Crus Atrophy

Sukkasem, Warawut; Moftah, Sherine George; Kicska, Gregory; Godwin, J. David; Pipavath, Sudhakar; Stern, Eric J.

doi:10.1097/rti.0000000000000276

Cited by 17 publications

(16 citation statements)

References 20 publications

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“…On coronal images, the right and left pillars were measured along the middle of the anterior part of L1 (Fig. 1B), according to the results found in the study of Sukkasem et al [10]. On coronal images, the difference in height between the two domes was measured in the anterior part of L1 (Fig.…”

Section: Ct Scan Evaluationmentioning

confidence: 60%

“…Compared with diaphragmatic ultrasonography, CT is capable of fully describing the anatomy of the diaphragm [9], is more available, not operator-dependent, and reproducible. In unilateral diaphragmatic paralysis, it has been shown that the pillars of the diaphragm become thinner and can be measured by CT [10]. In addition, measurement of pillar thickness at the level of the celiac artery and L1 has shown good intra-and inter-observer reproducibility [11].…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of computed tomography in the diagnosis of ultrasound-proven diaphragm dysfunction

Lallement,

Boussuges,

Habert

et al. 2023

Preprint

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Introduction: Computed tomography (CT) is routinely performed to assess dyspnea, but few data are evaluating diaphragmatic muscle using CT. This study aimed to assess CT in the diagnosis of diaphragmatic dysfunction. Methods: We retrospectively collected diaphragmatic ultrasounds performed between 2018 and 2021 at our center (Marseille, France). We measured diaphragmatic pillars on CT at the level of L1 and the celiac artery, as well as the difference in height between the two diaphragmatic domes in diaphragmatic dysfunctions and controls, and compared with ultrasound measurements. Results: 65 patients were included, 24 with diaphragmatic paralysis, 13 with diaphragmatic weakness, and 28 controls. The CT thickness of the pillars in the case group (paralysis and weakness) of left dysfunctions (n=24) was significantly thinner at the level of L1 and the celiac artery compared with controls (2.0mm vs. 7.4mm and 1.8mm vs. 3.1mm, p<0.001 respectively), and significantly different for paralysis (and not weakness) when right dysfunction (n=15) (2.6mm vs. 7.4mm and 2.2mm vs. 3.8mm, p<0.001 respectively for paralysis vs controls). Whatever the side of dysfunction, there was a significant difference in diaphragmatic height between cases and controls (7.70cm vs. 1.16cm and 5.51cm vs. 1.16cm, p<0.001 right and left dysfunction respectively). The threshold values (ROC curve analyses) for height differences between the two domes in favor of paralysis or weakness on the right dysfunctions were 4.44cm and 3.51cm respectively; and 2.70cm and 2.48cm on the left dysfunctions respectively, with good performances. Conclusion:The thickness of the pillars on CT was thinner in left diaphragmatic dysfunction and in paralysis in right diaphragmatic dysfunction. An increase in the difference in the diaphragmatic height may strongly identify diaphragmatic dysfunction with precise thresholds.

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Section: Ct Scan Evaluationmentioning

confidence: 60%

Section: Introductionmentioning

confidence: 99%

Evaluation of computed tomography in the diagnosis of ultrasound-proven diaphragm dysfunction

Lallement,

Boussuges,

Habert

et al. 2023

Preprint

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“…A crus thickness <2.5 mm has a high sensitivity and specificity for diaphragm dysfunction. 3 Abnormal thickness was considered when thickness was <2.5 mm at the celiac artery level (minimal thickness on the axial cuts) and/or <2.5 mm at the L1 vertebral level (at the anterior part on the coronal cuts).…”

Section: Methodsmentioning

confidence: 99%

“…Diaphragm thickness was measured using computerized tomography scan-based measurement of "crus" thickness at the levels of the celiac and superior mesenteric arteries and the L1 vertebral body as previously described. 3 Absolute measurements were included. The diaphragm thickness is preferentially measured at the crus than the dome of the diaphragm.…”

Section: Diaphragm Thicknessmentioning

confidence: 99%

“De Novo” Hypercapnic Respiratory Failure Unmasking Neuromuscular Disorders: Experiences From a Tertiary Care Center and Review of Literature

Nair,

Kandagaddala,

Sivadasan

et al. 2024

Journal of Clinical Neuromuscular Disease

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Objectives: Neuromuscular disorders could have respiratory involvement early or late into illness. Rarely, patients may present with a hypercapnic respiratory failure (with minimal motor signs) unmasking an underlying disease. There are hardly any studies which have addressed the spectrum and challenges involved in management of this subset, especially in the real-world scenario. Methods: A retrospective study comprising consecutive patients hospitalized with hypercapnic respiratory failure as the sole/dominant manifestation. The clinical–electrophysiological spectrum, phrenic conductions, diaphragm thickness, and outcomes were analyzed. Results: Twenty-seven patients were included, the mean age was 47.29 (SD 15.22) years, and the median duration of respiratory symptoms was 2 months (interquartile range [IQR] 1–4). Orthopnea was present in 23 patients (85.2%) and encephalopathy in 8 patients (29.6%). Phrenic nerve latencies and amplitudes were abnormal in 83.3% and 95.6%, respectively. Abnormal diaphragm thickness was noted in 78.5%. Based on a comprehensive electrophysiological strategy and paraclinical tests, an etiology was established in all. Reversible etiologies were identified in 17 patients (62.9%). These included myasthenia gravis (anti-AChR and MuSK), inflammatory myopathy, riboflavin transporter deficiency neuronopathy, Pompe disease, bilateral phrenic neuritis, and thyrotoxicosis. Respiratory onset motor neuron disease was diagnosed in 8 patients (29.6%). Despite diaphragmatic involvement, a functional respiratory recovery was noted at discharge (45%) and last follow-up (60%). Predictors for good outcomes included female sex, normal nerve conductions, and recent-onset respiratory symptoms. Discussion: A good functional recovery was noted in most of the patients including respiratory onset motor neuron disease. A systematic algorithmic approach helps in proper triaging, early diagnosis, and treatment. Clinical and electrodiagnostic challenges and observations from a tertiary care referral center are discussed.

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“…Asymmetric thinning of the diaphragmatic crus (<2.5 mm thickness on axial computed tomography [CT] at the level of L1) is a manifestation of denervation atrophy from local neuromuscular injury (phrenic nerve injury) and often accompanies hemidiaphragmatic paralysis (Fig. 3) while systemic neuromuscular disorders usually result in bilateral atrophy 6…”

Section: Diaphragmatic Dysfunctionmentioning

confidence: 99%

Atypical Causes of Dyspnea

Hoffman

Garner

Rojas

et al. 2022

Journal of Thoracic Imaging

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Dyspnea is a common presenting symptom among patients with cardiopulmonary diseases. However, several neuromuscular and chest wall conditions are often overlooked and under-recognized causes of dyspnea. These disorders frequently adversely affect the structure and function of the ventilatory pump (diaphragm, accessory muscles of ventilation) and can precipitate respiratory failure despite normal lung parenchyma. Weakened musculature impairs clearance of airway secretions leading to aspiration and pneumonia, further compromising respiratory function. Radiologists should be aware of the pathophysiology and imaging manifestations of these conditions and might suggest them to be causes of dyspnea which otherwise may not have been considered by referring clinicians.

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Crus Atrophy

Abstract: Atrophy of the crus assessed by CT is a good discriminator of paralyzed versus nonparalyzed hemidiaphragm in patients with suspected diaphragmatic dysfunction.

Cited by 17 publications

References 20 publications

Evaluation of computed tomography in the diagnosis of ultrasound-proven diaphragm dysfunction

Evaluation of computed tomography in the diagnosis of ultrasound-proven diaphragm dysfunction

“De Novo” Hypercapnic Respiratory Failure Unmasking Neuromuscular Disorders: Experiences From a Tertiary Care Center and Review of Literature

Atypical Causes of Dyspnea

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