Journal of Pediatrics & Child Care
Case Report
Diaphragmatic Paralysis Following Pigtail Chest Drain Placement in an Extremely Preterm Infant: A Case Report and Review of Literature
Pan M1, Gaurav Mathur G2, Saju E2, Mubarak A2 and Jain S2*
1John Sealy School of Medicine, The University
of Texas Medical Branch, Galveston, Texas, USA.
2Department of Pediatrics, The University of Texas Medical Branch, Galveston, Texas, USA.
2Department of Pediatrics, The University of Texas Medical Branch, Galveston, Texas, USA.
*Address for Correspondence:Sunil Jain, Department of Pediatrics, The University of
Texas Medical Branch, Galveston, Texas, USA. 301 University Blvd, Galveston, TX, 77550 E-mail Id:
skjain@utmb.edu
Submission: 22 May, 2026
Accepted: 16 September, 2026
Published: 19 September, 2026
Copyright: © 2026 Pan M, et al. This is an open access article
distributed under the Creative Commons Attr-ibution License,
which permits unrestricted use, distribution, and reproduction
in any medium, provided the original work is properly cited.
Keywords:Diaphragmatic Paralysis; Pigtail Chest Drain Insertion;
Pneumothorax; Preterm; Phrenic Nerve Injury.
Abstract
Background: Diaphragmatic paralysis is a rare complication of
chest drain placement in neonates, typically resulting from phrenic
nerve injury related to tube malposition or direct nerve trauma.
Case Presentation: We report a case of right-sided diaphragmatic paralysis following pigtail chest drain insertion for pneumothorax in an extremely preterm male infant born at 26 weeks gestational age. The infant developed pneumothorax requiring chest drain (pig tail) placement with subsequent resolution. Following pig tail removal, imaging confirmed right-sided diaphragmatic paralysis.
Conclusion: This case highlights the importance of proper chest drain (pig tail) positioning and monitoring for this uncommon but significant complication in vulnerable preterm infants. Apicomedial malposition of a pigtail chest drain may result in phrenic nerve injury and diaphragmatic paralysis in extremely preterm neonates. While a definitive causal mechanism cannot be confirmed without direct surgical or electrophysiological evidence, the temporal association, catheter position within the described “danger zone,” and exclusion of alternative etiologies strongly support a causal relationship. Clinicians should ensure chest drain tips are directed laterally and inferiorly, avoiding the apicomedial right hemithorax where the phrenic nerve is most vulnerable. Bedside diaphragmatic ultrasound should be considered following chest drain removal in preterm infants to enable early detection of this complication. A comprehensive review of the literature regarding incidence, mechanisms of injury, diagnostic approaches, and management strategies is provided.
Case Presentation: We report a case of right-sided diaphragmatic paralysis following pigtail chest drain insertion for pneumothorax in an extremely preterm male infant born at 26 weeks gestational age. The infant developed pneumothorax requiring chest drain (pig tail) placement with subsequent resolution. Following pig tail removal, imaging confirmed right-sided diaphragmatic paralysis.
Conclusion: This case highlights the importance of proper chest drain (pig tail) positioning and monitoring for this uncommon but significant complication in vulnerable preterm infants. Apicomedial malposition of a pigtail chest drain may result in phrenic nerve injury and diaphragmatic paralysis in extremely preterm neonates. While a definitive causal mechanism cannot be confirmed without direct surgical or electrophysiological evidence, the temporal association, catheter position within the described “danger zone,” and exclusion of alternative etiologies strongly support a causal relationship. Clinicians should ensure chest drain tips are directed laterally and inferiorly, avoiding the apicomedial right hemithorax where the phrenic nerve is most vulnerable. Bedside diaphragmatic ultrasound should be considered following chest drain removal in preterm infants to enable early detection of this complication. A comprehensive review of the literature regarding incidence, mechanisms of injury, diagnostic approaches, and management strategies is provided.