Ogawa Junichi, Nagashim Hiromi, Suhara Makoto, Yamauchi Kohei
Division of Pulmonary Medicine, Allergy, and Rheumatology, Department of Internal Medicine, Iwate Medical University School of Medicine.
Nihon Kokyuki Gakkai Zasshi. 2009 Mar;47(3):200-4.
We report a case of left phrenic nerve paralysis due to compression of left auricle caused by congenital partial left pericardial defect. A 56-year-old man was admitted with left phrenic nerve paralysis. His congenital partial left pericardial defect was incidentally diagnosed on video assisted thoracoscopic surgery (VATS). This case of left phrenic nerve paralysis was due to compression of the left auricle which protruded through the hole of a partial defect in the pericardium. When the patient was examined for dyspnea at our hospital, the chest X-ray revealed left diaphragmatic relaxation and chest computed tomography showed a high density mass in front of the left pulmonary artery. Electrophysiologic evaluation of the diaphragm by transcutaneous phrenic nerve stimulation indicated complete paralysis of the left phrenic nerve. VATS revealed that the phrenic nerve was compressed by the protruding left auricle due to a congenital partial left pericardial defect. Because of the complete paralysis of the left phrenic nerve, we chose to perform plication of the left diaphragm. The postoperative course was uneventful and the patient was discharged on the 23rd day after the operation. Congenital pericardial defect is an abnormality that is rarely found incidentally on thoracotomy or autopsy. However, we should perform a careful examination and consider the possibility of congenital pericardial defect in the differential diagnosis of phrenic nerve paralysis.
我们报告一例因先天性部分左心包缺损导致左心耳压迫引起的左膈神经麻痹病例。一名56岁男性因左膈神经麻痹入院。他的先天性部分左心包缺损在电视辅助胸腔镜手术（VATS）中被偶然诊断出来。这例左膈神经麻痹是由于左心耳通过心包部分缺损的孔洞突出而受到压迫所致。当患者因呼吸困难在我院接受检查时，胸部X线显示左膈松弛，胸部计算机断层扫描显示左肺动脉前方有一高密度肿块。经皮膈神经刺激对膈肌进行电生理评估表明左膈神经完全麻痹。VATS显示膈神经因先天性部分左心包缺损导致的左心耳突出而受压。由于左膈神经完全麻痹，我们选择对左膈肌进行折叠术。术后过程顺利，患者在术后第23天出院。先天性心包缺损是一种很少在开胸手术或尸检中偶然发现的异常情况。然而，在膈神经麻痹的鉴别诊断中，我们应进行仔细检查并考虑先天性心包缺损的可能性。
