Study Design: Retrospective, case series. Objectives: To evaluate the use of M mode ultrasonography in the evaluation of diaphragmatic paralysis in adults. Setting: Radiology department, Princess Alexandra Hospital, Brisbane, Australia. Methods: Ten patients who were referred for evaluation of suspected diaphragmatic paralysis were evaluated using M mode ultrasound. Results: Three of the patients who were scanned demonstrated normal diaphragmatic movement. The M mode trace demonstrated normal movement of the diaphragm bilaterally with quiet respiration and a sharp upstroke on the sniff test (indicating normal caudal movement of the diaphragm). Six patients were found to have a unilateral diaphragmatic paralysis. Four of these patients were noted to have a raised hemi-diaphragm on chest radiography. Of the two who did not have a raised hemi-diaphragm on chest radiography, one was permanently ventilated. The M mode trace of the paralyzed side showed no active caudal movement of the diaphragm with inspiration and abnormal paradoxical movement (ie cranial movement on inspiration) particularly with the sniff test. Conclusion: M mode ultrasonography is a relatively simple and accurate test for diagnosing paralysis of the diaphragm, in the adult population. It can be performed, if necessary, at the bedside and can be easily repeated if paralysis is not thought to be permanent. Equipment: Philips ATL Sono CT 5000 using a 2-5 MHz curved linear transducer.

We would like to thank physiotherapy management (especially Cherie Hearn, Peter Tonks and Tony Cassar) and radiology management (Angela McNeill) for their support and provision of clinical staffing to enable this study to be conducted. Intensive care management for actively supporting clinical research within the Princess Alexandra Intensive Care Unit. Research nurse Chelsea Davis, RN, for assistance with pre-trial governance, Rod Hurford, RN, Computer Information Systems Administrator, for assisting to set-up screening and data reports, Chantale Tremblay (sonographer) for data collection, and A/Prof. Jeremy Cohen (Intensivist) for safety monitoring.We would also like to thank the dedicated staff of the Princess Alexandra Hospital Physiotherapy Department and Intensive Care Unit for supporting this study.

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A number of findings at abdominal MDCT are associated with the need for surgery and other important surgical outcomes in patients with suspected SBO. Overall radiologist impression of need for surgical intervention was a better predictor than any clinical or laboratory parameter.