Diaphragmatic paralysis: the use of M mode ultrasound for diagnosis in adults

Lloyd, Thomas; Tang, Yu; Benson, Mark D.; King, Scott

doi:10.1038/sj.sc.3101889

Cited by 121 publications

(72 citation statements)

References 8 publications

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“…Fluoroscopy, ultrasound evaluation with using motion mode [3], or brightness mode ultrasonography [4] may be used preoperatively to confirm diaphragmatic paralysis, but we prefer to use thoracic computed tomography for differential diagnosis of herniation or subphrenic tumours.…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive thoracoscopic surgery with laparoscopic assistance approaches in diaphragmatic eventration management

Panko¹,

Karpitski²,

Zhurbenko³

et al. 2017

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Introduction: Thoracoscopic plication is an effective treatment for diaphragmatic eventration, but the procedure has some disadvantages such as inadvertent abdominal organ injuries or superficial sutures that are not strong enough. Aim of the research: In this study, we devised and tested the method of diaphragm plication through simultaneous laparoscopic-and thoracoscopic-assisted left mini-thoracotomy. Material and methods: During the period between October 2012 and March 2014 there were four patients operated on for left-sided diaphragmatic paralysis. The average age was 52.3 ±17.8 years. The preoperative examination included a routine laboratory study, spirometry, plain chest radiograph, and computed tomographic scan of the chest. The initial part of the surgery was a two-port laparoscopy to remove the adhesions between the abdominal viscera and the abdominal segment of the diaphragm using bipolar electrocautery. After that, video-assisted thoracoscopic surgery plication of the diaphragm was performed via anterior mini thoracotomy. Results: The mean operation time was 58 ±11 min, and the mean hospital stay was 9.0 ±2.1 days. All of the patients demonstrated good postoperative recovery. The descending distance of the diaphragm after the surgery ranged from two to four intercostal spaces, which was confirmed with plain chest X-ray. The follow-up ranged from 20 to 38 months and showed no recurrence of diaphragm elevation symptoms. Conclusions: Simultaneous thoraco-and laparoscopic assisted mini-thoracotomy surgery for diaphragm plication is a safe procedure with strong positive clinical effect, and it can serve as an alternative to conventional thoracoscopic approaches especially in patients with high risk of inadvertent abdominal organ injuries.

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Section: Discussionmentioning

confidence: 99%

Minimally invasive thoracoscopic surgery with laparoscopic assistance approaches in diaphragmatic eventration management

Panko¹,

Karpitski²,

Zhurbenko³

et al. 2017

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“…Sin embargo, existen reportes en la literatura sobre casos de parálisis diafragmática y aparición de componentes clínicos compatibles con bloqueo de la cadena simpática cervical, luego del bloqueo de plexo braquial por vía infraclavicular [3][4][5][6][7][8]. Diversos autores han utilizado la evaluación ultrasonográfi-ca del movimiento diafragmático como técnica simple, sensible y reproducible para el diagnóstico de la parálisis del diafragma, al compararla con técnicas como la radiografía de tórax y la fluoroscopia [7,[9][10][11][12][13].…”

Section: Introductionunclassified

“…En una serie de pacientes, la evaluación ecográfica del diafragma fue realizada en posiciones supino, semisentado y de pie, en que se comparó la medición basal de reposo (luego de espiración normal) con la medición en inspiración normal y en inspiración profunda (sniff, por su denominación en inglés) [14][15][16]. Los valores promedio de desplazamiento diafragmático en reposo y en inspiración profunda reportados en la literatura fueron 1,84 ± 0,76 y 7,88 ±del hombro, quienes aceptaron participar en el estudio y dieron su consentimiento informado por escrito.…”

Section: Introductionunclassified

Evaluación de la motilidad diafragmática por ultrasonido en pacientes llevados a cirugía ortopédica de miembro superior bajo anestesia regional utilizando bloqueo infraclavicular

et al. 2016

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Introducción: el bloqueo de plexo braquial por vía infraclavicular ofrece anestesia completa, efectiva y segura para cirugías del miembro superior desde el tercio distal del brazo. El presente estudio evaluó la afectación de la motilidad diafragmática mediante evaluación ecográfica estandarizada en pacientes a quienes se les realizó esta técnica anestésica. Materiales y métodos: se reclutaron 53 pacientes programados para cirugía ortopédica del miembro superior distal al hombro. Se realizó escaneo ultrasonográfico del diafragma de manera bilateral, antes y después de la realización del bloqueo. Se obtuvieron mediciones de motilidad diafragmática en inspiración forzada y espiración, utilizando un transductor Convex de baja frecuencia. Se localizó el punto más profundo de visualización del diafragma que permitiera su seguimiento durante inspiración/espiración en el modo M. Resultados: la medición de la motilidad diafragmática fue hecha de forma estandarizada en todos los pacientes antes y después del bloqueo, mediante una evaluación tanto cualitativa como cuantitativa, a fin de obtener un valor promedio absoluto de 6,63 cm (DE ± 0,35) y 6,75 cm (DE ± 0,42), respectivamente. La prueba de t de Student no mostró diferencia estadísticamente significativa en el desplazamiento diafragmático antes y después de la intervención. Conclusiones: el uso de la ultrasonografía en la evaluación de la motilidad diafragmática es una herramienta simple, no invasiva y reproducible. En el bloqueo de plexo braquial por vía infraclavicular no se encontró evidencia de parálisis diafragmática ipsilateral; sin embargo, el resultado podría estar relacionado con la baja prevalencia de esta complicación en el abordaje evaluado y con la ausencia de estandarización de las variables medidas.

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“…97 In addition to the above applications, m-mode USI has been used to assess pulmonary function, specifically diaphragm excursion, motility, and paralysis. 2,32,39,78,113 Furthermore, it has been found to be beneficial in assisting and guiding treatment in those with muscular dystrophy. Researchers assessing diaphragmatic motion using m-mode USI have found that gender, body mass index, waist circumference, and age influence the amount of excursion.…”

Section: M-mode Ultrasound Imagingmentioning

confidence: 99%

Rehabilitative Ultrasound Imaging: Understanding the Technology and Its Applications

Whittaker

Teyhen

Elliott

et al. 2007

J Orthop Sports Phys Ther

195

101

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From an historical perspective, ultrasound imaging (USI) has been used for medical purposes since the 1950s. The primary use of USI continues to be for traditional radiological goals, which consider the morphological characteristics and structural integrity of various organs and tissues. However, as the technology has been embraced as a safe, portable, objective, and relatively inexpensive means of examination, the ingenuity and diversity of applications has extended beyond these realms.Ultrasound imaging related to musculoskeletal rehabilitation has been developing rapidly since the 1980s. The first report of muscle imaging linked to rehabilitation was in 1968, when Ikai and Fukunaga 63 related the size of the upper arm muscles to strength. However, it was the work of Dr Archie Young and colleagues at the University of Oxford in the 1980s that sowed the seeds for the use of USI by physical therapists. A striking finding of their work was how dramatic limb muscle wasting is underestimated with a tape measure.144 Several studies of the quadriceps muscle followed, including investigation of the effect of knee joint injury, t SynopSiS: The use of ultrasound imaging by physical therapists is growing in popularity. This commentary has 2 aims. The first is to introduce the concept of rehabilitative ultrasound imaging (RUSI), provide a definition of the scope of this emerging tool in regard to the physical therapy profession, and describe how this relates to the larger field of medical ultrasound imaging. The second aim is to provide an overview of basic ultrasound imaging and instrumentation principles, including an understanding of the various modes and applications of the technology with respect to neuromusculoskeletal rehabilitation and in relation to other common imaging modalities. J Orthop Sports Phys Ther 2007;37(8):434-449. doi:10.2519/jospt.2007 for a review). This early research used compound B-scanning, which enabled whole cross sections of large muscles to be captured, because the image could be built up as the transducer was moved over the skin. The compound technique, which was expensive, was phased out as a routine tool and replaced by real-time USI (definitions are provided in the appenDix) both in general medical and musculoskeletal settings.A recent (1990s) resurgence in the interest of rehabilitative applications of USI has been seen amongst clinical therapists. This stems from a series of studies in which USI was used to detect atrophy of the lumbar multifidus (isolated to the side and spinal level of symptoms) in individuals with acute low back pain (LBP), 51 as well as to determine that recovery of this muscle was not automatic when pain subsided, 49 thus required specific training to reduce risk of future episodes. 47 In addition, these studies

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Diaphragmatic paralysis: the use of M mode ultrasound for diagnosis in adults

Cited by 121 publications

References 8 publications

Minimally invasive thoracoscopic surgery with laparoscopic assistance approaches in diaphragmatic eventration management

Minimally invasive thoracoscopic surgery with laparoscopic assistance approaches in diaphragmatic eventration management

Evaluación de la motilidad diafragmática por ultrasonido en pacientes llevados a cirugía ortopédica de miembro superior bajo anestesia regional utilizando bloqueo infraclavicular

Rehabilitative Ultrasound Imaging: Understanding the Technology and Its Applications

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