Diaphragm elevation and cortisone injection

[worriedintn]

My son, 19, has had fever up to 102.3 for the past 2 weeks. In the same time period, he's had a pain in his left side and top of left shoulder, possibly from lifting a 36 pound box at work. At the first doctor's visit, he was diagnosed with strained muscles and a virus and prescribed prescription-strength Naproxen Sodium. His fever continued so I took him back to the doctor who said fever was still probably due to a virus and to bring my son back in 2-3 weeks if he still had fever. At the same visit, the doctor injected cortisone in the top of my son's shoulder in the valley where it connects to the arm. Three minutes later, my son fainted. He says he wasn't nervous about the shot; the doctor attributed the fainting to the vagus effect. Three days ago, my son started having serious pain in his left, middle back between the spine and flank. Also, cannot lie on his back because of severe pain. Yesterday, I took my son to a walk-in clinic sponsored by an academic medical facility. Finally, he received diagnostic testing. His urine was normal. Doctor there also ordered a CBC-(results are not in, yet), a chest CT scan for later this afternoon, and an X-ray which revealed an elevated left diaphragm. The doc mentioned frozen diaphragm as a possibility. I've been exploring this website and am now afraid the cortisone shot has disturbed the phrenic nerve and caused unilateral paralysis of the left diaphragm. How likely is this and how likely is it that the paralysis, if that is the problem, will resolve on it's own and in what time frame? Thanks for your attention.

[National Jewish]

Inflammation or physical damage to the phrenic nerve may cause elevation of a diaphragm.  The phrenic nerve does not travel near the injection site, so it is unlikely to have been traumatized by the cortisone injection.  It is more likely that the injection caused a collapsed lung called a pneumothorax.  This should have been noticeable on the chest x-ray.  A collapsed lung, especially the lower lobe, can cause an elevated diaphragm.

Since the fever was present before the injection was given this excludes the injection as a cause.  The fever suggests an inflammatory problem or infection, possibly a viral infection.  Phrenic nerve failure due to a viral infection may spontaneously resolve.

The first step is to determine if the left side of the diaphragm moves.  If it does the CT scan may show some lung collapse.

This is a complex situation.  You should request consultation by a pulmonary specialist.

[worriedintn]

Thanks so much for you good advice. I appreciate the promptness of your reply.

I thought you might be curious to know the results of the CT scan. It revealed a very large (16 cm), probably fluid-filled, cyst, possibly connected to the spleen. We saw a surgeon today who thinks my son's 2-week fever has been caused by pneumonia. The surgeon sees no urgency in resolving these issues as the risk of hemorrhage is 1%. He said many people are walking around with these cysts without knowing it. They are usually caused from a blow. In my son's case, while on a hike through the mountains, he slipped on a large, wet rock and fell against it.

This particular surgeon has suggested doing surgery in about two weeks. However, since my son is very anxious to feel better and he is now experiencing shortness of breath with exertion, we will be finding another surgeon.

I'm so glad to have found this website and will be making a donation to help ensure it's continuance.

Thanks again.

[oakie26]

A related discussion, Frozen Left Diaphragm was started.