drain tip is at least 2 cm distant from the vertebrae.