Case 290

Case 290

Medical History

A 47 year-old female patient undergoes right shoulder arthroscopy for shoulder impingement syndrome treatment, performed under general balanced anesthesia associated with interscalene brachial plexus block via Winnie technique. Soon after waking up and being extubated, the patient presented sudden dyspnea, tachypnea and right-sided intercostal retraction and absence of breathing sounds. The patient mantained a blood oxygen saturation of 96% under 2 L/min supplemental oxygen. Posteroanterior and lateral chest radiographic images were obtained.

Posteroanterior chest radiograph.
Lateral chest radiograph.

After analysing the patient's history and the images, what is the most likely cause for the patient's dyspnea?

Test Question

(Medical residency examination question - UFSM 2017) In the upper thorax, the phrenic nerve is located: