Hemorrhagic compression of the phrenic nerve after streptokinase infusion.

A 72-year-old woman with acute myocardial infarction underwent intravenous streptokinase therapy following an unsuccessful attempt at right subclavian vein catheterization. Three hours after initiation of therapy, chest radiograph revealed a markedly elevated right hemidiaphragm. Subsequent computed tomography and fluoroscopy of the chest revealed paralysis of the phrenic nerve by hematoma. This case demonstrates the hazards of attempted cannulation of noncompressible vessels when fibrinolytic therapy is anticipated.