Respiratory failure due to diaphragm paralysis after brachial plexus injury diagnosed by point-of-care ultrasound

Abstract

A man in his fifties was injured in a traffic accident and diagnosed with traumatic subarachnoid haemorrhage, liver injury, and fractures of the rib, right clavicle, right scapula and right femur. He also presented with motor and sensory disturbances of the right upper extremity and was suspected of having a brachial plexus injury. After undergoing mechanical ventilation due to multiple traumas, he was extubated. However, he developed acute respiratory failure and required reintubation. Respiratory symptoms were not clear until just before reintubation. The diagnosis of right diaphragm paralysis was made using point-of-care ultrasound with no other findings that could cause respiratory failure. MRI led to the diagnosis of brachial plexus injury, which likely caused diaphragm paralysis. Point-of-care ultrasound provided a clear visualisation and rapid bedside diagnosis of diaphragm paralysis, which can be challenging to diagnose while ruling out other causes of respiratory failure.