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COVID-19 associated phrenic nerve mononeuritis: a case series
  1. Sheonagh MacPhail Law1,
  2. Kathryn Scott2,
  3. Ahmed Alkarn2,3,
  4. Aisha Mahjoub4,
  5. Arup K Mallik4,
  6. Giles Roditi5,6,
  7. Brian Choo-Kang7
  1. 1 Respiratory Medicine, NHS Forth Valley, Stirling, UK
  2. 2 Respiratory Medicine, Glasgow Royal Infirmary, Glasgow, UK
  3. 3 Faculty of Medicine, Assiut University, Assiut, Egypt
  4. 4 Institute of Neurological Studies, Queen Elizabeth University Hospital, Glasgow, UK
  5. 5 Department of Radiology, Glasgow Royal Infirmary, Glasgow, UK
  6. 6 Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
  7. 7 Department of Respiratory Medicine, Glasgow Royal Infirmary, Glasgow, UK
  1. Correspondence to Dr Sheonagh MacPhail Law, Respiratory Medicine, NHS Forth Valley, Stirling, UK;{at}


This study characterised the hemidiaphragm elevation on 3-month interval chest X-rays (CXRs) of patients post COVID-19 pneumonia. 467 CXRs were screened; 19 (4.1%) had an elevated hemidiaphragm. There were 15 (3.2%) patients of interest with new hemidiaphragm elevation, persisting on average 7 months post COVID-19 diagnosis. Symptomatic patients underwent diaphragm ultrasound (n=12), pulmonary function test (n=10), muscle function test (n=6) and neurophysiology (n=5), investigating phrenic nerve function. Ultrasound demonstrated reduced/paradoxical diaphragmatic movements in eight; four of eight had reduced thickening fraction. Neurophysiology peripheral limb studies did not support the differential diagnoses of critical illness neuropathy/myopathy. We propose that, in selected patients, COVID-19 may cause phrenic nerve mononeuritis.

  • COVID-19
  • Respiratory Muscles
  • Imaging/CT MRI etc

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  • Contributors Conception and design: SML, BC-K. Data collection: SML, KS, AA, AKM, AM, BC-K. Analysis and interpretation of data: SML, BC-K. Drafting of the article: SML. Critical revision of the article for important intellectual content: SML, AKM, GR, BC-K. Final approval of the article: SML, KS, AA, AM, AKM, GR, BC-K. Provision of study materials or patients: KS, GR, BC-K.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.