Thoracoscopic Diaphragm Sewing for Phrenic Nerve paralysis after Herpes Zoster Infection

Abstract

The patient was a 68-year-old woman with chronic rheumatoid arthritis. Four months preoperatively, she contracted herpes zoster and was admitted to the hospital with a diagnosis of disseminated herpes zoster infection and acute bacterial pneumonia based on decreased oxygen saturation levels on pulse oximetry. Bacterial pneumonia was treated with antibacterial agents. However, she continued to experience respiratory distress and was referred to a physician. Chest radiography showed elevation of the right diaphragm, which was not observed before the onset of herpes zoster infection. Respiratory function testing revealed a marked decrease in lung capacity, from 2.26 L to 1.47 L. The patient was diagnosed with diaphragmatic eventration due to phrenic nerve palsy associated with herpes zoster infection. She was referred to our surgical department to undergo a procedure to improve respiratory distress. The patient underwent four-port thoracoscopic surgery with carbon dioxide insufflation. An Endostitch^TM suturing device was used to place 14 stitches from the dorsal diaphragm to the ventral diaphragm. The patient developed re-expansion pulmonary edema immediately postoperatively but was discharged safely 13 days postoperatively. At 10 months postoperatively, the patient's respiratory distress and activities of daily living had improved.