Fig. 3.

A 53-year-old male with prolonged hospitalization for COVID-19 ARDS who developed multiple peripheral nerve injuries during his hospital course and presented with clinical concern of right phrenic nerve palsy. a Ultrasound of the right hemidiaphragm (arrowheads) at expiration and b inspiration demonstrates little change in thickness of the hemidiaphragm muscle, compatible with decreased contractility function. There is no evidence of right hemidiaphragm muscle atrophy. c High-resolution ultrasound of the phrenic nerve (arrow, calipers) demonstrates normal size and echogenicity. Differential diagnosis for hemidiaphragm paralysis includes critical illness myopathy, ventilator-induced diaphragm dysfunction, and the hypothetical plausibility of virus-related myopathy