Transpericardial phrenicotomy from a dagger wound.

Many examples of penetrating wounds of the heart and pericardium have been recorded (Barrett, 1950). The phrenic nerve has occasionally been divided in the neck as a result of knifing (Reichl, 1932) or of gun-shot wounds (Neuhofer, 1922), but the literature contains no reports of injuries to the phrenic nerve in the chest in which the patient has survived. The following case is therefore of interest. Two months later there was some tone in the diaphragm and the lung had re-expanded (Fig. 3). By March, 1953, 11 months after the injury, the right diaphragm was moving normally but had not quite recovered its full excursion. In the meanwhile the patient had become pregnant and was normally delivered. Electrocardiograms 36 hours after admission (Fig. 4a) showed elevation of the S-T segment in all chest leads and an inverted T-wave in lead 3. A week later (Fig. 4b) the T-wave was inverted in leads V2 and V3, the leads over the right ventricle, but the S-T segment was now normal. After two weeks (Fig. J4c) the E.C.G. had reverted to normal, T3 now being upright. The QRS type of VI lead and the QR complex in AVR indicate an unduly clockwise rotated heart with the right ventricle more anterior than usual.