Diaphragmatic paralysis in children: Diagnosis by TM-mode ultrasound

Abstract

Diaphragmatic paralysis, a difficult diagnosis in the pediatric age group, has classically been made by fluoroscopy or B-mode ultrasound. We report our experience with TM-mode exploration. Twenty-seven patients suspected to have diaphragmatic paralysis were examined by means of inspiratory and expiratory chest radiography, fluoroscopy and B-mode ultrasound. The diaphragmatic echo was recorded on TM-tracing during spontaneous breathing using coronal oblique scans. Direction, excursion and the pattern of the transition between inspiration and expiration were analysed. In 7 patients examination was normal and TM mode demonstrated movement of normal direction and excursion with a sharp aspect of the transition zone. Diaphragmatic paralysis was present in 11 patients: unilateral in 9 and bilateral in 2 cases. TM mode demonstrated paradoxical movement, reduced excursion and a smooth transition zone. In 9 patients with diaphragmatic dysfunction TM mode demonstrated movement in the normal direction but with reduced excursion and a smooth transition zone. Compared to other imaging modalities, TM-mode records diaphragmatic movements more objectively. It can identify direction of the movement even if they are fast and of weak amplitude and in the case of bilateral paralysis. TM can differentiate paralysis from dysfunction. Moreover, this low-cost, non-irradiating made of imaging can be performed at the bedside and is available on all basic devices.

Two‐dimensional ultrasound imaging of the diaphragm: Quantitative values in normal subjects

“…There are some normal data available regarding diaphragm excursion and side to side differences using M mode sonography, but these studies are few, with limited numbers of normal controls. 1,6,[22][23][24] In conclusion, two-dimensional B mode ultrasound of the diaphragm is a feasible, relatively inexpensive, radiation-free imaging modality that has advantages over video fluoroscopy and chest radiographs. This study provides an extensive database of normal diaphragm thickness and change in thickness with respiration, as visualized on real time ultrasound, with no significant differences seen in smokers versus nonsmokers.…”

A Rare Cause of Breathing Difficulty in Newborns; Isolated Phrenic Nerve Paralysis Detected by Echocardiography: Case Report

“…3,6 Akciğer grafisinde, paralitik tarafta akciğerde atelektazi ile birlikte diyafram elevasyonu, karın içi organların yukarıya doğru hareketi, kalp ve mediastenin karşı tarafa itilmesi saptanabilir. 7 Olgumuzda ekokardiyografik değerlendirmede, sağ diyaframın abartılı bir şekilde hareketli olduğu, sol diyafram hareketlerinin olmadığı belirlenerek diyafram paralizisi tanısı kondu. Tanıyı teyit etmek amacıyla yapılan floroskopik incelemede sağ diyaframın hareketli olduğunun ve sol diyaframda paradoksal solunum hareketinin izlenmesi ile diyafram paralizisi tanısı kesinleştirildi.…”

An evaluation of diaphragmatic movements in hemiplegic patients

“…For instance, it requires patient transportation and uses ionising radiation. Also, on an anteroposterior view, it shows only the least active anterior region of the diaphragm, and paralysis of the diaphragm may be overlooked when it is bilateral [12][13][14][15].…”